bluuebunny/crossref_metadata_2025 huggingface dataset:
A case report of cognitive behavioural and emotional therapy for depression in an ultra-high risk patient
Authors: Ben Massoued R. , Aissa A. , Larnaout A. , Lansari R. , Ouali U. , Jomli R.
Published: August 2023

Introduction

Psychotic disorders are associated with a degree of disability that is much more considerable if the duration of untreated psychosis is prolonged. This fact highlights the importance of early intervention strategies among individuals at ultra-high risk (UHR) for psychosis, often struggle with depressive symptoms.

Objectives

The objective of this work was to evaluate the effectiveness of cognitive-behavioral and emotional therapy on depressive symptoms in a patient at high risk of psychosis.

Methods

This is a detailed case report of a young adult at UHR for psychosis who was referred to psychiatry department “A” at Razi Hospital for treatment of depression symptoms.

The patient had benefited from 15 sessions of cognitive-behavioral and emotional psychotherapy, over eight months, from July 2021 to February 2022, at the rate of one 45-minute session per two weeks. The main psychotherapeutic techniques used were: behavioral activation, cognitive restructuring and relaxation.

An initial and final assessment was performed by the Hamilton Depression Scale and by the comprehensive assessment of mental states at risk.

Results

The clinical case illustrated concerns a 21-year-old female with a state of high risk of psychosis, suffering from depression symptoms that had been worsen since two years.

As the therapy progressed, an improvement in depressive symptoms and functioning has been noticed, by a decrease in the score of the Hamilton scale, from 28 to 11, with a response estimated at 61% and a score for social functioning and professional, initially estimated between 21 and 30, to became between 41 and 50 after therapy.

The active participation of the patient, and her assiduity were important factors in this success.

Conclusions

Cognitive-behavioral and emotional therapies for depressive symptoms could constitute an effective intervention approach for subjects at high risk of psychosis, allowing the improvement of the prognosis of psychotic disorders.

Disclosure of Interest

None Declared
An update on the Pharmacological and Psychotherapeutic Management of Treatment Resistant OCD
Authors: Van Ameringen M.
Published: August 2023

Although the rates of response to first-line pharmacological treatments (serotonin reuptake inhibitors – SRIs) are generally twice that of placebo, only 40-60% of patients respond sufficiently or are able to tolerate traditional first-line pharmacotherapy. Augmentation with dopamine antagonist medications is associated with the strongest evidence, yet dopamine antagonists benefit only a minority of those who try them and carry elevated risks of adverse effects. Based on evolving pathophysiologic models of OCD, a variety of agents targeting serotonin, dopamine, norepinephrine, glutamate, and anti-inflammatory pathways have been explored as alternative or adjunctive therapies for treatment-resistant OCD and have at least preliminary evidence of efficacy. Similarly, approximately 50% of patients do not respond optimally to first psychotherapeutic treatments including cognitive behavioural therapy (CBT) and exposure and response prevention (ERP), even when combined with pharmacotherapy. The psychotherapy outcome literature is heterogeneous and very few psychological strategies have been developed specifically to treat treatment resistant OCD. However, a recent systematic review concluded that CBT improved treatment response in individuals with pharmacotherapy resistance. This presentation will present an update on the pharmacological and psychotherapeutic treatment of refractory OCD including novel strategies such as the use of psychedelics.

Disclosure of Interest

M. Van Ameringen Grant / Research support from: Elvium, CIHR,Hamilton Academic Health Sciences Organization, Consultant of: Abbvie, Bausch Health, Boehringer Ingelheim, Elvium, Jazz, Vistagen, Speakers bureau of: Abbvie, Elvium (Purdue), Lundbeck, Otsuka, Sunovion, and Takeda
Alternative initiations with 6-monthly paliperidone palmitate. A retrospective study
Authors: Benavente López S. , Bolaño Mendoza S. , Parra González A. , Lara Fernández A. , Herencias Nevado A. , Baca García E.
Published: August 2023

Introduction

6-monthly paliperidone palmitate features an initiation regimen through 1-monthly paliperidone palmitate or 3-monthly paliperidone palmitate. Some patients do not have sufficient adherence to treatment and it is necessary at the clinical level to start directly with 6-monthly paliperidone palmitate. There is little clinical experience with these alternative initiations and through this work those that have been carried out for 12 months at the Hospital Universitario Infanta Elena are exposed.

Objectives

The main objective of the study is to describe the alternative initiations performed with 6-monthly paliperidone palmitate in routine clinical practice, having opted for a regimen different from the standard for clinical reasons.

Methods

A retrospective selection of patients will be made through non-probabilistic consecutive sampling, including all patients who have been administered 6-monthly paliperidone palmitate with a start different from the standard during the last 4 months. To do this, the electronic medical record will be used, first selecting the patients who have started 6-monthly paliperidone palmitate through the anonymized digital records and, later, including in the study only those who have followed an alternative initiation pattern. The variables studied will be the following: age, sex, diagnosis, dose of paliperidone palmitate, initiation regimen, consumption of toxic substances, absenteeism from 6-monthly paliperidone palmitate, and visits to the emergency room and admissions.

