bluuebunny/crossref_metadata_2025 huggingface dataset:
Stress and pain regulation: Parallel processes among traumatized individuals
Authors: Ginzburg K. , Defrin R.
Published: August 2023

Introduction

The human reaction to traumatic events is often marked by a dialectic alteration of two emotional states –a state characterized by intrusion, anxiety and hyperarousal, and a state of denial marked by dissociation and numbing. These two seemingly opposite states represent attempts to modulate stress, as gradual reduction of their intensity represents an adaptation to stress. Maladaptive reactions to trauma, however, reflect disrupted regulation capacities, manifested as persistent over-modulation or under-modulation of stress.

Objectives

To demonstrate that these manifestations of disrupted regulation, as observed among individuals with posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) are also reflected in patterns of pain modulation.

Methods

Three studies using self-report questionnaires and psychophysical tests, assessing sensitivity to pain, as reflected by pain thresholds, and reactivity to suprathreshold noxious stimuli, as implicated in their rating

Results

Study 1 Included 32 PTSD outpatients, 29 anxiety disorder outpatients, and 20 healthy controls. PTSD patients reported higher rates of chronic pain (83.3%) than anxiety patients (42.0%) and controls (5.0%). PTSD severity correlated with chronic pain severity (r = 0.61, p < 0.01). PTSD patients displayed a unique paradoxical pain profile, according to which their pain thresholds were significantly higher than those of the anxiety patients and controls (p < 0.01), but they perceived suprathreshold stimuli as being much more intense (p < 0.01).

Study 2 included 32 PTSD outpatients and 43 healthy controls. Findings replicated the paradoxical pain profile among PTSD patients. Pain thresholds were positively associated with dissociation level (b = 0.49; p < 0.05) and negatively associated with anxiety level (b = -0.63, p < 0.01). Pain ratings were positively associated with anxiety (b = 0.52, p < 0.05) and negatively related to dissociation levels (b = -.51, p < 0.05).

Study 3 included 46 women diagnosed with BPD and 47 healthy controls. Women with BPD reported higher levels of childhood trauma (p < 0.05) than the controls. They also demonstrated higher pain thresholds (p < 0.05). Among subjects with high levels of body dissociation, implicated by reduced body awareness, those with BPD demonstrated hyposensitivity to pain, manifested in higher pain thresholds, lower suprathreshold pain ratings, and pain evoked by higher temperature, than the controls. Among those with low levels of body dissociation, BPD subjects demonstrated increased reactivity to pain as manifested in higher pain ratings and pain evoked by lower temperature.

Conclusions

These findings demonstrate the association between over-modulation and under-modulation of stress and over-modulation and under-modulation of pain, respectively, among PTSD and BPD patients. These findings point to parallel processes of disrupted regulation among traumatized individuals.

Disclosure of Interest

None Declared
Peripheral Edema associated with Olanzapine: case report
Authors: Jemli H. , Zgueb Y. , Zaibi R.
Published: August 2023

Introduction

Olanzapine is a second generation antipsychotic. Sedation and weight gain are common treatment side effects. However, other rare side effects such as peripheral edema are yet to be documented.

Objectives

Our study aimed to describe the clinical presentation of edema in a patient taking Olanzapine.

Methods

Case report

Results

We present the case of a 42 male patient hospitalized for a manic episode. He was put on Olanzapine at 10 mg a day. During the hospitalization, the patient exhibited profuse pitting edema on his lower limbs and a rapid weight gain. He presented no other physical sign such as a fever, cutaneous lesions or trouble walking. Thrombophlebitis and erysipelas were eliminated after an extensive physical exam, complete blood work and doppler ultrasound exam of both legs.

Olanzapine was discontinued and the patient was prescribed a 4-day course of loop diuretics. Complete resolution of symptoms was noted 5 days later.

Conclusions

Further research regarding the mechanism behind edema in patients taking second generation antipsychotics are needed. We recommend monitoring for edema with initiation and titration of Olanzapine treatment.

Disclosure of Interest

None Declared
Current Controversies in Antidepressant Therapy: A Patient-level Perspective
Authors: Hieronymus F.
Published: August 2023

The value of pharmacological antidepressants have been contested since they were first introduced in the 1960s, but the points of contention have varied over time. This session will examine and critically discuss some of the concerns that are commonly voiced today, with particular emphasis on the evaluation of efficacy. The session will cover topics such as the utility of dichotomized outcome measures (e.g., response and remission) and whether the use of these measures risk inflating apparent efficacy, whether antidepressant effect sizes are too small to be clinically meaningful, and whether there is individual variability in the response to pharmacological antidepressants.

Disclosure of Interest

F. Hieronymus Speakers bureau of: I have received speaker’s fees from Janssen and H Lundbeck.
Access to a psychiatric emergency setting during the COVID-19 pandemic: focus on youth populations
Authors: Masini F. , Caramanico G. , Menculini G. , Latini G. , De Giorgi F. , Amantini K. , Moretti P. , Tortorella A.
Published: August 2023

Introduction

The COVID-19 outbreak and the related containment measures led to the emergence of psychological distress in youth populations, possibly due to concern for their families, social isolation, increased time spent on the Internet and social media, and anxiety about the future.

Objectives

The study aims to evaluate differences in the access of children, adolescents, and young adults to a psychiatric emergency setting before and after the onset of the COVID-19 pandemic.

