bluuebunny/crossref_metadata_2025 huggingface dataset:
Catchment area rates of involuntary care and subsequent patient morbidity and mortality in Norway
Authors: Nyttingnes O.
Published: August 2024

Introduction

Mental health legislation allows for involuntary care of patients with severe mental disorders, assuming it improves health and reduces risk. Professionals have warned against potentially adverse effects of recent initiatives to heighten involuntary care threshold, such as CRPD and national coercion-reduction strategies. We have not found that the impact of high thresholds for involuntary care have been studied.

Objectives

Our aim was to use national data from Norway to test implications of the hypothesis that areas with lower levels of involuntary care show higher levels of morbidity and mortality in their severe mental disorder populations compared to areas with higher levels. We pre-specified five models of how such adverse effects could manifest in national register data.

Methods

Using national register data, we calculated standardized (by age, sex, and urbanicity) involuntary care ratios across Community Mental Health Center areas in Norway. For patients diagnosed with severe mental disorders (ICD10 F20-31), we tested whether lower area ratios in 2015 interacted with 1) case fatality over four years, 2) an increase in inpatient days, and 3) time to first episode of involuntary care over the following two years. We also assessed 4) whether area ratios in 2015 predicted an increase in the number of patients diagnosed with F20-31 in the subsequent two years and whether 5) standardized involuntary care area ratios in 2014–2017 predicted an increase in the standardized suicide ratios in 2014–2018.

Results

We included 21481 patients with either an F20-31 diagnosis, an episode of involuntary care in 2015, or both. The standardization variables age, sex, and urbanicity explained 70.5% of the variance in raw rates of involuntary care, and the remaining extremal quotient was 2.5. Age and sex predicted case-fatality, but involuntary care-rate was insignificant. Patients with F20-31 and no involuntary care episode in 2015 showed a steady reduction in inpatient days the following years, but not significantly related to the area’s involuntary care rates. For the same sample, these rates did not predict the time to an episode of involuntary care. The area’s involuntary care rate in 2015 did not predict changes in the number of patients in treatment for a diagnosis of F20-31 from 2015-2017. Finally, the area’s involuntary care rate from 2014-2018 explained 1.2% of the variance in suicides in 2014-2019 in the area.

Conclusions

In the models, we found no significant associations between low standardized catchment area rates of involuntary care and the pre-specified outcomes. This raises questions about some assumptions in mental health legislation and merits further research.

Disclosure of Interest

None Declared
Involuntary Psychiatric Hospitalization of Minors Due to Court Orders: Effectiveness Assessing Through a Case Series
Authors: Yerlikaya Oral E. , Tekden M.
Published: August 2024

Introduction

Involuntary treatments in forensic psychiatry represents a complex intersection of mental health, legal systems and ethics. Judicial authorities may compulsorily refer children to inpatient clinics for receiving necessarily treatment. Despite its importance, there is limited research on the reasons behind and effectiveness of such interventions in minors.

Objectives

The objectives of this study were to describe the clinical characteristics of minors who have risks of harming themselves and/or others so receiving involuntary treatment due to a court order. It is aimed to assess the effectiveness of involuntary treatment.

Methods

A follow-up case series was conducted on 9 minors who hospitalized by court orders in a secure inpatient child and adolescent psychiatry clinic, in the year of 2023. Data collected from medical records, including demographic information, clinical presentation, diagnosis and discharge treatment. After one, three and six month of the discharge, interviews made with the patients and their families. Current data collected on treatment regimen, compliance, behavioral outcomes and reoffending rates. All data were anonymized to maintain patient confidentiality.

Results

The case series consisted of 3 males and 6 females, with a mean age of 16.5 years at the time of admission. The most common reason to hospitalization was homicide risk 88%, followed by substance use 66%. Conduct Disorder was the most common diagnosis with the rate of 88%, followed by Substance Use Disorder(66%) and Attention Deficit and Hiperactivity Disorder(50%). 44% of minors had a history of juvenile delinquency. School dropout rates were 100%. Treatment consisted of a combination of individual and group therapy and medication. Treatment refusal rates were 88% so in terms of treatment, 88% of the minors in this sample treated with depot form antipsychotic medications, with the most common medication being risperidone. Overall all of the sample showed a significant reduction in disruptive behaviors during their hospital stay. Follow-up data collecting is still continue and preliminary statistics show us that relapse rates are low and treatment compliance is relatively high of the sample.

Conclusions

The findings suggest that involuntary hospitalization can be effective in reducing disruptive behaviors and increasing treatment compliance in minors with conduct disorders, substance abuse disorders and a history of juvenile delinquency. These results underscore the need for comprehensive, multidisciplinary approaches that integrate psychiatric treatment, psychoeducation and social support. Given the relatively small sample size and short-term follow-up, further research is needed to determine the long-term effects of involuntary treatment and to identify factors that predict treatment response.

