bluuebunny/crossref_metadata_2025 huggingface dataset:
The cognitive behavioural approach to the treatment of hallucinations. Is every experience of hallucination a part of the symptoms associated to psychosis - or even schizophrenia ?
Authors: Goujon M. J. , Gallois E.
Published: August 2023

Introduction

We report here our experience of treating hallucinations (auditory, visual, sensorial) using Cognitive Behavioural Therapy (CBT), along with medications. Our experience goes towards the conclusion that diagnosis is usually made prior to medical treatment of symptoms with high doses of neuroleptic drugs.

Objectives

Our aim was to make a clear difference between hallucinations which need high doses of neuroleptics for cure and hallucinations that could respond to lesser drug treatment associated with CBT.

Methods

Our method was based on individual sessions of CBT.

Results

Our behavioural-cognitive method yielded high success rates as evidenced by thorough investigation into patients’ medical record including past medical history, prior drug use and life-threatening events.

This work is preliminary to a follow-up with the rigorous method for evaluation.

Conclusions

Further, we aim to promote out-patient follow-ups in our unit after a very short inpatient assessment and treatment.

Our therapeutic approach is now approved by our team and new patients are currently being included.

Disclosure of Interest

None Declared
Efficacious Web-Based Psychotherapy to Address Depression and Anxiety Among Patients Receiving Oncological and Palliative Care: an Open-Label Randomised Controlled Trial
Authors: Alavi N. , Omrani M. , Shirazi A. , Layzell G. , Eadie J. , Jagayat J. , Stephenson C. , Kain D. , Soares C. , Yang M.
Published: August 2023

Introduction

Oncological and palliative care patients face unique stressors which increase their risk of developing depression and anxiety. Cognitive behavioural therapy (CBT) and mindfulness has established success in improving this population’s mental health. Traditional face-to-face psychotherapy is costly, has long wait lists, often lacks accessibility, and has strict scheduling, each of which can make attending psychotherapy physically, mentally, and financially out of reach for oncological and palliative patients. Web-based CBT (e-CBT) is a promising alternative that has shown efficacy in this and other patient populations.

Objectives

To quantify the efficacy of online CBT and mindfulness therapy in oncological and palliative patients experiencing depression and anxiety symptoms.

Methods

Participants with depression or anxiety related to their diagnosis were recruited from care settings in Kingston, Ontario, and randomly assigned to 8 weekly e-CBT/mindfulness modules (N= 25) or treatment as usual (TAU; N=24). Modules consisted of CBT concepts, problem-solving, mindfulness, homework, and personalised feedback from their therapist through a secure platform (Online Psychotherapy Tool- OPTT) Participants completed PHQ-9 and GAD-7 in weeks 1, 4, and 8. (NCT04664270: REB# 6031471).

Results

Significant decreases in PHQ-9 and GAD-7 scores within individuals support the hypothesis of efficacy. At this time, 10 e-CBT/mindfulness and 12 TAU have completed the study. Decreases in PHQ-9 and GAD-7 scores within e-CBT group support the hypothesis of efficacy. Specifically, PHQ-9 scores decreased over the 3 repeated measures (ANOVA, 2 groups, 3 repeated measures and the decrease in GAD-7 scores was similarly large)

Conclusions

As hypothesized, the results suggest that e-CBT/mindfulness therapy is an affordable, accessible, and efficacious mental health treatment for this population. The virtual, asynchronous delivery format is particularly appropriate given the unique barriers.

Disclosure of Interest

N. Alavi Shareolder of: OPTT inc, Grant / Research support from: department psychiatry Queen’s University, M. Omrani Shareolder of: OPTT inc, A. Shirazi: None Declared, G. Layzell: None Declared, J. Eadie: None Declared, J. Jagayat: None Declared, C. Stephenson: None Declared, D. Kain: None Declared, C. Soares: None Declared, M. Yang: None Declared
Combined clinical and laboratory diagnostics of neurodegenerative disorders
Authors: Sidenkova A. , Litvinenko V.
Published: August 2023

Introduction

Alzheimer’s disease (AD) is a neurodegenerative pathology that develops mainly in elderly and senile people.

Objectives

The aim of the study was a comparative analysis of the results of neuropsychological tests with the indicators of the study of oral fluid and buccal epithelium cytograms in patients with Alzheimer’s disease.

Methods

In the main group of 12 patients with Alzheimer’s disease, m=76.25±4.89. There were 12 cognitively healthy people in the control group. The average MMSE score among the observations of the main group was 13.42±3.63. The ADAS-COG scale was used to detail the impaired cognitive functions. The concomitant pathology is compensated. The content of BDNF, TNF-α, IL1RA, IL-6, and IL-8 was determined in the oral fluid and in the blood serum. The concentration of salivary and serum biomarkers was determined by multiparametric fluorescence analysis with magnetic microspheres. Micronuclei, karyopycnosis, karyorexis, and karyolysis were determined in the cellular structures of the buccal epithelium. The material for cytological examination was collected from the inner surface of the cheek.

