bluuebunny/crossref_metadata_2025 huggingface dataset:
Off-label prescribing of antipsychotics: prescribing practices and clinical experiences of Finnish physicians
Authors: Rautio N. , Ylitolonen L. , Haapea M. , Huovinen H. , Alakokkare A.-E. , Niemelä S. , Miettunen J. , Penttilä M. , Koponen H. , Seppälä J. , Isohanni M. , Jääskeläinen E.
Published: September 2022

Introduction

Off-label use of antipsychotics has increased in many countries. In adult populations antipsychotics off-label prescriptions varied from 40 to 75% of all AP users.

Objectives

To examine the off-label prescribing practices and experiences of antipsychotic medication in Finland.

Methods

An electronic questionnaire on physicians’ prescription practices of antipsychotics, especially for off-label use, was sent in 2019 for physicians (n=1195) in different health care facilities including primary health care, occupational health care, in- and outpatient mental health services and services for substance abuse. The sample was selected by systematic and convenience sampling covering five university hospital areas in Finland.

Results

In total, 216 physicians (18% of the target sample) participated in the study, and 94% had prescribed antipsychotics for off-label use. The most common off-label indications were insomnia and anxiety. The most common antipsychotic used was quetiapine. Off-label antipsychotics was not prescribed as a first-choice medication: 99% of the physicians reported that the patients with off-label use have previously had other medications for the corresponding symptoms. In all, 88% of clinicians monitored the patients’ clinical condition, whereas metabolic values were followed more rarely. About 68% of physicians reported more benefit than harm from the antipsychotics off-label
use.

Conclusions

Antipsychotics are often prescribed for off-label use, most commonly for insomnia and anxiety. Most of the physicians see more benefits than harms for the patient in off-label use. There is a need to analyse the long-term benefits and harms of off-label use of antipsychotics and create more detailed treatment algorithms and clinical recommendations for such use.

Disclosure

No significant relationships.
Effect of Tramadol on Corticosteroid Receptor Function in patients with Major Depression
Authors: Minenko S.
Published: September 2022

Introduction

It is important to study the corticosteroid receptors hypothesis of Depression.

Objectives

The goal of current study was - to test the influence of the opioid, adrenergic and benzodiazepine drugs on the immunosuppressive levels of leukocyte pyruvat dehydrogenase activity (LPDG) during the DST in patients with Major Depression and Anxiety Disorder.

Methods

Patients. 40 male/ mean age, 33,1+3,2 years/ and 20 premenopausal female /35,1+1,6 years/ patients with Primary Major Depressive Episode were studied. All patients were diagnosed by a psychologist and fulfilled DSM- IV criteria for Major Depressive Episode. The DST was conducted to 60 patients with Primary Depressive Episode and 30 healthy subjects

Results

In the cases of Primary Major Depressive Episode in separation with an Anxiety Disorder after TRAMADOL and DIASEPAM administration activity of LPDG increased more than 25%. Tramadol of a 50 mg dose and Diasepam of a 10 mg dose had a higher immunosuppressive effect than L-DOPA (0,5 g) on alteration of LPDG activity (more than 5 mmol/l/hour, p <0,05/.

Conclusions

TRAMADOL immunosuppresssive action was higher than L-DOPA and DIASEPAM on LPDG activity in patients with an Anxiety Disorder and Major Depression. Diasepam immunosuppressive action did not correlate with positive dynamics of LPDG levels of DST in patients with Anxiety Disorder (after the 4-5 th week of Diasepam treatment). From other side, mechanism of L-DOPA action on corticosteroid receptors stimulated LPDG-activity (L-DOPA therapeutic effective dose-3 g). It means that opiate, adrenergic and benzodiazepine receptors are interactiing with each other and influencing on the corticosteroid receptors in different ways during immunosuppression.

Disclosure

No significant relationships.
Mental Health, Burnout and Problematic Drinking in Norwegian Medical Doctors
Authors: Tyssen R.
Published: September 2022

Previous studies have found relatively good physical health in doctors, whereas several studies now report relatively high levels of stress and burnout among them. With the exception of higher suicide rates, we have less evidence of poorer mental health among doctors than among other professionals. The elevated suicide rate may represent the tip of an iceberg of frustration and inadequate mental health care among medical doctors. There are very few longitudinal studies that can identify possible risk factors and causality. The Longitudinal Study of Norwegian Medical Students and Doctors (NORDOC) has since 1993/94 followed repeatedly two cohorts of medical students (N=1052) in seven waves during 25 years (Facebook: @docsinrush). Outcomes presented here are on mental health, burnout and problematic drinking. There are two main hypotheses with regard to possible risk factors. First, it may be due to individual factors such as personality traits, past mental health problems etc. Second, contextual stress may influence mental health among doctors, whether this be unhealthy working conditions or negative life events (i.e. stress outside of work). The presentation will give and overview of both individual and work-related predictors of stress and mental health problems among Norwegian physicians. Individual and organizational interventions to reduce stress and physician burnout will also be dealt with.