Results

The study included a total of 20 patients (n: 20). 80% of the patients were male and 20% were female. The mean age was 39.7 years. 75% of the patients had an associated substance use disorder. The following alternate starting schedules were performed with biannual paliperidone palmitate: monthly paliperidone palmitate on days 1 and 8, and 6-monthly paliperidone palmitate on day 38 (n: 11); monthly paliperidone palmitate 150 mg together with semi-annual paliperidone palmitate both on day 1 (n: 5); biannual paliperidone palmitate on day 1 supplemented with oral paliperidone for 45 days (n:4). A total of 0 visits to the emergency department and 0 admissions were observed after the 6-monthly paliperidone palmitate regimen.

Conclusions

Alternative initiations with 6-monthly paliperidone palmitate may be a useful and safe clinical alternative in patients with very low adherence who, due to clinical needs, require starting 6-monthly paliperidone palmitate earlier in order to guarantee adherence.

Disclosure of Interest

None Declared
More bipolar than bipolar disorder – a polygenic risk score analysis of postpartum psychosis
Authors: Hörbeck E. A. , Jonsson L. , Pålsson E. , Landén M.
Published: August 2023

Introduction

Postpartum psychosis is a rare psychiatric emergency, occurring days to weeks after 1-2 per 1000 deliveries. Its low prevalence makes it difficult to recruit enough participants to investigate the underlying pathophysiology. It is epidemiologically linked to bipolar disorder, which one study also found it to resemble in genetic susceptibility for psychiatric disorders (Di Florio et al. Lancet Psych 2021; 8: 1045–52).

Objectives

In this study we aim to investigate polygenic liability for psychiatric disorders in two new Swedish postpartum psychosis cohorts.

Methods

Cases with postpartum psychosis, defined as a psychiatric hospitalization within 6 weeks after delivery, and/or receiving a diagnosis of F53.1 (ICD 10) or 294.40 (ICD 8.), parous women with severe mental illness without postpartum psychosis, and healthy parous controls were identified in two Swedish genetic studies: the Swedish bipolar collection (SWEBIC) and Predictors for ECT (PREFECT). Polygenic risk scores (PRS) were calculated from summary statistics from genome wide studies on bipolar disorder (Mullins et al. Nat Genet 2021; 53 817-829), schizophrenia (Trubetskoy et al. Nature 2022; 604 502-508) and major depression (Wray et al. Nat Genet. 2018; 50 668-681). The p-value thresholds best predicting their respective phenotype were used in logistic regression analyses with the first six principal components and genotyping platform as confounders.

Results

We identified 176 patients with postpartum psychosis and genetic information (N(SWEBIC)=126, N(PREFECT)=50). Compared with healthy parous women, patients with postpartum psychosis had significantly higher PRS for bipolar disorder (SWEBIC: odds ratio [OR] 2.6 (95% confidence interval [CI] 1.9-3.5), PREFECT: OR 2.4 (95% CI 1.8-3.2), Figure 1.) and schizophrenia (SWEBIC: OR 1.6 (95% CI 1.2-2.2), PREFECT: OR 1.8 (95%; CI 1.3-2.5)). Patients with postpartum psychosis had significantly higher PRS for bipolar disorder (SWEBIC: OR 1.4 (95% CI 1.2-1.8), PREFECT: OR 1.5 (95% CI 1.1-2)) compared with parous women with severe mental illness without postpartum psychosis. We found no associations with major depression PRS in either cohort.

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Conclusions

We replicated previous findings of significantly higher PRS for bipolar disorder and schizophrenia in postpartum psychosis compared with healthy controls. In contrast to previous research, we find postpartum psychosis cases to have higher PRS for bipolar disorder than bipolar disorder cases. Our findings highlight the genetic influence in postpartum psychosis and support previous genetic and epidemiological evidence that postpartum psychosis lies on the bipolar spectrum.

Disclosure of Interest

None Declared
Stress and self-esteem in young high school students
Authors: Chiha K. , Ben Touhemi D. , Chaabane M. , Boudabous J. , Kammoun W. , HadjKacem I. , Ayadi H. , Khemakhem K. , Moalla Y.
Published: August 2023

Introduction

The course of adolescence is marked by feelings of insecurity, vulnerability and can be accompanied by the emergence of several mental health problems.

Having a good self-esteem brings many benefits such as security, well-being and a strong sense of confidence. Low self-esteem is often accompanied by psychological distress such as stress.

Objectives

To assess the level of stress and self-esteem in young high school students and to identify the risk factors associated with low self-esteem in these adolescents.

Methods

This was a cross-sectional, descriptive and analytical study conducted among a sample of adolescents randomly collected in 6 schools in the region of Sfax-Tunisia, during the month of February 2022. The level of stress was assessed using the Lovibond Depression Anxiety Stress Scale (DASS-21) and self-esteem by the Rosenberg Self-Esteem Scale, both scales are validated in Arabic.

Results

We collected 396 adolescents. The mean age was 16.65+/-0.897 years and the sex ratio was 0.82.

Of these adolescents, 102 had stress symptoms according to the DASS-21 scale, i.e. 26% of the sample. Stress was severe to extremely severe in 37.2% of cases.

Low to very low self-esteem was found in 65.7% of cases compared to 14.7% with high self-esteem.

In addition to the association with high levels of stress in these adolescents (p=0.002), low self-esteem was associated with other psycho-social factors such as intra-family relationship problems (p=0.014), a history of repeating a year (p=0.026), low to average school performance (p=0.027) and behavioural problems in the school environment (p=0.032).

Conclusions

These results suggest that the association of stress with certain psycho-social factors helps the deterioration of self-esteem in adolescents and vice versa.

