bluuebunny/crossref_metadata_2025 huggingface dataset:
Bipolar Disorder due to Cushing’s Disease, with manic characteristics. Regarding a clinical case.
Authors: Blasco Fresco M. D. C. , Ciria Villar S. , Durán Sandoval L. T. , Perez Poza A. , De La Fuente Ruiz E.
Published: August 2024

Introduction

The increase in cortisol can be exogenous or endogenous. As etiologies of endogenous increase we find: Cushing’s disease, 68% of cases, generally due to an ACTH-producing pituitary tumor; Adrenal Cushing syndrome (17%); Ectopic Cushing syndrome (15%) due to lung tumor most frequently. It is relevant since among its symptoms one of the most notable are the psychiatric alterations it produces, among them mood disorders, depression being the most common, as well as psychotic symptoms, delirium and anxiety disorder.

Objectives

To carry out a correct differential diagnosis of the pathologies that could present with symptoms of a manic episode.

Methods

Clinical case description of a 52-year-old woman, who presented with manic symptoms in 2020, requiring hospitalization. Upon discharge from the acute care unit, she consulted with the endocrinologist due to weight gain, revealing an increase in abdominal diameter, hyperpigmentation, a moon-like face, and a hump. Free cortisol was measured in 24-hour urine, with a high result, followed by brain MRI, and pituitary microadenoma was confirmed.

Results

The patient underwent surgical resection of the microadenoma, which was partially effective, so she maintained high cortisol levels, even despite oral retreatment. In 2023 she had a new manic episode, with a cortisol value of approximately 300 nmol/day.

Conclusions

The importance lies in the correct diagnosis to provide appropriate treatment and avoid the chronicity of the disease and the patient psychiatrization. In this case and as in many other diseases, which present with psychiatric symptoms, it is important to differentiate whether it is a primary psychiatric disorder or are component symptoms of another disease that, upon receiving treatment, would resolve the psychiatric symptoms.

Disclosure of Interest

None Declared
Mental health of children in ukraine. risks and challenges today
Authors: Markova M. , Aliieva T. , Piontkovska O.
Published: August 2024

Introduction

Today, the most vulnerable group of Ukrainians are children. Their physical and mental health has been tested since 2020, from COVID-19 to 2022, the start of a full-scale-russia’s war against Ukraine. The children of Ukraine were the first to feel the changes, since a complete change in life and the principles of acquiring primary adaptive skills of social interaction were distorted by COVID-19. Subsequently, new challenges in the form of war deformed the idea of life, happiness and the future.

Objectives

Studying the level of adaptation potential in children and adolescents living in the front-line zone in Ukraine.

Methods

The examination included the use of clinical-psychological, psychodiagnostic and psychometric research methods.

Results

The study in 2021 involved 217 children and adolescents with signs of maladjustment. In 2022, 378 children and adolescents with signs of maladjustment, of which 285 children are still in the frontline zone of Ukraine, 93 children, at the time of 2022, were taken abroad and returned to Kharkov in 2023.

During the initial analysis of the results, it was revealed that children with low adaptive resources are more susceptible to showing signs of maladjustment. One of the main factors of an adaptation resource is interaction with others (direct communication). It was this criterion that became the primary frustrating factor for children in the first months of the war. External isolation has led to a lack of communication between children and everyone in Ukraine, who during COVID-19 have adapted to a way of communicating while staying at home in physical isolation. War is a powerful independent psychogenic factor for the formation of maladaptation, but in today’s realities it has also become an additional trigger for a previous psychogenic event in the life of Ukrainians.

Parents, for their part, note a sharp deterioration in the well-being of their children, frequent complaints of headaches (89.4%), overwork, aggressiveness (81,5%), closed-mindedness (78,6%), health complaints (74,5%), which is why they have to often consult a doctor and endlessly carry out diagnostics in search of reasons for deterioration (72,3%), weight loss (64,5%). The data indicate the frustration of being in the front-line zone, which aggravates mental health and triggers the process of disruption of adaptation and mental health of children and adolescents.