Results

When analyzing buccal cytograms, attention was drawn to a pronounced increase in the number of cells with micronuclei in patients with AD to 1.8%; in the control group, the median was 0.1% (p<0.05). A direct correlation was established between the number of binuclear cells and the level of BDNF in the blood serum (r=0.646; p=0.03) in patients with AD. It is also important to note that the level of serum BDNF had a significant direct correlation with immediate memory, and the concentration of salivary BDNF correlates with the parameter of naming objects.

Conclusions

Correlations between amnesia, speech disorders, praxis, gnosis and pathology of the oral fluid and buccal epithelium, especially with the severity of karyopycnosis and karyorexis, have been established, indicating a direct correlation between the neurodegenerative process pathogenetically associated with Alzheimer’s disease and the processes of systemic inflammation and degeneration of the buccal epithelium.

Disclosure of Interest

None Declared
Efficacy of paliperidone palmitate 3-month formulation in preventing hospital admissions and emergency room visits. 66 months of follow-up
Authors: Romero Guillena S. L. , Plasencia Garcia de Diego B. O. , Gomez Gonzalez J. , Gotor Sánchez-Luengo F.
Published: August 2023

Introduction

Paliperidone Palmitate 3-month formulation (PP3M) has shown a significantly longer time to relapse compared to placebo, with similar efficacy and safety to Paliperidone Palmitate 1-month (PP1M) (Carpiniello et al. Drug Des. Devel. Ther. 2016; 10 1731–1742).

Objectives

The main objective of this study was to determine the effectiveness of PP3M in preventing hospital admissions and emergency room visits, in people with non-acute schizophrenia in a naturalistic psychiatric outpatient setting

Methods

Sample: 30 people with diagnosis of schizophrenia (DSM 5 criteria), who had started treatment with PP3M, after being stabilized with PP1M (the dose was not modified in the four months prior to inclusion in the study)

Quarterly basis, the following evaluations were performed during a follow-up period of 66 months:

The Clinical Global Impression-Schizophrenia scale (CGI-SCH)

Treatment adherence, concomitant medication and the number of hospitalizations and emergency visits

Efficacy values: Percentage of patients who remained free of admissions at the end of 66 months of follow-up.

Other evaluation criteria: Percentage of patients who never visited the emergency department at the end of 66 months of follow-up. Average change from baseline visit to the final evaluation as assessed by score obtained on the following scale: GSI-SCH, percentage of patients on antipsychotic monotherapy and treatment adherence rate.

Results

The mean dose of PP3M was 401. 55 mg

The percentage of patients who remained free of admissions at the end of the 66 months was 83.25% and the percentage of patients who never visited the emergency department at the end of 66 months was 79.92%

Mean variations from baseline scores at 66 months were: (-0.36 ±0-37) on the GCI-SCH.

The percentage of patients on antipsychotic monotherapy at the end of the 66 months was 76.56%

The rate of adherence was 86.58%

.

Conclusions

In our study, we found that paliperidone palmitate 3-month formulation was effective in reducing the number of admissions and visits to the emergency department, under conditions of daily clinical practice.

Disclosure of Interest

None Declared
Irrational polypharmacy and potentially inappropriate medications in patients with dementia: Treatment strategies
Authors: Štuhec M. ,   EPA2023SP-1103
Published: August 2023

Most patients with dementia are treated with irrational polypharmacy, which leads to higher mortality and other negative consequences (higher costs). Nearly 50% of elderly patients take one or more medications that are not medically necessary, which represents another important aspect of medication optimization. Research has established a strong relationship between irrational polypharmacy and its negative clinical consequences, including a negative impact on dementia, especially in patients with excessive polypharmacy (10 or more medications). These patients are underrepresented in the treatment guidelines and randomized controlled trials, although they represent a substantial patient population. The burden of irrational polypharmacy has also been associated with a greater risk of adverse drug events, drug-drug interactions, medication non-adherence and a higher risk of potentially inappropriate medication (PIM) use. Different treatment strategies have been available to reduce irrational polypharmacy in this population. The best intervention for irrational polypharmacy reduction in this population involves an inter-professional approach (collaborative care approach) that often includes special tools, a basic pharmacological approach and collaboration with a clinical pharmacist.

Disclosure of Interest

None Declared
Coercion rates in different mental health care models: flexible assertive community treatment vs care as usual
Authors: Tomcuk A. ,   RECOVER E Montenegro Research Team
Published: August 2023

Abstract: Introduction

In 2018, within the Horizon 2020 program, RECOVER-E project activities were initiated in Montenegro. During the years 2019 and 2020 Community mental health team (CMHT) within the Special Psychiatric Hospital Kotor was established. This team became responsible for management of treatment of a group of users with severe mental health illnesses, based on the principles of „Flexible Assertive Community Treatment (FACT – A Dutch model). Objectives: The main objective of this research was to establish whether there were substantial differences regarding the use of seclusions, restraints and forced medication during the hospital readmissions in the group of patients treated by the CMHT, compared to usual mental health care in Montenegro.

