bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduced activity in a liaison psychiatry service during the peak of the COVID-19 pandemic: Comparison with 2019 data and characterisation of the SARS-COV-2 positive cohort
Authors: Butler M. , Delvi A. , Mujic F. , Broad S. , Pauli L. , Pollak T. , Gibbs S. , Lam C.C. Sin Fai , Calcia M. , Posporelis S.
Published: February 2022

Introduction

The COVID-19 pandemic led to changes in how healthcare was accessed and delivered. It was suggested that COVID-19 will lead to an increased delirium burden in its acute phase, with variable effect on mental health in the longer term. Despite this, there are limited data on the direct effects of the pandemic on psychiatric care.

Objectives

1) describe the mental health presentations of a diverse acute inpatient population, 2) compare findings with the same period in 2019, 3) characterise the SARS-CoV-2 positive cohort of patients.

Methods

We present a descriptive summary of the referrals to a UK psychiatric liaison department during the exponential phase of the pandemic, and compare this to the same period in 2019.

Results

show a 40.3% reduction in the number of referrals in 2020, with an increase in the proportion of referrals for delirium and psychosis. One third (28%) of referred patients tested positive for COVID-19 during their admission, with 39.7% of these presenting with delirium as a consequence of their COVID-19 illness. Our data indicate decreased clinical activity for our service during the pandemic’s peak. There was a marked increase in delirium, though in no other psychiatric presentations.

Conclusions

In preparation for further exponential rises in COVID-19 cases, we would expect seamless integration of liaison psychiatry teams in general hospital wards to optimise delirium management in patients with COVID-19. Further consideration should be given to adequate staffing of community and crisis mental health teams to safely manage the potentially increasing number of people reluctant to visit the emergency department.
Telecommunication and neuropsychiatric symptoms in long term care dementia patients during the COVID-19 lockdown ERA
Authors: Konstantinou A.
Published: February 2022

Introduction

Ippokrateio Therapeutirio in the city of Larissa, Thessaly, Greece is a private for-profit psychogeriatric hospital focusing on Long Term Care on patients with dementia. During the COVID-19 era lockdown visits by carers/relatives/friends were forbidden due to the preventive government measures. At that same time appearance and/or exaggeration of neuropsychiatric symptoms was observed. In order to restore communication issues we performed telecommunication sessions (videocalls) and measured, among other factors, neuropsychiatric symptoms before and after sessions.

Objectives

Primary objective was to check for relations between video-calls and changes in neuropsychiatric symptoms using NeuroPsychiatric Inventory (NPI). Secondary objective was to check for carers and patients satisfaction, mainly through qualitative information.

Methods

120 patients with diagnosis of minor or major neuroconitive disorder of any type participated in the video call sessions. Two video calls per patient took place (1 per week) with a 10-inches tablet. Neuropsychiatric Inventory (NPI) was performed before the start of the video-calls. NPI had been performed again the week after both sessions were completed. Satisfaction of carers and patients was recorded, mostly as qualitative data.

Results

Neuropsychiatric symptoms improved in patients with mild or moderate neurocognitive decline. In more severe cases though anxiety, irritability and sleep problems worsened. Satisfaction reached almost 95% of the carers.

Conclusions

Video calls could be a very good way to surpass the communication burden during the pandemic restrictions for LTC dementia patients. Caution should be given to severely demented patients since clinical observations show that a cluster of symptoms worsens.
AI-driven adaptive treatment strategies in internet-delivered CBT
Authors: Kaldo V. , Isacsson N. , Forsell E. , Bjurner P. , Abdesslem F. Ben , Boman M.
Published: February 2022

Introduction: Adaptive Treatment Strategies warns therapists of patients at risk of treatment failure to prompt an adaption of the intervention. Internet-delivered Cognitive Behavioural Therapy (ICBT) collects a wide range of data before and during treatment and can quickly be adapted by adjusting the level of therapist support. Objectives: To evaluate how accurate machine learning algorithms can predict a single patient’s final outcome and evaluate the opportunities for using them within an Adaptive Treatment Strategy. Methods: Over 6000 patients at the Internet Psychiatry Clinic in Stockholm receiving ICBT for major depression, panic disorder or social anxiety disorder composed a training data set for eight different machine learning methods (e.g. k-Nearest Neighbour, random forest, and multilayer perceptrons). Symptom measures, messages between therapist and patient, homework reports, and other data from baseline to treatment week four was used to predict treatment success (either 50% reduction or under clinical cut-off) for each primary symptom outcome. Results: The Balanced Accuracy for predicting failure/success always were significantly better than chance, varied between 56% and 77% and outperformed the predictive precision in a previous Adaptive Treatment Strategy trial. Predictive power increased when data from treatment weeks was cumulatively added to baseline data. Conclusions: The machine learning algorithms outperformed a predictive algorithm previously used in a successful Adaptive Treatment Strategy, even though the latter also received input from a therapist. The next steps are to visualize what factors contributes most to a specific patient’s prediction and to enhance predictive power even further by so called Ensemble Learning.