Conclusions

The study is aimed at developing a psychorehabilitation program for children and adolescents with a low level of adaptive resource.

Disclosure of Interest

None Declared
Assessment of various dimensions of impulsivity and their expression in unipolar and bipolar affective disorder
Authors: Dmitrzak-Weglarz M. , Bilska K. , Skibińska M. , Narożna B. , Zakowicz P. , Rajewska-Rager A. , Kapelski P. , Pawlak J. M.
Published: August 2024

Introduction

Impulsivity is the tendency to take quick and rash actions without the ability to assess their consequences, resulting in an increased frequency of risky behaviors. In recent years, it has been indicated that impulsivity is a multidimensional construct with different ways of expression in various mental illnesses. Moreover, personality traits might predispose do different psychiatric diagnoses and impact its course.

Objectives

Because differences in the manifestation of impulsivity can be observed at several levels (e.g., behavioral/motor, cognitive, attention, or emotionally related), we applied several tools to check whether they would allow for the differentiation of unipolar (UD) and bipolar (BD) affective disorders.

Methods

The study used data from 282 patients with affective disorders and 95 healthy controls of both sexes. Among the patients, we distinguished a subgroup diagnosed with UD and BD. We included a homogeneous group of patients in euthymia state at the end of hospitalization due to the last depressive episode. The following tools were used: subdimension novelty seeking (NS) of The Temperament and Character Inventory (TCI) and The Barratt Impulsiveness Scale version 11 (BIS-11) to assess various dimensions of impulsivity. The Coping Orientation to Problems Experienced (COPE) was used to assess the strategy of coping with stress. Statistical analyses were performed in Statistica 13.3 StatSoft, Krakow, Poland.

Results

We observed significant differences in BIS-11 dimensions such as motor (MI) (p=0.0006), nonplanning (NP) (p=0.0249), and the sum of impulsivity (p= 0.0095) between UD and BD patients. We found no significant differences in the intensity of impulsivity measured by the NS subdimension, regardless of the type of affective disorder. In the Spearman rank correlation analysis, the following correlations of novelty seeking were revealed (p>0.05):

NS with BIS-11 MI (rs=0.3877, p=0001), BIS-11 NP (rs=-0.2926, p=0042) and COPE-planning (rs=-0.2552, p=0191) dimensions. Moreover, a unique and strong correlation of NS with COPE - focus on and venting of emotions was revealed in BD patients (rs=0.5402, p=0.0461).

Conclusions

The obtained correlation results confirm the multidimensional nature of impulsivity. The relationship between NS and the motor and nonplanning dimensions comes to the fore. Among the tests used, BIS-11 best differentiated unipolar and bipolar patients.

Disclosure of Interest

None Declared
The biology of mental pain: a systematic review to map the different expressions, definitions, hypotheses, experimental paradigms, investigation methods and candidate biomarkers of mental pain in human subjects
Authors: Duranté E. K. , Ribeiro A. , Gaspard-Boulinc L. , Lemogne C. , Boutron I. , Chevance A.
Published: August 2024

Introduction

Mental pain is a transdiagnostic symptom, predictive of suicide and reported as a critical outcome by patients. A previous systematic review of epidemiological and clinical research has shown a lack of consensual definition of mental pain in clinical research and high heterogeneity across the different measurement instruments of mental pain. Up today there is no systematic review synthetizing all published biological investigations on mental pain.

Objectives

This study aims to map the field of biological investigations of mental pain in human to identify what and how biomarkers are investigated with a meta-research approach, by providing a critical appraisal of the terms and definitions of mental pain, the studies’ hypotheses, the experimental paradigms used to induce or mimic mental pain and the measurement instruments used to measure mental pain.

