bluuebunny/crossref_metadata_2025 huggingface dataset:
Applying the Surgical Checklist Approach for Psychiatric Trainees to a Busy, Time Sensitive Psychiatric Crisis Environment
Authors: Celentano L. , Sadeghpour A. , Durand D.
Published: August 2023

Introduction

The Jackson Hospital Crisis (Psychiatric ED) Center serves the entirety of Miami-Dade County in Florida and is considered one of the top three busiest and per capita of clinical staff likely the busiest nationally across the United States. Simultaneously, the management of mental health emergencies has ascended near the top of international priorities driven by multiple trends (e.g., growing social isolation associated with the pandemic, de-stigmatization). The crisis environment presents a uniquely difficult challenge in applying high quality medical care: frequent suicidal gestures, impulsive often intoxicated or psychotic patients, unprecedented demand, diminishing staff capacity, and requirements to consistently apply specific medical and psychiatric protocols. These challenges are specifically difficult for new trainees who are not yet accustoms to the high acuity situations found in psychiatry. Moreover, academic, institutional, and governmental policies change on a monthly, or even weekly basis, often with the objective of improving care. Nevertheless, such constant shifts in workflow result in opportunities for errors that impact patient trajectories.

Objectives

As such we endeavored to apply an evidence-based approach to improving the likelihood of success. One such vetted approach, the use of checklists, benefits from 10+ years of peer-reviewed research in “operational” medical specialties (e.g., surgery, ED, ICU) where work is segmented around interventions or time-shifts which share commonalities with the Psychiatric ED model. Yet the difficulty in implementing such models is typically not in the “hard” aspects of defining the checklist, but in the “soft” implementation dimensions of syndication, distribution, and enablement in the context of the individual unique settings.

Methods

We developed a checklist that will be implemented on the Jackson Crisis emergency department, with the aim of having first year trainees complete the check list on each individual patient. Surveys were administered before implementation of checklist and will be distributed on a quarterly basis to trainees to evaluate for changes in resident confidence and clinical care.

Results

Over six months, we launched this initiative with drivers of adoption focused on accelerating and easing new resident training, safety incident targeting, and in the balancing of “push” top/down and “pull” bottom/up dynamics. Initial learnings include rapidly improving resident satisfaction as well as various other impacts currently being observed throughout the institution.

Conclusions

Overall reception to the checklist has been positive from attendings and new trainees alike, further evidence will be analyzed and presented as the checklist is utilized throughout the psychiatric ED.

Disclosure of Interest

None Declared
Antiviral and Anti-Inflammatory Activities of Fluoxetine in a SARS-CoV-2 Infection Mouse Model
Authors: Péricat D. , Leon-Icaza S. A. , Sánchez-Rico M. , Mühle C. , Zoicas I. , Schumacher F. , Planès R. , Mazars R. , Gros G. , Carpinteiro A. , Becker K. A. , Izopet J. , Strub-Wourgaft N. , Sjö P. , Neyrolles O. , Kleuser B. , Limosin F. , Gulbins E. , Kornhuber J. , Meunier E. , Hoertel N. , Cougoule C.
Published: August 2023

Introduction

The coronavirus disease 2019 (COVID-19) pandemic continues to cause significant morbidity and mortality worldwide. Since a large portion of the world’s population is currently unvaccinated or incompletely vaccinated and has limited access to approved treatments against COVID-19, there is an urgent need to continue research on treatment options, especially those at low cost and which are immediately available to patients, particularly in low- and middle-income countries. Prior in vitro and observational studies have shown that fluoxetine, possibly through its inhibitory effect on the acid sphingomyelinase/ceramide system, could be a promising antiviral and anti-inflammatory treatment against COVID-19.

Objectives

The aim of this sudy was to test the potential antiviral and anti-inflammatory activities of fluoxetine against
SARS-CoV-2 in a K18-hACE2 mouse model of infection, and against several variants of concern in vitro, and test the hypothesis of the implication of ceramides and/or their derivatives hexosylceramides.

Methods

We evaluated the potential antiviral and anti-inflammatory activities of fluoxetine in a K18-hACE2 mouse model of SARS-CoV-2 infection, and against variants of concern in vitro, i.e., SARS-CoV-2 ancestral strain, Alpha B.1.1.7, Gamma P1, Delta B1.617 and Omicron BA.5.

Results

Fluoxetine, administrated after SARS-CoV-2 infection, significantly reduced lung tissue viral titres (Figure 1) and expression of several inflammatory markers (i.e., IL-6, TNFα, CCL2 and CXCL10) (Figure 2). It also inhibited the replication of all variants of concern in vitro. A modulation of the ceramide system in the lung tissues, as reflected by the increase in the ratio HexCer 16:0/Cer 16:0 in fluoxetine-treated mice, may contribute to explain these effects (Figure 3).