Having high self-esteem may protect the individual from psychological vulnerabilities such as stress and help him/her to cope with them.

Disclosure of Interest

None Declared
Efficacy and safety of deep brain stimulation in OCD
Authors: Menchon J. M.
Published: August 2023

Deep brain stimulation has become a last resource procedure for severe, chronic and refractory OCD. However, the procedure is highly invasive and its efficacy must be balanced against the risks it may entail. In addition, there are a number of procedure-related issues that may influence the efficacy of DBS, such as the target of stimulation, the stimulation parameters to be selected, the presence of comorbidities as exclusion criteria, or the efficacy in different OCD subtypes, among others. A comprehensive review of the knowledge and experience of DBS in OCD may be useful in helping to select appropriate candidates.

Disclosure of Interest

None Declared
Telepsychiatry: the use of technology to improve access to mental health care
Authors: Palazzo M. , Conti D. , Galbassini A. , Prodi T. G. , Cerioli M. , Bernardo D.
Published: August 2023

Introduction

Telepsychiatry (TP) uses communication technology to provide psychiatric consultation to patients unable to reach consultation services. Due to COVID-19 outbreak, many mental health services implemented TP. The University of Milan developed a patient-specialist video consultation service: the Cure Ospedaliere Domiciliari (Home Hospital Care system; COD20).

Objectives

The aim of the study was to assess the digital skills of the mental health professionals and to assess both the confidence and the satisfaction with the COD20 platform, as well as their skills in handling certain degrees of technostress.

Methods

Mental health professionals of the outpatient clinics of the department were interviewed through an online anonymous survey. Data collected were sociodemographic, job position, educational level, digital skills, adequacy of devices in the workplace, satisfaction degree, ease of use of the COD20 tool, as well as main technostress score. Data were analyzed using SPSS v.27.

Results

Among 95 subjects, more than 95% of the sample is familiar with the use of electronic devices, such as smartphones, tablets, and computers; 93% employs appropriate devices in the workplace. Only 12% had an ECDL certificate, while the majority of the sample (77%) learnt the use of electronic devices independently. The levels of the digital skills were considered intermediate-advanced for communication and information research. Despite all the respondents being aware of the use of COD20, only 50% received adequate training; 77% deemed it worthwhile to attend an individual or a group training (40% vs 43%). Telemedicine was used for clinical interviews by 80% of the sample: 41% of these used Telemedicine at least 10 times/year, 18% between 10 and 20 times/year, and 42% more than 20 times/year. With regard to the appreciation of the COD20 platform, 75% of the sample considered this tool useful, while 61% considered it easy to use. There is a significant correlation between the ease of use and a higher level of education (p<0,00). Among all categories, psychologists were more likely to use the platform compared to other workers ( p=0,016). The average score of technostress among operators was 22.78±6.84 (maximum score: 45).

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Conclusions

TP can improve mental health professionals’ working conditions. The COD20 platform represents a valid implementation in mental health care. It is necessary to provide training and updated programs for healthcare workers in order to facilitate the use of TP tools.

Disclosure of Interest

None Declared
Gender gap in nonmedical use of anxiolytics among high school adolescents: Tunisia, 2021
Authors: Rejaibi S. , Silini A. , Zid M. , Mallekh R. , Ben Slema I. , Zoghlami N. , Zribi M. , Ben Youssef S. , Ben Salah N. , Aounallah-Skhiri H.
Published: August 2023

Introduction

Non-Medical Use of Anxiolytics (NMUA) and sedatives is a focus of scientific interest worldwide. In Tunisia, no national epidemiological data related to this issue, are published.

Objectives

We aimed to determine the prevalence of NMUA in Tunisian adolescents and assess specificities from a gender scope.

Methods

Data from the 2021-Mediterranean school Survey on Alcohol and other Drugs (MedSPAD) were used. Based on random sampling method (three-stage stratification), high school teenagers in first and second year of secondary education, were enrolled. Data were collected using a self-administered standardized questionnaire assessing socio-demographic characteristics, and specific questions related to NMUA (among adolescents and close environment), perceived accessibility and initiation age. We studied weighted prevalence estimates of NMUA at least once in a lifetime, presented with 95% Confidence Interval (CI). Epi data software was used for data entry and statistical analysis was performed with STATA software.

Results

The survey included 6.201 adolescents with a mean age of 16.8 years and sex ratio F/M equal to 1.5. Only half of surveyed adolescents, perceived accessibility to NMUA as “impossible” and almost 20% had at least one family member or friend using a nonmedical prescription of anxiolytics. The overall prevalence of NMUA was (8.4%; 95% CI [7.6-9.2]), significantly higher among girls (9.8% Vs 6.1%, p-value<10-4). Initiation age was over 13 years for almost 70% of consumers.

Conclusions

Our study highlighted high prevalence of NMUA, mainly among girls. Although COVID mental health impact might have a role in explaining our findings; however, decisions makers should be aware of non-medically prescribed anxiolytics accessibility especially among this vulnerable population. Audit prescription monitoring programs should be reinforced, and multisectoral collaboration should be reinforced to promote adolescents mental well being and avoid falling into addiction trap.