Methods

We conducted a systematic review (compliant with PRISMA guidelines) of all primary research reporting to investigate candidate biomarkers of mental pain in human subjects as stated by the authors. We searched from inception to June 23rd, 2022, the 3 databases MEDLINE, Web of Science and EMBASE. We extracted the study characteristics (e.g., year of publication, population, etc.), the terms used for meaning mental pain, the definition of mental pain, the method to induce mental pain and its rational, the hypotheses and aims, the measurement instruments of mental pain, the candidate biomarkers, and their method of investigation. We performed descriptive statistics of the sample’s characteristics and the extracted data, a qualitative analysis of the definitions, hypothesis, aims and experimental paradigms, and a data visualization linking candidate biomarkers, experimental paradigms, and their investigation methods.

Results

The search retrieved 5685 papers of which we included 72 primary research publications constituting 78 distinct research studies. Only 37.5% of studies reported a definition of mental pain. 11.5% of studies did not show a measurement instrument of mental pain. The Cyberball (a social exclusion paradigm) was the most frequently used paradigm in experimental studies (62.7%). The cingulate cortex was the most frequently investigated biomarker category (15.3% of all candidate biomarkers), with fMRI as the most frequent investigation method (53.7% of all investigation methods).

Conclusions

The field of biological investigations on mental pain shows a marked heterogeneity of definitions, terms, hypotheses, experimental paradigms, and measurement instruments, with an over-representation of the construct of social pain and the Cyberball. These could compromise the comparison and combination of studies results in evidence synthesis and their translation into clinical practice.

Disclosure of Interest

None Declared
M2 macrophage-derived soluble factors enhance neuronal density in the frontal cortex of depression-like mice
Authors: Markova E. , Rashchupkin I. , Shevela E. , Serenko E. , Amstislavskaya T. , Ostanin A. , Chernykh E.
Published: August 2024

Introduction

Chronic inflammation in depression is associated with decreased levels of neurotrpohic factors and suppressed neurogenesis. We have previously shown that intranasal therapy with soluble factors from M2 macrophages polarized by interaction with apoptotic cells in serum deprivation conditions (M2(LS); LS - low serum) and characterized by anti-inflammatory and pro-regenerative activity leads to the correction of the behavioral pattern in mice with a depression-like state.

Objectives

The present study focuses on the effect of M2(LS) macrophages on neuronal density in the frontal cortex and hippocampus of depression-like
mice.

Methods

Depressive-like state was formed in passive male mice (CBAxC57Bl/6)F1) as a result of repeated experience of defeat in agonistic interactions with aggressive partner during 20 days (the sensory contact model). Depression-like mice were then treated intranasally with M2(LS) macrophages conditioned medium for 7 days. After that, the number of mature neurons in the frontal cortex and hippocampus was assessed using Nissl staining.

Results

The neuronal density in the pyramidal layer of the frontal cortex was significantly lower in depression-like mice than that in the intact control group of mice (p=0,047). At the same time, the number of neurons in the experimental group of mice that received soluble M2(LS) factors, was higher than that in depressive-like untreated control mice (p=0,003) and was comparable to that in the intact group of mice. At the same time  the neuronal density in the CA1 and CA3 hippocampal areas did not change in depression-like mice following intranasal treatment with conditioned medium of M2(LS) macrophages.

Conclusions

The data obtained may indicate the neuroprotective effect of M2(LS) macrophages in the stress-induced depression model, which is realized through soluble factors and manifests itself in an increase of the pyramidal neurons density in the frontal cortex.

Disclosure of Interest

None Declared
Attention flexibility is associated with retinal cup-to-disk ratio in patients with schizophrenia spectrum disorders
Authors: Jerotic S. , Maric N.
Published: August 2024

Introduction

In recent years, there has been increasing interest in the potential use of retinal imaging as a non-invasive and easily accessible tool for investigating the neurobiological underpinnings of schizophrenia. Studies have suggested that patients with schizophrenia spectrum disorders (SSD) have structural abnormalities in the retina, including changes in retinal thickness and the ratio of the retinal cup-to-disk ratio.

Objectives

To investigate the relationship between retinal cup-to-disk ratio and cognitive performance in patients with SSD using a high-definition retinal imaging device – optical coherence tomography (OCT) scanner.