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Conclusions

Our findings demonstrate the antiviral and anti-inflammatory properties of fluoxetine in a K18-hACE2 mouse model of SARS-CoV-2 infection, and its in vitro antiviral activity against variants of concern, establishing fluoxetine as a very promising candidate for the prevention and treatment of SARS-CoV-2 infection and disease pathogenesis.

Disclosure of Interest

None Declared
Brain correlates of perceived cognitive impairment after covid-19 infection: a multimodal MRI study.
Authors: Bettonagli V. , Paolini M. , Palladini M. , Mazza M. G. , Rovere Guerini P. , Poletti S. , Benedetti F.
Published: August 2023

Introduction

Many different long-term neuropsychiatric sequelae of the novel Coronavirus have been described after the pandemic outbreak. One of the most common symptoms in the months following infection is related to “brain fog”. This condition includes several signs of cognitive impairment like mental slowness, deficits in attention, executive functions, processing, memory, learning, and/or psychomotor coordination, which can be perceived on a subjective level and further confirmed by objective data. Since this kind of mental status has been documented in previous viral infections, and the SARS-COV-2 has been characterized by a worldwide diffusion, investigation into this condition in post-covid individuals is warranted. Currently, several hypotheses on its pathophysiology have been put forward, mostly hypothesizing a direct effect of the virus on the central nervous system or indirect consequences of the inflammatory response.

Objectives

The aim of our research is to analyze brain correlates of subjective cognitive complaints in Covid-19 survivors using multimodal brain imaging.

Methods

We performed a voxel-based morphometry (VBM) and a resting state functional connectivity analysis on 60 post-COVID-19 individuals recruited from the San Raffaele Hospital in Milan, that underwent a 3 tesla MRI scan. We assessed the perceived cognitive impairment both after the infection and at the time of the MRI scan through the PROMIS Cognitive Abilities scale. The difference of the two scores (delta PROMIS) was calculated as a measure of cognitive improvement over time.

Results

We found the perceived amelioration of cognitive abilities (delta PROMIS) to be positively associated to grey matter volumes in the bilateral caudate, putamen and pallidum (pFWE: ˂0.001). Moreover, in the resting state fMRI analysis, subjective cognitive status at MRI was found to be associated with functional connectivity between the right putamen and pallidum, and two clusters belonging to the attentional (pFWE: ˂0.001) and salience (pFWE: 0.02) networks.

Conclusions

This is one of the first studies investigating brain correlates of subjective cognitive impairment after COVID-19 infection; our main finding is the convergence of structural and functional results on brain areas located within the basal ganglia, implying their possible role in the pathophysiology of the condition. Moreover, this research could be interpreted as the first step toward understanding a very complex condition, with potential implications for the development of treatment and neurorehabilitative strategies.

Disclosure of Interest

None Declared
Comparison of VR-Assisted Therapy to Cognitive-Behavioral Therapy in the treatment of verbal hallucinations in patient with treatment-resistant schizophrenia
Authors: Beaudoin M. , Potvin S. , Dumais A.
Published: August 2023

Introduction

Auditory verbal hallucinations (AVH), which often present in individuals with schizophrenia, can cause great psychological distress. Although antipsychotic medication can reduce AVH, 30% of patients will be resistant. Treatment resistance could be associated with important consequences, and there are only few treatment alternatives. Unfortunately, more than 50% of patients will not respond favorably to the best available psychological therapy, cognitive-behavioral therapy (CBT). However, using virtual reality (VR), our research team has adapted a therapy whose goal is to recreate the faces and voices of the patients’ persecutory voices as avatars. By interacting with an external representation of their hallucinations, patients implement new strategies to control their voices and to regulate their emotions. A small clinical trial (proof of concept) has demonstrated the safety and validity of this therapy as well as its superiority compared to the usual treatment.

Objectives

(1) To verify whether VR-Assisted Therapy (VRT) is superior to CBT for the treatment of AVH; and (2) to examine the effects of VRT and CBT on the symptomatology and quality of life.

Methods

For this single-blind randomized controlled clinical trial, 136 patients will by recruited (68/intervention) The effects on psychotic symptomatology as well as on quality of life is assessed using standardized questionnaires. Patients are included if they hear persecutory voices and have not responded to at least 2 trials of antipsychotics. Both groups are randomized from an external site and begin with an initial clinical assessment prior to randomization. Participants then receive 9 weekly one-hour therapy sessions (CBT or VRT), beginning the following week. A second clinical evaluation is carried out one week after the last session. A linear mixed effects model will be used to compare the effects of the 2 interventions.

Results

Results from a pilot randomized comparative trial evaluating the short- and long-term efficacy of VRT over CBT for patients with treatment-resistant schizophrenia (N=37/group) showed that both interventions produced significant improvements in AVH severity and depressive symptoms. Although results did not show a statistically significant superiority of VRT over CBT for AVH, VRT did achieve larger effects particularly on overall AVH (d = 1.080 for VRT and d = 0.555 for CBT). The recruitment of the current clinical trial is in progress.