Disclosure

No significant relationships.
Covid19 pandemic impacts on mental health of tunisian health care workers
Authors: Dhemaid M. , Abbes W. , Kerkeni A. , Bader S. , Abbes M. , Medhaffer K. , Zitoun K. , Ghanmi L.
Published: February 2022

Introduction

Covid19 pandemic in Tunisia has disturbed the health system. Health care workers, who were in the frontline to face this disease, had experienced reactions of anxiety, depression and distress.

Objectives

To assess the level of anxiety and depression among health care workers of regional hospital of Gabes (south of Tunisia) and its associated factors.

Methods

We conducted a cross-sectional study, from April 19, 2020, to May 5, 2020 on healthcare workers in Gabes regional Hospital. All hospital departments and units were included. We used a self-administered anonymous questionnaire containing sociodemographic and clinical data. Hospital Anxiety and Depression Scale (HAD) validated in the Tunisian dialectal version was used to assess anxiety and depression.

Results

Among the 289 responding participants, 100 (34.6%) were frontline health care workers directly engaged in managing patients with coronavirus disease. Our study revealed that 43.6% of health care workers were suffering from anxiety and 44.3 % from depression. There was a significant association between anxiety and female gender (p<0.001), being married (p=0.006), mental health conditions (p<0.001) especially anxiety disorders (p<0.001) and depressive disorders (p=0.03), personal medical history of dysthyroidism (p=0.013) and smoking (p=0.005). Nurses experienced more likely anxiety symptoms than other occupation (p=0.021). There was significant relationship between depression and female gender (p<0.001), married status (p=0.02), age under 50 (p=0.032) and mental health conditions (p<0.001) such as anxiety disorders (p=0.001) and depressive disorders (p=0.013).

Conclusions

It is crucial to provide care for health care workers with mental health problems during their struggle with covid19.
“I am the coronavirus”: A case report and review
Authors: Camilo J. , Silva R. , Vaz I. , Roque M.
Published: February 2022

Introduction

As disorders of thought, delusions are modified by patients’ background, and so their content varies widely according to location and throughout the ages. The COVID-19 pandemic has shown its global impact on society and mental health of the population, thus becoming a new delusional topic.

Objectives

We report a case where the COVID-19 pandemic has been integrated into a patient’s delusion in an attempt to raise professional awareness for this new psychotic presentation.

Methods

Review of clinical notes and literature review.

Results

A 38-year-old female patient with no prior psychiatric history presented with psychotic symptoms characterized by self-referential ideas, feelings of guilt and delusions of ruin, with a sudden onset of less than 24 hours prior to observation. The patient claimed that she was the coronavirus and, as such, she was a common topic of conversation in both television and social media, and the reported deaths caused by COVID-19 were her own doing. As a result of this, the patient was asking doctors to kill her in order to save everyone else affected by the virus. After evaluation, a diagnosis of Acute and Transient Psychotic Disorder was considered. The patient was initially treated with paliperidone, but due to hyperprolactinemia and menstrual changes this was switched to aripiprazole. Symptoms remitted fully after 21 days of treatment, and six months later no recurrences have been described.

Conclusions

This case illustrates the potential of the coronavirus pandemic outbreak as a new delusional topic. Possible side effects of treatment are also discussed.
Denial attitude towards COVID-19 among general population in Saudi Arabia
Authors: Alsubaie S. , Alshahrani H. , Alshahrani A. , Asiri A. , Alfaifi A. , Ibrahim R. Al , Alqahtani W.
Published: February 2022

Introduction

During the current crisis of COVID 19, recent studies evident that it has a huge impact on public mental health and individuals’ behavior.

Objectives

Our study aimed to estimate the prevalence of high denial attitude towards the emerging pandemic of COVID 19 among the general population of Saudi Arabia.

Methods

A cross-sectional online survey was conducted from April 3, 2020 to May 5, 2020. All participants (N= 1817) were asked to complete an online questionnaire survey that included socio-demographic and other variables, and Denial Attitude Questionnaire towards COVID-19 pandemic (DAQ-COVID-19).

Results

High denial attitude was prevalent among 728 (40.1 %) of the participants. It was associated with old age, being married, having low educational level, working in a non-medical professions, do not have a past history of infectious diseases, spending less than one hour following COVID-19 news, satisfied with the government procedures for COVID-19, and highly depressed and anxious respondents, where p-values were 0.001, 0.019, <0.001, 0.027, <0.001, <0.001, 0.004, 0.008, and 0.026; respectively.

Conclusions

About two out of five participants had high denial attitude. To our knowledge, the current study is the first study that tries to evaluate a high denial attitude during the initial COVID 19 outbreaks, especially in Saudi Arabia. However, further exploration in this field is needed. We suggest conducting such a study at the end of the current pandemic or in the second wave of the outbreak
Using developmental psychotechnics during COVID-19 pandemic: The case of children and adolescents failing to follow covid-related guidelines
Authors: Burlakova N. , Oleshkevich V.
Published: February 2022

Introduction

The problem of COVID-19 is acute now in all the countries. Nevertheless, the techniques of applied clinical psychology are rarely implemented in this struggle.

Objectives

The aim was to examine the possibilities of the applied clinical psychology in instructing children and adolescents and in exerting psychological influence on them in order to decrease the incidence.

Methods

The following methods were used: thematic analysis of relevant information on TV and on Russian-speaking internet, interviews with adolescents refusing to wear masks (110 adolescents), observation.