Methods

The sample was comprised of twenty patients with SSD (F20-F29 according to ICD-10 criteria). All diagnoses were confirmed by a researcher using the Mini International Psychiatric Interview. All patients underwent complete ophthalmological examination, excluding any ocular pathology. Retinal thickness was measured in both eyes of all patients with a high-definition spectral-domain OCT device. Examined retinal parameters were: total retinal nerve fiber layer thickness (RNFL); RNFL thickness in all eye quadrants (nasal, temporal, superior, inferior); RNFL symmetry; average macular volume (MV); average macular thickness (MT); ganglion cell layer thickness (GC); average retinal cup-to-disk (C/D) ratio, vertical C/D ratio. Cognitive performance of all patients was tested using the Intra/Extradimensional Set Shift Task (IED). IED is a component of a state-of-the-art computerized battery for cognitive assessment – Cambridge Neuropsychological Automated Test Battery. IED is a measure of maintenance, shifting and flexibility of attention. Associations between retinal variables and IED measures were determined with Pearson correlation analyses.

Results

Mean age of patients was 33 ± 7.5 years. Fifty five percent of the sample was male, illness duration was 6.2 ± 3.9 years. Daily dosage of chlorpromazine was 225.7 ± 108.8 mg. Retinal C/D ratio in the right eye was positively associated with IED total errors (r=0.50; p=0.02) and negatively with IED stage progression (r=-0.52, p=0.18). Likewise, vertical C/D ratio was positively associated with IED total errors (r=0.49; p=0.02) and negatively with IED stage progression (r=-0.52, p=0.18).

Conclusions

Previous analyses of retinal parameters in patients with schizophrenia point towards enlargement of retinal cup-to-disk ratio, irrespective of any underlying somatic comorbidities. Our data shows worsening of attention flexibility in association with the increase of cup-to-disk ratio in patients with schizophrenia spectrum disorders. The significance of cup-to-disk retinal disturbance in schizophrenia spectrum disorders and its connection with cognitive performance should be further evaluated and supplemented with measurements of functional adaptation in these patients.

Disclosure of Interest

None Declared
“Neighbohod Vulnerability and Disability in First Episode of Psychosis”.
Authors: Leal I. , Izquierdo A. , Cabello M.
Published: August 2024

Introduction

Neighborhood socioeconomic status seems to be related to functioning in patients with first episode of psychosis

(FEP).

Objectives

The present study aimed to assess if neighborhood vulnerability and risk of social exclusion could predict functional outcomes in people with FEP after controlling for other key variables identified in previous literature.

Methods

A total of 137 patients with FEP (DSM-IV-TR criteria) and 90 controls comprised the study sample from February 2013 to May 2019. Functioning was assessed with the WHO Disability Assessment Schedule. Neighborhood vulnerability was measured using a multidimensional socioeconomic deprivation index; data for the index were collected by the Madrid City Council and based on the participant’s home address. Multilevel mixed-effects regression analyses were conducted to estimate the effects of neighborhood vulnerability on functioning.

Results

Our results show that FEP patients could be more vulnerable to the effects of neighborhood-level characteristics than healthy controls (B = 1,570.173; z = 3.91; Pc .001). In addition, our findings suggest that higher neighborhood vulnerability is related to greater functional disability in people with FEP, after controlling for other relevant confounders (B = 1,230.332; 2=2.59; P=.010). based on the participant’s home address. Multilevel mixed-effects regression analyses were conducted to estimate the effects of neighborhood vulnerability on functioning.

Results

Our results show that FEP patients could be more vulnerable to the effects of neighborhood-level characteristics than healthy controls (B = 1,570.173; z = 3.91; Pc 001). In addition, our findings suggest that higher neighborhood vulnerability is related to greater functional disability in people with FEP, after controlling for other relevant confounders (B = 1,280.332; z=2.59; P= 010).

Conclusions

These results highlight the importance of incorporating contextual factors into assessment of patients with FEP, since psychosocial difficulties observed In these patients could be partially related to the quality of neighborhood social-related resources.