Disclosure of Interest

None Declared
The risk of antidepressant-induced hyponatremia: A meta-analysis of antidepressant classes and compounds
Authors: Gheysens T. , De Picker L. , Van Den Eede F.
Published: August 2024

Introduction

Hyponatremia (hypoNa) is a potentially serious adverse event of treatment with antidepressants. Previous research suggests that risk of drug-induced hyponatremia differs between antidepressants.

Objectives

This meta-analysis sought to determine the risk of antidepressant-induced hypoNa, stratified by different compounds and classes.

Methods

PubMed and Web of Science were searched for studies reporting on incidence or risk of hypoNa in adults using antidepressants (PROSPERO, CRD42021269801). We modelled random-effects meta-analyses to compute overall incidence and risk of any and clinically relevant hypoNa for each compound and class, and ran head-to-head comparisons based on hypoNa incidences. We conducted subgroup analyses for geriatric populations, study context and sodium cut-off value.

Results

Thirty-nine studies (n = 8,459,033) revealed that exposure to antidepressants was associated with significantly increased odds of hypoNa (OR = 2.82 (1.79 – 4.45)). The highest event rates were found for SNRIs (7.17%), SSRIs (5.20%), and TCAs (2.26%); the lowest for mirtazapine (1.02%) and trazodone (0.89%). The highest odds ratios were found for MAOIs (4.12 (1.92 – 8.86)), SNRIs (3.16 (1.77 – 5.67)), and SSRIs (2.78 (1.57 – 4.91)); the lowest for mirtazapine (2.82 (1.87 – 4.21)) and TCAs (1.85 (1.28 – 2.69)). Compared to SSRIs, SNRIs were significantly more likely (OR = 1.27 (1.13 – 1.42), p < 0.001) and mirtazapine significantly less likely (OR = 0.61 (0.39 – 0.96), p = 0.032) associated with hypoNa.

Conclusions

Our meta-analysis demonstrated that, while no antidepressant can be considered completely risk-free, for hypoNa-prone patients mirtazapine should be considered the treatment of choice and SNRIs should be prescribed more cautiously than SSRIs and TCAs.

Disclosure of Interest

None Declared
The Potential Cardiovascular Benefits of Physical Exercise in Early Onset Psychosis and Bipolar Disorder
Authors: Bohman H. C. , Lundberg M.
Published: August 2024

Introduction

Early onset psychosis (EOP) and bipolar disorder (EOBP), occurring before the age of 18, have been linked to early signs of atherosclerosis and an elevated risk of cardiovascular disease (CVD). Physical exercise is a well-established factor in reducing the risk of developing CVD. However, it remains unclear whether regular physical activity can mitigate cardiovascular risk factors and signs of atherosclerosis in individuals with EOP and EOBP.

Objectives

This study aimed to explore the impact of physical exercise on cardiovascular risk factors in these populations.

Methods

We assessed the physical exercise habits of 71 individuals, including 22 with EOP, 21 with EOBP, and 28 age-matched healthy controls. Participants’ physical exercise routines were categorized as 0, 1, 2, or 3 or more times per week, with each session lasting at least 30 minutes. Our analysis included adjustments for conventional CVD confounders. Additionally, we used high-frequency ultrasound (22 MHz) to evaluate different layers of the arterial wall in the left common carotid artery (LCCA).

Results

Compared to the control group, adolescents with EOP and EOBP exhibited significantly thicker LCCA intima thickness (0.132 vs. 0.095 mm, p<0.001) and intima/media ratio (0.24 vs. 0.17, p<0.001). Remarkably, adolescents with EOP and EOBP who engaged in physical exercise three times or more weekly (n=13) displayed significantly less intima thickness (0.142 vs. 0.116 mm, p<0.01). However, we did not observe a significant association between exercise and other CVD risk factors. Even when considering factors such as the extent of antipsychotic medication use or the severity of the disorders in our regression analysis, the significant association between exercise and reduced intima thickness persisted (p<0.05).

Conclusions

Among adolescents with EOP or EOBP, those who engaged in physical exercise three or more times weekly exhibited less pronounced LCCA intima thickness compared to their less active counterparts, although it remained thicker than that of healthy controls. These findings, if replicated, suggest that regular physical exercise, specifically three or more times a week, could potentially offer protection against the future development of CVD in individuals with EOP and EOBP. Further research is warranted to confirm and expand upon these promising results.

Disclosure of Interest

None Declared
Prevalence and predictors of Anxiety and Depression among Adolescents and Young Adults: Findings from the MoreGoodDays Support Program in Alberta, Canada
Authors: Belinda A. , Shalaby R. , Hay K. , Pattison R. , Eboreime E. , Korthuis M. , Wei Y. , Agyapong V. I. O.
Published: August 2024

Introduction

The COVID-19 pandemic has led to a rise in psychological disorders among adolescents and young adults. There is an increase in the prevalence of likely anxiety and likely depression among the subscribers of MoreGoodDays supportive text message program, reflecting the impact of the COVID-19 pandemic on this cohort.

Objectives

To assess the prevalence, severity, and correlates of likely generalized anxiety disorder (GAD) and likely major depressive disorder (MDD) among subscribers of MoreGoodDays program.