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Conclusions

VRT, which is currently under clinical investigation, presents itself as an interesting complement to existing pharmacological treatments. Since VR technologies allow the recreation of scenarios that are nearly impossible to reproduce in real life, VR-assisted psychotherapy could eventually become an integral part of our clinical practices.

Disclosure of Interest

None Declared
Striatal ups or downs? Neural correlates of monetary reward anticipation, cue reactivity and their interaction in gambling disorder and alcohol use disorder
Authors: Goudriaan A.
Published: August 2023

Striatal dysfunction is a key characteristic of addictive disorders, but neuroimaging studies have reported conflicting findings. An integrative model of addiction points to the presence or absence of addiction-related cues as an explanation for striatal hypo- or hyperactivations, respectively, but has never been directly tested. Here, we developed a novel paradigm to investigate striatal activation during monetary reward anticipation in the presence versus absence of addiction-related pictures using functional MRI. Across two studies, we compared 24 gambling disorder (GD) patients with 22 matched healthy controls and 46 alcohol use disorder (AUD) patients with 30 matched healthy controls. A behavioral interaction was seen where gambling cues made participants respond faster for bigger, but slower for smaller rewards. During monetary reward anticipation, hypoactivation of the reward system was seen in AUD individuals compared to HCs. However, no striatal differences were seen between the participants with GD or AUD and their matched controls. In sum, these findings suggest that striatal dysfunction is a key but heterogeneous mechanism within both AUD and GD and indicate an important but complex role for addiction-related cues in explaining striatal dysfunction in addiction.

Disclosure of Interest

None Declared
Reducing Inequality for Persons with Disabilities: Demystifying the ‘and’ Between Disability and Development
Authors: Gairola V.
Published: August 2023

Introduction

The aim of this paper lies in demystifying, historicizing, and de-alienating the relationship between disability and development. Both disability and development inform each other and are informed by each other in various ways which are on one hand similar and on the other hand unique. Disability is heterogeneous in nature. Disability and development are about power, access, solidarity, advocacy, inequality, rights, voice, and support. It is about accessing accessibility. It is important to understand the politics of language—how we conceptualize persons with disabilities.

Objectives

The paper theorizes the ‘and’ between disability and development. What is that bridging telling us? There is already an invisible ‘and’ which joins disability and development even before this visible ‘and’ was placed in between them. It is to understand how disability is related to gender, caste, class, and poverty. The paper also looks at the government policies and adds suggestions as to what can be done practically to reduce inequality for persons with disabilities for developing a new India.

Methods

This research used primary sources like books, articles, government programmes, and policies to make sense of how disability is understood and experienced in India.

Results

It shows how disability and development inform each other and are informed by each other. The paper shows how each person has disabling parts and “normal” parts. Representation helps one to know the multifarious dimensions of what is awful, reprehensive, acceptable, possible, desirable, etc. Representation structures reality. Hence, they are a critical component of bringing about rights.

Conclusions

It is crucial to look at the needs and challenges at the ground level contextually. It is important to understand why survival is considered sufficient and not full participation. Policies need to resonate culturally as otherwise, they tend to be confined to particular lases and groups in societies with access to technology, information, and the English language. What matters is the visibility of disability.

Disclosure of Interest

None Declared
Neuroimaging studies of addiction: The need to incorporate real life data and profile
heterogeneity
Authors: Sescousse G.
Published: August 2023

Neuroimaging studies of addiction seek to understand the brain mechanisms that
predispose to and support the maintenance of addictive behaviors. Traditional studies are
case-control cross-sectional studies, i.e. they conceptualized
individuals suffering from addiction as a homogenous group, and report lab-based experiments
conducted at one particular point in time. In this talk, I will argue that a refined
understanding of addictive behaviors requires the use of dimensional
longitudinal studies. Using dimensions will reveal the existence of
heterogenous profiles within diagnostic groups, and allow
researchers to incorporate individual variability in their models.
In turn, using longitudinal follow-up measures should allow researchers to determine whether
brain-related abnormalities are predictive of symptoms in
real-life. I will illustrate these points using a few example
studies from the literature.

Disclosure of Interest

None Declared
Fear of COVID-19 and severity of particular autistic traits in the general population.
Authors: Bieczek D. M. , Ściślicka A. I. , Bobowska A. V. , Tomsia F. M. , Wilczyński K. M. , Janas-Kozik M.
Published: August 2023

Introduction

A lot of issues have raised since the beginning of the pandemic and doctors had to learn how to deal with increasing problems of stress and anxiety. The new situation was a great threat to one’s safety and some more vulnerable people could experience a higher level of anxiety. Patients with autistic traits might be more prone to it. It is essential to find out who is more exposed and who will require additional care.