Disclosure

No significant relationships.
Prisoners with Attention Deficit Hyperactivity Disorder: Co-morbidities & Service Pathways
Authors: Rawat A. , Chaplin E. , Perera B. , Mccarthy J. , Courtenay K.
Published: September 2022

Introduction

Effective diagnostic and treatment pathways for ADHD are needed in prison settings due to the high prevalence of ADHD and comorbidities in the prison population.

Objectives

In this presentation, we will describe two studies conducted in seperate London prisons in England. In the first study, the aim was to identify prisoners with ADHD with a focus on describing comorbidity. In the second study, using QI (quality improvement) methodology, the aim was to measure the practicability and effectiveness of a specialist ADHD diagnostic and treatment pathway for prisoners.

Methods

Two studies were carried out in two separate prisons in London. Firstly, data were collected to understand the prevalence of ADHD and the comorbidities. The second study used quality improvement (QI) methodology to assess the impact of a diagnostic and treatment pathway for prisoners with ADHD.

Results

Of the prisoners, 22.5% met the diagnostic criteria for ADHD. Nearly half of them were screened positive for autistic traits, with a higher prevalence of mental disorders among prisoners with ADHD compared to those without. The QI project led to a significant increase in the number of prisoners identified as requiring ADHD assessment but a modest increase in the number of prisoners diagnosed or treated for ADHD.

Conclusions

Despite various challenges, an ADHD diagnostic and treatment pathway was set up in a prison using adapted QI methodology. Further research is needed to explore the feasibility of routine screening for ADHD in prison and examine at a national level the effectiveness of current ADHD prison pathways.

Disclosure

No significant relationships.
Decision-making capacity regarding healthcare, welfare and finances in a secure forensic setting
Authors: Tong K. , Har C. , Kennedy H. , Davoren M.
Published: September 2022

Introduction

Impairment in decision-making capacity is a serious consequence of executive dysfunction secondary to serious mental disorders like schizophrenia. Functional mental capacity (FMC) refers to an individual’s ability to make and communicate legally competent decisions autonomously. Studies have shown that FMC is dependent on severity of psychosis and can improve with treatment.

Objectives

To ascertain the correlation between the scores on a structured judgement tool, namely the Dundrum Capacity Ladders (DCL) with level of acuity of treatment setting and length of stay in a secure forensic hospital.

Methods

Sixty-two patients were interviewed using the DCL across three domains – healthcare, welfare and finances. Correlation between DCL scores, length of hospital stay and level of acuity of treatment setting was assessed.

Results

As patients moved from higher to lower dependency wards, mean DCL score increased, indicating a higher level of capacity. Patients in high dependency wards were most impaired while those in the low dependency wards performed significantly better (rs=0.472, p<0.001). The longer the patients stayed in the hospital, up until five years, the higher the mean welfare domain score (rs=0.402, p=0.011) and mean DCL score (rs=0.376, p=0.018). Beyond five years of hospital stay, those who had lower DCL scores and did not improve had longer length of stay.

Conclusions

Patients’ FMC improve as they progress from high to low level of acuity of treatment setting. However, this is dependent on the length of hospital stay. FMC may be a measure of recovery in the forensic setting.

Disclosure

No significant relationships.
How to execute research projects in clinical practice in a large medium secure forensic psychiatric facility
Authors: Brandt-Christensn A.M. , Gruber E. , Christensen M. , Nerdrum H. , Pedersen L.M. , Sass M. , Fink-Jensen A.
Published: September 2022

Introduction

While effective project planning is crucial for the success of a clinical research project, being able to execute the plan is even more important. In Denmark, approval for health research projects is applied for at regional or national committees on health research ethics, which have been reluctant to approve clinical research projects involving forensic psychiatric in-patients, due to the admission usually being pursuant to treatment sanctions. However, recently we received approval for a clinical research project exclusively targeted towards inpatients at a large medium secure forensic psychiatric facility in Denmark.

Objectives

Describing the process of project execution from planning to submitting the manuscript which is inherently multi-faceted and inundated with stress factors. How to connect theory, knowledge, project with clinical practice, with clinical research?

Methods

Qualitative data collecting while undertaking an exploratory, open-label, non-randomised weight reducing trial with a glucagon-like peptide-1 receptor agonist.

Results

Challenges in finding, screening, motivating, recruiting, obtaining valid confirmed consent from potential study participants and other stakeholders, team communication, responsibilities and accountabilities within the team, Pareto Principle, scope creep, building project reports manually, real-time data gathering, unpredictable and other project deliverables will be presented

Conclusions

Experiences of the hospital staff (psychiatrists, doctors and nurses) in execution process of the project investigation performed and made possible through participation of their forensic psychiatric in-patients.

Disclosure

No significant relationships.
Attenuated positive and negative symptoms in patients at clinical high-risk for psychosis
Authors: Omelchenko M.
Published: September 2022

Introduction

The clinical high-risk for psychosis (CHR) is mainly established by the presence of attenuated positive symptoms (APS), but there is evidence of the role of attenuated negative symptoms (ANS) in the development of psychotic spectrum disorders. It is important to establish a link between APS and ANS in patients at CHR in order to improve early detection of psychosis.