Methods

This study used a cross-sectional design. An online survey questionnaire was used to collect sociodemographic and clinical information from subscribers of MoreGoodDays program, a daily supportive text message program co-designed with adolescents and young adults for their peers in Alberta. Validated instruments, the Generalized Anxiety Disorder GAD-7 and Patient Health Questionnaire-9 PHQ-9 were used to collect information on likely GAD and likely major depressive disorder (MDD), respectively. Data was analyzed with SPSS version 25 using chi-squared tests and binary logistic regression analysis.

Results

343 subscribers of MoreGoodDays participated in the survey. Overall, 117 (56.0%) respondents had a likely MDD and 97 (46.6%) had a likely GAD. Participants who would like to receive mental health counselling were 27 times more likely to experience GAD (OR = 27; 95% CI: 3.09–250.00) and 40 times more likely to experience MDD (OR = 40.03; 95% CI: 4.43–361.51) than those who did not. Respondents who had received mental health counselling in the past were 18.5 times more likely to experience MDD compared with those who had not (OR = 18.52; 95% CI: 1.55–200.00). Demographic variables, including age, education, employment, and relationship status, and clinical variables, such as history of anxiety, depression, obsessive-compulsive disorder, ADHD, and adverse childhood experience, did not independently the predict presence of likely GAD or MDD in subscribers of MoreGoodDays.

Conclusions

The prevalence of anxiety and depression was relatively high among subscribers of MoreGoodDays, indicating the long-term effect of the COVID-19 pandemic. This finding has significant implications in the broader context of mental health research and emphasizes the need for more research into innovative mental health support for this cohort. The desire to receive counselling was predictive of both anxiety and depression and is a positive sign of the openness of this cohort to receive psychological intervention. Since this group is mostly adapted to mobile text technology, government agencies and policymakers should prioritize and implement readily accessible interventions such as supportive text messages to support their psychological well-being.

Disclosure of Interest

None Declared
The effect of prophylactic esketamine in labor and cesarian delivery on the prevention of postpartum depression (PPD): A systematic review and meta-analysis of randomized controlled trials
Authors: Kozhokar Mikhaylovskaya A. , Shimit A. Q.
Published: August 2024

Introduction

Postpartum depression (PPD) is a common psychiatric illness affecting maternal health, which can lead to poor outcomes for the infant, mother and family. Since the usual pharmacological treatment has low efficacy and a delayed onset of action, new treatment options should be explored. A recent meta-analysis demonstrated positive effects of racemic ketamine on PPD, but limited evidence is available on its more potent derivative esketamine.

Objectives

To determine the effect of esketamine administered prophylactically during labor on the risk of incidence of PPD at 1 week and 6 weeks after delivery.

Methods

PubMed, Scopus and GoogleScholar databases were searched for randomized controlled trials that studied the efficacy of esketamine that screened for PPD using the Edinburgh Postpartum Depression Scale (EPDS). Risk ratio was used to determine the effect of incidence on PPD. Heterogeneity was examined with I2 statistics. A random-effects model was used, as per moderate heterogeneity (I2=59%, p-value<0.05).

Results

We included 7 RCTs with 1287 patients, 635 having received esketamine (49.3%). Patient-controlled intravenous analgesia (PCIA) or single intravenous dose during the delivery or cesarian section were the main drug delivery methods. Follow-up ranged from 4 weeks to 6 months, and EPDS cut-off scores for depression risk differed between studies, from 9 to 13 points. Dosages varied from 0.2mg/kg to 0.5mg/kg for single-dose administration and 0.1mg/kg to 1.25mg/kg for PCIA. Incidence of PPD at one week (RR: 0.459 95%CI 0.217-0.970; p<0.05; figure 1A) and at 6 weeks (RR: 0.470 95%CI 0.273-0.810; p<0.01; figure 1B) was significantly less common in patients who received esketamine during or after labor. Risk of bias was low in 5 studies and moderate in 2 studies. Risk of publication bias is significant.

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Conclusions

Prophylactic esketamine seems to improve EPDS scores in women at one and six weeks after birth. A more thorough analysis of the adverse effects on maternal and neonatal health are required, and long-term benefits are not fully understood. Larger multicenter studies would be a welcome addition to the issue at hand.

Disclosure of Interest

None Declared
Role of L-Arginine supplementation in Long Covid-related Fatigue and Depression in Elderly Outpatients
Authors: Moniello G. , Bonfitto I. , Simonetti F. , Dimalta S. , Rizzo M. R. , Bellomo A.
Published: August 2024

Introduction

Chronic fatigue and psychiatric manifestations (depression, anxiety and sleep disturbances) appear to be key features of post-COVID-19 syndrome and increase significantly in prevalence over time (Lavienraj et al. J Neurol Sci 2022;434:120162). Several studies have suggested an association between altered levels of arginine metabolites and depression, anxiety and stress severity (Arisoy et al. J Psychiatr Res 2020;120:21-28). L-arginine supplementation has also been shown to improve walking performance, muscle strength, endothelial function and fatigue in adults with Long COVID (Tosato et al. Nutrients 2022;14(23):4984).