Objectives

The aim of this study was to assess the level of fear of COVID-19 and explore its possible correlation with the severity of the particular autistic traits in the general population.

Methods

The study was conducted online, utilizing the questionnaire consisting of Autism-Spectrum Quotient (AQ) to assess the severity of autistic traits (social skills, attention switching, attention to detail, communication and imagination) and questionnaire FCV-19S that was used to assess the level of fear of COVID-19. Access to the questionnaire was possible from 16.02.2021 to 11.06.2021 and 214 unique records were gathered during this period.

Results

In the multiple regression (R2= 0,16, p<0,0001) a positive relationship between the level of felt fear of COVID-19 and the severity of difficulties with attention switching (p=0,006) and age (p=0,000015) was found.

Conclusions

People with higher severity of problems with attention switching demonstrated higher levels of fear of COVID-19 due to cognitive stiffness and disturbances in the regulation of emotions. Older people presented a higher level of fear as well.

Disclosure of Interest

None Declared
Substance use: comparison between the pandemic period and post-pandemic
Authors: Abu Shehab A. H. I. , Mihai T. , Bulgaru I. D. , Gheorman V. , Voinescu D. C. , Ciubară A.
Published: August 2023

Introduction

Substance abuse is a pattern of compulsive substance use that is accompanied by repeated substantial interpersonal, social, professional, or legal negative effects, such as repeated absences from work or school, arrests, or marital issues.

Objectives

The study aims to show the influence of psychological factors among the consumption of alcohol in the general population.

Methods

A retrospective study that was conducted at the “Elisabeta Doamna” Psychiatry hospital of Galati, Romania. The study shows the fluctuations in hospital admissions of patients with alcohol related disorders in the period November 2020 till September 2022.

Results

The study was conducted to show the difference in the number of admissions before and after the date of 1st March 2022, which is the date when the authorities in Romania have lifted the restrictions that were implemented to reduce the spread of Covid_19 virus. The number of total cases in the period between the 1st of November 2020 and 28th of February 2022 were 672 patients, from which 518 patients were males from Urban areas. In the period between the 1st March 2022 and the 1st of September 2022, the number of patients that were admitted due to substance use were 232 cases. This shows a significant decrease in the number of admissions that can be related to the decrease of psychological stressing factors that were accompanied with the restriction measure of the pandemic.

Conclusions

Overall, the results of this retrospective study suggest that the prevalence of adult substance use has declined with the decrease of the restriction measures that were imposed by the authorities. Monitoring and ongoing surveillance of substance use will be necessary over the years following the pandemic.

Disclosure of Interest

None Declared
Predicting Depression Severity from Spontaneous Speech as Prompted by a Virtual Agent
Authors: König A. , Mina M. , Schäfer S. , Linz N. , Tröger J.
Published: August 2023

Introduction

One of the major challenges in clinical psychiatry remains the absence of well established objective measures of symptoms’ severity. Clinical insights are mainly provided through keen behavioral observation and subjective questionnaires and scales.

Objectives

The aim of this paper is to predict depression severity through speech using the features extracted from the speech as provided by participants during a semi-structured dialogue with a virtual avatar.

Methods

We use data from a subset of the DAICWOZ dataset consisting in 142 dialogues between participants and a virtual avatar during which the avatar uses several prompts to maintain a conversation with the participant. The avatar uses prompts involving the topics of travel, dream jobs, and memorable experiences. From the speech generated from the dialogue, we extract participant utterances separated by prompt and extract features from the three sets of transcripts. We extract content features from the transcript and acoustic features from the excerpt corresponding to the speech from the participant for the prompt in question.We perform regression experiments on the PHQ8 items using the features extracted from each set of transcripts. Furthermore, we combine the features extracted from each set of transcripts and compute partial spearman correlations between them and the PHQ8 items using gender as a covariate.

Results

With our best regression model we obtain an R2 of 0.1, explaining 10% of the variance in the PHQ total score. Additionally, we obtain a mean absolute error of 1.25, suggesting that the regressor can detect with more or less precision clinically meaningful differences in depression severity between participants. Partial correlations between the total score and the features show significant correlations between features dependent on the amount of speech generated by each participant, along with the complexity of syntactic structures used.

Conclusions

Automatic analysis of spontaneous speech could help with the detection and monitoring of signs of depression. By combining the use of this technology with timely intervention strategies for instance provided by a virtual agent it could contribute to timely prevention.

Disclosure of Interest

A. König: None Declared, M. Mina Employee of: ki:elements GmbH, S. Schäfer Employee of: ki:elements GmbH, N. Linz Shareolder of: ki:elements GmbH, Employee of: ki:elements GmbH, J. Tröger Shareolder of: ki:elements GmbH, Employee of: ki:elements GmbH
Early Outcomes of Repetitive Transcranial Magnetic Stimulation in Complex Clinical Population
Authors: Samokhvalov A. V. , Weber M.
Published: August 2023

Introduction

Repetitive Transcranial Magnetic Stimulation (rTMS) is a new emerging neuromodulation treatment that has been tried for multiple psychiatric conditions [1, 2]. Its major approved application is treatment-resistant depression (TRD) [1]. At the same time there is a perceived potential for its use for other clinical conditions, primarily other mood and anxiety disorders [2]. At Homewood Health Centre we have been using rTMS as an adjunct treatment for patients with TRD and multiple comorbidities.