Methods

A sample of 202 users of mental health services from Kotor and surrounding municipalities were recruited. Patients were randomized into two similar-sized groups - intervention group, whose treatment was managed by the multidisciplinary CMHT, and control group where treatment as usual was continued (outpatient treatment without field work and hospital readmissions during the psychotic relapses).

To estimate and follow-up the frequency of application of coercive measures in this research, hospital documentation was used.

Results

Patients in the intervention group had statistically significant less coercive intervention (such are mechanical restraining, seclusions, isolations and forced medication) during the study. There were no significant differences in the number of hospital days and readmission rates.

Conclusions

This study showed that CMHT care could reduce some of the coercive measures during the treatment of severe mental illnesses.

Disclosure of Interest

None Declared
Determinants of postpartum post-traumatic stress disorder
Authors: Ben Soussia R. , Nour F. , Bouali W. , BelHAdj I. , Bouchahda H. , Zarrouk L.
Published: August 2023

Introduction

Post-traumatic stress disorder, following stress of a particular intensity, is often related to the perception of childbirth as a traumatic event requiring the optimization of follow-up and the interest of early detection.

Objectives

To determine the factors associated with post-traumatic stress disorder related to childbirth.

Methods

This is a longitudinal prospective analytical study carried out in the obstetrics gynecology department of the Tahar Sfar Mahdia hospital. The study population was women who gave birth during the study period from March 15, 2020 to September 15, 2020. We used a pre-established questionnaire including sociodemographic and clinical characteristics as well as a psychometric part containing the psychiatric scale for screening for post-traumatic stress disorder.

Results

Our sample included 120 women. The average age was 28.2±5.3.Five participants (4.2%) had a psychiatric history .

Thirty-five patients (29.1%) had a pathological obstetric history. However, fifteen patients (12.5%) were hospitalized during their pregnancies. Psychometric assessment revealed a prevalence of PTSD at 5.8% with PTSD symptomatology in 18.4% of women.

Twenty-two patients (18.3%) described the childbirth as painful and traumatic.

The frequency of PTSD was higher in women with a history of abortion (6.9%)

Postpartum PTSD was statistically associated with a low level of education (p=0.02), postpartum complications (p=0.05) and sex of the newborn (p=0.01)

Conclusions

The detection of factors associated with postpartum posttraumatic stress disorder seems to be essential for comprehensive and multidisciplinary management of women at risk.

Disclosure of Interest

None Declared
Tyrosinemia type 1 and ADHD like symptoms similarity or comorbidity about a case
Authors: Belhadga H. , Elmaataoui Z. , Kisra H.
Published: August 2023

Introduction

Many metabolic diseases influence brain function and are associated with psychiatric symptoms and neuropsychiatric disorders (including autism-spectrum disorders, ADHD and psychotic disorders). Attention-deficit-/hyperactivity disorder (ADHD) is among the most common neurodevelopmental disorders in children, with a worldwide prevalence of about 5% in childhood. Tyrosinemia is caused by a genetic mutation in the fumarylacetoacetase gene that leads to a deficiency in the encoded enzyme, which catalyzes the cleavage of tyrosine metabolites to acetoacetic acid and fumaric acid. In recent studies of children with tyrosinemia type 1, a strong correlation was observed between symptoms of ADHD and blood levels of tyrosine, supporting a direct role of this amino acid in the pathogenesis.

Objectives

we report this case of tyrosinemia type 1 associated to ADHD symptoms to contribute in literature to provide more insights into possible shared pathophysiological mechanisms and how these affect their treatment.

Methods

We report the case of an 8-year-old child, followed since the age of 3 months for a tyrosinemia type 1 who presented symptoms of ADHD.

Results

scales and questionnaires were used to detect ADHD symptoms, the SNAP IV - Swanson, Nolan and Pelham Teacher and Parent Rating Scale was used with the mother, the items concerning inattention (items 1 to 10) and Hyperactivity-Impulsivity (items 11 to 20) were revealing; The Conners Evaluation Questionnaire was delivered, confirming the same result, a neuropsychological evaluation of the child with IQ evaluation by WISC-IV - Wechsler Intelligence Scale for Children and Adolescents revealed limited intellectual performance with an IQ of 65.

Conclusions

NMDs, such as HT-1, constitute a large group of conditions that are often containable with early clinical intervention, but still present lifelong difficulties and high societal costs. many studies suggest that there may be similar biological mechanisms behind the cognitive difficulties seen in ADHD and HT-1. In clinical settings, the impaired dopamine synthesis due to substrate inhibition in treated HT-1 may be compensated for by standard ADHD medication, such as methylphenidate or amphetamine. Similarly, the reduced serotonin synthesis may be counteracted by tryptophan supplementation.