Objectives

To study effects of L-arginine oral supplementation on chronic fatigue and depressive symptoms reported 3 months or more after acute COVID-19 onset in elderly outpatients without severe comorbid conditions.

Methods

This is a parallel-group, double-blind, randomized controlled trial conducted on 96 over 65 non-hospitalized patients suffering from Long Covid-related fatigue and depression. The first group included patients that received 1,66 g L-arginine twice a day in addition to a standard antidepressant therapy based on Selective Serotonin Reuptake Inhibitors (SSRIs), whereas the second group received antidepressant only. Severity of fatigue and depressive symptoms was evaluated at baseline and after 8 weeks of treatment using Fatigue Symptom Inventory (FSI) and Hamilton Rating Scale for Depression (HAM-D), respectively.

Results

At baseline, 64 patients (66,7%) reported moderate fatigue (4-6) and the remaining 32 (33,3%) reported severe fatigue (7-10). In this phase the average HAM-D score was 12,85 ± 5,97; among patients, 57,3% experienced mild symptoms of depression, 32,3% experienced moderate symptoms and 6,4% experienced severe symptoms. After two months, patients treated with L-arginine supplementation exhibited a 30% greater improvement in fatigue-related symptom severity (p=0.008) and a significantly decrease in average HAM-D score (p=0.002) compared to the group treated with SSRI only.

Conclusions

According to our results, adding oral L-arginine to standard antidepressant therapy in elders with Long Covid-related fatigue and depression significantly decreases severity of both physical and affective symptoms. Further studies are needed to clarify the intriguing role of L-arginine in the treatment of Post Covid-19 syndrome and its potential effects in promoting geriatric patients’ health, wellbeing and quality of life.

Disclosure of Interest

None Declared
Impact Of Emotion Dysregulation On Eating Behavior Among The Tunisian General Population
Authors: Hadj Ali A. , Turki M. , Zribi A. , Halouani N. , Ellouze S. , Aloulou J.
Published: August 2024

Introduction

Previous theoretical models and reviews have documented a strong connection between emotion dysregulation and eating disorders (ED) psychopathology among the general and clinical populations.

Objectives

We aimed to assess the link between emotional dysregulation and ED in the Tunisian general population.

Methods

We conducted a cross-sectional, descriptive and analytical study among Facebook group members, using an online questionnaire, over the period from February 17, 2023 to May 26, 2023. Emotional dysregulation was assessed via the “Difficulties in Emotion Regulation Scale” (DERS), which is composed of six sub-scores : “Non-acceptance” (N), “Strategies” (S), “Impulse” (I), “Goal” (G), “Clarity” (C) and “Awareness” (A). The Eating Attitude Test (EAT-26) was used to assess the risk of developing ED.

Results

A total of 528 responses were included. The mean EAT-26 score was 12.36±10.34; and 12.3% of our population were at high risk of developing an ED. The mean N, S, I, B, Cl, C and overall DERS scores were 7.78; 8.24; 7.08; 9.57; 6.46; 7.61 and 46.74, respectively.

We showed that the EAT-26 score was correlated with the overall DERS score (r=0.260; p<0.001) as well as with the N (r=0.208; p=0.002), S (r=0.228; p<0.001), I (r=0.212; p=0,025), B (r=0.198; p<0.001), C (r=0,122; p=0,005) and Cl (r=0.136; p=0.002) scores.

Conclusions

Our study showed that participants with a high risk of developing an ED seem to have more difficulties with emotional regulation. Thus, our findings call for interventions that target emotion regulation in the treatment of ED.

Disclosure of Interest

None Declared
The Zen Garden Virtual Reality App for eating disorders: description and preliminary results
Authors: Gravina D. , Kirupakaran S. , Badr M. , Meaburn A. , Kresojevic M. , Dell’Osso L. , Treasure J. , Himmerich H.
Published: August 2024

Introduction

Virtual Reality (VR) represents an emerging and promising tool to enhance standard care for patients with eating disorders (EDs). Indeed, VR provides an immersive and interactive experience in a safe and controlled environment that can simulate real-life situations, showing encouraging findings on various components of psychological treatments such as exposure therapy, psychoeducation, and emotional regulation.

Objectives

This study aims to evaluate the Zen Garden VR App in patients with anorexia nervosa (AN) in order to obtain pilot data regarding changes in mood, relaxation, anger, anxiety, and weight and shape concerns. A secondary aim was to receive feedback from participants about the VR experience, its components, and its possible application for people with AN.

Methods

Self-reported baseline and post-intervention data were collected from a sample of six female inpatients with AN recruited at the Eating Disorders Service at the Bethlem Royal Hospital of the South London and Maudsley NHS Foundation trust (SLaM). The technology used during the VR session consisted of an Oculus head-mounted display headset and two controllers which provided continuous rotational and positional tracking (Figures 1, 2 and 3).