Methods

Data concerning the psychiatric consultations carried out at the Emergency Department of the University Hospital of Perugia was collected. Socio-demographic and clinical information, including diagnostic and treatment features, was entered into an electronic database. We considered two different time spans, one before (01.06.2017-31.12.2018) and one after (01.06.2020-31.12.2021) the COVID-19 pandemic outbreak. The characteristics of consultations carried out before and after the pandemic outbreak were compared by means of bivariate analyses (p<0.05).

Results

2,457 psychiatric consultations were carried out in the index periods. 1,319 (53.7%) were requested before, while 1,138 (46.3%) after the COVID-19 outbreak. As for the latter, these were more frequently requested for female subjects (64.2% vs 54.5%, p=0.0042), while institutionalized people underwent psychiatric consultations less frequently in the post-COVID-19 period (5.6% vs 18.2% p<0.001). A significant difference in the prevalence of anxiety disorders (9.7% post-COVID-19 vs 18.8% pre-COVID-19, p=0.009) and adjustment disorders was found (7.1% vs 1.5%, p=0.009). Substance-related disorders were significantly reduced (8.0% vs 15.8%, p=0.016) after the COVID-19 outbreak. About psychopharmacological treatment, there was an increase in people who had received treatment in the past but were no longer on treatment (52.3% vs 30.8%, p<0.001). The prescription of antipsychotics also increased (29.3% vs 18.5%, p=0.012). At discharge, subjects were more frequently hospitalized in the Psychiatric Inpatient Unit in the post-COVID-19 period (22.2% vs 12.8%, p=0.012).

Conclusions

Our data confirms the vulnerability of youth populations during the pandemic. The consequences of health emergencies on the psychological well-being of this population must not be underestimated and tailored treatment strategies should be implemented.

Disclosure of Interest

None Declared
The effects of the mother’s ADHD on her parenting role
Authors: Moutafi C.
Published: August 2023

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is the second most common psychiatric disorder in childhood, affecting 5-7% of the child population. The same disorder in adults is less documented and is estimated at 2.5% of the population. The mothers of children with ADHD are 24 times more likely to develop ADHD than mothers of children without ADHD. About 17% of mothers of children with ADHD meet criteria for the disorder themselves. The core symptoms of ADHD are inattention, hyperactivity and impulsivity.

Objectives

The objective of this e-poster is to describe the effects of the mother’s ADHD on her parenting role

Methods

The current poster is based on the bibliographic reviews of papers via the ‘PubMed’ search engines.

Results

In some studies mothers with ADHD may use ineffective discipline methods in order to limit their children.The mothers with ADHD often have difficulties with executive functions such as planning, organizing and implementing goals and with self-control. Characteristically, in a study with a sample of mothers with children aged 3-6 years were observed difficulties in defining the boundaries of the children, unstable behavior and low self-esteem. Additionally, mothers with ADHD may have difficulty forming and maintaining social relationships and this have a negative effect on children’s social skills. The maternal role is influenced by when the mother suffers from depression, anxiety, uses alcohol or psychotropic substances. In addition, her role is influenced by when there are problems in the marital relationship or she is a single parent. The reactions of the mother with ADHD may be influenced not only by whether she has ADHD but also by whether or not her child has been diagnosed with ADHD. The mother with ADHD and child with ADHD has to deal not only with her own symptoms but also with her child’s symptoms. The coexistence of the specific disorder in both may cause increased levels of stress to the mother. Nevertheless, some research reports that these mothers show empathy towards their children, i.e. they have a more positive and supportive behavior, they are more protective, less irritable and less frustrating (similarity-fit hypothesis). In other studies mothers with ADHD worsen their children’s symptoms with their behavior (similarity-misfit hypothesis). There is a significant correlation between the mother’s ADHD and the child’s emotional, behavioral and social functioning.

Conclusions

In conclusion, mothers with ADHD may experience difficulties in all developmental stages of their children. Therefore, the treatment of the disorder (medication and cognitive-behavioral psychotherapy) is necessary in order to improve the mothers’ symptoms, the mental condition of their children and the family’s quality of life.

Disclosure of Interest

None Declared
The Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE): an easy tool for investigating Self-Disorders, subjective experiences and global functioning
Authors: Magnani F. , Amorosi S. , Dell’Anna C. , Lucarini V. , Ballerini M. , Marchesi C. , Tonna M.
Published: August 2023

Introduction

Self Disorders (SDs) are regarded as the subjective phenotype of Schizophrenia vulnerability. The EASE (Examination of Anomalous Self-Experiences) scale is the most detailed and widely used instrument to investigate SDs, but it requires long administration times and specific training. The IPASE (Inventory of Psychotic-like Anomalous Self-Experiences) scale might be a self-administered instrument of widespread use for an easier SDs investigation.

Objectives

The present study was aimed at validating the Italian version of IPASE, testing its internal consistency and usability for a first level SDs survey. A secondary objective was to confirm the correlations between IPASE, EASE, main symptom dimensions, subjective bodily experiences, symptoms of schizophrenic autism as well as levels of global functioning.

Methods

Fifty patients with Schizophrenia were administered the IPASE scale in its Italian version, the Examination of Anomalous Self-Experiences scale (EASE), the Positive And Negative Symptoms Scale (PANSS), the Social and Occupational Functioning Assessment Scale (SOFAS) to assess global functioning, the Autism Rating Scale (ARS) and the Abnormal Bodily Phenomena questionnaire (ABPq). The internal consistency of IPASE in its Italian version was investigated and the correlations between IPASE, EASE, ABP, ARS, PANSS and SOFAS were explored.