Disclosure of Interest

None Declared
Associations between placental DNA methylation and emotional and behavioral outcomes in preschoolers: insights from the EDEN Mother-Child Cohort study
Authors: Nakamura A. , Broseus L. , Tost J. , Vaiman D. , Martins S. , Keyes K. , Bonello K. , Fekom M. , Strandberg-Larsen K. , Sutter-Dallay A.-L. , Melchior M. , Heude B. , Lepeule J.
Published: August 2023

Introduction

Behavioral (externalizing) and emotional (internalizing) problems were showed to be associated with the prenatal environment. Changes in placental DNA methylation was identified as a relevant potential mechanism of such association.

Objectives

We aimed to explore the associations between placental DNA methylation and child behavior in order to explore pathways that could link prenatal exposures to child behavior.

Methods

Data including 441 children of 3 years of age from the EDEN mother-child cohort. Child behavior assessed using the Strengths and Difficulties Questionnaire (SDQ). Both hypotheses-driven and exploratory analyses (including epigenome-wide association studies (EWAS) and differentially methylated regions (DMR) analyses) were conducted. The analyses were adjusted for confounding and technical factors and estimated placental cell composition. All the p-values were corrected using a false discovery rate (FDR) procedure for multiple tests.

Results

In the hypothesis-driven analysis, cg26703534 (AHRR), was significantly associated with emotional problems (pFDR = 0.03). In the exploratory analyses, cg09126090 (pFDR = 0.04) and cg10305789 (PPP1R16B; pFDR < 0.01) were significantly associated with peer-relationship problems and 33 DMRs were significantly associated with at least one of the SDQ subscales. Placental DNA methylation showed more associations with internalizing than externalizing symptoms, especially among girls. DMRs tented to include highly methylated CpGs.

Conclusions

This study investigated for the first time the associations between placental DNA methylation and internalizing and externalizing symptoms in preschoolers. Further analyses, such as consortium meta-analyses would be necessary to confirm and extend our results.

Disclosure of Interest

None Declared
Criminal behaviors and substance abuse in psychiatric patients
Authors: Benatti B. , Achilli F. , Leo S. , Molteni L. , Piccoli E. , Gobbo D. , Dell’Osso B. M.
Published: August 2023

Introduction

People with mental illness are overrepresented throughout the criminal justice system. In Italy, an ongoing process of deinstitutionalization has been enacted: the Judicial Psychiatric Hospitals are now on the edge of their closure in favor of small-scale therapeutic facilities (Residenze per l’Esecuzione delle Misure di Sicurezza - REMS). Law 81/2014 prescribes that a patient cannot stay in a REMS for a period longer than a prison sentence for the same index offense. Therefore, when patients end their duty for criminal behaviors, their clinical management moves back to outpatient psychiatric centers. Elevated risks of violent behavior are not equally shared across the spectrum of psychiatric disorders. In the past several years, multiple studies in the field of forensic psychiatry confirmed a close relationship between violent offenders and comorbid substance abuse.

Objectives

In order to broaden the research in this area, we analyzed sociodemographic, clinical and forensic variables of a group of psychiatric patients with a history of criminal behaviors, attending an outpatient psychiatric service in Milan, with a focus on substance abuse.

Methods

This is a cross-sectional single center study, conducted in 2020. Seventy-six subjects with a history of criminal behaviors aged 18 years or more and attending an outpatient psychiatric service were included. Demographic and clinical variables collected during clinical interviews with patients were retrospectively retrieved from patients’ medical records. Appropriate statistical analyses for categorical and continuous variables were conducted.

Results

Data were available for 76 patients, 51,3% of them had lifetime substance abuse. Lifetime substance abuse was significantly more common in patients with long-acting injectable antipsychotics therapy, >3 psychiatric hospitalizations, history of previous crimes and economic crime (Table 1). Additionally, this last potential correlation was confirmed by logistic regression.Table 1.Lifetime substance abusers (N=39)Non-lifetime substance abusers (N=37)Proportion DifferenceP-valueN%N%Depot administrationYes11(28,9%)0(0%)28,9%0,02HospitalizationsFour or more25(64,1%)5(33,3%)30,8%0,04Economic crimeYes15(40,5%)1(6,7%)33,8%0,02Previous crimesYes17(51,4%)2(13,3%)38,1%0,02

Conclusions

Data emerging from this survey provide new information about offenders in an Italian mental health service with a focus on lifetime substance abuse in these patients. Our preliminary results should be confirmed in larger sample sizes.

Disclosure of Interest

None Declared
One year snapshot: antipsychotic use in institute of forensic psychiatry of kosovo
Authors: Halilaj G. , Gjocaj M. , Dakaj N. , Drevinja F. , Rakaj S. , Fanaj N.
Published: August 2023

Introduction

The use of antipsychotics in the treatment of the mentally ill represents a complex modality, especially in specialized institutions such as the Institute of Forensic Psychiatry of Kosovo. Current best practices are summarized in clinical guidelines, which nevertheless recognize the importance of individualizing treatment. In literature there is the scarcity of knowledge on the effectiveness of pharmacological treatment within a forensic psychiatric population.

Objectives

To understand the features of the use of antipsychotics in IPFK as a prerequisite for increasing the quality and adequate treatment in psychiatric institutions in Kosovo.

Methods

It is a retrospective study. The files of 100 patients admitted to IPFK for evaluation and treatment in 2021 were analysed. The age ranged from 18 to 71 years (Mage=36.33; SD=12.66). General demographic data, types of antipsychotics, their doses, their combinations were looked at. Data analysis was processed with SPSS 26 and Microsoft Excel 2016.