Results

87% of adolescents are sure that they are “fully informed about the COVID-19.” Moreover, 70% are certain they “will not be infected with COVID-19” and even if they do, they will “have a mild form of the disease.” Such information was widely reproduced in the Russian media and proved by medical statistics. It influenced negatively the attitude of adolescents toward masks, social distancing, etc.

Conclusions

1) The information concerning COVID-19 requires introduction of the changes based on psychological data. 2) The ways of informing children and adolescents should be carefully analyzed using psychological data. In information for young people, their responsibility, solidarity and empathy toward others should be involved. 3) The situation of COVID-19 may become a space for potential development, this situation may shape respect toward the health of other people. 4) The “situation of test,” which is significant for the self-awareness of adolescents, should be employed as a way to persuade adolescents to follow the health restrictions.
Interrelation between job satisfaction and self-regulation resources in professionals under work stress due to the COVID-19 pandemic
Authors: Titova M.
Published: February 2022

Introduction

The problem of job satisfaction connected with work efficiency and psychological well-being of professionals is especially actual in stress conditions due to COVID-19 pandemic. The stress has a negative effect on job satisfaction (Singh et al., 2019). The one of the most important criteria for successful activities is a job satisfaction (Burić & Moè, 2020). The highest level of job satisfaction can be achieved by the high adaptive potential of professionals, who have a diverse arsenal of self-regulation resources and apply them adequately to working conditions (Kuznetsova et al., 2019).

Objectives

The study was held in 45 professionals from different fields, who work remotely during the self-isolation due to COVID-19 pandemic and aimed to estimate the correlation between job satisfaction and self-regulation resources of professionals under work stress.

Methods

The assessment methods included: 1) test “Job Satisfaction” by V.A. Rozanova 2) S. Hobfoll’s “SACS” 3) Ch. Spilberger’s “Trait Anxiety”.

Results

The results revealed an average level of anxiety with a tendency to growth. Avoidance, asocial and aggressive behaviour are frequently used. The direct correlation between the level of job satisfaction and such a resource of self-regulation as a search for social contact was revealed (r=0.291; p=0.049). The general level of anxiety is directly related to avoidance (r=0. 374; p=0.011), manipulative (r=0.343; p=0.021) and aggressive actions (r=0.343; p=0.021), and negatively correlates with assertive actions (r=-0.703; p=0).

Conclusions

The results of the study can be used to develop programs to improve the psychological well-being and performance of employees working under stress due to COVID-19 pandemic.
Models for successful interactions of psychiatrists with indigenous patients and communities
Authors: Mehl-Madrona L. , Mainguy B.
Published: February 2022

Introduction

Conventional psychiatric services are not always acceptable to indigenous communities and people.

Objectives

To present successful models of interactions of psychiatrists with indigenous patients and communities based upon our work with five communities in Maine.

Methods

We reviewed the strategies that worked for community interaction from our project for supporting indigenous communities to implement medication-assisted treatment and we reviewed the literature to see what other strategies are reported successful.

Results

Psychiatrists working in these communities may need to share more personal details than to what they are usually accustomed to be accepted. They may need to acknowledge local culture and spirituality and work with traditional knowledge holders to create collaborative healing approaches. As part of this, a narrative approach appeared to work best in which the psychiatrist worked within the stories and beliefs of the community which required taking the time in dialogue to learn those stories and beliefs. Specifically, we address the challenges of flying into northern, rural, and remote communities, of academic physicians consulting to tribal-based opiate treatment programs, of modifying usual counseling techniques such as motivational interviewing to an indigenous population, and of the changes made in practice styles when taking into account the critiques made by indigenous people about medicine in general and psychiatry in particular.

Conclusions

We propose that participatory action-based approaches can improve service delivery to indigenous people. Indigenous cultures share a collectivist mindset in which the needs of the group supersede the needs of individuals, a reliance upon stories, and commitment to a biopsychosocial and spiritual approach.
Polyunsaturated fatty acid in treatment resistant depression: A pilot study
Authors: Jannini T. , Longo L. , Barone Y. , Niolu C. , Bernardini S. , Siracusano A. , Bertucci P. , Lorenzo G. Di
Published: February 2022

Introduction

The deficiency of polyunsaturated fatty acids (PUFAs) and an alteration between the ratio of omega-6 and omega-3 PUFAs may contribute to the pathogenesis of depressive disorders.

Objectives

To investigate the levels of omega-3 and omega-6 in red cell membranes (mPUFAs) and plasma (pPUFAs) of patients with treatment-resistant (TRD) and non-treatment resistant depression (non-TRD).

Methods

TRD and non-TRD consisted of 75 patients enrolled at the Psychiatric and Clinic Psychology Unit of the University of Rome Tor Vergata, Rome, Italy, and met the DSM-IV criteria for major depressive disorder (MDD). A group of healthy controls (HC) matched for agender and age was enrolled. All blood samples were performed in conditions of an empty stomach between 07:00 am and 09:00 am. For each subject were obtained 5 ml of whole blood with the use of tubes for plasma with EDTA as an anticoagulant. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) for omega-3 and arachidonic acid (AA) for omega-6 were measured.