Objectives

Establish the relationship between APS and ANS in depressive patients at CHR.

Methods

130 depressive young in-patients at CHR with APS (average age 19.5) and 71 ones with ANS (average age 19.5) were examined. The HDRS scale was used to assess depressive symptoms, the SOPS scale was used to assess APS and ANS, and the SANS scale was used to assess ANS. The results are presented in median values.

Results

No differences were found between two groups in the severity of depressive symptoms on the HDRS scale and CHR symptoms on the SOPS scale (22 vs 23.5 and 45 vs 43 respectively). Statistically valid differences have been established between the groups in the APS severity on the sub-scale of positive symptoms SOPS: 11 and 7 (p 0.001). No differences in the ANS severity on the sub-scale of negative symptoms were detected (17 and 18.5, p=0.207). There were also no differences in the ANS severity on the SANS scale (40 and 47, p=0.163).

Conclusions

It has been established that patients at CHR with APS also have ANS, which may have clinical significance for early detection of psychosis.

Disclosure

No significant relationships.
A systematic review of the relationship between emotional intelligence and diabetes management
Authors: Pérez Fernández A. , Fernández-Berrocal P. , Gutiérrez-Cobo M.J.
Published: September 2022

Introduction

Diabetes has been associated to affective disorders and mental health problems which complicate the management of the disease. Emotional intelligence (EI), or the ability to perceive, facilitate, understand and regulate emotions has shown to be a protective factor of emotional disorders in general population.

Objectives

To evaluate the role of EI and EI training in the biological and psychological variables related to people with Type 1 and 2 diabetes.

Methods

A systematic review was conducted in PubMed and Scopus database without time limitations, for studies examining the link between diabetes and EI. A total of 11 eligible studies were selected according to the inclusion criteria.

Results

We divided the results into four sections: 1) EI and HbA1c, 2) EI training effects, 3) Differences in EI between persons with diabetes and without diabetes, and 4) EI and psychological adjustment and well-being. The results showed negative correlations between EI and HbA1C, positive effects of EI training on quality of life, anxiety and glycaemic control, no differences in EI between people with diabetes and healthy individuals and, finally, negative correlations between EI and different psychological variables such as diabetes-related anxiety and distress, and positive correlations with quality of life, well-being and marital satisfaction.

Conclusions

EI appear to be a promising protective factor for biological and psychological variables in individuals with diabetes. This systematic review offers a starting point for a theoretical and practical understanding of the role played by EI in the management of diabetes. Limitation and future lines of investigations will be discussed.

Disclosure

No significant relationships.
Mental Health Sequelae in Health Professionals in Spain during the COVID Pandemic
Authors: Lusilla-Palacios P.
Published: September 2022

The COVID-19 pandemic has raised several concerns regarding its mental health effect on patients and professionals. In the beginning, the absence of knowledge about the disease transmission or effective therapies, the quick spread among the population collapsing hospitals in combination with the lack of protection measures put healthcare professionals working in the frontline in a high stressful situation. The professionals had to face several unprecedented challenges: improvised hospitals, living in hotels to avoid infecting the family, deciding, as in wartime, which patients could be intubated and which could not, doubling shifts, and above all, the uncertainty about the disease, the high severity and the contagiousness that isolated the patients from their family, leaving the health professional with the responsibility of being a caregiver in the broad sense of the word. With this picture several studies have reported a high prevalence of mental disorders. A survey of 9138 Spanish professionals conducted during the first wave of the pandemic showed that 45.7% had a mental disorder (depression, generalized anxiety disorder, panic attacks, post-traumatic stress disorder and SUD), 14.5% had any disabling current mental disorder and 8.4% had suicidal thoughts. In Spain, managed by the Galatea Foundation, there is a special programme of confidential care for doctors with a mental illness or addiction. During the pandemic, a 30% increase of requests for help were registered, 70% of which came from primary health care professionals. The presentation provides also qualitative data with testimonies of professionals and anti-stress protection measures implemented by some health institutions.

Disclosure

No significant relationships.
An Overview Of The Mental Health Problems Among Elite Athletes – Is It A Dream Or A Nightmare?
Authors: Nombora O. , Lopes L. , Santa Marinha L.
Published: September 2022

Introduction

Mental health problems (MHP) are common among elite athletes (EA) and have received increased attention recently, revealing the need to assess them properly. Although EA are increasingly speaking out on their own MHP in public, research-informed approaches for practitioners are still lacking.

Objectives

We aim to perform an overview of the MPH among EA, emphasizing the potential risk factors and interventions.

Methods

We conduct a non-systematic review of the recent evidence on the topic using PubMed/Medline database.