Results

43% of patients were not prescribed any antipsychotic drugs. 38% used one antipsychotic, 16% used 2 antipsychotics at the same time and 3% used three types of antipsychotics. 12% of patients used four types of psychotropic drugs (antipsychotic, anxiolytic and mood stabilizer), 12% were on three types of psychotropic drugs, 42% did not use any type of medication. No side effects were noted. Only one case of refusal of therapy was recorded. The doses of the drugs used are within the recommended therapeutic limits. Most of the antipsychotics used were of the second generation. In 44% of cases they received Risperidone, in 17% of cases Haloperidol, in 14% of cases Olanzapine, in 5% of cases Clozapine and in only 1% Aripiprazole.

Conclusions

Antipsychotic medication is the main method of treatment in IPFK, based on the specifics of the cases. The impression of overuse of several antipsychotics at the same time requires deeper professional consideration in order to avoid chemical restraint as a management method.

Disclosure of Interest

None Declared
Burnout among physicians: Prevalence and predictors of depersonalization, emotional exhaustion and professional unfulfillment among resident doctors in Canada
Authors: Shalaby R. , Oluwasina F. , El Gindi H. , Eboreime E. , Nwachukwu I. , Hrabok M. , Agyapong B. , Abba-Aji A. , Agyapong V.
Published: August 2023

Introduction

Burnout in the medical profession has garnered a lot of attention over the recent years. While it is reported across all specialties and all stages of medical education; resident physicians in particular are at high risk for burnout throughout their years of training.

Objectives

This study aimed at evaluating the prevalence and correlates of burnout among resident physicians in Alberta.

Methods

Through a descriptive cross-sectional study design, a self-administered questionnaire was used to gather data from resident physicians at two medical schools in Alberta, Canada. Maslach Burnout Inventory was used as an assessment tool. Chi-squared and multivariate binary logistic regression analyses were used.

Results

Overall burnout prevalence among residents was 58.2%. Working more than 80 hours/week (OR= 16.437; 95% CI: 2.059 – 131.225), being dissatisfied (OR= 22.28; 95% CI: 1.75– 283.278) or being neither satisfied nor dissatisfied with a career in medicine [(OR= 23.81; 95% CI: 4.89 – 115.86) were significantly associated with high depersonalization. Dissatisfaction with efficiency and resources (OR= 10.83; CI: 1.66- 70.32) or being neither satisfied nor dissatisfied with a career in medicine (OR= 5.14; CI: 1.33- 19.94)] were significantly associated with high emotional exhaustion. Working more than 80 hours/week (OR= 5.36; CI: 1.08- 26.42) and feeling that the residency program is somewhat having enough strategies aimed at resident well-being in place (OR= 3.70; CI: 1.10- 12.46) were significantly associated with high work exhaustion and interpersonal disengagement. Young age of the residents (≤ 30 years) (OR= 0.044; CI: 0.004- 0.445) was significantly associated with low professional fulfillment.

Conclusions

Burnout is a serious occupational phenomenon that can degenerate to other conditions or disrupts one’s professional performance. Significant correlates were associated with high rates of burnout. Leaders of medical schools and policy makers need to acknowledge, design, and implement various strategies capable of providing continuous effective mental health support to improve the psychological health of the medical resident across Canada.

Disclosure of Interest

None Declared
Quality in Psychiatric Care in a global perspective
Authors: Schröder A. , Lundqvist L.-O.
Published: August 2023

Introduction

Worldwide efforts to standardize instruments measuring quality in psychiatric care are rare. The international project “Quality in Psychiatric Care” (QPC) is a large research programme aiming at adapting the versions of the QPC instrument for patients and staff to different international settings.

Objectives

The aims were to test the psychometric properties and equivalence of dimensionality of the different language versions of QPC and also to describe and compare the quality of psychiatric out-patient, in-patient, forensic in-patient and psychiatric care across different countries.

Methods

The QPC is a family of instruments based on a definition of quality of psychiatric care from the patients perspective with adapted versions for staff. In this project, we used different language versions in three areas for patient and staff: psychiatric out-patient (QPC-OP/OPS), in-patient (QPC-IP/IPS), and forensic in-patient (QPC-FIP/FIPS).

Results

Patients in out-patient psychiatric care in Brazil rated the quality of care higher than Swedish patients. Comparisons of forensic in-patient care (QPC-FIP/FIPS) patients were more critical of the care they received while staff were generally more positive on the quality of care provided in both Denmark and Sweden. Quality of in-patient care (QPC-IP/IPS) in Spain show staff rating lower quality of care than patients and lowest in the secure environment, which the Swedish staff rated low as well. In Indonesia the patients rated lower quality than staff and lowest in the discharge dimension, followed by the participation dimension. Generally, staff and patients were similar in their perceptions of the low quality of participation. Several studies in Turkey, Indonesia, Spain, Faroe Islands and Norway is ongoing.

Conclusions

The psychometric test and validations of the instrument QPC in different language and country versions will assist countries to compare quality of care, quality improvement and permits benchmarking. Since there are few standardized instruments for measuring quality of care in the psychiatric care, the QPC is expected to make an important contribution to the development in the field.