Results

The internal consistency of the Italian version of IPASE was high (α 0.97). The IPASE and EASE total scores were positively correlated with each other, as were many of the conceptually related subdomains of both scales. The IPASE score was negatively correlated with global functioning (SOFAS) and positively correlated with total PANSS scores and with PANSS negative domain. Moreover, the IPASE total score was positively correlated with autism dimension (ARS), while anomalies in subjective experience of the lived body were coherently correlated with higher scores in IPASE “somatization” subdomain.

Conclusions

The IPASE may be an easy instrument with high internal consistency for an initial investigation of SDs. IPASE domains appear to be correlated with the SDs investigated through EASE and with the main symptomatologic dimensions of Schizophrenia, in particular with negative symptoms. IPASE might also be a useful instrument for a first level investigation of subjective experiences concerning intersubjectivity and bodily dimensions.

SDs are confirmed to be a core feature of the schizophrenia psychopathology, with a adverse impact on global functioning.

Disclosure of Interest

None Declared
Correlates of aggressive behavior in the moroccan context
Authors: Tounsi A. , Bencharfa Z. , Azraf F. , Laboudi F. , Ouanass A.
Published: August 2023

Introduction

Violence among the mentally ill population has long been a subject of stigma, and controversy. Clinicians’ ability to assess the violent potential is still limited.

Objectives

The objective of this work is to identify the positively correlated indicators of aggressive behavior in patients admitted to hospital emergency departments.

Methods

It is a retrospective and descriptive paper based on the records of patients admitted to the emergency department of Arrazi University Psychiatric Hospital in Salé during a one-month period.

The psychiatric diagnosis was formulated using the DSM-5 diagnostic criteria and Violent behavior was assessed using the Modified Overt Aggression Scale (MOAS). The existence of aggressive behavior was defined by a MOAS score ≥3.

We used SPSS 15 to analyse results

Results

Sixty-five case files were selected during the study month. The average age was 35.3 (19;64).

The mean of our sample MOAS aggression scale score was 31.5 [0; 79] and 90% of patients had a score ≥ 3 (image 1)

Among the 65 admissions, heteroaggressive risk was the most frequent reason for hospitalization (N=53), followed by psychomotor excitement. IMAGE 2

Statistical analysis revealed a significant association between high MOAS scores and substance use, history of suicide attempt, educational level and socioeconomic level

Image:

Image 2:

Conclusions

In the current research, the prevalence of aggressive behavior was high among these patients, which may be due to the conditions of psychiatric hospitalization in our region, which is often reserved for the most serious and dangerous patients.

Disclosure of Interest

None Declared
The efficacy of cognitive remediation in children and adolescents: results from a new meta-analysis.
Authors: Moscoso A.
Published: August 2023

This presentation will share data from a new meta-analysis of RCT studies using cognitive remediation to treat children and adolescents with ADHD. For this matter, 25 studies were accessed, and results will focus on outcomes immediately after the end of the program and in follow-up. Outcomes include subjective measures of functioning (through validated scales), neuropsychological measurements and academic performance. Comparisons regarding length of training, intensity, concomitant use of pharmacological treatments will also be provided. These findings will build on previous meta-analysis on the issue that were performed in the past.

Disclosure of Interest

None Declared
Interplay between plasticity, environment and depression
Authors: Branchi I.
Published: August 2023

Plasticity is the ability to modify brain and behavior, ultimately promoting an amplification of the impact of the environment on the individual’s mental health. Thus, plasticity is not beneficial per se but its value depends on contextual factors. High plasticity is beneficial in favorable, but can be detrimental in adverse living conditions, while the opposite applies to low plasticity. Consequently, resilience and vulnerability are not univocally associated to high or low plasticity. Here I will present recent findings supporting this theoretical framework and showing the role of the serotonin system in enhancing plasticity. First, we explored the Sequenced Treatment Alternatives to Relieve Depression-STAR*D dataset and analyzed the outcome of the SSRI citalopram treatment according to socioeconomic status (SES) and SSRI dosage. The results showed that SSRIs are plasticity-enhancer drugs as they amplify the influence of the living conditions on mood in a dose-dependent fashion. Second, we exploited a meta analytic approach to investigate the contribution of the serotonin-transporter-linked promoter region (5-HTTLPR) to depression vulnerability considering time as moderating factor. We found that the 5-HTTLPR x stress interaction is a dynamic process, producing different effects at different time points and confirming that individuals with high plasticity are both at higher risk and more capable to recover from depression. Overall, our findings indicate that treatments and conditions enhancing plasticity have a therapeutic value that depends on context.

Disclosure of Interest

None Declared
Mental health and post-traumatic growth in multiple sclerosis
Authors: Gil-González I. , Pérez-San-Gregorio M. Á. , Martín-Rodríguez A.
Published: August 2023

Introduction

people suffering from multiple sclerosis (MS) can experience post-traumatic growth (PTG), a sense of personal growth and benefit gain. Patients mental health can play an important role in PTG development.

Objectives

to explore possible differences in mental health according to PTG levels.