Disclosure of Interest

None Declared
Emotional Intelligence and Attention-deficit/hyperactivity disorder (ADHD)
Authors: Ben Turkia I. , Brahim T. , Sahli L.
Published: August 2023

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and adolescents. It is characterized by age-inappropriate inattention/impulsiveness and/or hyperactivity symptoms.

However, emotional symptoms are frequent in patients with ADHD and may, in some cases, be responsible for a major part of the negative impact on functioning and outcome.

It is now well established that a large number of children with ADHD and without any comorbid disorder exhibit symptoms of emotional lability.

Recently , given the importance of the impact of emotional symtoms , several authors have argued that emotional intelligence affects health and is essential for success in academics as well as life in general and it is defined as the ability to perceive, appraise, and express emotions; the ability to access and/or generate feelings when they facilitate thought; and the ability to regulate emotions to promote emotional and intellectual growth.

Objectives

•Our research aimed to evaluate and compare the emotional and social functioning of two groups of children, with and without ADHD , aged 6 to 19 .

Methods

•One hundred twenty child (N=60 ADHD, N = 60 Control cases) were assessed with the BarOn Emotional Quotient Inventory: Youth Version (BarOn EQ-i:YV™), providing an estimate of their underlying emotional and social intelligence.

•The BarOn EQ-i:YV is specifically designed to assess the coping skills, adaptability, and well-being of children and teenagers.

•Children with ADHD and control cases were compared with each other.

Results

•The results showed that the Emotional Quotient (EQ) was significantly lower in the group of children with ADHD (p=0.01).

•Also, our results showed that there are statistically significant differences in intrapersonal skills (p˂0.0010) Adaptability Scale(p=0.005) ; General Mood Scale (p=0.004) and positive impression (p = 0.001) of emotional intelligence between children with ADHD and control cases. Thus, the first group got lower scores than the second one in all aspects.

Conclusions

•ADHD is a disorder that affects the life quality of the person who suffers from it in the personal and social areas. Therefore, the emotional intelligence study in individuals with this diagnosis is important.

•And considering the fact that abilities associated with emotional intelligence can be learned and improved, emotional intelligence can be thought as a target for therapy by individualized education for patients with ADHD who have inadequate abilities compared to the healthy population .

Disclosure of Interest

None Declared
Drugs and high hospitalization rate: are they related?
Authors: Figueiredo I. M. , Cargaleiro I. , Nascimento M.
Published: August 2023

Introduction

Substance use continues to be an important problem among mental health patients either as main diagnosis or as comorbidity. Acute care visits, including emergency department visits and hospitalizations, related to substance use disorders (SUD) are increasing and can be opportunities to engage individuals to get proper treatment (Suen LW et al. J Gen Intern Med 2022; 37(10):2420–2428).

Both mental disorders and SUD lead to subsequent chronic physical conditions, premature death, suicide or overdose (Bennett AC. Public Health Rep 2019; 134(1):17-26) that can be accidental or not.

24% to 32% of patients with Substance Induced Psychosis develop later a schizophrenia spectrum disorder or bipolar disorder (Starzer MSK et al. Am J Psychiatry 2018;175(4):343–350) leading to a chronic use of medication and, in several instances, to a necessity of psychiatric in-patient treatment with long hospital stays and high readmission rates (Khan S. Health Reports (2017) 28(8)3-8).

Objectives

Our goal was to analyze if substance use is associated with higher psychiatric hospitalization rates.

Methods

An independent-samples t-test was run to determine if there were more hospitalizations among patients with substance use. Afterwards, the Cohen’s D was calculated to measure the effect size and to see the magnitude of the experimental effect.

Results

A sample of 2604 in-patient treatment episodes was used. The sample had 1696 female patients, 908 male patients and 823 patients had substance use. We found that patients with substance use had a statistically significant higher hospitalization rate (6.82±5.27) than the ones without it (5.32±4.84), t(1483)=6.945, p<0.001. Cohen’s effect size value (d=.30) suggested a small practical significance.

Conclusions

Our findings go mainly accordingly the literature; we found a significant effect of drugs on readmission rates (Böckmann V et al. Front Psychiatry 2019; 10:828) but we might have thought it would be bigger. That could be explain by undiagnosed substance use (refusal to admit the use, drugs not detected on lab tests, not requesting toxic lab tests) or higher sample percentage of confounding comorbid diagnoses.

However, is undoubtable the several risks that drugs bring to our health and so the authors aim to raise awareness among the medical community to the importance being alert for signs of use or psychiatric symptoms to avoid reaching a no turning point. It’s known that doctors frequently fail to diagnose SUD in hospitalized patients and given the linkage between use of certain substances and particular medical reasons for admission, it would be well-advised to search for SUD in certain admission diagnoses (Weintraub E et al. Am J Addict 2001;10(2):167-77). Knowledge of substance use behavior may help reducing relapse rates and to reduce the risk of developing a SUD (Andersson HW et al. Nordic Journal of Psychiatry, 75:3, 160-169).