Disclosure of Interest

None Declared
Relationship between self-esteem, self-efficacy and academic procrastination among medical students
Authors: Turki M. , Sahnoun F. , Guermazi A. , Elleuch O. , Bennaceur F. , Halouani N. , Ellouze S. , Aloulou J.
Published: August 2023

Introduction

Recent studies proved that academic procrastination is a very common pervasive problem that has a negative impact on general well-being, causing distress, anxiety, remorse and unhappiness. It could also result in poor academic performance and negatively affect students’ satisfaction with themselves and their academic life.

Objectives

The aim of this study was to explore the influence of self-esteem and self-efficacy on academic procrastination among Tunisian medical students.

Methods

We conducted a cross-sectional, descriptive and analytical study among medical students from Tunisia. Data were collected through an anonymous online questionnaire, exploring sociodemographic characteristics, the “Tuckman Procrastination Scale” (TPS), the “Rosenberg’s self-esteem scale” (RSES) and the “General Self-Efficacy Short Scale” (GSESS).

Results

A total of 133 participants completed the questionnaire. Their mean age was 26 ± 3,8 years, with a sex-ratio (F/M) of 4,5. Among them 87.2% were engaged in academic procrastination, 57,1% showed low self-esteem and 55,6% perceived themselves as non-effective.

GSESS score were higher among males (p=0.019)

TPS score was negatively correlated with RSES score (p<0.001; r=-0.372). RSES score was positively correlated with GSESS score (p<0.001; r=0.44).

No relationship was proved between TPS and GSESS.

Conclusions

Even though procrastination is most of the time considered as a maladaptive and detrimental behavior with a psychological cost, some authors consider it acting in a beneficial way, as it reflects self-reliance, autonomy and self-confidence knowing that they are able to finish their task in time. As a result, procrastination is linked to feelings of superiority and it should be recoined as “purposeful delay”.

Disclosure of Interest

None Declared
High number of refugees in Italy - which strategy works in Italy?
Authors: Galderisi S.
Published: August 2023

A negative impact on mental health of Ukrainian people who will survive the war is very likely.

Those who leave are exposed to the trauma of leaving behind home, relatives, friends, job, habits, i.e., most of what they had built in their life, and to the unpleasant feeling of knowing nothing of what they will go through.

Mutual support and nurture problem-solving strategies, including favoring family reunion, restoring people dignity and control over the environment, help children recover a more positive social reality, are major protective factors in buffering the impact of war, displacement and related trauma.

By November 2022, Italy had hosted more than 170.000 Ukrainian refugees. The National Service intervention, coordinated by the Civil Protection Department, has developed a Plan for the reception and assistance of the population from Ukraine to uniform the response to the emergency on the national territory. The plan has focused on two aspects: humanitarian assistance and reception. The network for reception is composed of the CAS - Extraordinary Reception Centers and the SAI - Integration Reception System. The Plan also provides measures related to health care and education to ensure mandatory vaccination requirements and the access to the school system for unaccompanied foreign minors. As to plans aimed to address mental health issues, the right to care is guaranteed, but several issues can be identified that limit the impact of the national policies on the needs of this population.

Disclosure of Interest

None Declared
Differences In Antipsychotic Prescriptions In Relationship To Physician Demographics And In-patient Setting At An Inner-city hospital – A Prospective Cohort Study
Authors: Ghatoura R. S. , Bhela J. , Trevino C.
Published: August 2023

Introduction

Antipsychotics are medications with an array of FDA approved indications in the field of psychiatry including Schizophrenia, Bipolar Mania, Bipolar Depression, Maintenance treatment for Bipolar Disorder, Schizoaffective Disorder, as well as an Adjunct treatment in Unipolar Depression and Tic disorders, among other indications for non-adult patients. Antipsychotics are widely used in psychiatric inpatient units throughout the United States, and globally. We observed trends of antipsychotic use in 3 different adult inpatient units with the same patient demographics located within one inner city hospital in the Bronx over a period of 4 months. We correlated the choice of antipsychotic to the prescribing physician’s period of training/date of graduation from psychiatry residency and reported the results.

Objectives

Identify the choice of antipsychotics used by different psychiatrists.

Correlate the dates of each psychiatrists residency training to the antipsychotics they chose.

Identify whether the psychiatry residency training accuried in different decades has influenced psychiatrics to pick certain antipsychotics.

Methods

We obtained the dates of psychiatric residency training for each of 3 psychiatrists (Physicians 1, 2 and 3) assigned to one of 3 different inpatient psychiatric units which share the same patient demographics in an inner-city hospital in the Bronx. We obtained a record of total psychiatric inpatient hospitalizations from February 10th 2022 to June 10th 2022 in all 3 psychiatric inpatient units. The principal diagnoses for the total hospitalizations (300 patients) were reviewed and patients with diagnoses that do not have FDA approval for antipsychotic use were excluded. Among the remaining patients (267) we compared antipsychotic prescription trends and grouped patients according to antipsychotic of choice. We then correlated the antipsychotic of choice groups to one of three units/prescribing physician and the years of psychiatry residency training. The trends for antipsychotic of choice were compared to training dates and presented in a table.

Results

Physician 1 who trained from 1980 to 1984 prescribed: 87% HALDOL and 13 % Chlorpromazine. Physician 2 who trained from 1992 to 1996 prescribed: 91 % PALIPERIDONE and 9% Risperidone. Physician 3 who trained from 2003 to 2007 prescribed: 60 % ABILIFY and 40% Olanzapine.