Disclosure of Interest

None Declared
Relationship of Interoceptive Accuracy with Craving, Personality Dimensions, and Alexithymia in Alcohol Use Disorder
Authors: Kahyacı Kılıç E. , Sönmez M. B.
Published: August 2024

Introduction

Interoception encompasses processes that involve receiving, processing, and integrating bodily signals with external stimuli, ultimately influencing ongoing motivated behaviors. Disruptions in these interoceptive processes are believed to contribute to the development and progression of alcohol use disorder (AUD). Interoceptive accuracy (IAc), the objective dimension of interoception, has been shown to be decreased in patients with AUD. Traits linked to substance use vulnerability, such as personality dimensions and alexithymia, may be associated with decreased IAc.

Objectives

Our objective was to compare the heartbeat perception (HBP) scores, as a measure of IAc, between abstinent inpatients with AUD and healthy controls. Additionally, we aimed to investigate potential associations between IAc and variables such as alcohol craving, personality dimensions, and alexithymia.

Methods

The study comprised 48 abstinent inpatients with AUD and 68 healthy control subjects. All participants completed a heart rate tracking task, serving as an objective physiological measure of IAc. In addition to the IAc task, several assessments were administered to the patient group, including the Alcohol Use Disorders Identification Test (AUDIT), the Penn Alcohol Craving Scale (PACS), the Temperament and Character Inventory (TCI), and the Toronto Alexithymia Scale (TAS-20). Patients were recruited for a 28-day abstinence-based inpatient treatment program, and all assessments were conducted during the final week of hospitalization at the Alcohol and Substance Addiction Treatment Center in Trakya University School of Medicine (Edirne, Türkiye).

Results

Patients’ HBP scores (mean ± standard deviation: 0.59±0.21) were significantly lower than those of healthy control subjects (0.74±0.15) (t=-4.469, p<0.001). The patients’ HBP scores showed significant negative correlations with AUDIT (r=-0.312, p=0.035), PACS (r=-0.361, p=0.019), and TAS-20 scores (r=-0.406, p=0.004). Additionally, there was a significant positive correlation between patients’ HBP scores and TCI self-directedness scores (r=0.371, p=0.009), and a near-significant correlation with TCI persistence scores (r=0.282, p=0.052). TCI novelty seeking, harm avoidance, reward dependence, cooperativeness, and self-transcendence scores did not significantly correlate with patients’ HBP scores (p>0.05).

Conclusions

Our findings may support the hypothesis that interoceptive processes play a role in AUD, and that certain traits linked to vulnerability to alcohol use are associated with decreased IAc.

Disclosure of Interest

None Declared
The uncharted territory of female adult ADHD: a comprehensive review
Authors: Oroian B. A. , Costandache G. , Popescu E. , Nechita P. , Szalontay A.
Published: August 2024

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD), once considered a predominantly childhood condition, has increasingly gained recognition as a prevalent and clinically significant concern among adult women. They often display a distinctive symptom profile characterized by high levels of inattention, emotional dysregulation, and difficulties in executive functioning. Diagnosis of female adult ADHD is frequently complicated by gender bias in traditional diagnostic criteria, which may fail to account for the unique ways in which women manifest the disorder.

Objectives

This comprehensive literature review aims to characterize the unique symptomatology of female adult ADHD, including variations in inattention, hyperactivity, and impulsivity, as well as the presence of emotional dysregulation. It also seeks to explore the diagnostic challenges stemming from gender bias in diagnostic criteria and the role of comorbidity in diagnostic complexity. Additionally, the review assesses the broad spectrum of functional impairments experienced by adult women with ADHD, spanning academic, occupational, interpersonal, and emotional domains.

Methods

This literature review comprises a systematic examination of published research articles, clinical studies, and relevant academic literature addressing female adult ADHD. A comprehensive search strategy involving electronic databases, including PubMed, PsycINFO, and Google Scholar, was employed to identify peer-reviewed articles published between 2000 and 2023. The selected studies underwent critical appraisal for quality and relevance to the review’s objectives.