Objectives

To evaluate the effectiveness and feasibility of rTMS in complex clinical populations.

Methods

Observational study. Quick Inventory of Depressive Symptomatology (QIDS). Generalized Anxiety Disorder Questionnaire (GAD-7). Descriptive statistics.

Results

We have treated 30 patients, 12 women (40%) and 18 men (60%), with average age of 42.0±15.6 years. All patients had a primary diagnosis of major depressive disorder. The standard questionnaires were used to quantify the severity of depressive symptoms (QIDS) and anxiety (GAD-7). The average baseline scores for depression and anxiety were 16.1±4.9 and 15.0±4.4, respectively. The patients received an average of 28.1±5.1 treatments. All patients but one received the full course of treatment as planned. The average end-of-treatment (EoT) scores for severity of depressive symptoms and anxiety were 9.6±6.5 and 7.3±5.3, respectively. The rates of improvement and remission for depressive symptoms were 66.7% and 36.7%, respectively. The rates of improvement and remission for anxiety symptoms were 76.9% and 30.8%, respectively.

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Conclusions

Our data indicate that rTMS provides significant improvement and recovery rates in complex clinical populations and is well-tolerated. While further research is required, we recommend wider implementation of rTMS for treatment of mood and anxiety disorders.

References

1. Brunoni AR, Chaimani A, Moffa AH, Razza LB, Gattaz WF, Daskalakis ZJ, Carvalho AF: Repetitive Transcranial Magnetic Stimulation for the Acute Treatment of Major Depressive Episodes. JAMA Psychiatry 2017, 74(2):143.

2. Somani A, Kar SK: Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far. Gen Psychiatr 2019, 32(4):e100074.

Disclosure of Interest

None Declared
Euthanasia and assisted suicide (EAS) in psychiatric patients
Authors: Pedro Felgueiras P. , Silva R.
Published: August 2023

Introduction

A legal definition for EAS describes this procedure as “intentionally terminating life by someone other than the person concerned, at the latter’s request”. The number of requests for EAS has been progressively increasing in countries where this procedure is allowed, including concerning psychiatric patients (2% of all requests). EAS for reasons of unbearable suffering raises ethical concerns due to lack of criteria for psychiatric patients.

Objectives

To discuss the avaliable data about EAS and its controversial value in psychiatric patients.

Methods

Non-systematic review of literature on current knowledge about EAS, particularly in patients with mental disorder.

Results

In terms of sociodemographic and clinical characteristics, these patients were mostly women, with at least two psychiatric conditions; the main diagnosis is a (treatment-resistant) mood disorder, with some medical comorbidity. Psychological suffering was the main motivation, in patients with severe symptomatology associated with psychiatric and physical conditions (26% reported both psychological and physical suffering). These patients tend to be empowered and value self-determination. There is to highlight a high percentage of patients still alive after a not granted pEAS request (69%) and a high rate of pEAS requests withdrawals (37%).

Conclusions

Suicide prevention remains a priority in terms of public health. Thus, there is a need to ensure that EAS isn`t a way to increase suicide mortality by giving access to lethal methods to suicidal patients. In some cases, EAS request has a paradoxical value to regain control of life and it`s related to the transient nature of unbearable mental suffering.

The actual process provides a continued recovery-oriented care in parallel with the EAS evaluation, and a thorough evaluation which requires a multi-expert panel with the envolvement of mental health professionals. Ethical concerns remains about its paradox: unbearable psychological suffering is a target for suicide prevention and also a required criterion for EAS.

Disclosure of Interest

None Declared
Comparing the distribution of neuropsychiatric symptoms among individuals with depression and mild cognitive impairment
Authors: Keng A. , Kapustin D. , Ma C. , Bingham K. , Fischer C. , Mah L. , Gallagher D. , Butters M. A. , Bowie C. R. , Voineskos A. , Graff A. , Flint A. , Herrmann N. , Pollock B. , Mulsant B. , Rajji T. , Kumar S. ,   P.-M. Study Group
Published: August 2023

Introduction

Neuropsychiatric symptoms (NPS) are common during the course of neurocognitive disorders. NPS have been previously reported in early and late stages of Alzheimer’s Disease. However, our understanding of NPS in high-risk states for dementia such as mild cognitive impairment (MCI) and major depressive disorder (MDD) is poor.