Methods

the sample was composed of 392 outpatients with MS from Virgen de la Macarena University Hospital (268 women; 124 (31.6 %) men, ages 19-78 years old (mean 45.61 years, SD=11.16 years). Expanded Disability Status Scale (EDSS) mean score was 3.38 (SD=2.06). Relapsing remittent (n=327) and progressive (n=65) MS type were reported. Post-traumatic Growth Inventory (PGI-21) measured patients perception of personal benefit gain after MS experience. General Health Questionnaire-28 (GHQ-28) evaluated Mental Health distress symptoms. Unpaired t-test was used to identify differences in mental health distress between “low PTG ≤49 score” and “high PTG ≥50 score” groups.

Results

Significant differences were found in social dysfunction (t=2.521, p=0.012) and severe depression (t=2.442, p=0.015), “high PTG group” (n=194) presented lower scores compare to “low PTG group” (n=198). No significant difference was detected in somatic symptoms (t=0.185, p=0.087) and anxiety and insomnia (t=0.859, p=0.391).

Conclusions

patients with higher PTG reported a better mental health. This suggests the relevance of mental health status in positive outcomes development after an adverse life event. Particularly, social dysfunction and depressive symptoms should be considered in interventions aimed to promote positive outcomes as personal gain and benefit finding in MS population.

Disclosure of Interest

None Declared
Off-label use of atypical antipsychotics- Where are we?
Authors: Vaz R. P. , Martins J. , Costa A. L. , Brás J. , Sousa R. , Almeida E. , Abreu J. , Castro N. , Andrade R. , Gil N.
Published: August 2023

Introduction

Nowadays, In the exercise of psychiatric clinical activity, the prescription of atypical antipsychotics is a widespread practice.

However, despite the approval in the treatment of psychoses and bipolar affective disorder, where its effectiveness is clearly demonstrated, these drugs are off-label prescribed in most of the clinical situations.

Objectives

This work aims to clarify which atypical antipsychotics are most frequent prescribed and the clinical conditions where their off-label prescription is more common.

Methods

Bibliographic research in the Pubmed® database using the terms “atypical antipsychotics and off-label use”

Results

According to the scientific literature consulted, the off-label prescription of atypical antipsychotics may represent about 70% of the total prescription of these psychotropic drugs.

Risperidone, olanzapine, quetiapine and aripiprazole are the most off-label prescribed among the atypical antipsychotics.

The psychiatric conditions where atypical antipsychotics are most often off-label prescribed are addictive disorders, anxiety disorders, post-traumatic stress disorder, personality disorders, eating disorders, insomnia and dementia, where therapeutic benefits are demonstrated when carefully selected.

Conclusions

The off-label prescription can be interpreted from two points of view. On the one hand, it can guide innovation in clinical practice and improve symptoms in patients who do not respond to standard treatments. On the other hand, it may be associated with negative consequences due to the lack of data on safety and efficacy in these situations.

Despite widespread prescribing of atypical antipsychotics, there is no evidence-based recommendation beyond psychoses and bipolar affective disorder.

Thus, when prescribed, we must proceed with careful monitoring and consider the risks and benefits in relation to off-label prescription.

Disclosure of Interest

None Declared
Coping Strategies and Relationship with Burnout among Residents in Thailand
Authors: Kusalaruk P. , Saravithi J.
Published: August 2023

Introduction

Burnout is prevalent in residents and coping is one of the important modifying
factors.

Objectives

This study aimed to investigate coping strategies, burnout, and their relationship
among residents.

Methods

A cross-sectional descriptive study was conducted among residents from October 2019 to
April 2020 in Thailand. The Brief COPE Inventory Thai version and The Maslach Burnout
Inventory Thai version were used, and the associations between coping strategies and burnout
were examined.

Results

The number of 280 residents replied the questionnaire (response rate 41.5%). The most
favored copings were self-distraction and acceptance and the least common were denial and
substance use. Most residents had high level of emotional exhaustion (n = 113, 40.4%) and
moderate level of reduced personal accomplishment (n = 99, 35.4%). However, low degree of
depersonalization was reported predominantly (n = 164, 58.6%). The coping of venting,
behavioral disengagement and self-blame independently predicted emotional exhaustion and
depersonalization. Behavioral disengagement was the only predictor of burnout in all
dimensions, whereas positive reframing is the only strategy that had independent and
protective effect against burnout in all dimensions.
Table 1

Multivariate analysis of factors associated with emotional exhaustion

Variablesaassociated
with emotional exhaustion
β
(S.E.)
95%
CI
P
value

Venting
.17**
(.50)
(.50, 2.46)
< .01

Behavioral
disengagement
.29*** (.51)
(1.52, 3.55)
< .001

Self-blame
.15**
(.47)
(.30, 2.15)
.01

Planning
.15**
(.51)
(.32, 2.33)
.01

Positive
reframing
-.26*** (.50)
(-3.08, -1.12)
< .001

Table 2

Multivariate analysis of factors associated with depersonalization

Variablesaassociated
with depersonalization
β
(S.E.)
95%
CI
P
value

Sex
-.12* (.58)
(-2.37, -.07)
.04

Alcohol use
.18**
(.75)
(.74, 3.69)
< .01

Venting
.14* (.26)
(.07, 1.11)
.03

Behavioral
disengagement
.18**
(.25)
(.28, 1.27)
< .01

Self-blame
.21*** (.23)
(.38, 1.28)
< .001

Positive
reframing
-.18* (.23)
(-1.17, -.27)
< .01

Use instrumental
support
-.14* (.24)
(-1.03, -.10)
.02

Table 3

Multivariate analysis of factors associated with personal
accomplishment

Variablesaassociated
with personal accomplishment
β
(S.E.)
95%
CI
P
value

Behavioral
disengagement
-.13* (.38)
(-1.59, -.09)
.03

Positive
reframing
.21** (.41)
(.42, 2.03)
< .01

a

Only statistically significant variables are displayed

Conclusions

A large number of residents had emotional exhaustion. Behavioral disengagement and
positive reframing were the most influential coping strategies related to burnout. This study
might inform residency training program of some specific approaches for burnout
prevention.