Results

The synthesis of existing literature reveals that female adult ADHD presents a distinctive clinical picture characterized by a higher prevalence of inattention, emotional dysregulation, and comorbid conditions such as mood and anxiety disorders. Diagnostic challenges arise from gender bias in diagnostic criteria and the absence of overt hyperactivity, often leading to delayed diagnosis or misdiagnosis. Functional impairments extend to academic, occupational, interpersonal, and emotional domains, affecting the overall quality of life for affected individuals. Gender-specific factors, including societal expectations and biases in healthcare evaluation, contribute to diagnostic disparities and hinder timely access to appropriate interventions.

Conclusions

The literature review underscores the critical need for enhanced recognition, understanding, and tailored support for female adults with ADHD. The distinct symptomatology, diagnostic complexities, functional impairments, and gender-specific factors contribute to a multifaceted clinical landscape. Advancing gender-sensitive diagnostic criteria, increasing awareness among healthcare professionals, and developing interventions that address the unique needs of this population are essential steps toward improving the quality of life and outcomes for female adults with ADHD.

Disclosure of Interest

None Declared
Factors associated with anxious distress in major depressive episodes: a cross-sectional study
Authors: Bartoli F. , Bachi B. , Callovini T. , Palpella D. , Piacenti S. , Morreale M. , Di Lella M. E. , Crocamo C. , Carrà G.
Published: August 2024

Introduction

The comorbidity between depression and anxiety is a common occurrence. The DSM-5 introduced the “anxious distress” (AD) specifier that can be applied to any depressive episode – both in major depressive disorder (MDD) and bipolar disorder (BD) – when symptoms such as feelings of tension, restlessness, difficulty concentrating, and fear that something awful may happen or to lose control are present. Longitudinal data showed that the AD specifier may be an effective predictor of chronicity, time to remission, and functional disability in depressive disorders. In addition, evidence on AD proved its association with increased depressive symptom severity.

Objectives

Available literature seems to suggest that AD occurs in a specific subgroup of patients, thus enabling a peculiar clinical profile to be outlined. To expand knowledge in this field, we performed a cross-sectional study aimed at identifying clinical correlates of AD in people with major depressive episodes.

Methods

Adult people admitted to two psychiatric inpatient units in the northern area of the Metropolitan City of Milan from May 2020 to December 2022 were screened for a major depressive episode and relevant specifiers using the Structured Clinical Interview for DSM-5 (SCID-5). Data on socio-demographic and clinical variables were collected. The severity of depressive and manic symptoms was assessed using the Montgomery–Åsberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS), respectively. Univariate comparisons between participants with and without AD were conducted, and two multiple logistic regression models were arranged to investigate the association between AD and candidate explanatory variables.

Results

We included 206 inpatients with a major depressive episode (mean age =48.4 ± 18.6 years; males = 38.8%), of whom 155 diagnosed with MDD and 51 with BD. AD was present in 137 participants (66.5%). Mixed features (p=0.049), higher YMRS scores (p=0.004), psychotic features (p<0.05), and a diagnosis of MDD (p<0.05) were found to be associated with AD in the multiple logistic regression analysis.

Conclusions

Notwithstanding some limitations, such as the cross-sectional design and the inclusion of inpatient only, our study highlights the association of AD with mixed and psychotic features, as well as with MDD. Clinical implications of these results include the possible contribution in delineating a specific symptom profile in people with AD during a major depressive episode.

Disclosure of Interest

None Declared
Comorbidity costs for the healthcare of mental patients
Authors: Dr. Fadgyas-Freyler P.
Published: August 2024

Introduction

Most patients with mental disorders exhibit multiple comorbidities. Without doubt the presence of multiple co-occurring somatic and mental disorders is associated with a higher insurance spending for the psychiatric patients. The details of this association need to be elucidated.

Objectives

The aim of current study was 1) to delineate the typical nonmental comorbidities that occur among mental patients, and 2) to investigate social health insurance spending on comorbidities compared to the direct mental care costs of the same population. The analysis offers unique insight into the health care spending, since it focuses not only the costs of psychiatric care but reflects the whole range of treatments delivered to this group.