Results

Findings showed a global improvement after the VR Zen Garden App session, mainly in reducing levels of anxiety (Cohen’s d= 1.07) and promoting relaxation (Cohen’s d= 0.95), with possible applications especially before and after meals when food fears are at their highest. In addition, the music that was played during the intervention had a particularly positive effect.

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Conclusions

Despite limitations, such us the small sample size and the one time point measurement, positive clinical implications have been highlighted for the Zen Garden VR App in patients with AN, although further studies are needed to confirm these preliminary findings. It is possible that VR could usefully augment and personalize care for people with an EDs. A range of interventions might be used to target the most compromised symptoms such as designing interventions that can help with triggers to eating disorder psychopathology.

Disclosure of Interest

None Declared
Regional Inequalities in Diagnosis and Therapies in Greece regarding Autism Spectrum Disorders
Authors: Kouznetsov R. , Angelopoulos P. , Moulinos S. , Andrianopoulou A. , Dimakos I. , Gourzis P. , Jelastopulu E.
Published: August 2024

Introduction

Autism spectrum disorders (ASD) represent a major public health concern on a global scale. The increasing prevalence of ASD worldwide, coupled with the arising demand for treatments, underscores its important role in the public mental health discourse. Ensuring the equitable integration of children with ASD and their families into all aspects of society becomes an imperative task, in order to eradicate the stigma associated with the broad spectrum of autism, encompassing both visible and concealed dimensions.

Objectives

The primary objective of this study was to determine the crude prevalence of ASD in Greece nationwide, while also examining regional disparities in both prevalence and therapies. The study spanned a three-year period from February 2019 to February 2022 and relied on retrospective data sourced from the Greek National Organization for Healthcare Services Provision (EOPYY).

Methods

EOPYY provided de-identified data, including information such as sex, age, diagnosis, and treatment for each child, facilitated by hashed social security numbers. Statistical analysis of the dataset was performed using the open-source statistical program R.

Results

A total of 18,245 children aged 2 -17 years were diagnosed with ASD in Greece, representing a nationwide crude prevalence rate of 1.16%. Regional disparities were evident, with prevalence rates ranging from 0.49% in the North Aegean to 1.57% in Crete. Over the three-year study period, a total of 15,328,327 non-medical therapies were prescribed, corresponding to an annual average of 264 therapies per child. Statistically significant differences between the thirteen regions in Greece were observed, ranging from 230 to 323 annual therapies per child.

Conclusions

Our findings align Greece’s ASD prevalence with the global estimate of 1 in 100 children, as per the World Health Organization. Disparities between rural and urban areas in Greece may be attributed to differences in diagnostic procedures and the availability and accessibility of specialized services for autistic individuals. Thus, the establishment of a national surveillance system for ASD is recommended to enhance our understanding of the autism spectrum, monitor changes in prevalence, and identify potential contributing factors to autism conditions. Furthermore, these evidence-based results offer invaluable insights for crafting policies concerning healthcare, education, and employment for individuals with ASD in order to ensure the development of people with autism, their wellbeing, and a good quality of life.

Disclosure of Interest

None Declared
Recovery among people with mental health challenges and alcohol and drug use issues in the Northern Territory, Australia
Authors: Tari-Keresztes N. , Armstrong N. , Gupta H. , Smith J. A. , Endemann S.-A. , Goding S. , Downes J.
Published: August 2024

Introduction

The Northern Territory (NT) has Australia’s highest mental health burden. It has a diverse and transient population, including Aboriginal and Torres Strait Islander people and various multicultural communities. While peer support has been widely used nationwide, in the NT, peer support is poorly implemented in psychosocial support activities.

Objectives

The NT Lived Experience Network (NTLEN), in allyship with a team of researchers from Flinders University, has secured multiple fundings aimed to develop, implement, and evaluate a peer education and recovery program called Recovery Together (RT) for individuals with mental health and alcohol and drug use issues and related challenges.

Methods

The suitable evaluation approach was co-designed with live experience representatives from NTLEN and other local key stakeholders. It applied a mixed-method approach, including pre and post-program surveys (n=64) and individual interviews with program participants and the program delivery team (n=32). The evaluation findings were also informed by data collected by NTLEN via feedback forms n=38). We also used a co-design approach to develop survey instruments to ensure they were strengths-based and recovery-oriented.

Results

Participants reported poor and fair self-perceived health, high stress levels, dissatisfaction with their relationships and relatively low recovery scores, which showed improvements at post-program completion. They discussed their journeys in the interviews and shared their experiences with local mental health services and the Recovery Together program. Many expressed that mental health professionals are not necessarily the care providers they feel comfortable engaging with. However, they described their experience with the peer program as highly positive, empowering, safe, non-judgmental, and beneficial, satisfying their support needs. The program gave them hope and tools to manage their mental health challenges and opportunities to gain insight into non-clinical aspects of recovery. Participants conceptualised personal recovery in their own words and described the facilitators and barriers to their recovery. They emphasised that recovery is being empowered, strong within themselves and the leader of their journey, living their best possible life, understanding themselves, having the necessary knowledge about mental health, and looking forward in a hopeful way.