Disclosure of Interest

None Declared
Benzodiazepine Prescription for Anxiety Disorders Increase the Risk of Substance Use Disorders: A Retrospective Cohort Study
Authors: Sun C.-F. , Lin Y. , Pola A. S. , Kablinger A. S. , Trestman R. L.
Published: August 2023

Introduction

While the role of benzodiazepines (BZDs) has been well established for anxiety and related disorders, there are significant concerns about BZD dependence, withdrawal, and tolerance. There is a lot of ambiguity regarding the potential long-term effects of BZDs on mental health. However, the risk of developing subsequent other substance use disorders is in question.

Objectives

In this electronic medical record (EMR) based retrospective cohort study, the study cohort was defined as patients between the ages of 18 and 65 with anxiety disorders (ICD-10-CM: F40-F48) prescribed with at least one BZD; the control cohort was defined as patients between the ages of 18 and 65 with anxiety disorders (ICD-10-CM: F40-F48) with no BZD prescription during the five-year timeframe examined. We excluded patients with pre-existing substance use disorders (ICD-10-CM: F10-F19), et al.

Methods

We collected data from TriNetX Research database, a real-time international EMR network, from September 2017 to September 2022. Patients in the two cohorts were matched by gender, age, race, ethnicity, and common medical conditions at a 1:1 ratio by propensity scoring and then underwent Kaplan–Meier analysis and association analysis.

Results

A total of 626,754 patients were identified and matched for analysis. Patients in the study cohort were more likely to be female (67.6% vs. 66.7%, p < 0.001), non-Hispanic (65.8% vs. 62.5%, p < 0.001) and white (72.8% vs. 69.1%, p < 0.001). Kaplan–Meier analysis showed the survival probability at the end of the time window was 94.1% for the control cohort and 89.5% for the study cohort (Hazard ratio, 2.20; 95% CI, 2.16-2.25; P < 0.001) in all type of substance use disorders. (Table 1)
Table 1.

Hazard ratio of substance use disorders difference in BZD cohort versus the control cohort.

BZD Cohort
n (risk%)Control Cohort
n (risk%)Hazard Ratio
(95% Cl)P valueSubstance Use Disorders*26,569 (4.2)11,976 (1.9)2.20 (2.16-
2.25)<0.001Sedative/hypnotic/anxiolytic related disorders656 (0.1)152 (0.0)4.26 (3.57- 5.09)<0.001Alcohol Related Disorder5,749 (0.9)2,064 (0.3)2.74 (2.61-2.88)<0.001Opioid Related Disorder2,807 (0.4)815 (0.1)3.38 (3.13-3.66)<0.001Stimulant Related Disorder1,658 (0.3)551 (0.1)2.94 (2.67- 3.24)<0.001Cannabis Related Disorder3,376 (0.5)970 (0.2)3.41 (3.17- 3.66)<0.001*

Substance use disorders was defined as Mental and behavioral disorders due to psychoactive substance use (ICD-10-CM: F10-F19).

Conclusions

Patients with an anxiety disorder who were prescribed BZDs are at higher risk of not only BZD dependence but all types of substance use disorders than a matched cohort not prescribed BZDs. Given this notable association, clinicians should be cautious while prescribing BZDs and inform the patient about the risks associated with their utilization.

Disclosure of Interest

None Declared
Memory deficits in children and adolescents with psychotic disorders: A systematic review and meta-analysis
Authors: Rodríguez Toscano E. , Díaz-Carracedo P. , de la Higuera-González P. , Padilla G. , de la Torre-Luque A.
Published: August 2023

Introduction

Cognitive symptoms in psychosis represent a major unmet clinical need (Acuna-Vargas et al. Cog in Psych 2019; 21(3), 223–224). Deficit in memory has been largely described in first episode early onset psychosis (Mayoral et al. Eur Psych 2008; 23(5), 375-383) and has been associated to a worse functionality (Øie et al. Neuropsychology 2011; 25(1), 25–35). However, results from existing studies are quite mixed on memory deficits of early psychosis patients, particularly in terms of memory contents and storage resources.

Objectives

The aims of this study were 1) to examine the nature and extent of cognitive impairment in early-onset psychosis and 2) to analyze which type of memory (verbal and visual) is more affected in the disorder.

Methods

The present systematic review and meta-analysis was conducted according to the PRISMA criteria (Moher et al. Systematic Reviews 2015; 4(1), 1 - 9). A systematic search of CINAHL, PsycInfo, PubMed, Redalyc, SCOPUS and Web of Science (published from 2000 to 2020) identified case-control studies of early onset psychotic disorder (under 18 years old). Those studies focused on both verbal and visual memory performance.