Methods

A database with the claim records of the Hungarian NHIF was created including direct healthcare costs for mental diagnosis. Patients were recorded either in primary or in specialist care with at least one mental health diagnosis in the last pre-pandemic year (2019). Adopting a case-control design, spending and comorbidities were compared to the control group, which comprised patients who did not have any mental diagnosis. Cases and controls were matched on demographic characteristics like age, gender, place of residence with deprivation index and marital status..

Results

Mental problems affected in 2019 more than 1,5 million persons in Hungary. Half of them did not access specialist care but were only seen with the mental diagnosis by a GP. Direct insurance spending for mental care is around 156 million EUR/year with 4% of the total direct health spending. Besides these costs another 665 million EUR (+17% of all health spending) were reimbursed for the same patient group for the treatment of other diseases. With regards to affected patient numbers, the three most important comorbidities were cardio-vascular conditions (34% of mental patients with 14% of all spending of the group); diseases of the digestive system (29% vs 14%); and musco-sceletal conditions (28% / 9% ) In terms of spending three other disease groups also have to be considered as of high significance: carcinomas (4% patients vs 13% of spending); neurological disorders (13% /vs 7%); and diseases of the endocrine, nutritional and metabolic system (24% vs 6%).

Conclusions

The analysis aims to raise awareness for the complex issues of comorbidities of mental patients. We see that this patient group suffers heavily from other conditions the costs of which is much higher than the direct mental care costs. A better understanding of the coexistence of somatic and mental disorders and a holistic approach of treatment (care integration, reimbursement across different types of care, etc.) would be desirable.

Disclosure of Interest

None Declared
Drug repurposing as add-on treatment strategy for mania and bipolar depression: systematic synthesis and qualitative appraisal of the existing meta-analytic evidence
Authors: Cavaleri D. , Bartoli F. , Crocamo C. , Carrà G.
Published: August 2024

Introduction

In the complex pathophysiology of bipolar disorder (BD), increasing evidence supports the involvement of neurobiological abnormalities beyond the classical ones, suggesting them as potential alternative therapeutic targets. Several drugs approved for different indications have thus been repurposed for the treatment of BD, all of them supported by a plausible biological rationale. Some recent reviews have provided an update on these possible additional treatment options for mania and bipolar depression, but no systematic synthesis and qualitative evaluation of meta-analytic findings has been made.

Objectives

To provide a guidance on the available evidence on these treatments and their potential role in clinical practice, we conducted an umbrella review of meta-analyses of randomized placebo-controlled trials investigating drugs repurposed as add-on treatments for mania and bipolar depression.

Methods

We performed a systematic search and screening of the existing literature looking for the most up-to-date or comprehensive meta-analyses of randomized controlled trials (RCTs) on adults suffering from BD during an acute mood episode (mania or depression) which compared a repurposed drug and placebo as adjunctive treatments. We performed a critical appraisal according to “A MeaSurement Tool to Assess systematic Reviews” Version 2 (AMSTAR 2). We synthesized meta-analytic findings regarding efficacy, tolerability, and safety, also assessing the quality of evidence using the “Grading of Recommendations, Assessment, Development and Evaluations” (GRADE) approach.

Results

In nine eligible meta-analyses investigating 12 drugs (four for mania and eight for bipolar depression) we observed a heterogeneous quality of reporting was according to AMSTAR 2.

In mania, allopurinol (for symptoms reduction and remission at 4-8 weeks) and tamoxifen (for response and symptoms reduction at 4-6 weeks) showed higher efficacy than placebo, with evidence of low and very low quality, respectively.

In bipolar depression, modafinil/armodafinil (for response, remission, and symptoms reduction at 6-8 weeks) and pramipexole (for response and symptoms reductionat 6 weeks) were superior to placebo, with low-quality evidence. Results on celecoxib and N-acetylcysteine were of low quality and limited to certain outcomes.