Conclusions

The physician with the earliest graduation date used mainly HALDOL, a first-generation antipsychotic, to treat disorders with FDA approval for antipsychotic use. The physician with the most recent graduation date, used mainly ARIPIPRAZOLE, a third-generation antipsychotic, to treat disorder with FDA approval for their use. The physician with a graduation date between them, used mainly (PALIPERIDONE), a second-generation antipsychotic to treat the disorders.

Disclosure of Interest

None Declared
Next-generation antipsychotics- Trends and perspectives beyond dopaminergic and glutamatergic agents
Authors: Vasiliu O. , Mangalagiu A. G. , Petrescu B. M. , Candea C. A. , Tudor C. , Ungureanu D. , Miclos M. , Florescu C. , Draghici A. I. , Bratu-Bizic R. E. , Dobre M. , Fainarea A. F. , Patrascu M. C.
Published: August 2023

Introduction

Three generations of antipsychotics, all of which are based on the dopaminergic hypothesis of schizophrenia, are available for clinical use. Still, more than 66% of the patients diagnosed with schizophrenia spectrum disorders (SSD) could not achieve remission. Also, the glutamatergic hypothesis of schizophrenia is supported by translational models of this disease, even if the antipsychotics derived from this conceptual framework are not yet available on the market. However, the need for new pathogenesis models for schizophrenia and new generations of antipsychotics is acute, therefore, an exploration of the antipsychotics in the pipeline could be helpful in understanding the current stage of research in schizophrenia.

Objectives

To assess the evidence supporting the potential benefits of new antipsychotics in the pipeline.

Methods

A literature review was performed through the main electronic databases PubMed, Cochrane, Clarivate/Web Of Science, and EMBASE) and clinical trials repositories (US National Library of Medicine and World Health Organization Clinical Trials Registry Platform) using the search paradigm “antipsychotics” AND “schizophrenia” AND “non-dopaminergic” AND “non-glutamatergic”. All papers published between January 2010 and September 2022 were included.

Results

Xanomeline/trospium (xanomeline is a muscarinic M1/M4 receptor agonist at the central nervous system, while trospium limits its peripheral effects) was efficient for schizophrenia in one phase III clinical trial. Pimavanserin (a selective 5HT2A inverse agonist and antagonist) was efficient in improving negative symptoms of schizophrenia in a phase II trial. Roluperidone (a 5HT2A and σ2 receptor antagonist) has been associated with favorable results in phase III clinical trials, mainly on negative symptoms of schizophrenia. SEP-363856 is a TAAR-1 agonist and 5HT1A agonist, currently explored in phase III clinical trials for schizophrenia. MK-8189 is a phosphodiesterase 10A inhibitor, investigated in phase III clinical trials for schizophrenia.

Conclusions

Based on the retrieved data in the literature, multiple mechanisms, other than glutamatergic and dopaminergic pathways, are currently being investigated, and many of the antipsychotics based on these mechanisms are in the advanced stage of research. This is important not only for the clinical need to find more efficient and tolerable drugs for patients with schizophrenia but also because they may shed new light on the pathogenesis of this disease.

Disclosure of Interest

None Declared
Defining the therapeutic reference range for cariprazine
Authors: Kapás M. , Horváth A. , Djuric D. , Csehi R. , Barabássy Á.
Published: August 2023

Introduction

According to the Consensus Guideline, the “therapeutic reference range” (TRR) defines ranges of drug blood concentrations that specify a lower limit below which a drug-induced therapeutic response is unlikely to occur and an upper limit above which tolerability decreases or the therapeutic improvement ceases. The TRR can be obtained from concentration measurements (trough (pre-dose) plasma concentration under steady-state conditions) in studies at therapeutically effective doses.

Objectives

The aim is to examine the TRR for cariprazine (CAR: 1.5 mg/day to 6 mg/day) in schizophrenia studies.

Methods

The population based TRR for CAR is derived by PK/PD evaluation from phase 2/3 schizophrenia efficacy studies with sparse PK sampling. The population PK simulated TRR is compared to the actually measured values obtained from two PK studies. As the two active metabolites of cariprazine also contribute to the drug effect, plasma exposure is given for Total cariprazine (CAR + DCAR + DDCAR) and the parent drug (CAR).

Results

PK/PD analyses demonstrated an increase in efficacy with increasing exposure. These efficacy results are related to Total cariprazine trough concentrations of ca. 30 nM and 100 nM that determine the lower and upper TRR limits. For the parent drug, the pre-dose mean plasma concentration at 6 mg/day was between 5.7-10 ng/mL in different studies, while at 1.5 mg/day it was 1.9 ng/mL.

Conclusions

The TRR of the trough plasma levels at steady state is ca. 30 – 100 nM for Total cariprazine and ca. 2-10 ng/mL for the parent drug (unchanged drug) for schizophrenia treatment.

Disclosure of Interest

M. Kapás Employee of: Gedeon Richter Plc., A. Horváth Employee of: Gedeon Richter Plc., D. Djuric Employee of: Gedeon Richter Plc., R. Csehi Employee of: Gedeon Richter Plc., Á. Barabássy Employee of: Gedeon Richter Plc.
Suicide and Violence against Women in Azerbaijan: Risk Factors and Barriers for Seeking Mental Healthcare
Authors: Alonzo D. , Zubaroglu P.
Published: August 2023

Introduction

Azerbaijan ranks among the top 3 countries with the highest rates of suicide in the Muslim world. Yet, research indicates an underestimate of risk due to cultural stigma related to suicidal behavior that may influence reporting and given that many Muslim-majority countries, where populations exceed 100 million, do not report any data on suicide rates. Violence against women also occurs at alarming rates in Azerbaijan and is a significant risk factor for suicide.