Results

Levels of pPUFAs did not differ between the three groups. The mPUFAs were altered in the MDD. TRD and non-TRD had lower EPA and AA values respect to the HC. DHA in red cell membranes was lower in TRD than non-TRD and HC.

Conclusions

Changes in levels of PUFAs in red cell membranes, but not in plasma, may be an important factor to evaluate the resistance to the pharmacological treatment.
Overnight affective dynamics and sleep characteristics as predictors of depression and its development
Authors: Minaeva O. , George S. , Kuranova A. , Wichers M. , Riese H. , Booij S.
Published: February 2022

Introduction

Greater affective inertia during the day (higher carry-over effects of prior affect to the current moment) is associated with depression and its development. However, the role of overnight affective inertia (from evening to morning) in depression, and the role of sleep therein, has been scarcely studied.

Objectives

We examined i) the difference in overnight inertia for positive (PA) and negative affect (NA) between individuals with past depression, current depression, and no depression; ii) how sleep duration and quality influence overnight affective inertia in these groups, and iii) whether overnight affective inertia predicts depression development.

Methods

We used data of 579 women from the East-Flanders Prospective Twin Survey. First, individuals with past (n=82), current (n=26), and no depression (n=471) at baseline were examined, and then individuals who did (n=58) and did not (n=319) develop depression at 12-months follow-up. Affect was assessed 10 times a day for 5 days. Sleep was assessed with sleep diaries. Affective inertia was operationalized as the influence of affectt-1 on affectt. Linear mixed-effect models were used to test the hypotheses.

Results

Overnight affective inertia was not associated with depression, neither was it differently associated with sleep characteristics in the depression groups. However, sleep characteristics were more negatively associated with morning NA in both depression groups compared to the non-depressed group. Overnight affective inertia did not predict the development of depression at follow-up.

Conclusions

Depression and sleep characteristics might be more related to mean affect levels rather than to more complex emotion dynamics measures. Replication of these findings with longer time-series is needed.
Inaugural seizure in a patient submitted to electroconvulsive therapy and anti-psychotic treatment: Who’s the culprit?
Authors: Figueiredo I. , Rodrigues A.C. , Pereira I. , Oliveira C. , Bento A.
Published: February 2022

Introduction

Electroconvulsive Therapy (ECT) is one of the most effective treatments for Depressive Disorder. Although its safety and tolerability have been throughout the years, it still holds common mild and rarely persistent side effects.

Objectives

The aim is to review some of the most recent data on the connection between inaugural seizures in psychiatric patients being submitted to ECT for treatment of Major Depressive Disorder, while also discussing the possible contribution of the concomitant use of clozapine and clomipramine.

Methods

The authors present a case report of an episode of an inaugural seizure in a patient submitted to ECT, with concomitant use of clozapine and clomipramine. A search on Pubmed and Clinicalkey was performed, from which the relevant publications were selected and reviewed.

Results

The authors present a 62 year old woman who developed an inaugural generalized tonic-clonic seizure after being submitted to ECT for treatment of Recurrent Major Depressive Disorder (RMDD), while also carrying out clozapine and clomipramine dosage reduction, with the purpose of discontinuation. The patient had no history of previous seizures, nor were there relevant findings in the patient’s neurological examination, blood work, brain CT or EEG.

Conclusions

There is a plethora of possible factors involved in the development of an inaugural seizure. Although, the risk of spontaneous seizure during ECT is low, it may be increased by the concomitant use of drugs which can lower the seizure threshold. In most cases, when ECT was resumed after removal of such triggers, there were no further complications.
Dysthymia through time: A review
Authors: Valadas M.T. , Freitas R. Mota
Published: February 2022

Introduction

Dysthymia is defined in ICD-10 as a chronic depression of mood which does not currently fulfil the criteria for recurrent depressive disorder, mild or moderate severity, in terms of either severity or duration of individual episodes. Although it only entered the psychiatric classifications in DSM-III and ICD-10, this syndrome has been a subject of several changes in conceptualization and classification.

Objectives

We aim to perform an historical review on dysthymia and related concepts.

Methods

We performed an updated review in the PubMed database using the terms “dysthymia”, “dysthymic disorder”, “persistent depressive disorder”, “neurotic depression” and “depressive personality”. The included articles were selected by title and abstract. We also consulted reference textbooks.

Results

Depressive symptoms have been recognized since Antiquity, however, depressive disorders with a chronic course were only conceptualized in the 1970s. Dysthymia represents the confluence of older concepts, including neurotic depression and depressive personality and entered the psychiatric classifications in DSM-III and ICD-10. Presently, this syndrome is classified as persistent depressive disorder (dysthymia) in DSM-5 and named dysthymic disorder in ICD-11.

Conclusions

The concepts regarding mental illness and psychiatric diagnoses are constantly evolving. Having knowledge about historical concepts is essential for a clear communication among psychiatrists, adding to the differential diagnosis process and improving patient care.
Health anxiety in patients with depression with somatic symptoms and psychodermatological disorders
Authors: Ermusheva A. , Vinogradova M. , Tkhostov A. , Pechnikova L.
Published: February 2022

Introduction

As significance of medically unexplained symptoms increases in general practice it is important to discuss psychopathological comorbidity regarding the impact of health anxiety indicating sufferers excessive care use.