Results

Although EA have comparable prevalence rates of MHP to the general population, they are exposed to various sports-related stressors. Studies reveal that 50% of EA face MHP during their career, with onset peak around 19 years. Therefore, there is a need for early detection and intervention. Burnout, alcohol abuse, anxiety, depression, insomnia and eating disorders are some MHP reported. Their management should address psychosocial and environmental aspects. Psychoeducation and psychotherapy are considered the first line treatment. Moreover, EA may encounter barriers to seeking mental healthcare. Therefore, it is important to promote positive attitudes about MHP, create an environment that supports mental well-being, resilience, psychological flexibility, self-compassion and coping skills. Screening tools may facilitate the process, so there is a need for validated athlete-specific questionnaires for MHP screening and measuring.

Conclusions

Mental health is an integral dimension of EA wellbeing and performance and should be assessed. Specific programs to support EA mental health are recommended and research targeting common MHP for athletes are needed to better understand how to minimize their distress.

Disclosure

No significant relationships.
Interrelations between insomnia, dreaming, and schizotypy in the general population: A network model
Authors: Báthori N. , Polner B. , Simor P.
Published: September 2022

Introduction

Insomnia and Nightmare disorder are the two most common comorbid sleep disturbances in psychotic conditions. However, insomnia and psychotic symptoms are umbrella terms that hide the heterogeneity of these concepts. Several studies have found that worsening sleep quality is associated with the strengthening of psychotic symptoms. Until now, there was less interest in the relationship between the specific insomnia symptoms (trouble with falling asleep, fragmented sleep, early awakenings, daytime consequences) and the specific dimensions of schizotypy (disorganization, unusual perceptual experiences, anhedonia, and impulsive nonconformity).

Objectives

The study aimed to depict the network structure of insomnia, dreaming features (dream recall/bad dream/nightmare frequency), and schizotypy dimensions.

Methods

Exploratory network analysis was conducted on cross-sectional data of the general population (N=1419, 77 % female). We modeled the interrelations between insomnia symptoms (Athens Insomnia Scale), dreaming features (the frequency of dream recall/bad dreams/nightmares), and the dimensions of schizotypy (OLIFE-S).

Results

show a highly connected network with strong stability. The nodes of schizotypy, insomnia, and dream feature perfectly correspond to their own clusters, but the nodes were also densely connected between the three clusters. Disorganization, frequent awakenings, and nightmares are the most central nodes of the clusters. The node of frequent nightmares seems to be the bridge symptom in this network which connects unusual experiences dimension and frequent awakenings.

Conclusions

These results suggest that specific dimensions of schizotypy and specific sleep complaints are differently connected. However further research is needed to investigate the finer details of these heterogenic phenomena.

Disclosure

No significant relationships.
Mourning and psychotic disorders: A different way to experience the loss
Authors: Rodríguez Hernández L.T. , Costa M.L.
Published: September 2022

Introduction

We present the case of a 48-year-old female patient diagnosed with schizoaffective disorder whose father passed away recently. The patient was facing an appalling mourning which was expressed in the form of behavior disorder and positive psychotic symptoms. Mourning is a natural reaction to the loss of a loved one which involves an internal world transformation, affecting both images of the self and the perceived environment.

Objectives

To analyse the guidelines for mourning approach in chronic psychotic patients.

Methods

A case report is presented alongside a review of the relevant literature regarding mourning in patients with chronic psychotic conditions.

Results

Accepting the loss, working through disruptive emotions, adjusting to a world without the deceased and finding an enduring connection with the loved one are the four tasks of mourning described by Worden. In our case, the patient was immersed in the first two tasks. Difficulties in accepting the loss, tolerating harmful emotions and establishing new affective links were observed, as well as massive projection of unbearable emotions such as sadness, anger, fear and guilt. The available literature identifies these idiosyncrasies as common in the grief processing in patients with chronic psychotic disorders.

Conclusions

In patients with psychosis, difficulties in symbolization, emotional processing and social bonding could have repercussions in the development of grief. However, these features do not imply a pathologic mourning. Tolerating mourning as a normal reaction in psychotic patients is needed, even if the patient expresses non-typical symptoms such as acute psychosis symptoms, hallucinations or behavior disorder.

Disclosure

No significant relationships.
Insomnia as a concerned mental health issue during COVID-19 pandemic: A google trend analysis
Authors: Aniwattanapong D. , Phetsayanavin V.
Published: September 2022

Introduction

Insomnia is one of the most common major health issues during the COVID-19 pandemic. There has been limited evidence that showed the correlation between insomnia and COVID-19 using Google trend.

Objectives

To investigate the impact of the COVID-19 pandemic on interest in insomnia, including national mental health by a Google trend analysis that implicitly represents the state of distress and concern for this pandemic.

Methods

We examined the Google trend search query data from these sleep-related keywords: insomnia, restless leg, and obstructive sleep apnea (OSA) from 1 Jan 2020 to 30 May 2020 and explored the correlation between the internet search volumes for insomnia and the cumulative number of new COVID-19 cases. In addition, we investigated the internet search pattern over time, before and during the COVID-19 pandemic.