Disclosure of Interest

None Declared
Telemedicine in Psychiatry: benefits and challenges of the the Home-Hospital Care system (COD20) project
Authors: Palazzo M. , Prodi T. G. , Cerioli M. , Conti D. , Galbassini A. , Nicolini G. , Dell’Osso B.
Published: August 2023

Introduction

Telepsychiatry (TP) is the use of telecommunication technologies to provide psychiatric assessment, diagnosis, treatment, and consultation. During the COVID-19 outbreak, TP has shown potential for connecting with people unable to access traditional in-person services, and also enabling patients to receive mental health care safely from home. The Home Hospital care system (Cure Ospedaliere Domiciliari; COD20) is a video consultation service developed by the University of Milan.

Objectives

We aimed at investigating the potential of Telemedicine (TM) in a sample of psychiatric patients.

Methods

As of now, 208 consecutive patients of an outpatient clinic belonging to ASST Fatebenefratelli-Sacco in Milan were interviewed through an online anonymous survey. Data collected were sociodemographic, job position, educational level, digital skills and both satisfaction degree and ease of use of the COD20 tool. Data were analyzed using SPSS v.27.

Results

Among 208 patients, 87.7% had Internet access, 94.5% used a smartphone, 74% used a computer and 37% used a tablet. The levels of digital skills were considered intermediate-advanced in communication and information research for the majority of the cases. A high percentage of patients (80.8%) learned how to use electronic devices by themselves, while only 12.3% had an ECDL certificate. The most represented diagnoses were Mood Disorders (44.5%) and Anxiety Disorders (14%). The majority of the sample (54.8%) was visited using TM for clinical interviews: 24.7% of them used TM at least 10 times/year, and 19.8% more than 20 times/year. Among all the clinical interviews conducted using TM, 61% concerned psychiatric consultation, while 30% were dedicated to psychotherapy. The most used tool was the COD20 platform (21.9%): it was considered easy to use in 47.9% of cases, while 43.8% of patients would like to use it again in the future. The main reasons leading to the usage of TM were the difficulties in reaching the ambulatory (for 43.9%) and the workplace (for 30%).

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Conclusions

TM represents a valid implementation in the traditional clinical practice, and we showed it is well received in terms of appreciation and ease of use. The COD20 platform could increase access to care, and overcome barriers such as distance, travel costs and time management. TP contributes to develop a more inclusive healthcare process for patients, with better performance in terms of compliance.

Disclosure of Interest

None Declared
Aggressive behavior and severe mental disorders in Prison psychiatry
Authors: Voulgaris A.
Published: August 2023

Introduction

Aggressive behavior can be understood as a compelx and social phenomenon. A number of studies have shown that the risk of aggressive behavior is increased for patients with severe mental disorders such as schizophrenia. Although specialized forensic institutions exist in many countries, most offenders with mental disorders are still found in prison settings what corresponds to international literature suggesting an increased prevalence of mental disorders in prison inmates. Still, data on the specific characteristics of patients demonstrating aggressive behavior in medical and mental health settings is limited, especially for prison environments.

Objectives

The aim of our study was to identify patient characteristics that are potentially associated with aggressive incidents in a prison psychiatric setting.

Methods

In routine documentation in German prisons, specific incidents, as e.g. aggressive behavior are reported through an official reporting system. Analyzing these official reports, we collected all aggressive incidents concerning at the Department of Psychiatry of the Berlin prison hospital between 1997 and 2019. In addition, for each patient acting aggressively, we collected data on an equal number of patients who did not demonstrate this behavior during their hospital stay. For those patients with more than one inpatient treatment period, only the first stay in the prison hospital was included. Furthermore, patients were excluded based on age (younger than 16 or older than 70) or death during treatment. The statistical data was analyzed descriptively.

Results

In total, 225 treatment episodes were included of which in 118 cases violent behavior were documented. The items older age, German citizenship, previous violent crimes (OR = 0,40, 95 % KI: 0,35 – 1,17) and antipsychotic (OR = 0,28, 95 % KI: 0,14 – 0,55) or antidepressant (OR = 0,35, 95 % KI: 0,13 – 0,88) treatment within six months prior to admission had a rather protective effect on the occurrence of aggressive behavior during inpatient treatment. Alcohol (OR = 1,21, 95 % KI: 0,64 – 2,27) and drug use disorders (OR = 2.18, 95 % KI: 1,09 – 4,44) tended to be risk factors for aggressive behavior. Thus, the results in this prison psychiatric population correspond to the risk factors described in the literature.

Conclusions

The reported results point in the direction that optimising the availability of psychopharmacological treatment options and offering specialized treatment for patients with comorbid substance use disorder may lead to the prevention of aggressive behavior in patients with a schizophrenia diagnosis.