Objectives

To study the impact of health anxiety in depression with somatic symptoms.

Methods

50 patients with depression with somatic symptoms compared to 79 patients with psychodermatological disorders with complaints of pathological skin sensations completed the Hospital Anxiety and Depression Scale (HADS) and the Short Health Anxiety Inventory (SHAI). The Mann-Whitney U-Test was applied. The psychosemantic method “Classification of sensations” was used to differentiate patients’ bodily experience. Factor analysis was performed.

Results

Scores on HADS-anxiety and SHAI were significantly higher in depression (U=645, p=0.009; U=89.5; p=0.036), although there were no significant differences on HADS-depression. Factor analysis showed a polarization of bodily experience categories in depression as the first factor (38% of total variance) included negative emotions with somatic sensations of exhaustion and the second factor (10% of total variance) included pleasant sensations and positive emotions with the negative sign of factor loadings. In psychodermatological disorders the first factor (31% of total variance) was quite similar, however the second factor (12% of total variance) included skin and general somatic sensations illustrating the higher concern with somatic symptoms.

Conclusions

Higher health anxiety in depression with somatic symptoms compared to psychodermatological disorders (more concerned with bodily experience) could be associated with patients’ complaints of emotional state indicating differences in psychological mechanisms. The research was supported by Russian Foundation for Basic Research with the Grant 20-013-00799.
Prescribing exercise as a treatment for depression
Authors: Pereira F. , Martins P. , Barros J.
Published: February 2022

Introduction

Depression is a heterogeneous syndrome linked to significant structural brain abnormalities, such as volumetric reductions in the hippocampus, anterior cingulate cortex and prefrontal cortex, as well as compromised white matter integrity. Recent growing evidence suggests that exercise is a promising and compelling treatment for depression in adults, showing effects that are comparable to other first-line treatments for depression.

Objectives

This review aims to improve our understanding of the biological pathways involved in both the pathophysiology of depression and the antidepressant effects of exercise.

Methods

This literature review considers the latest available scientific research addressing a comprehensive analysis of the antidepressant effect of physical exercise and the biological pathways involved.

Results

Physical activity has been shown to have a multimodal effect that stimulates biochemical pathways and restores neuronal structures disturbed in depression. Experimental evidence supports exercise-induced increases in hippocampal, anterior cingulate cortex and prefrontal cortex volume, suggesting that exercise and antidepressant medication may alleviate depression through common neuromolecular mechanisms. However, the benefits of exercise may also persist beyond the end of treatment, unlike antidepressant medication.

Conclusions

Given the undeniable scientific evidence favoring physical exercise in alleviating depression, it is of crucial importance to recommend this treatment in adjunct to psychotherapy and medication. Individuals at risk for depression also greatly benefit from it’s neuroprotective effects and should prioritize lifestyle changes. In older adults, there is a greater need for non-pharmaceutical treatments for depression due to limited efficacy of pharmaceutical treatments in this population.
Pending challenges to e-mental health in the COVID-19 era: Acceptability of a smartphone-based ecological momentary assessment application among patients with schizophrenia spectrum disorders
Authors: Lopez-Morinigo J.-D. , Luisa B.-E. Maria , Porras-Segovia A. , Martínez A. Sánchez-Escribano , Escobedo-Aedo P.-J. , Ruiz-Ruano V. González , Mata-Iturralde L. , Muñoz-Lorenzo L. , Sánchez-Alonso S. , Artés-Rodríguez A. , Baca-Garcia E.
Published: February 2022

Introduction

Concerns have been raised about ecological momentary assessment (EMA) acceptability among patients with schizophrenia spectrum disorders (SSD), which is of major relevance during the e-Mental health-focused COVID-19 pandemic.

Objectives

To investigate i) the levels of adherence to a passive smartphone-based EMA tool, the Evidence-Based Behavior (eB2), among SSD patients; and ii) putative predictors of this.

Methods

Sample: SSD (F20-29-ICD10) outpatients, age 18-64, without financial incentives, recruited over 17/06/2019-11/03/2020 at the Hospital Universitario Fundación Jiménez Díaz (Madrid, Spain). Those who accepted the eB2 installation -users- and those who did not -non-users- were compared in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight and metacognitive variables by a multivariable binary logistic regression model.

Results

Sample (N=77): n=41 males; age: 47.69±9.76 years, n=24 users (31.2%). n=14 users (70%) had the eB2 installed at follow-up (median=14.50 weeks).Multivariable binary logistic regression model on ‘user’ as outcomeβSEWaldpOR95% CIAge-0.0750.0383.9100.0480.9280.861-0.999Education level-0.9671.2890.5630.4530.3800.030-4.755Early adolescence premorbid adjustment-0.2850.1106.6950.0100.7520.606-0.933Trail Making Test A-0.0300.0251.4880.2220.9700.924-1.018Trail Making Test B-0.0050.0100.2780.5980.9950.976-1.014Cognitive Insight0.0620.0611.0430.3071.0640.944-1.200

X2=25.296,df=6,p<0.001. Nagelkerke-R2=44.7%. Correctly classified: 76.9%, users:54.5%, non-users:88.4%.