Conclusions

Our findings highlighted the demand and need for ongoing delivery of the RT program in the NT, which was highly effective in supporting personal recovery, addressing the service delivery gap and complementing the available clinical and mental health practices. They also showed the importance of providing recovery-oriented and trauma-informed education for medical and mental health professionals.

Disclosure of Interest

None Declared
The impact of clinical context on the recognition of facial expressions
Authors: De Sousa C. , Morgado S. , Ferreira J. , Tukaiev S. , Fonseca R.
Published: August 2024

Introduction

Several authors have demonstrated the relevance of the therapist sensitivity to the affective expression of his client (Merten & Schwab, 2005; 150-158), as well as to his own emotional experience (Haynal-Raymond et al., 2005;142-148) in order to build a more effective therapeutic relationship, and results. An important source of information to decode the emotional expression hints is the face, and its expression (Ekman & Friesen, 1975; Russel & Fernández-Dolls, 1997;275-294). Despite common sense saying that context is relevant to understand the meaning of the emotional facial expression, the literature review shows inconsistent results.

Objectives

The main goal of this study was to evaluate the impact of clinical context over the perception of the emotional facial expression.

Methods

This study followed a within-subjects design, and its sample consisted of 60 clinical psychologists. 21 combinations of prototypical expression images with mixed emotional signals, and clinical information texts were presented to the participants. Then their judgement on the type of emotion displayed was requested. The presentation of the text-image pairs was randomized between three conditions: consistent, and non-consistent, and neutral.

Results

The results suggest that emotions are more easily recognized in the presence of a concordant context than a non-concordant or neutral one, and that the greater the similarity between the facial expression of the image presented and the face prototypically associated with the context, the greater the influence of the context.

However, In the recognition of mixed emotional signs, there was greater recognition of signs of anger in the facial expression, as a non-dominant emotion, when in the presence of the neutral story than of the story that agreed with the dominant emotion (sadness). There was also greater recognition of sadness, as a non-dominant emotion, in the presence of a story in agreement with fear than in the presence of a neutral story. There was also a statistically significant increase in the attribution of anger to images in which it is not present and whose dominant emotion is fear, when associated with a context of aggression vs. a neutral context.

It was also found that there was a significant decrease in the attribution of fear to the sadness-anger image (25%-75%) in the presence of the aggression context compared to the neutral and panic contexts.There was also a statistically significant decrease in the attribution of sadness to an image of fear in the neutral context compared to the other contexts (panic and aggression).

Conclusions

In conclusion, our study have shown an impact of context over overvaluation or the undervaluation of the emotional facial expression as well as either with prototypical expressions or the mixed emotional signals when referring to sadness, fear, and anger. Thus, mental health clinicians should consider the influence of these contexts.

Disclosure of Interest

None Declared
Piled-up Risk Factors: a Case Report of Diogenes Syndrome
Authors: Freixo J. L. , Rodrigues S. G. , Novo T. , Brandão D.
Published: August 2024

Introduction

Diogenes Syndrome (DS) is an uncommon neurobehavioral syndrome characterized by social isolation, extreme neglect of personal care and a tendency to excessively accumulate useless objects in the home, usually leading to unsanitary living conditions. It is further characterized by a lack of insight into the condition, leading to a refusal to seek assistance.

Objectives

To outline the clinical features of primary DS, unassociated with other psychiatric conditions, emphasizing key risk factors contributing to its development.

Methods

Descriptive report of a case of DS, based on an interview with the patient, review of his clinical file, and a non-systematic literature review using the PubMed database.

Results

We report a case of a 62-year-old man, widowed since the age of 33, without children, living alone in a rural area in the north of Portugal. Currently retired, he worked as a Philosophy Professor. He had no known psychiatric history until 2015, when he attended two psychiatric appointments, due to anxiety and changes in sleep pattern. He has since lost psychiatric follow-up and in May 2022 he was brought to the emergency department by his neighbor, due to changes in his behavior. He was seen several times rummaging trough trash and he didn’t leave the house for a few weeks, resulting in a cluttered and unsanitary living space. He looked malnourished, unkempt and dirty. Despite not recognizing his behavior as problematic, he accepted hospitalization. No obsessive-compulsive, depressive or psychotic symptoms were detected, nor were dysfunctional personality traits. Reversible causes of dementia were excluded, a cranioencephalic CT scan revealed no abnormal findings and a neuropsychological assessment showed no changes in cognitive functions. Post-discharge, local health services provided home support, with meal delivery and house cleaning. However, he did not buy the medication and canceled the home support service several times, ending up being hospitalized again. After this second hospitalization in August 2023, he went to live with his brother in another city and has remained stable, medicated with an SSRI and low dose Aripiprazole.