Disclosure of Interest

None Declared
Promoting occupational justice policies in mental health organizations: A model based on the experiences of mental health rehabilitation consumers and employees
Authors: Cohen H. , Schreuer N. , Vashdi D. R.
Published: August 2023

Introduction

: Occupational justice (OJ) regards the human right to be engaged in meaningful life occupations (work, leisure, learning, house management etc.). It highlights the idea that all society members should be able to actively participate in all occupations as equals. Yet, people with mental health problems remain at the margins of society and struggle to fully participate in life activities. At the same time, such participation has been shown to lead to better functional abilities, higher quality of life, and better illness management among this population. It provides routine, connectedness, belonging, purpose, and identity. Moreover, impaired occupational participation due to mental health problems has resulted in functional impairment, symptomatic deterioration, loss of social roles, and a reduced sense of competence. Despite the importance of such participation, it is unclear in many mental health rehabilitation service organizations how to design policies that will achieve better occupational participation for their consumers.

Objectives

To better understand the OJ concept and to create a conceptual model pertaining to the challenges and solutions, which may serve policy makers as a theoretical basis for enhancing OJ based policies.

Methods

We conducted a qualitative phenomenological study that included in-depth interviews with mental health rehabilitation consumers, to identify their experiences and perceptions in relation to OJ and focus groups with rehabilitation employees and managers. Data analysis was a multi-staged process using a systematic and inductive procedure.

Results

Based on our analysis, the three key themes clarifying the interviewees’ experiences with the OJ concept were a) the importance of and barriers for achieving meaningful participation, b) the required resources for implementing OJ, and c) principles for practice. These elements comprise a holistic OJ construct, affording a practical understanding of what a service that implements OJ means. Such a service would use the resources and practices discussed in this study and address meaningful participation as the desired outcome to achieve.

Conclusions

Unlike other forms of justice, OJ emphasizes the need for flexible and tailor-made services that address the consumer’s changing needs and circumstances. It considers the consumers’ role as active rather than passive service recipients. Recently, the fields of health and rehabilitation have increasingly acknowledged the importance and applications of involving consumers. Their genuine involvement would enhance OJ and provide a basis for more accurate assessments and customized interventions.

Disclosure of Interest

None Declared
Establishing priorities for a Mental Health strategy in Castilla y Leon: The cohesion of professionals and society
Authors: Pelayo-Terán J. M. , Zapico-Merayo Y. , Saez Aguado A. M. , Villa Carcedo R. , Álvaro Prieto Á.
Published: August 2023

Introduction

The reform of mental health care is a key health policy target. Mental health care provision in Spain is designed with national and regional strategies that stablish the objectives to develop. The Castilla y Leon regional strategy 2022-2026 aim to stabilsh the priorities for objectives and actions with stakeholders from th eregional society.

Objectives

To evaluate priorities in the implementation of a Mental Health strategy with the consensus of professionals and society.

Methods

An initial consensus was achieved with the regional health goverment and local mental health representatives, considering the 2022-2026 national strategy and other mental health plans from nearby regions. Lines in the strategy included transversal lines (part of all the mental health scope) and action lines (priorities focused in one relevant field)

Priorities were stablished by different representatives from mental health and other healthcare professionals, social and educational stakeholders, scientific societies, people with mental health disorders and families. After agreeing to participate in the process, they had to answer an online survey. For each line, they have to score from 0 to 10.

Results

500 subjects participated (44% Healthcare workers, 5.8% education or social services, 3.8% Justice, 8,6% workers for associations, 14% Mental Health Care users). All the lines were highly appreciated (mean score >7). Within the transversal lines, the highest score was for the Humanization line (8.81±1.43) and the lowest for the Digitalization line (7.18±1.92). In the Action Lines, the highest score was for Suicide (9.03±11.5) and the lowest for Elder people (8.04±1.94).

Prevention line had higher scores by Education, Justice, Associations and Healthcare professionals and the lowest was for users (F: 2.754; p=0.012). In the Digitalization line the higher scores were in the health professionals and scientific societies and the lowest in the users (F:4.665; p<0.001). In the research, innovation and Training line, the higher scores were for professionals, societies and users and the lowest in the education and justice groups. The only differences found in the Action lines was for the Addiction line, with higher scores for societies, social services, professionals and users and lower in Associations and Justice (F:2.219; p=0,040)

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Conclusions

Highest transversal priority for the MH Strategy was Humanization of Mental Health Services, and the most critical action was Suicide prevention. Professionals, Scientific societies and Users considered more important research, innovation and training compared with other society groups, whereas the less important areas for the users were digitalization and prevention users. These priorities will help to design the implementation and schedule for the lines of the Mental Health Strategy in Castilla y León.

Disclosure of Interest

None Declared
A Pragmatic Approach to define “DIFFICULT TO TREAT” patients
Authors: Nascimento M. , Lourenço A. , Falcão A. L. , Soares G. , Rodrigues C. , Petta J. , Oliveira C.
Published: August 2023

Introduction

Multiple definitions for “difficult to treat” patients (DTP) were given throughout the years. While most authors focus on diagnoses, others focus on clinical, social and demographic factors, which should be regarded as factors of bad prognosis and elevated costs for the healthcare systems.