Conclusions

Acceptability of a smartphone-based EMA application among SSD patients was low. Age (young) and good premorbid adjustment predicted acceptability. e-Mental Health methods need to be tailored for patients with SSD. Otherwise, these highly vulnerable individuals may be neglected by e-health-based services in the post-COVID-19 years ahead.
Effectiveness of internet-based cognitive behavioural therapy for binge eating disorder
Authors: Jensen E. , Linnet J. , Holmberg T. , Tarp K. , Nielsen J.
Published: February 2022

Introduction

Binge eating disorder (BED) is the most prevalent specific eating disorder. It is characterized by recurrent episodes of binge eating and is associated with feelings of shame and a lack of control. Internet-based treatments are gaining increasing attention as a way to reach more patients with evidence based treatments In 2020 we conducted a preliminary analysis on the effectiveness of an internet-based cognitive behavioural therapy treatment project (Jensen ES, Linnet, J, Holmberg TT, Tarp K, Nielsen JH, Lichtenstein MB. Effectiveness of internet-based guided self-help for binge-eating disorder and characteristics of completers versus noncompleters. Int J Eat Disord. 2020;1-6. https://doi.org/10.1002/eat.23384).

Objectives

This study aims to update the analyses on treatment effect with the patients who have completed treatment in the year following the last data extraction.

Methods

The iBED treatment project is a 10-session psychologist guided internet-based self-help program based on cognitive behavioural therapy. When applying for treatment and upon completion patients respond to a survey containing, among other scales, the eating disorder examination-questionnaire (EDE-Q), binge eating disorder-questionnaire (BED-Q) and various sociodemographic questions. Data will be extracted from the treatment project in anonymized form for analyses.

Results

The preliminary analyses were conducted on 36 completers. These showed large standardized effect sizes on both the EDE-Q subscales (Cohens d ranging from .88-1.65) and on the BED-Q (d = 1.38). The updated effectiveness analyses will be presented at the conference. We expect approximately 70-80 patients to have completed treatment at this time.

Conclusions

Results will be discussed and presented at the conference.
Evidence-based therapeutic management of binge-eating disorder
Authors: Vasile D. , Vasiliu O.
Published: February 2022

Introduction

Binge-eating disorder (BED) is a difficult-to-manage clinical entity, that may associate both organic (e.g., obesity, metabolic syndrome) and psychiatric (e.g., anxiety, mood, or substance use disorders) co-morbidity. Psychotherapeutic and pharmacological approaches are usually combined in order to reach the best outcome for these patients, but the disorder seems to have prolonged evolution even under appropriate therapeutic managment.

Objectives

To evaluate the most evidence-based therapies focused on BED.

Methods

A literature review was conducted through main electronic databases, and papers published between January 2000 and August 2020 were included in the analysis.

Results

Cognitive-behavioral therapy (CBT) is supported by multiple trials, and it led to decreased number of binge episodes and increased rates of remission. Behavioral activation may improve certain symptoms of BED (depressive mood, anxiety), but not the binge episodes frequency. Interpersonal group therapy (IPT) may be helpful for BED patients with an external locus of control and significant interpersonal dificulties. Dialectical behavior therapy (DBT) has been applied in BED patients, but the results have been inconclusive. Lisdexamfetamine dimesylate is the only FDA approved drug for this indication, as dasotraline was rejected by FDA and its research discontinued by the manufacturer. Fluoxetine, sertraline, escitalopram, duloxetine, bupropion, atomoxetine, reboxetine, armodafinil, disulfiram, baclofen, zonisamide, lamotrigine, topiramate, samidorphan, liraglutid, and orlistat need more trials in order to validate their efficacy, especially on long term.

Conclusions

There is only one drug currently FDA approved for this indication, lisdexamfetamine, and a number of psychotherapies, with CBT and IPT being the most supported by evidence.
What drives the excess of physical exercise observed in patients with anorexia nervosa?
Authors: Lodovico L. Di , Hatteea H. , Couton C. , Duriez P. , Treasure J. , Gorwood P.
Published: February 2022

Introduction

Anorexia Nervosa (AN) is a severe mental illness characterized by weight reducing strategies such as food restriction, purging behaviours and excessive physical exercise. The persistence of physical exercise despite underweight and its maintaining factors are poorly understood.

Objectives

The aim of this study is to explore the attitudes towards physical exercise and its effects on mood, body image perception and cognitive functioning in patients with AN, and to assess if these effects are associated with trait, or state.

Methods

Eighty-eight patients with AN, 30 unaffected relatives and 89 healthy controls were compared about their attitudes towards three aspects of physical exercise, namely the Exercise Dependence Scale (EDS), the Godin Leisure Time Exercise Questionnaire (GLTEQ) and a standardized effort test. Evaluations of positive and negative affects, cognitive rigidity and body image distortion were repeated at baseline and after the effort test to assess for correlations between the exercise measures and exercise-induced modifications in the three groups.

Results

Patients with AN showed higher scores on the EDS, the GLTEQ and used more effort in the standardized effort test (p<.05). These three aspects of physical exercise correlated with baseline negative emotions (p<.01). AN patients and unaffected relatives, but not controls, showed a marked emotional improvement after physical exercise (p<.01).