Results

During the early phase of the COVID-19 pandemic between January and May 2020, the Relative Search Volumes (RSV) curves showed that the cumulative number of new COVID-19 cases was significantly correlated with the rising search for these keywords linking to sleep-related conditions as follows: ‘insomnia’ (r = 0.41, p < 0.001), and ‘restless leg’ (r = 0.19, p = 0.009). However, it was not correlated with the keyword ‘OSA’ (r = -0.14, p = 0.07).

Conclusions

These findings emphasize the impact of the COVID-19 pandemic on insomnia and the crucial need for public mental health interventions to be offered and accessible. The Google trend could be used as a new tool for public mental health surveillance in a new normal lifestyle.

Disclosure

No significant relationships.
Self-stigma and coping strategies in remitted Tunisian patients with bipolar disorder
Authors: Jenhani R. , Ellouze S. , Bougacha D. , Znaidi F. , Ghachem R.
Published: September 2022

Introduction

Patients with bipolar disorder may adjust their behaviors and choose a coping strategy to face self-stigma and avoid unpleasant social and professional adversities. These coping orientations are either defensive, or active behavioral strategies.

Objectives

The aim of this study was to assess self-stigma in remitted patients with bipolar disorder and to investigate coping strategies to struggle the internalized stigma.

Methods

We conducted a cross-sectional, descriptive, and analytical study of 61 patients with bipolar disorder. Euthymia was verified using the Hamilton scale for depression and the Young scale for mania. We used the Internalized Stigma of Mental Illness (ISMI) to evaluate self-stigma, the Stigma coping orientation Scale (SCOS) to assess coping strategies.

Results

The mean age of patients was 43.4 years. The sex ratio was 2.4. The mean score on the ISMI was 2.36. More than half of our patients (59%) were self-stigmatized. Secrecy (57%) and withdrawal (56%) were the most adopted coping strategies. The mean self-stigma score was significantly associated with higher scores on defensive coping strategies such as secrecy (p<10-3) and withdrawal (p<10-3). However, scores on challenging (p<10-3), education (p<10-3) and distancing (p=0.014) strategies were inversely correlated with self-stigma scores. The logistic regression analyses revealed a significant association between defensive coping strategies (secrecy and withdrawal) and internalized stigma.

Conclusions

The relationship between defensive coping strategies and self-stigma appears to be bidirectional. Enhancing coping strategies oriented to education, challenging and engaging patients in social interaction and reducing the use of deleterious coping strategies focusing on secrecy and withdrawal may lead to restrict self-stigma.

Disclosure

No significant relationships.
Internalized stigma and self-esteem among remitted patients with bipolar disorder
Authors: Jenhani R. , Ellouze S. , Bougacha D. , Znaidi F. , Ghachem R.
Published: September 2022

Introduction

Self-stigmatization in patients with bipolar disorder could lead to shame, self-judgement, impaired quality of life, and could negatively affect self-esteem imeding recovery.

Objectives

The aim of this study was to assess self-stigma in remitted patients with bipolar disorder and to evaluate its impact on self-esteem.

Methods

We conducted a cross-sectional, descriptive, and analytical study of 61 patients with bipolar disorder. Euthymia was verified using the Hamilton scale for depression and the Young scale for mania. We used the Internalized Stigma of Mental Illness (ISMI) to evaluate self-stigma, and the Rosenberg scale to assess self-esteem.

Results

The mean age of patients was 43.4 years. The sex ratio was 2.4. The mean score on the ISMI was 2.36. More than half of our patients (59%) were self-stigmatized. With regard to self-esteem, the mean score obtained on the Rosenberg scale was 27.72. Low or very low self-esteem was found in 54% of patients. The most self-stigmatized patients had significantly lower self-esteem (p<10-3).

Conclusions

Internalized stigmatization negatively affects self-esteem of patients with bipolar disorder. Psychoeducation and cognitive behavioral therapy would improve self-esteem and enhance psychosocial treatment adherence and move people with bipolar disorder toward a culture of recovery based on hope and self-determination.

Disclosure

No significant relationships.
Working memory performance in euthymic bipolar patients
Authors: Charfi N. , Bouaziz A. , Gassara I. , Feki R. , Smaoui N. , Omri S. , Maalej M. , Zouari L. , Ben Thabet J. , Maalej M.
Published: September 2022

Introduction

Working memory (WM) deficit in bipolar disorder (BD) is heterogeneous and seems to be affected by both, demographic and clinical aspects, of the patient.

Objectives

To assess the WM performance in euthymic bipolar patients (BP) comparing to healthy controls (HC) and to identify demographic and clinical factors associated with it.

Methods

A case-control study was conducted among euthymic bipolar patients according to DSM-5. The recruitment of patients was performed in the outpatient psychiatric unit in the university hospital Hedi Chaker in Sfax during the period from January to December 2020. The HC were matched to BP on gender, age and education level. The Screening for Cognitive Impairment in Psychiatry scale (SCIP) was used to assess the WM performance by the WM test (WMT).