Objectives

To identify and haracterize DTP patients admitted in acute ward, based on practical criteria.

Methods

Through the hospital’s IT services, all acute inpatient episodes at Centro Hospitalar Psiquiátrico de Lisboa were collected, since 2017. Cluster analysis was performed, regarding number of previous admissions (PA) and days of admission. Descriptive and comparative statistics (with multiple comparisons) for the different clusters, regarding age, gender, diagnosis at discharge (according to ICD10), and, to the DTP, previous medical following, compliance to medication, and substance use at admission.

Results

Three clusters were identified: (C1, n=5861) a larger, uncharacteristic one; (C2, n=1168) with a higher number of PA (average of 8, versus less than 2 on the others); and (C3, n=1462) with higher number of days of admissions (58 versus less than 16). Statistical significance was found regarding age (higher in C3), gender (more men in C2), nationality (C1 with more foreigners). Regarding diagnosis at discharge, statistical difference was found between the 3 groups: C1 has significantly less patients with Schizophrenia (11% versus 30% in the others), but more depressive (21% versus 6% in C2 and 12% in C3) and neurotic disorders. C2 presented less dementias (0,5% versus 3% in C1 and 10% in C3) and delusional disorders, but more bipolar disorders (24% versus 15% in C1 and C3); C3 represented less episodes due to substance abuse (alcohol or others) and personality disorders. In both C2 and C3, no psychiatric consultation happened in the 3 months prior admission to around 40% of episodes, and 50% had stopped medication. The majority had only oral medication. Almost 24% of C2 tested positive for cannabinoids, with no differences regarding other substances.

Conclusions

These findings allow the definition of 2 kinds of DTP, which present unique characteristics but some common features (namely poor adherence to consultations and are in therapeutic compliance). An assertive multidisciplinary approach, focused on current treatment and relapse prevention (including social structures, more frequent clinical follow-up, and rehabilitation centers), will be the key to their treatment.

Disclosure of Interest

None Declared
Depression, anger and coping strategies of students in polish medical faculties
Authors: Wizner M. H. , Kawalec A. , Rodak N. , Wilczyński K. M. , Janas-Kozik M.
Published: August 2023

Introduction

Stress related to high expectations towards students, a large amount of knowledge necessary to assimilate in a brief period of time, and peer pressure are an important factor in the deterioration of the mental state of medical students. As a consequence, it can lead to burnout and even the development of mental disorders such as depression. Mechanisms of coping with difficulties play an extremely important role in moderating this risk. For this reason, it was of the interest what strategies medical students adopt in the face of everyday stress and how it affects their well-being and functioning.

Objectives

The objective was to determine how medical studies impact mental health of students and what coping strategies are used by them to mitigate the negative influence of stress associated with high expectations, peer pressure and overwork.

Methods

A cross-sectional study was conducted among students of polish medical faculties using an online questionnaire. Risk of depression was assessed using validated BDI inventory, aggression using STAXI inventory and evaluation of coping strategies was conducted with Brief-COPE inventory.

Results

Study was conducted among 329 participants. The majority of respondents were female (71.4%; n=235) and average age in the whole population equaled 22.46 years (95%CI: 22.1-23.01). There was no statistically significant difference in age between females and males. Average outcome in BDI equaled 13.84 (95%CI: 12.8-14.8) with higher levels among females (13.84 vs. 12 p<0.05). 165 (49.6%) students had a score above threshold for the increased risk of depression while 32 (9.63%) for severe symptoms of it. In case of aggression average outcome of STAXI equaled 24.89 (95%CI: 22.6-27.1). There was a statistically significant correlation between STAXI and BDI (r=0.3; p<0.05). In terms of the coping mechanisms in terms of coping strategies, a clear advantage of approach strategies was observed (65.36% of respondents). In the multiple regression analyses coping strategies did not influence neither STAXI nor BDI outcomes.

Conclusions

What draws attention are the high level of depression among the surveyed students, where over 50% show results above the cut-off point for an increased risk of a depressive episode. The advantage of approach strategies is also interesting, especially in terms of planning strategies and positive reformulation. Interestingly coping strategies in the analysed population did not constitute a significant protective factor in relation to the severity of the depressive symptoms and agression. Meanwhile, the sense of satisfaction and contentment with the chosen direction was a very good protective factor in terms of the severity of depressive symptoms.

Disclosure of Interest

None Declared
Global signal topography of the depressive syndrome in bipolar disorder
Authors: Gulino G. , Scalabrini A. , Paolini M. , Palladini M. , Benedetti F.
Published: August 2023

Introduction

Previous findings show that the depressive state is characterized by a peculiar suppression of the resting state functional connectivity (rsFC) anti-correlation between resting-state networks (e.g., Default Mode Network) and task-positive networks (e.g., Sensory-Motor Network) in favor of an abnormal positive rsFC pattern. This suggests a large-scale functional disbalance in adaptively switching the attentional focus from an internal-oriented cognitive modality to an external-oriented processing modality. Yet, according to further evidence, such a functional inversion is primarily driven by the global signal (GS) (i.e., by an abnormal large-scale topographical reconfiguration) in major depressive disorder (MDD). However, it is not clear if similar alterations may affect bipolar disorder (BD) in depressive phase.