Conclusions

Excessive physical exercise seems a trait-associated feature of AN, driven by a state-related effect of physical exercise on emotional wellbeing. The mood-related drive for physical exercise has the characteristics of an endophenotype in the patients of the present sample.
Personal and clinical traits in adolescents, diagnosed with «anorexia nervosa»
Authors: Balakireva E. , Zvereva N. , Voronova S.
Published: February 2022

Introduction

Eating disorders are among the most common mental health problems. The prevalence of diseases in this circle is 1-2% of the population; in adolescents - 1%. There is a significant “rejuvenation” of eating disorders with the appearance anorexia nervosa cases in preschool and primary school age. The prevalence of such disorders among adolescents is a significant reason for detailed and comprehensive study of the issue. Many factors lead to development of eating disorders: genetic predisposition, family background, socio-cultural factors, life experience. We suggested that due to many mutually overlapping factors in the syndrome of anorexia nervosa, there may also be distortions of personality characteristics, sometimes reaching the level of personality disorders.

Objectives

assessment of personality feachers 34 patients with leading diagnosis of F-50.0 (ICD-10) were examined in FSBSI MHRC (inpatient treatment/outpatient observation). All adolescents received drug therapy.

Methods

The study was carried out using modern pathopsychological methods with the inclusion of research questionnaires aimed at identifying personal pathology (LoPF 12-18, AIDA).

Results

During the research, the following personality traits were revealed: perfectionism, the desire to correspond to a certain ideal image of oneself, instability of Ego, unstable identity violations; reduced ability to form a picture of the future and themselves in the future; also showed a tendency to abuse psychoactive substances.

Conclusions

Thus, the general for all patients with diagnosed disorder was persistent refusal to eat (up to dystrophy), distortion of Ego, characteristic of personality disorders were also observed. Further studies are required to obtain a more detailed picture and clarify the prognostic outcome.
Sociodemographic and clinical profiles comparison in an acute hospital unit after a decade (2006-2007 vs 2017-2018)
Authors: Peraire M. , Guinot C. , Villar M.
Published: February 2022

Introduction

It has been recently proposed that diagnoses traditionally framed in axis II of the DSM and diseases related to the elderly are progressively replacing serious mental illness in acute inpatient wards.

Objectives

To study the clinical and sociodemographic characteristics of the patients in an acute psychiatric unit, and to compare them between a ten-year period.

Methods

Observational, descriptive, and retrospective study that analyzes the data recorded in the discharge reports from the acute ward of the Hospital Provincial de Castellón.

Results

Among the studied patients, we found statistically significant differences regarding gender, age, readmission rate, and stay duration between the two periods. In the most recent one (2017-18), more women and elderly have entered, with shorter stays and fewer readmissions. In both periods, the most prevalent psychiatric diagnoses are by far serious mental illness (bipolar disorder, schizophrenia). By grouping the diagnoses into five broad categories (serious mental illness, dementias, personality disorders, drug misuse, and others), we found significant differences in their distribution. Lately, more personality disorders and dementias were admitted as the main diagnosis, while serious mental illness and substance use disorders increased their prevalence as accessory diagnoses.

Conclusions

The research carried out allows us to conclude that the clinical and sociodemographic profile of patients admitted to an acute unit is changing. It would be advisable to investigate the causes that motivate it and modify the devices to adapt to this new reality.
On the relation between a green and bright window view and length of hospital stay in affective disorders
Authors: Mascherek Anna , Weber Sandra , Riebandt Kevin , Cassanello Carlos , Leicht Gregor , Brick Timothy , Gallinat Jürgen , Kühn Simone
Published: February 2022

Background

The salutary effect of window views on greenery for inpatients in hospitals on length of stay and recovery rate has been repeatedly shown, however, not for psychiatric inpatients. The study assessed the association between a window view on green trees or man-made objects and brightness of the room on length of stay in a sample of psychiatric inpatients from one clinic.

Methods

Data records of 244 psychiatric inpatients (mean age in years 41.8; SD = 11.8; 59.8% female, length of stay varying between 7 and 100 days) that were admitted between May 2013 and October 2018 with affective disorders were examined. Window view was assessed with images taken from each room and classified into showing man-made objects or green trees. The percentage of green within each image was also calculated as greenness of the view. Brightness was assessed with a luxmeter.

Results

Although no effect was found for the dichotomous measures (man-made objects vs. green trees), a suppression effect emerged for percentage of green and brightness. The results indicate that both greenness of the window view as well as brightness significantly reduce length of stay in psychiatric inpatients with affective disorders.

Conclusions

The suppression effect likely results from the characteristics of the windows; the greenest rooms also being the darkest. Due to the infrastructure of the ward, greenness and brightness came at the expense of each other. The results generally support the importance of a view into greenery and natural sunlight for recovery.
Predictive Modeling of Survival and Toxicity in Patients With Hepatocellular Carcinoma After Radiotherapy
Authors: Chamseddine Ibrahim , Kim Yejin , De Brian , El Naqa Issam , Duda Dan G. , Wolfgang John , Pursley Jennifer , Paganetti Harald , Wo Jennifer , Hong Theodore , Koay Eugene J. , Grassberger Clemens
Published: February 2022

PURPOSE

To stratify patients and aid clinical decision making, we developed machine learning models to predict treatment failure and radiation-induced toxicities after radiotherapy (RT) in patients with hepatocellular carcinoma across institutions.