Objectives

To compare the frequency and factor structure of neuropsychiatric symptoms among individuals with Mild Cognitive Impairment (MCI), Major Depressive Disorder (MDD) in remission, and comorbid MCI and MDD (in remission) (MCI-D).

Methods

We used baseline data from the Prevention of Alzheimer’s Dementia with Cognitive Remediation Plus Transcranial Direct Current Stimulation in Mild Cognitive Impairment and Depression (PACt-MD) study, a multicenter trial across five academic sites in Toronto, Canada (clinical trial No. NCT0238667). We used ANOVA or χ2-test to compare frequency of NPS across groups. We used factor analysis of Neuropsychiatric Inventory Questionnaire (NPI-Q) items in the three groups.

Results

We included 374 participants with a mean age of 72.0 years (SD = 6.3). In the overall sample, at least one NPS was present in 64.2% participants, and 36.1 % had at least moderate severity NPS (36.1%). Depression (54%, χ2 < 0.001) and apathy (28.7%, χ2=0.002) were more prevalent in the MCI-D group as compared to MCI and MDD groups. In factor analysis, NPS grouped differently in MCI, MDD, and MCI-D groups. A “psychotic” subgroup emerged among MCI and MCI-D, but not in MDD. Night-time behaviors and disinhibition grouped differently across all three groups.

Conclusions

Prevalence of NPS seems higher in persons with MCI-D as compared to those with only MCI or MDD. The factor structure of NPS differed between MCI, MDD, and MCI-D groups. Future studies should investigate the association of NPS factors with cognition, function, and illness biomarkers.

Disclosure of Interest

None Declared
Anti-inflammatory properties of Risperidone : A clinical Trial
Authors: Askri F. , Aissa A. , Jedda S. , Ben Chaabene A. , Abaza H. , Ouali U. , Zgueb Y.
Published: August 2023

Introduction

The evidence of an inflammatory status at onset of psychosis supports the adjunction of anti-inflammatory agent to antipsychotic (AP). Some negative results of these clinical trials lead us to wonder about the anti-inflammatory power of AP.

Objectives

Would the action of associated anti-inflammatory agents be negligible compared to the anti-inflammatory potential of AP?

Methods

We conducted a prospective study. We included patients hospitalized for acute relapse of schizophrenia. They were all treated with Risperidone. We measured High sensitive C Reactive Protein (Hs CRP) at baseline and 8 weeks after.

Results

We included 24 patients. Mean age was 34,5 +7,32 years with 75% of female. Mean age of onset of illness was 24,63 ±4,81 years and illness duration was 10,70 +6,42 years. After 8 weeks, PANSS scores decreased significantly from 79,13 +12,07 to 47,21 +8,41 and Hs CRP levels dropped by 1,55 +3,96 mg/l.

Conclusions

These results highlighted the anti-inflammatory action of Risperidone. Clinical trial should consider the proportion of anti-inflammatory agents action.

Disclosure of Interest

None Declared
Coercion rates in different mental health care models: flexible assertive community treatment vs care as usual
Authors: Tomcuk A. , Roganovic V. , Tomcuk K. , Dedovic S. , Djurisic T. , Dedovic J.
Published: August 2023

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
The influence of depression symptoms on postmorbid adaptation of patients after SARS-CoV-2 infection
Authors: Barkhatova A. , Sorokin S.
Published: August 2023

Introduction

The study discusses the possibility of assessing postmorbid adaptation in depressed patients who had SARS-CoV-2 infection, within the framework of a multimorbidity model. This model takes into account not only mental, but also somatic clusters and allows to identify non-randomly occurring, related conditions and their impact on the ability to recover.

Objectives

The aim of the study is evaluation of the impact of psychosomatic and anxiety symptoms of depression on the formation of postmorbid adaptation in a group of patients who underwent outpatient SARS-CoV-2 infection.

Methods

The data of 54 patients aged 25-55 years with a current depressive episode who underwent outpatient SARS-CoV-2 infection were analyzed. We used the Hamilton depression rating scale (HDRS); the somatic condition was assessed using a general assessment of the patient’s function limitation at the stage of convalescence. A linear regression analysis was performed to assess the association of psychosomatic and anxiety symptoms with somatic condition in SARS-CoV-2 infection, regardless of other factors.

Results

An association was established in patients with SARS-CoV-2 infection showing signs of psychosomatic and anxiety symptoms of depression. Patterns of somatic and anxiety symptoms were independently associated with impaired postmorbid adaptation, other manifestations of depression did not show such association. This fact raises the question of whether depression syndrome is really associated with an impaired postmorbid adaptation in the postcovid period, or only certain specific symptoms of somatic anxiety explain the low readaptation capacity in this group of patients.

Conclusions

Identification of clusters of symptoms associated with an impact on the full recovery possibilities in the SARS-CoV-2-postmorbid period can significantly help in providing high-quality and targeted psychopharmacological care.