Results

We recruited 61 BP (37 males and 24 females) and 40 HC (20 males and 20 females). The average age of BP was 41.75 years (SD=11.6 years). The BD group included 47 BD type I and 14 BD type II patients. The mean duration of illness was 9.75 years (SD=7.93 years). Thirty-seven BP (60.7%) had a history of psychotic symptoms. The WMT score was significantly lower among BP than HC (p<0,001). The female gender, the type II of BD and the history of psychotic symptoms correlated with a poorer performance on WMT (p=0.019; 0.017 and 0.002, respectively).

Conclusions

BP have shown significant impaired performance in WM even during euthymia. Female gender of patient, type II of BD and psychotic symptoms seem to be the predictors of this impairment.

Disclosure

No significant relationships.
Characteristics of Perpetrators of Neonaticide
Authors: Klier C. , Amon S. , Fernandez Arias P.
Published: September 2022

Authors: Klier CM, Amon S, Fernandez Arias P Introduction Denial of pregnancy the most important risk factor for neonaticide and is a frequent pregnancy associated disorders. It occurs more often than placenta previa or uterus rupture. Wessel found that 1 in 475 women deny pregnancy, but a new study by Simermann even found a higher prevalence of 1:300. We studied how women face their reproductive potential before the denied pregnancy occurs. Moreover pregnancy variables in this group were compared to Austrian population data. Methods In total, there were 69 neonaticide victims between 1995 and 2017. We analysed 55 neonaticide cases, committed by 48 perpetrators, whereas 4 of them were repeated perpetrator and responsible for 11 cases. We also included three cases of suspected neonaticides, whereas later the coroner identified a natural cause of death. The datasheet contains 553 variables, all cases were code by one rater SA. Specifically we looked at the following variables: method of contraception, partner’s interest in contraception, abortion, evidence of pregnancy, motives of pregnancy negation, pregnancy symptoms, prenatal care, awareness of environment, living situation during pregnancy and at birth, immediate reaction to birth Results We found a high percentage of women who did not use contraception (53%), specifically when compared to the percentages of the Austrian population data from a recent survey (26%). When the contraceptive methods were looked at, women in the neonaticide group did practically not use any method with a pearl index of <4, in comparison to 20% in the general population. A high adolescent birth rate (47%) could be shown in comparison to the population (3%). Conclusions It needs further research to find out how denial of pregnancy and reproductive potential are connected and if the reasons for denial of pregnancy are the precursors of the reproductive denial also.

Disclosure

No significant relationships.
Can we really treat mentally ill patients involuntarily?
Authors: Gonçalves Cerejeira J. , Medina Ojeda G. , Santos Carrasco I. , De Andrés Lobo C. , Jiménez Aparicio T. , Vallecillo Adame C. , Guerra Valera G. , Queipo De Llano De La Viuda M. , Gonzaga Ramírez A.
Published: September 2022

Introduction

The therapeutic alliance is critical to the efficacy of psychiatric treatment and can be weakened by involuntary treatment measures. In Western culture, mental illness is still associated with violence and if significant risk of violence is detected, in Spain a civil court can order the application of involuntary treatments such as Involuntary Outpatient Commitment.

Objectives

To discuss the effectiveness of some psychiatric involuntary treatments used in Spain.

Methods

- Literature review about involuntary psychiatric treatments used in Spain - Case report about a patient undergoing Involuntary Outpatient Commitment

Results

We present the case of a 54-year-old man, diagnosed with schizophrenia, admitted to our acute psychiatric yard more than five times due to violent behavior and psychotic symptoms. Five years ago, he was summitted to a period of three years of Involuntary Outpatient Commitment. In Spain this measure can include the administration of involuntary medication, an injectable antipsychotic treatment in this case. At the end of the order, he immediately stops attending consultations and abandoned psychopharmacological treatment.

Conclusions

Involuntary Outpatient Commitment is a controversial measure and it stirs up the concepts of stigma, coercion, care, patient autonomy and, globally, the values of humanization in psychiatry.

Disclosure

No significant relationships.
Impact of childhood trauma on functioning of patients with bipolar disorder
Authors: Bougacha D. , Ellouze S. , Jenhani R. , Ghachem R.
Published: September 2022

Introduction

Exposure to severe childhood trauma has been associated with the onset and the severity of bipolar disorder in adults.

Objectives

The aim of this study was to examine the relationship between childhood trauma and functioning of patients suffering from bipolar disorder.

Methods

We conducted a cross-sectional, descriptive, and analytical study, including sixty-one remitted patients with BD. We used the Childhood Trauma Questionnaire (CTQ-SF) to measure history of traumatic childhood experiences and the Functioning Assessment Short Test (FAST) to assess functioning.