Results

Twenty articles were included in the review. A deficit in memory in child and adolescent psychotic disorders was obtained displaying a large effect size in memory tasks (g = -0.83). Also, a medium effect size was found in visual memory tasks (g = - 0.61) and a large effect size was found in verbal memory tasks (g = -1.00).

Conclusions

It was observed a strong memory deficit on early psychotic disorders already present at the onset of the illness. This deficit was stronger when verbal memory tasks were used compared to the effect found with visual memory tasks. Based on previous literature (García-Nieto et al. Jou Cli Child & Ado Psych 2011; 40(2), 266-280; Lepage et al. Eur Psych 2008; 23(5):368- 74; Hui et al. Psych Med 2016; 46(11):2435-44), these results contribute to describe and characterize the cognitive symptoms in the first-episode psychosis in a youth population.

Disclosure of Interest

None Declared
Chronic activation of inflammasome signaling complexes and enhancement of behavioral abnormalities
Authors: Abdelmoula B. , Bouayed Abdelmoula N.
Published: August 2023

Introduction

Inflammasomes are cytosolic multi-component signaling platforms critical to the innate immune response to infectious diseases and the dysregulation of their activation can lead to the development of neurodegeneration and cancer.

Objectives

We aim through this review to ass a possible interplay between dysregulation of inflammasome activation, development of chronic inflammatory disease and enhancement of behavioral abnormalities.

Methods

We comprehensively review the scientific literature using Pubmed database and other search platforms such as Google scholar to assess the role and the actors of chronic activation of inflammasome signaling complexes to establish a potential association between dysregulation of inflammasome activation, chronic inflammatory disease and enhancement of behavioral abnormalities.

Results

Our bibliographic review revealed that dysregulation of the inflammasome is associated with the onset and progression of several autoinflammatory and autoimmune diseases, including cryopyrin-associated periodic fever syndrome, familial Mediterranean fever, rheumatoid arthritis, and systemic lupus erythematosus. These multimeric complexes form in response to molecular patterns unique to pathogens and cellular damage, triggering a cascade of downstream responses, including the induction of pyroptotic cell death and release of proinflammatory cytokines. Some inflammasomes directly recognize these patterns, while others indirectly sense these patterns through changes in the homeostatic environment of the cell. Moreover, although being a normal part of the skin flora, yeasts of the genus Malassezia are associated with several inflammatory skin diseases including pityriasis versicolor (tinea versicolor), atopic eczema, psoriasis, Malassezia folliculitis and onychomycoses. In the context of tolerating fungi during colonization and eliciting, activation, of inflammasomes signaling complexes, has been identified as an integral part of antifungal host defense. While the activation of inflammasomes mainly the NLRP3 one, was shown to be pivotal for innate immunity against pathogenic fungi such as candida albicans, their role in the fungal genus Malassezia remains imprecise. Even though, many observations suggest that simultaneous activation of NLRP3, NLRC4 and AIM2 inflammasomes may play an important role.

Conclusions

Whereas, chronic inflammasome activation such as by chronic infectious has been tied to the development of metabolic syndromes, neurodegenerative diseases, and cancer progression, a possible interplay between chronic invasion by the genus Malassezia, vigorous immune response to eliminate invading fungal pathogens, disruption of immune sensors of genotoxic stress, development of chronic inflammatory disease and behavioral abnormalities may be a new field of scientific researches.

Disclosure of Interest

None Declared
Late diagnosis of attention deficit hyperactivity disorder and cocaine abuse
Authors: De Andrés Lobo C. , Vallecillo Adame C. , Jiménez Aparicio T. , Queipo de Llano de la Viuda M. , Guerra Valera G. , Gonzaga Ramírez A. A. , Fernández Lozano M. , Navarro Barriga N. , Mateos Sexmero M. J. , Rodríguez Rodríguez B. , Calvo Valcárcel M. , Andreo Vidal M. , Pando Fernández M. P. , Martínez Gimeno P. , Santos Carrasco I. D. L. M. , Gonçalves Cerejeira J. I. , Rodríguez Campos A.
Published: August 2023

Introduction

Adult ADHD diagnosis sometimes represents a challenge for the clinician, due to the comorbid psychiatric diseases that are often associated and which complicate de recognition of the primary symptoms of ADHD. The prevalence of ADHD in adult populations is 2’5% and it is a relevant cause of functional impairment.

Objectives

Presentation of a clinical case of a male cocaine user diagnosed with adult ADHD.

Methods

Literature review on adult ADHD and comorbid substance abuse.

Results

A 43-year-old male who consulted in the Emergency Department due to auditory hallucinosis in the context of an increase in his daily cocaine use. There were not delusional symptoms associated and judgment of reality was preserved. Treatment with olanzapine was started and the patient was referred for consultation. In psychiatry consultations, he did not refer sensory-perceptual alterations anymore, nor appeared any signals to suspect so, and he was willing to abandon cocaine use after a few appointments. He expressed some work concerns, highlighting that in recent months, in the context of a greater workload, he had been given several traffic tickets for “distractions.” His wife explained that he had always been a inattentive person (he forgets important dates or appointments) and impulsive, sometimes interrupting conversations. In the Barkley Adult ADHD Rating Scale he scored 32 points.

He was diagnosed with adult ADHD and treatment with extended-release methylphenidate was started with good tolerance and evolution, with improvement in adaptation to his job and social environment. Since then, the patient has moderately reduced the consumption of drugs, although he continues to use cocaine very sporadically.