Conclusions

Primary Diogenes Syndrome is rare and and its etiopathogenesis remains poorly understood. It is known that there is no distinction between genders, profession or socioeconomic status, and that it is more common in the elderly, single people, widowers and people with poor or non-existent social links with their local community. Familiarity with DS characteristics enables earlier recognition of such individuals, thereby facilitating prompt provision of social and clinical support in order to reduce morbidity, mortality, and enhance public health.

Disclosure of Interest

None Declared
Aberrant Salience, Psychotic-Like Experiences, and Anxiety: a Case-Control Study
Authors: Merola G. P. , Patti A. , Benedetti D. , Bozza B. , Ballerini A. , Ricca V.
Published: August 2024

Introduction

In this research, we investigate how Aberrant Salience (AS), Psychotic-Like Experiences (PLEs), and anxiety are interlinked in both healthy individuals and subjects with psychotic disorders. AS is a trait contributing to a susceptibility to psychosis and anxiety, while PLEs are subclinical states often leading to psychosis. We hypothesize that AS impacts the occurrence and severity of PLEs, which in turn influences anxiety.

Objectives

The goal is to offer a more nuanced understanding of the risk factors leading to psychotic disorders and to shed light on anxiety psychopathogenesis in healthy and psychotic populations.

Methods

We used self-reported questionnaires like the Aberrant Salience Inventory (ASI), Community Assessment of Psychic Experiences (CAPE), and Symptom Check List-90-revised (SCL-90-R). Data analysis included descriptive statistics and mediation analysis, adjusting for age, gender, and education. Controls were sourced through convenience and snowball sampling, while out-patients diagnosed with Schizophrenia Spectrum Disorder, Bipolar Disorder with psychotic features, or Major Depression with psychotic features were recruited from Florence University Hospital.

Results

A total of 207 participants were included, with 163 controls and 44 patients. Descriptive statistics are shown in Table 1. Mediation analysis showed that PLEs frequency acted as a mediator between AS and anxiety only in the control group (Figure 1), not in patients (Figure 2).Table 1.

Descriptive statistics - Mean ± Std. Deviation.

Control Group (N=163)Psychotic Group (N=44)p-value
ASI11.690 ± 6.09814.360 ± 7.1630.014CAPEposF1.391 ± 0.3401.617 ± 0.4880.001CAPEposD1.792 ± 0.6151.941 ± 0.6940.167SCL-90-R-ANX0.678 ± 0.6000.905 ± 0.6430.030

Legend: ASI, Aberrant Salience Inventory; CAPEposF, Community Assessment of Psychic Experiences - positive dimension - Frequency; CAPEposD, Community Assessment of Psychic Experiences - positive dimension - Distress; SCL-90-R-ANX, Symptom Check List-90-revised, Anxiety.

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Conclusions

PLEs triggered by AS led to anxiety in the control group but not in psychotic patients. The discrepancy could be due to reduced novelty and awareness of experiences in the patient group. This may affect how bodily responses to PLEs are perceived and suggests the need for specialized treatment approaches for anxiety in these two groups.

Disclosure of Interest

None Declared
Decision-making competence in patients with depression and a history of suicide attempt: A systematic review
Authors: Pavlou I. , Efstathiou V. , Karvouni A. , Theodoridou I. , Smyrnis N. , Michopoulos I. , Gournellis R. , Papadopoulou A.
Published: August 2024

Introduction

Decision-making is a complex process, and little is known about the various elements that comprise it. Recent literature on neurocognitive deficits in patients with a history of suicidality has highlighted that impaired (non-adaptive) decision-making is one of the most consistent deficits in individuals with a history of suicidality.

Objectives

This study aims to systematically review the available evidence on decision- making capacity in depressed patients with a history of suicide attempts.

Methods

A systematic search was conducted in PubMed, Psycnet, Elsevier and Scopus with additional searching through bibliographic references. This search was performed until the 31st of August 2022 and provided information on decision-making capacity in relation to suicidality and depression.

Results

The literature review provided 377 references, the titles and abstracts of which were reviewed for relevance to this study and the entry criteria set. The review of the title and abstract of these studies resulted in 50 articles that were potentially relevant to the study topic and a further review was then conducted to re-examine the selected studies and articles, which resulted in the final selection of 20 studies. The outcome measure used by the majority of studies as a measure of decision-making ability was the IOWA Gambling Task (IGT), in which the performance of patients with a history of depression and self-harm in most studies was significantly worse than that of healthy controls. Some methodological characteristics of the studies included in this review complicated the interpretation of the results, such as the sample size and characteristics of each study.

Conclusions

Decision-making ability shows alterations in patients with a history of suicidality and depression, confirming the findings of previous studies. Furthermore, an impaired or dysfunctional decision-making ability may potentially be a predictor of suicidal behaviour in patients with depression, a possibility that could be a reason for further research in this field, both in the context of investigating predictors and in developing appropriate treatments for these patients.

Disclosure of Interest

None Declared
Suicide prevention: Precision suicidology is needed
Authors: Courtet P.
Published: August 2024

Suicidal behavior is a public health challenge that resists the various efforts made toward its prevention and treatment. Indeed, suicide rate have not significantly changed in the past decades. Then one may wonder if precision psychiatry could be the solution?