Results

The mean age of patients was 43.4. The sex ratio was 2.4. Almost two-thirds of patients (64%) had experienced at least one type of childhood trauma. An overall functional impairment was found in 70.5% of participants. The CTQ total score was significantly associated with low educational level (p=0.001), low socio-economic status (P=0.034), a family history of psychosis (P=0.022), the number of mood episodes (P=0.001), the number of hospitalizations (P=0.04), the number of relapses with psychotic features (p=0.002) and that of depressive relapses (P<0.001), rapid cycling (P=0.012), higher rates of suicide attempts (P=0.04) and poor functioning (P<0.001).The logistic regression analyses showed a significant association of childhood trauma with low educational level (p=0.001), high number of depressive episodes (p=0.013) and poor functioning (p<0.001).

Conclusions

Our findings demonstrate that childhood abuse and neglect are risk factors associated with worsening clinical course of bipolar disorder and higher functional impairment. These findings press the urgency for preventive practices and early intervention strategies to diminish the prevalence of childhood trauma and minimize their impact.

Disclosure

No significant relationships.
Euthanasia in Mental Health. About a case
Authors: González Bocelo I. , Millan Lozano I.
Published: September 2022

Introduction

Reflection on the impact of this law on people with a Mental health disorder is required. It is a complex issue, in which it must be considered that these disorders are very prevalent, can greatly affect the quality of life and are often resistant to treatment.

Objectives

Explore the first request of this type and review aspects to consider in patients with mental health disorders.

Methods

Collection of data from the first patient who requests it and review related aspects.

Results

This is a patient with a personality disorder who presents significant suffering, in a chronic context, but at the same time makes the request in a moment of crisis as an impulsive gesture.

Conclusions

Pending evolution, we consider that it is difficult to assess compliance with the requirements of the law in patients of this type and we recommend caution.

Disclosure

No significant relationships.
Inflammation and autoimmune indicators in the differential diagnosis of autism spectrum disorders in children
Authors: Androsova L. , Simashkova N. , Zozulya S. , Shushpanova O. , Otman I. , Klyushnik T.
Published: September 2022

Introduction

Autism spectrum disorders (ASD) is one of the most urgent problems of psychiatry because of their high prevalence, diagnostic difficulties as well as insufficient knowledge of the pathogenetic mechanisms.

Objectives

To determine the number of inflammation markers in patients with various forms of ASD in links with features of a clinical condition for creating diagnostic criteria for differential diagnosis and improve reliability.

Methods

The clinical examination of patients (135 children with various ASD forms) was carried out by using psychometric scales (CARS, BFCRS, CGI-S). The activity of inflammation markers (LE and α1-PI) and the level of autoantibodies to S-100b and MBP were measured in plasma. Complex evaluation of immune system activation was also conducted, taking into consideration interactions of innate and adaptive immunity.

Results

Non-psychotic ASD forms (Asperger’s syndrome and Kanner’s syndrome) were not accompanied by a change of the immunological indices in comparison with control. In psychotic ASD forms, a significant increase of the studied indices was revealed (р<0.05). Correlation between the complex evaluation of the immune system activation and the stage of the disease (r=0.49, р<0.05) was demonstrated. Also the significant correlations between the severity of autistic disorders according to CARS (r=0.48, p<0.05), catatonic disorders by BFCRS (r=0.42, p<0.05), and the assessment by CGI (r= 0.61, p<0.05) were observed.

Conclusions

The immune markers as well as their complex evaluation may be used as additional diagnostic criteria in the clinical examination for differential ASD diagnostics and assessment of the quality of remission, and also monitoring of the patient condition.

Disclosure

No significant relationships.
Investigation of anti-NMDA receptor antibodies in first episode psychosis patients
Authors: Zsigmond R.I. , Herman L. , Réthelyi J.
Published: September 2022

Introduction

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune limbic encephalitis, where psychiatric symptoms are often the initial presentation dominant initially. These patients are mainly admitted to psychiatric wards, due to first episode psychosis (FEP).

Objectives

Multiple studies analysed whether anti-NMDAR antibodies were present in the sera of schizophrenic patients, but results have not verified this hypothesis. It is possible, however, that unknown autoimmune antibodies play a role in FEP, similarly to anti-NMDAR antibodies.

Methods

40 patients with FEP and 30 healthy controls have been recruited to the study. Patients with affective psychosis, drug-related psychosis and patients with diagnosed encephalitis were excluded. The sera were tested with immune fluorescent assays for anti-NMDAR antibodies. A non-specific method was used to test anti-brain antibody activity on monkey-cerebellum and rat-hippocampus slices.

Results

Neither the samples from the 40 patients, nor the samples of healthy controls contained anti-NMDAR antibodies. 14 of the patients’ and only 6 of the healthy controls’ serum showed positive reaction of the neuroendothelium. These results suggest that there is a difference between the groups, although the results are not significant.

Conclusions

None of the 40 patients proved positive for anti-NMDAR antibodies in agreement with previous studies. However, a higher proportion of samples from the FEP group showed activity in the neuroendothelium of non-specific immune fluorescent assays compared to healthy controls. Based on literature and on our experience, it is possible, that unknown autoimmune antibodies play role in FEP.