Conclusions

Early detection of ADHD and its comorbidities has the potential to change the course of the disorder and the morbidity that will occur later in adults. Comorbidity in adult ADHD is rather the norm than the exception, and it renders diagnosis more difficult. The most frequent comorbidities are usually mood disorders, substance use disorders, and personality disorders. Treatment of adult ADHD consists mainly of pharmacotherapy supported by behavioral interventions. When ADHD coexists with another disorder, the one that most compromises functionality will be treated first and they can be treated simultaneously. The individual characteristics of each patient must be taken into account to choose the optimal treatment.

Disclosure of Interest

None Declared
Psychedelics for depression: from neurobiology to treatment
Authors: Kuypers K. P.
Published: August 2023

Decades ago, the classical psychedelics psilocybin and LSD entered the therapeutic setting and already then showed their therapeutic potential in the treatment of psychiatric disorders. For thousands of years another psychedelic, ayahuasca, is being used by tribes in western Amazonia for healing and divination, and in recent years its use has expanded worldwide.

Research into the therapeutic potential of these substances has re-emerged and (preliminary) findings are promising, showing that after one or two administrations remission is reached in depressed patients that were labeled as treatment-resistant. This is a remarkable finding as the therapeutic effects of treatment with conventional pharmacological agents like SSRIs take longer to lead to remission, with one-third of the patients failing to reach this stage.

The fast onset of positive therapeutic effects by psychedelics increases the interest to discover the mechanism of action behind this. There is a debate about the importance of the psychological experience caused by these agents in the therapeutic outcome, while science also tries to understand the neurobiological correlates. The latter will be addressed in my talk and I will link it to psychedelics’ therapeutic effects.

Disclosure of Interest

None Declared
Use of a Two-Eyed Seeing Approach to Increase Client Satisfaction with Psychiatric Services Among an Indigenous Population
Authors: Mehl-Madrona L. , Mainguy B.
Published: August 2023

Introduction

Psychiatry has historically had difficult relationships with Indigenous people, tending to dismiss their views on mental health and illness as superstitious or primitive. Indigenous people have responded by refusing to come for services, missing appointments, and dismissing treatment offered. Canadian Mi’qmak elder Albert Marshall introduced the term,
etuaptmumk, to highlight the idea that Indigenous Knowledge and Practice has equal value to contemporary psychiatry. While translated as two-eyed seeing, the term refers to explanatory pluralism and invites a respectful dialogue among cultures as equals.

Objectives

We implemented a two-eyed seeing research in Indigenous communities to explore the differences of some Indigenous North American cultures in their view of mind and mental health from conventional Euro-American psychiatry and how their cultural practitioners negotiated those differences. We wondered how perception of services would change if mental health practitioners were aware and were more respectful of those differences.

Methods

We engaged in a series of discussions with traditional knowledge keepers about their views on mind and mental health. We used constructivist grounded theory methods to identify what was common among these views. We developed a training program to engage mental health clinicians in understanding and responding to these differences. We engaged community members receiving services in a discussion about their perception in the change in the quality of the services. We summarized their responses.

Results

Differences between Indigenous views and those of conventional psychiatry included (1) greater emphasis on the role of community and socio-environmental influences on mental health, (2) inclusion of spirituality and spiritual beings in their expectation for cause of problems and treatment, (3) greater emphasis on inter-generational trauma and historical trauma in addressing mental health. After inclusion of practitioners in the mental health services who had been oriented to these differences and integration of ceremony into the mental health services, ninety-four percent of respondents asked if the service had improved responded in the positive. Attendance at scheduled appointments increased from 56% to 81%. Adherence to recommendations increased from 27% to 67%, which were significant.

Conclusions

Awareness of cultural differences in beliefs about causes of mental illness and acceptable types of treatment increased client satisfaction with services offered, improved attendance rates, and improved adherence rates to treatments offered among Indigenous people. These results could generalize to other populations who hold different views than those of conventional psychiatry. The concept of two-eyed seeing, or explanatory pluralism, holds heuristic value for psychiatry by allowing multiple points of view to be true at the same time.

Disclosure of Interest

None Declared
The impact of lifestyle on adherence to treatment in a sample of patients with Major Depression
Authors: Conti D. , Girone N. , Vanzetto S. , Cocchi M. , Achilli F. , Leo S. , Bosi M. , Benatti B. , Dell’Osso B.
Published: August 2023

Introduction

Poor adherence to treatment is currently stated to be one of the causes of depression relapse and recurrence.

Objectives

Aim of the present study was to assess potential differences in terms of clinical and socio-demographic characteristics specifically related to adherence to treatment features, medical comorbidities, and substance abuse in a sample of patients diagnosed with Major Depression in an Italian psychiatric department.

Methods

Patients with a DSM-5 diagnosis of Unipolar or Bipolar Major Depressive Episode, of either gender or any age were recruited from the Psychiatry Department of Luigi Sacco University Hospital in Milan. Main clinical and socio-demographic variables were collected reviewing patients’ medical records. Moreover, adherence to psychopharmacological treatment was assessed using the Clinician Rating Scale (CRS; Kemp et al, 1996; 1998). Adherence was defined as ratings of > or =5 on the CRS. Descriptive and association analyzes were performed, setting the significance level at p<.05.