Objectives

We examine perspectives towards suicide and violence against women and barriers to care among key stakeholders.

Methods

Thirty qualitative interviews and 4 semi-structured focus groups were held with female survivors of suicide and mental health professionals working with individuals at risk of suicide to assess for perspectives on suicide and violence against women, factors influencing help-seeking, and the nature of existing resources.

Results

Most participants viewed suicide (83%) and violence against women (73%) as problems. Nevertheless, 33% reported negative stereotypes regarding suicide and 50% reported psychological treatment as unaccepted in Azerbaijan. Findings highlight that domestic violence is the strongly identified as risk factor for suicide among women in Azerbaijan. Stigma and related cultural values regarding gender norms are significant contributors to violence against women and suicide. Existing services are underrecognized and perceived of as unavailable or insufficient.

Conclusions

Employing a social determinants of health lens, multi-level programming is needed that spans micro (individual level supports), mezzo (family level supports), and macro (advocacy and outreach) levels to support a comprehensive strategy that beings with prevention and extends to address intervention, management, and capacity building to halt the increasing rates of suicide and deter violence against women.

Disclosure of Interest

None Declared
Prevalence of comorbid pathological gambling in substance use disorders
Authors: Cargonja P. , Jonovska S. , Šendula Jengić V. , Sugnet T.
Published: August 2023

Introduction

Since gambling opportunities expanded over the last four decades, gambling, including pathological and problem gambling, has received increased attention from clinicians and researchers worldwide.

Objectives

Prevalence of gambling disorders varies according to the screening instruments, measurement used as well as accessibility of gambling opportunities but it is believed that gambling disorders affect 0.2–5.3% of adults worldwide. In addition, considering that the gambling disorders are highly comorbid with other substance use and mental health disorders, for both the causes and treatment implications of this disorder a further understanding is needed.

Methods

This research has been conducted at the Addiction and Psychotrauma Department of the Insula County Hospital over a period of two months on a sample of 150 people using a questionnaire that was distributed to patients whose primary diagnosis was substance use disorder but did not have a diagnosed gambling addiction with the aim of early detection of it.

Results

Substance abuse may include minimizing one’s use, hiding other comorbid addictions including gambling, and an underestimation of the effect one’s use has on life areas as well as family members.

Conclusions

This article highlights the prevalence of comorbid unrecognised pathological gambling in substance use disorders, but also reviews definition, clinical similarities and differences and treatment approaches.

Disclosure of Interest

None Declared
Mixed States and Suicidality in Bipolar Disorder: Results from the Stanley Foundation Bipolar Treatment Network
Authors: Macellaro M. , Cafaro R. , Dell’Osso B. , Suppes T.
Published: August 2023

Introduction

Mixed states in bipolar disorder (BD) are characterized by the simultaneous occurrence of both manic and depressive features. Growing evidence suggests that they are associated with longer duration of illness, increased relapse risk, and higher prevalence of comorbidities. Suicide risk among BD patients is up to 20–30 times greater than in the general population, although there is not a univocal consensus in whether mixed states should be considered as a high-risk state for suicide.

Objectives

The objective of this study was to identify whether depressive and hypo/manic episodes with mixed features, are associated with more frequent suicidal behavior or ideation when compared to pure hypo/manic and depressive ones. We hypothesized that suicidal ideation or behavior would be more common in those experiencing mixed symptoms. We subsequently also tested whether gender or bipolar subtype moderated the relation between mood and suicidality.

Methods

In a naturalistic study, 903 adult BD outpatients participating in the Stanley Foundation Bipolar Network were followed longitudinally across 14,213 visits for 7 years. The scores at the Inventory of Depressive Symptomatology–Clinician-Rated Version (IDS-C) and at the Young Mania Rating Scale (YMRS), administered at each visit, were used to define the mood episode. Given partial overlap of items between these scales, analyses were also conducted by removing overlapping items. The presence of suicidality was evaluated through the 18th item of the IDS-C (Suicidal Ideation).

Results

During the observation period, up to 60.7% of subjects had at least one visit with suicidal ideation or behavior, broadly defined as a score ≥ 1 at the 18th item of the IDS-C. The distribution of suicidality among visits in different mood states is reported in Figure 1 (N° of visits in which suicidality was detected by mood state at the time of visit). Depressive symptoms were associated with suicidal ideation and behavior either during mixed depression and hypo/mania (p < 0.0001). Hypomanic or manic symptoms appeared to be related to suicidality only during hypo/mania, either pure or mixed (p 0.007). When overlapping items between the two psychometric scales were removed results seemed to confirm these hypotheses. Moreover, male gender appeared to have a protective role against suicidal ideation when hypo/manic (p 0.002).

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Conclusions

The primary role of depressive symptoms in predicting suicidal risk was confirmed by our results, which however suggest that mixed symptoms relate to suicidal ideation and behavior more intensely than pure hypo/manic symptoms. More importantly, hypo/manic symptoms did not appear to have a protective role during mixed episodes. Future studies considering also deaths by suicide are required in order to better clarify the role of mixity on suicidality.

Disclosure of Interest

None Declared