Advances towards precision suicidology will be detailed from detection to oportunities for treatment.

First, current suicide risk assessment methods are unable to detect suicidal risk with sufficient accuracy and while thousand of risk factors for suicide have been identified, they are no more accurate in predicting suicidal behavior than flipping a coin. Second, we are lacking specific and effective evidence based strategies for suicide prevention.

The aim of precision psychiatry is tailoring efficient preventive and therapeutic approaches to the unique characteristics of each patient. It assumes that the determination of a reliable medical diagnosis is unfeasible if based on symptomology alone and it must integrate genomics data, clinical dimensions, biomarkers, and environmental and lifestyle factors and this amount of data analysed by artificial intelligence would give us “biosignatures” that would yield a more appropriate diagnosis, treatment and prognosis.

We will cover advances in genomics, imaging, inflammatory markers and digital health that witness the realistic possibility to change the field of suicide prevention.

Disclosure of Interest

None Declared
The Role of Pet Companionship in Older Adults’ Mental Health: A Qualitative Study during the Covid-19 Pandemic
Authors: von Humboldt S. , Silva S. , Leal I.
Published: August 2024

Introduction

Human functioning in the physical, emotional, psychological, and social arenas is improved by contact with animals.

Objectives

This study aimed to explore the affective relationship of older adults with their pets during the COVID-19 pandemic; and to assess how the affective relationship with pets contributed to older adults’ mental health.

Methods

This qualitative study included 176 participants aged 65-88 years from Portugal, the United Kingdom, and Spain. All interviews went through content analysis.

Results

Findings indicated five themes: (1) Meaningful Emotional Relations (86%); (2) Intimacy with Partners (68%); (3) New Emotional Connections (61%); (4) Sensory Stimulation (55%); and; (5) Physical Enjoyment (23%). As for the second objective, three main themes emerged from the content analysis: (1) Decreasing Depressive and Anxiety Symptoms (73%); (2) Easing Feelings of Loneliness (68%); and (3) Reducing Mood Swings (43%).

Conclusions

The affective relationship between older adults and their pets was relevant during the COVID-19 pandemic, since it allowed for solidifying affection relationships with their partner and creating new ones. Additionally, it contributed for deepening the affective relationship with themselves, in terms of sensory stimulus, physical touch and physical pleasure. Owning a pet, was important for improvement in mental health symptoms, associated to depression, anxiety, and mood swings.

Keywords: Affective relationship; animal companionship; COVID-19 pandemic; mental health; older adults; pets.

Disclosure of Interest

None Declared
Differential attrition in randomized controlled trials of digital mental health interventions in the workplace: A systematic review and meta-analysis (EMPOWER H2020 project)
Authors: de Miquel C. , Haro J. M. , van der Feltz-Cornelis C. M. , Ortiz-Tallo A. , Chen T. , Sinokki M. , Naumanen P. , Olaya B. , A Lima R.
Published: August 2024

Introduction

Digital interventions have been found to be successful in preventing occupational mental health concerns, however, they seem to be affected by attrition bias through high attrition rates and differential attrition. Differential attrition arises when the rates of participant dropouts differ across different treatment conditions and is considered a significant challenge to internal validity.

Objectives

We aimed at systematically review and meta-analyse differential attrition of digital mental health interventions in the workplace setting.

Methods

On January 2, 2022, we performed a search in the following electronic databases: PubMed, Scopus, and Web of Science Core. We utilized a combination of terms from five distinct areas, namely mental health, intervention, workplace, implementation, and study design. The study encompassed adult employees who took part in a randomized control trial aimed at preventing mental health issues in the workplace through an online intervention. A team of six reviewers collaborated on the study selection process, while two independent researchers conducted the data extraction for the selected studies. We performed a meta-analysis of the log-transformed relative attrition rates of the included studies using a random-effects model with limited maximum-likelihood (REML) estimation to account for the degree of heterogeneity.

Results

A total of 19 studies were included in the meta-analysis. For baseline to post-intervention, the average total attrition was 26.27% (SD = 21.16%, range = 0 – 66.3%) and the random effects model revealed a higher attrition rate in the intervention group compared to the control group, with a pooled risk ratio of 1.05 (95% CI: 1.01 - 1.10, p = .014). For baseline to follow-up measurement the average total attrition was 27.71% (SD = 20.80%, range = 0 – 67.78%), however, in this case the random effects model did not indicate a higher attrition in the intervention group when compared to the control group (pooled risk ratio = 1.05, 95% CI: 0.98 – 1.12, p = .183).

Conclusions

There is an indication of higher attrition in the intervention group as compared to the control group in occupational e-mental health interventions from baseline to post-intervention, however this does not seem to be the case for baseline to follow-up attrition. These results should be taken into account in the design process of studies and statistical analyses should be adapted to counteract the bias that could result from differential attrition.

Disclosure of Interest

None Declared