MATERIALS AND METHODS

The models were developed using linear and nonlinear algorithms, predicting survival, nonlocal failure, radiation-induced liver disease, and lymphopenia from baseline patient and treatment parameters. The models were trained on 207 patients from Massachusetts General Hospital. Performance was quantified using Harrell's c-index, area under the curve (AUC), and accuracy in high-risk populations. Models' structures were optimized in a nested cross-validation approach to prevent overfitting. A study analysis plan was registered before external validation using 143 patients from MD Anderson Cancer Center. Clinical utility was assessed using net-benefit analysis.

RESULTS

The survival model stratified high-risk versus low-risk patients well in the external validation cohort (c-index = 0.75), better than existing risk scores. Predictions of 1-year survival and nonlocal failure were excellent (external AUC = 0.74 and 0.80, respectively), especially in the high-risk group (accuracy > 90%). Cause-of-death analysis showed differential modes of treatment failure in these cohorts and indicated that these models could be used to stratify RT patients for liver-sparing treatment regimen or combination approaches with systemic agents. Predictions of liver disease and lymphopenia were good but less robust (external AUC = 0.68 and 0.7, respectively), suggesting the need for more comprehensive consideration of dosimetry and better predictive biomarkers. The liver disease model showed excellent accuracy in the high-risk group (92%) and revealed possible interactions of platelet count with initial liver function.

CONCLUSION

Machine learning approaches can provide reliable outcome predictions in patients with hepatocellular carcinoma after RT in diverse cohorts across institutions. The excellent performance, particularly in high-risk patients, suggests novel strategies for patient stratification and treatment selection.
Optimizing Utilization of Blood Products in the Hematologic Malignancy Clinic: Less Is More
Authors: Binder Adam F. , Loos Katy , Xu Alexander , Peedin Alexis R. , Gergis Usama , Karp Julie Katz , Wilde Lindsay
Published: February 2022

PURPOSE:

There are no universal guidelines for blood product transfusions in patients with hematologic malignancies (HMs). Excess utilization of platelet and RBC transfusion in patients with HM increases the cost of care and likelihood of adverse events. We aim to decrease the total number of transfused units and multiunit orders of platelets and RBCs in the HM clinic by 25% from March 2020 to December 2020.

METHODS:

A multidisciplinary, interprofessional team was formed. Baseline rates of blood product utilization were determined using Qlik Analytic software. Strategies to improve utilization were developed, and three interventions were initiated. Data were collected on monthly intervals. Data for total number of platelet and RBC units ordered, total multiunit orders, average number of units ordered per encounter, and pretransfusion hemoglobin thresholds were collected from May 2019 to December 2020.

RESULTS:

Through our Plan-Do-Study-Act cycles from March 2020 to December 2020, the total number of platelet transfusion orders per month decreased from 164 to 98, multiunit platelet orders decreased from 63 to 2, and the average number of platelet transfusions per encounter decreased from 1.62 to 1.03. The total number of RBC transfusion orders decreased from 172 to 141, multiunit RBC orders decreased from 25 to 16, and the average number of RBC transfusions per encounter decreased from 1.21 to 1.18.

CONCLUSION:

Implementation of our multidisciplinary interventions led to more appropriate use of blood products in the outpatient setting. Ongoing efforts are underway to continue to improve utilization in the inpatient and outpatient setting.
Body Mass Index and Risk of Diabetic Nephropathy: A Mendelian Randomization Study
Authors: Lu Jingru , Liu Xiaoshuang , Jiang Song , Kan Shuyan , An Yu , Zheng Chunxia , Li Xiang , Liu Zhihong , Xie Guotong
Published: February 2022

Context

The associations of obesity and diabetic nephropathy (DN) in type 2 diabetes are inconsistent in observational studies, and causality remains unclear.

Objective

To explore the causal effect of body mass index (BMI) on DN, estimated glomerular filtration rate (eGFR), and proteinuria in type 2 diabetes by a 2-sample Mendelian randomization (MR) analysis.

Methods

A total of 56 genetic variants were selected as instrumental variables for BMI in 158 284 participants from BioBank Japan, and their effects on DN risk, eGFR, and proteinuria were estimated in 3972 individuals with type 2 diabetes. Then, sex-stratified MR analysis was performed between BMI and DN. We selected generalized summary MR analysis as the primary method and 6 other robust methods to test MR assumptions.

Results

One SD increase in BMI was causally associated with higher DN risk [odds ratio (OR) 3.76, 95% CI 1.88-7.53, P < 0.001] and lower eGFR level (OR 0.71, 95% CI 0.59-0.86, P < 0.001). However, BMI was not causally associated with proteinuria (P = 0.22). Sex-stratified analyses indicated the causal effect of BMI on DN was stronger in women (OR 14.81, 95% CI 2.67-82.05, P = 0.002) than in men (OR 3.48, 95% CI 1.18-10.27, P = 0.02). Sensitivity analyses did not show evidence for violation of the MR assumptions.

Conclusions

Genetic evidence showed that higher BMI levels were causally associated with increased risk of DN and decreased eGFR levels. Moreover, the increase in BMI level had a greater impact on DN risk in women.