Results

80 patients with a diagnosis of Unipolar Major depressive episode (48.9%) and Bipolar Major Depressive Episode (51.1%) were included. For the purposes of the study, the total sample was divided into two subgroups based on adherence to pharmacological treatment (A+ vs A-). Significantly higher rates of inpatients from psychiatric ward were A- compared to A+ patients (84.6% vs 48.1%, p=.011). A- patients were significantly more unemployed (57.9% vs 23.8%, p=.015), were mostly living in their family of origin (50% vs 21.4%, p=.027), and had fewer years of education compared to A+ subgroup (10.52±3.28 vs 12.2±3.1 years, p=.053). Higher rates of Bipolar Depression diagnosis and a prevalent manic polarity lifetime emerged in A- compared to the A+ group (73.1% vs 42.3%, p=.010; 30.8% vs 3%, p=.011, respectively). Moreover, A+ reported significantly higher rates of depressive prevalent polarity lifetime (72.7% vs 30.8%, p=.011). A- reported significantly higher rates of comorbidity with alcohol or other substance use disorders lifetime (46.2% vs 5.7%, p=.006) and almost one involuntary commitment lifetime (23.1% vs 11.1%, p=.013).

Conclusions

In our sample adherence to treatments showed significant differences in terms of clinical and socio-demographic characteristics. Low levels of adherence have been associated with higher hospitalization rates, involuntary commitments, greater comorbidity with alcohol or drugs. Our data therefore seem to suggest that less adherence leads to a worse disease course and a worse quality of life. It therefore appears useful to include an assessment of adherence in the clinical practice and implement interventions to improve therapeutic adherence and ensure a better quality of life.

Disclosure of Interest

None Declared
The role of miRNA in diagnosing and clarifying the pathomechanisms in major depressive disorder
Authors: Ho C. S. , Soh M. W. , Tay G.
Published: August 2023

Introduction

There are currently no diagnostic or treatment-guiding biomarkers for major depressive disorder (MDD). Microribonucleic acids (miRNA) may facilitate understanding the reorganisation of gene expression networks in MDD. Identifying miRNA and target mRNA pathways that contribute to MDD may open new therapeutic avenues, such as inhibiting endogenous miRNA or administering exogenous miRNA.

Objectives

This study investigates how miRNAs can clarify the molecular mechanisms of MDD by comparing the miRNA levels in the blood serum of patients with MDD and healthy individuals. The study also investigates the discriminative ability of miRNAs to distinguish between depressed patients and healthy controls.

Methods

Sixty depressed patients were matched with 60 healthy controls based on age, gender, ethnicity, and years of education. The severity of depression was measured using the Hamilton Depression Rating Scale, and venous blood was collected for miRNA profiling. Using the QIAGEN Ingenuity Pathway Analysis, networks were constructed to identify the biological pathways associated with MDD influenced by the differentially expressed miRNAs. Analyses of the receiver operating characteristic (ROC) were performed to examine the capacity of miRNAs to distinguish between depressed and healthy individuals.

Results

Six miRNAs (miR-542-3p, miR-181b-3p, miR190a-5p, miR-33a-3p, miR-3690, and miR-6895-3p) were significantly down-regulated in untreated depressed patients compared to healthy controls. miR-542-3p has experimentally validated mRNA targets predicted to be associated with MDD. ROC analyses determined that a panel containing miR-542-3p, miR181b-3p, and miR-3690 distinguished between depressed and healthy individuals with an area under the curve value of 0.67.

Conclusions

Specific miRNAs, including miR-542-3p, miR181b-3p, and miR-3690, may be biomarkers with targets implicated in the pathophysiology of depression. They could also be used to distinguish accurately between depressed and healthy individuals.

Disclosure of Interest

None Declared
Organic affective disorder due to meningioma, case report
Authors: Garcia-Moreno M. , de Cós Milas A. , Beatobe Carreño L. , del Sol Calderón P. , Izquierdo de la Puente Á.
Published: August 2023

Introduction

Brain tumors can be associated with psychiatric symptoms in up to 50% of cases. The most frequent primary is meningioma and the clinic will depend on its location. Since surgical treatment does not always guarantee complete resolution of the condition, concomitant psychopharmacological treatment is usually recommended.

Objectives

To review about organic mania and its differential diagnosis.

Methods

We carry out a literature review about organic affective disorder accompanied by a clinical description of one patient with organic mania.

Results

A 50-year-old woman admitted due to psychotic symptoms. She had a diagnosis of frontal and parietal meningioma treated with surgical treatment 10 years ago. In this context she had a diagnosis of Organic Affective Disorder and 3 previous psychiatric admissions due to affective or psychotic symptoms. Current episode consisted in dysphoria, magalomanic ideation, delusional ideation of harm and mystical-religious content, high speech pressure and insomnia with little awareness of the disease. Cranial magnetic resonance showed postoperative right frontal changes and stability in parietal meningioma, with no significant differences compared to the previous study. Diagnosis of Organic Affective Disorder is maintained and reintroduced treatment with aripiprazole withdrawaled by the patient weeks before. Because of adverse effects and persistence of the symptoms described, it was changed to olanzapine with good response and tolerability. The behavior was progressively adapted with improvement of the dysphoria and without psychotic symptoms at discharge.

Conclusions

Affective symptons due to organic disorders such as brain tumors can be treated surgically and with psychopharmacological treatment.

Disclosure of Interest

None Declared