Disclosure of Interest

None Declared
N-acetylcysteine (NAC) and in psychodermatological conditions. Is it useful?
Authors: Jimenez A. , Gutiérrez T. , Rivera Ruiz I. , Montes L. , Reyes López M.
Published: August 2023

Introduction

Pathologic grooming disorders can lead to clinically significant distress and functional impairment. Various psychopharmacological and nonpharmacological treatments have been used to ameliorate the symptoms of these disorders. N-Acetylcysteine (NAC) is a newer modality in the treatment of these disorders and has shown promise in treatment of obsessive-compulsive and related disorders.

Objectives

To determine whether NAC is useful in the treatment of body-focused repetitive behavior disorders.

Methods

A literature review was carried out in PubMed using the descriptors: “body-focused repetitive behaviour disorders” “grooming disorders” AND “N-Acetylcysteine”.

Six results were obtained when using the time limit of 5 years. We selected two of them for their relevance to the PICO question. Subsequently, the search was repeated using the same descriptors and the time limit in the Cochrane Library, Epistemokinos and Tripdatabase, in which no additional results were found.

Results

Overall, thirty-three articles were included in these systematic reviews that we studied, which consisted of 23 case reports, one case series, and seven randomized controlled trials. Dosing of oral NAC ranged from 450 to 3,000 mg per day, and treatment periods lasted from 1 to 8 months. Side effects were uncommon, mild, and usually gastrointestinal in nature, with severe aggression reported in one child. Two randomized controlled trials showed a significant improvement in trichotillomania and excoriation disorder in adults. The other two were performed in pediatric population, showing no statistical difference. Two randomized controlled trials and six case reports studying the effects of NAC in patients suffering from trichotillomania (one performed in adults and the other one in infants) were included. Only the one performed in adults showed improvement when adding NAC to the treatment using the Massachusetts General Hospital, Hairpulling Scale (MGH-HPS). Four case reports and two randomized controlled trials included patients with excoriation disorder showed statistical differences in all of them. Three case reports and one randomized controlled trial in patients with onicotylomania showed a difference that wasn’t consistent after two months of treatment.

Conclusions

There are multiple case reports an several clinical trials supporting both the safety and efficacy of NAC in the treatment of body-focused repetitive behavior disorders. Based on these positive preliminary results and the absence of serious adverse effects, carrying out a therapeutical trial with NAC is a plausible option in the management of this pathology, especially in those in which other therapeutic options have not been effective. Further studies are needed to develop a treatment algorithm and elucidate the difference in the efficacy of NAC between children and adults with this disorder.

Disclosure of Interest

None Declared
Relationship between Glycated Hemoglobin (HbA1c) in Adolescents with Type 1 Diabetes Mellitus (T1DM) and Parental Anxiety and Depression
Authors: Silina E. , Taube M. , Zolovs M.
Published: August 2023

Introduction

T1D is the most common chronic endocrine pathology in children. The management of type 1 diabetes requires strong diet, physical activity, lifelong insulin therapy, and proper self-monitoring of blood glucose and is usually complicated and, therefore may result in a psychosocial problem for the whole family. Metabolic control of the disease is determined by glycated haemoglobin (HbA1c), the main criterion for diabetes compensation. It is assumed that anxiety and depression symptoms negatively affect glycemic control. A correlation was observed between anxiety and depression level and glycaemic control, as well as a three-way interaction among HbA1c, frequency of blood glucose monitoring, and diabetes-related stress (Buchberger et al., 2016). Parental psychological distress was associated with higher child self-report of stress and depressive symptoms, and it had negative effects on diabetes management.

Objectives

To evaluate the relationship between parental depression and anxiety and metabolic control of their adolescents with T1DM.

Methods

The cross-sectional study recruited adolescents with T1D (N=251) and their parents (N=251). The 7-item Generalized Anxiety Disorder (GAD-7) scale measured anxiety level. The Patient Health Questionnaire – 9 (PHQ-9) detected depressive symptoms. Glycaemic control of patients was assessed using the last glycated haemoglobin (HbA1c) values. GLM mediation analysis was performed to determine the potential mediating effect of parent’ mental health depression and anxiety on the relationship between depression and anxiety of child on the level of HbA1c.

Results

502 respondents were eligible for screening. Mediation analysis was performed to assess the mediating role of parent GAD-7 on the linkage between HbA1c and child GAD-7 and child PHQ-9. the results relevated that the total effect of child GAD-7 on HbA1c was significant but the total effect of child PHQ-9 was not significant. With the inclusion of the mediating variable (parent GAD-7) (Figure 1), the impact of child GAD-7 and child PHQ-9 was founding insignificant (p ≥ 0.05) but the indirect effect of child GAD-7 and child PHQ-9 on HbA1c though parent GAD-7 was found significant (p ≤ 0,01) (Table 1). This indicates that the relationship between HbA1c and child GAD-7 and PHQ-9 is fully mediated by parent GAD-7.