Objectives

Investigation of the global topography of the depressive syndrome as a potential transnosographic endophenotype and evaluation of the GS on generating differences between groups.

Methods

We compared large-scale rsFC patterns in a group of healthy controls (HC) (n=70) and a group of patients with BD (n=70) during a depressive episode. In order to investigate the impact of the GS, we further performed all analyses both with and without GS regression (GSR).

Results

Compared to HC, patients with an ongoing major depressive episode exhibit specific resting-state changes that are only observed when analysis is performed without regressing GS. Patients were found to exhibit an (i) abnormally strong GS contribution within an extended cluster comprising regions known to be part of highly interconnected hubs (i.e., transmodal networks) and showing functional relations’ core along the cortical midline and a (ii) diminished influence of the GS in correspondence of frontoparietal and occipitotemporal regions. Notably, no traces of such changes -differentiating the global topography of patients from HC- held when applying GSR.

Conclusions

Our results (i) suggest that rsFC alterations detected stem from a global rather than a local source and (ii) corroborate the impact GS can exert on generating within and between-networks differences. Hence, we underline the necessity that future investigations on groups with expected altered topographical distribution include GS within data-analysis and a proper evaluation of its involvement. Nonetheless, our results are in line with previous evidence of altered global topography in MDD. Hence, we interpreted this finding as a benchmark of a whole-brain functional disbalance toward self-oriented cognition characterizing the transnosographic depressive syndrome.

Disclosure of Interest

None Declared
Telephone-Delivered Interventions for Suicide Prevention in Schizophrenia and Related Disorders: A Systematic Review
Authors: Comendador Vázquez L. , Cebrià A. I. , Sanz A. , Pérez V. , Palao D. J.
Published: August 2023

Introduction

Suicide is a health concern among individuals diagnosed with schizophrenia. Telehealth technology has become an emerging intervention that may afford opportunities for reaching this at-risk group. Consideration of the implementation of telehealth systems in the treatment of patients diagnosed with schizophrenia and suicidal behavior calls for a review of the evidence.

Objectives

The present aim was to explore the literature on the effectiveness of suicide prevention telephone delivered interventions among patients with schizophrenia and related disorders.

Methods

The bibliographic search was performed in the electronic databases PubMed, PsycInfo, Scopus, and Web of Science following PRISMA guidelines. Two reviewers independently conduct screenings, data extraction and methodological quality assessment. A total of 352 articles were retrieved, of which five studies met the eligibility criteria.

Results

Based on the limited data available, the use of modalities involving telephone contacts appears to be feasible in patients with schizophrenia and suicidal behaviors. In addition, preliminary evidence suggests this system appears to reduce suicidal ideation.

Conclusions

The current data presented here reflect an early stage of effectiveness of telephone-delivered interventions targeted at suicide prevention in patients with schizophrenia. Further research is needed to design evidence-based future interventions and to determine whether this approach can improve patient outcomes.

Fundings: This work was supported by the Instituto de Salud Carlos III (grant number: PI19/01484 SURVIVE).

Acknowledgements: SURVIVE project (PI19/01484).

Keywords: schizophrenia, suicide, telehealth, monitoring.

Disclosure of Interest

None Declared
Individual psychotherapy may help to reduce suicidal ideation in first episode psychosis: results from a 2-year Italian follow-up study
Authors: Pelizza L. , Leuci E. , Quattrone E.
Published: August 2023

Introduction

Suicidal thinking is relevant in patients with First Episode Psychosis (FEP). However, longitudinal studies specifically examining treatment response for suicidal ideation in FEP are still relatively scarce, especially with long-term design and in real-world clinical settings.

Objectives

The aims of this research were (A) to longitudinally assess suicidal thoughts in people with FEP along a 2-year follow-up period and (B) to overtime investigate any significant association of suicidal ideation levels with the specific treatment components of an ‘Early Intervention in Psychosis’ (EIP) protocol along the 2 years of follow-up.

Methods

At entry, 232 FEP participants (aged 12–35 years) completed the Brief Psychiatric Rating Scale (BPRS), including a ‘Suicidality’ item subscore. Multiple linear regression analysis was then performed.

Results

Across the follow-up, FEP subjects showed a relevant decrease in suicidal thinking levels overtime. This was specifically predicted by the total number of individual psychotherapy sessions offered within the 2-year EIP protocol and antidepressant dose (at least as regards the first year of our intervention).

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Conclusions

Suicidal ideation is clinically relevant in FEP but seems to improve overtime together with the provision of specific, patient-tailored and integrated EIP treatments, especially individual psychotherapy.

Disclosure of Interest

None Declared