Disclosure

No significant relationships.
Dynamics of immune markers in different variants of post-psychotic depression after first-episode psychosis in young adult age
Authors: Zozulya S. , Tikhonov D. , Kaleda V. , Klyushnik T.
Published: September 2022

Introduction

Research in recent decades focuses on understanding the role of the immune system in First-Episode Psychosis (FEP) at a young age. Our studies indicate that different stages of schizophrenia differ in the spectrum of inflammation markers. These indicators reflect the activity of the pathological process, using them as markers of the clinical state of patients at different stages of the disease.

Objectives

To assess the relationship of immune markers with the clinical features of remission in patients after FEP.

Methods

Fifty patients aged 15-25 years with post-psychotic depression (PD) after FEP (F20, F25) and 30 healthy men were included in the study. The follow-up period was two years. PD typological variants with positive affectivity (PA) (n=30) and negative affectivity (NA) (n=20) were distinguished. Leukocyte elastase (LE), a1-proteinase inhibitor (a1-PI) activity, and S-100B autoantibodies in plasma samples were measured.

Results

The increase of LE and a1-PI activity in plasma of both types of PD patients compared to controls was detected (p<0.01). There was the highest LE activity and S-100B autoantibodies in PD with NA (p<0.05). The different dynamics of immune markers in both groups were correlated to the clinical features of remission. PD with PA was associated with a decrease in inflammatory markers (p<0.05) and a favorable prognosis. PD patients with NA had a further increase in LE activity and S-100B autoantibodies (p<0.01), and an unfavorable prognosis.

Conclusions

The results confirm using the immune indicators as markers to assess the quality of remission after FEP in young adult age and the risk of recurrent psychotic attacks.

Disclosure

No significant relationships.
Developmental trajectories of gambling severity after cognitive-behavioral therapy
Authors: Jimenez-Murcia S. , Granero R. , Fernandez-Aranda F.
Published: September 2022

Introduction

Gambling disorder (GD) is characterized by repeated problematic gambling behavior associated with unsuccessful and uncontrollable urges to keep gambling, which leads to considerable distress and impairment. Several types of interventions exist to treat GD, with cognitive behavior therapy (CBT) being one of the most widely used approaches.

Objectives

To estimate trajectories of the gambling disorder (GD) severity for 12 months following a manualized cognitive-behavior-therapy (CBT) program, and to identify the main variables associated with each trajectory.

Methods

Latent Class Growth Analysis examined the longitudinal changes of n = 603 treatment-seeking patients with GD.

Results

Five separate empirical trajectories were identified: T1 (n = 383, 63.5%) was characterized by the most highest baseline gambling severity levels and positive progress to recovery during the follow-up period; T2 (n = 154, 25.5%) featured participants with high baseline gambling severity and good progress to recovery; T3 (n = 30, 5.0%) was made up of patients with high gambling baseline severity and slow progress to recovery; T4 (n = 13, 2.2%) and T5 (n = 23, 3.8%) contained participants with high baseline gambling severity and moderate (T4) and poor (T5) progress in GD severity during the follow-up. Psychopathology, personality traits, poor compliance and relapses discriminated between trajectories.

Conclusions

These results show that treatment seeking patients with GD are heterogeneous. In addition, the obtained findings could be useful in the design of more efficient interventions for this behavioral addiction. Funding oftained from RTI2018-101837B-I00

Disclosure

No significant relationships.
Effect of Tobacco Cessation Aids on Smoking Cessation and Duration of Abstinence : a French Population-Based Study
Authors: Fekom M. , Nguyen-Thanh V. , Andler R. , Quatremere G. , Guignard R. , Melchior M.
Published: September 2022

Introduction

Although smoking prevalence has been decreasing worldwide, sustained tobacco cessation remains a challenging goal for many smokers. Nicotine replacement therapy (NRT) products remain among the most widespread type of cessation tobacco aids, along with the more recently introduced electronic cigarette, the efficiency of which is still a matter of debate in the public health community.

Objectives

This study aims to contribute to the ongoing discussion about effective ways of encouraging tobacco cessation and in particular evaluating the role of the two aforementioned tobacco cessation aids with regard to lasting smoking abstinence in real-life settings.

Methods

The study is based on the French 2017 Health Barometer, a cross-sectional survey conducted by Santé Publique France. Two distinct outcomes related to tobacco cessation were used: smoking status at 6 months follow-up (yes vs. no) and the duration of smoking abstinence. These two study outcomes were examined respectively among N1 = 2783 and N2 = 1824 participants. All results were weighted based on inclusion probability weights and controlled for propensity scores via overlap weighting (OW), which is appropriate when exposure groups are disparate.

Results

After adjusting on potential confounders, tobacco cessation at 6 months remains significantly associated with e-cigarette use (OR: 1.50 (1.12-1.99)) and e-cigarette use combined with NRT (OR:1.88 (1.15-3.07)). This association did not reach statistical significance in the long-term analysis, nor did the results of NRT use alone in both analyses.

Conclusions

Overall, while electronic cigarette use alone and combined with NRT is associated with an increase in the likelihood of smoking cessation, the long-term effects are probably limited.

Disclosure

No significant relationships.