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Conclusions

Glycated haemoglobin in adolescents with Type 1 diabetes is related to adolescents’ mental health via parents’ anxiety. It means that parents’ anxiety plays more significant role in the level of glycated haemoglobin in adolescents than depression and anxiety of the adolescent.

Disclosure of Interest

None Declared
Insecure adult attachment styles are associated with parental reflective functioning pre-mentalizing modes
Authors: Erkoreka L. , Urrutia G.
Published: August 2023

Introduction

Parental Reflective Functioning (PRF) refers to parents’ capacity to view their child’s and their own behavior considering inner mental states, like thoughts, desires, and intentions. It has been related to attachment, mentalizing capacities, and psychopathology in children. An association between adult attachment style and reflective functioning has been described. Studies have also suggested that parental insecure attachment is related to lower levels of PRF.

Objectives

We aim to study the association between specific adult attachment styles (anxious [Anx] and/or avoidant [Av]) and specific PRF modes (pre-mentalizing [PM], certainty about mental states [CMS] and/or interest and curiosity [IC]).

Methods

A sample of 238 parents (228 mothers and 34 fathers) of 263 children aged 0 to 5 years old were recruited through informal difussion of the study in social media. These parents completed the Experiences in Close Relationships-Revised (ECR-R) and the Parental Reflective Functioning Questionnaire-18 (PRFQ-18) online. Sex and age of parents and children were also gathered. In the first place, Pearson’s correlation was conducted to study the association between the ECR-R and the PRFQ-18 subscales. In a second step, general linear models were used to control for the effect of sex and/or age, when necessary.

Results

Mothers’ mean age was 35,59±4,55 and fathers’ 38,26±4,47. Among children, a total of 119 were girls (45,2%) and 140 (53,2%) boys; in 4 (1,5%) cases the sex was not specified. The association between attachment and PRF subscales is shown in Table 1.
1
2
3
4
5
6
78Parent age-Parent sex-0,196**-Child age0,273**0,054-Child sex0,0620,0140,041-PRFQ PM0,120-0,0590,072-0,001-PRFQ CMS-0,1090,135*0,137*0,015-0,256**-PRFQ IC-0,0990,163**0,121-0,069-0,0720,078-ECR-R
Anx0,115-0,138*-0,0270,0060,410**-0,232**-0,035-ECR-R Av0,137*-0,0490,007-0,0910,186**-0,049-0,1030,279****

p<.001,

*

p<.05

In a second step, the influence of Anx attachment on CMS was controlled for parents’ sex and children’s age; β-value of Anx was -0,288 (p<.000) and the whole model explained 70% of the variability of CMS.

Conclusions

We observed that Anx attachment is associated with lower CMS and greater PM. With regard to CMS, both high and low extreme scores have been proposed to be less adaptative than average scores. Av attachment has also been related to higher PM scores. PM mode, which involves “an inability to hold the child’s mental states in mind and/or to have malevolent attributions about the child’s behavior”, is indicative of pathological PRF, and seems to be associated with insecure attachment (↑Anx/Av). Our results are in line with previous works (San Cristobal et al. Front. Psychol. 2017; Luyten et al. PLOS ONE 2017), and suggest that PRF could play a role in the intergenerational transmission of attachment, which should be further investigated.

Disclosure of Interest

None Declared
One year later: mental health among employees in long-term care of the elderly after COVID-19 in Italy
Authors: Gesi C. , Grossi C. , Consorti E. , Vercesi E. , Cerveri G.
Published: August 2023

Introduction

The COVID-19 emergency have imposed a great burden on the Italian health and social health system. In this context, healthcare workers (HCWs) have been exposed to high levels of stress. While many studies addressed the consequences of COVID-19 on hospital workers, little interest has been devoted to the employees of nursing homes.

Objectives

To evaluate levels of depressive, anxious and post-traumatic symptoms in a population of nursing homes workers in Italy one year after the begin of the pandemic.

Methods

The research involved 177 nursing homes, to evaluate the Mental Health outcome of the COVID-19 pandemic 12 months after the first lockdown on a large sample of workers. Participants answered a self-assessment tools aimed to assess the level of trauma experienced, the level of anxiety and depression, the quality of professional life and social and work adjustment.

Results

A consistent level of psychological suffering in the HCWs 12 months after the first lock-down and after the third wave of Covid-19 is highlighted, in accordance with what has been observed in similar research. It turns out that about 30% of subjects, more often women, have elements suggestive of symptoms related to PTSD, with moderate levels of anxiety. On the other hand, 15% of the sample presents moderate levels of depressive symptoms and a severe impact on social and occupational functioning. Of these about 40% of staff has significant interference and just over 15% has a severe impact (see figure 1).

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Conclusions

Interventions tailored to support mental health are needed not only for HCWs from hospital units but also for those working in nursing homes and long-term care units.

Disclosure of Interest

None Declared