Conclusions

Overall, the lack of evidence of high and moderate quality does not allow firm conclusions on the clinical utility of repurposed drugs as adjunctive treatments for mania and bipolar depression, limiting recommendations for their use in clinical practice. However, since some lines of evidence seem to hold some potential, and standard treatments for mania and bipolar depression remain not entirely satisfactory, the search for novel therapeutic targets and strategies for the management of BD warrants further research in the field.

Disclosure of Interest

None Declared
Mental health needs of defendants with intellectual disabilities presenting at court
Authors: McCarthy J. , Chaplin E. , Harvey D , Marshall-Tate K , Ali S , Forrester A
Published: August 2024

Background

Studies in different countries of defendants with mild to borderline intellectual disability found they have distinct characteristics from other defendants. The aim of this study was to examine several characteristics among defendants with intellectual disability comparing to those defendants without intellectual disability presenting to court services in London, England.

Method

This was a retrospective data analysis of routine administrative data collected by the Liaison and Diversion services across five Magistrates courts in London, England. Data were analysed on defendants identified through screening to have an intellectual disability and compared to defendants without an intellectual disability.

Results

9088 defendants were identified and of these 349 (4%) had an intellectual disability. Defendants with intellectual disability were over four times more likely to have comorbid attention deficit hyperactive disorder and over 14 times more likely to have autism spectrum disorder. There was an increased odds ratio of self-reported suicidal/self-harming behaviour for those defendants with intellectual disability compared to those without intellectual disability.

Conclusion

This study has highlighted the increased vulnerability of defendants with intellectual disability for other neurodevelopmental disorders.

Disclosure of Interest

J. McCarthy Grant / Research support from: Guy’s & St. Thomas’ Charity for £674,000, E. Chaplin Grant / Research support from: Guy’s & St. Thomas’ Charity for £674,000
Prevalence of ADHD in Adults: An Umbrella Review of International Studies
Authors: Ayano G. , Tsegay L. , Gizachew Y. , Necho M. , Yohannes K. , Demelash S. , Anbesaw T. , Alati R.
Published: August 2024

Introduction

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder commonly diagnosed in school-age children. However, it can affect individuals of all age groups. This study aimed to provide a comprehensive analysis of the prevalence of ADHD in adults by conducting an umbrella review of systematic reviews and meta-analyses.

Objectives

To provide a comprehensive synthesis of published evidence on the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in adults through an umbrella review of systematic reviews and meta-analyses, with the aim of highlighting the significance of addressing and managing ADHD in the adult population.

Methods

To conduct this study, we adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). We systematically searched databases such as PsychINFO, Web of Science, PubMed, and Scopus to identify relevant studies. Our review protocol was registered with PROSPERO (registration number: CRD42023389704). The quality of the studies included in our analysis was assessed using the A Measurement Tool to Assess Systematic Reviews (AMSTAR). For the purpose of conducting a meta-analysis, we employed a random-effects model.

Results

Our umbrella review examined findings from five systematic reviews that encompassed data from 57 unique international primary studies undertaken between 2009 and 2021. These studies involved a total of 21,142,129 adult participants. The meta-analysis, employing an inverse variance-weighted random effect model, yielded a pooled prevalence estimate for ADHD in adults of 3.10% (95% confidence interval: 2.60%–3.60%). Regarding ADHD subtypes, our analysis revealed that ADHD-I (inattentive type) remained the most prevalent among adults, followed by ADHD-HI (hyperactive type) and ADHD-C (combined type).

Conclusions

Our results underscore the relatively high prevalence of ADHD among adults, with ADHD-I emerging as the most common subtype. These findings emphasize the need for proactive measures to prevent, mitigate, identify, and effectively manage ADHD in the adult population.

Disclosure of Interest

None Declared
Habit Learning in OCD: Preliminary Data from a Spanish Sample
Authors: Prime Tous M. , Lopez Solà C. , Hermida L. , Fullana M. A.
Published: August 2024

Introduction

Instrumental learning involves goal-directed and habitual systems. The Slips-of-Action Task (SOAT) is extensively used to measure habit tendencies and the likelihood of making erroneous responses for devalued outcomes. The SOAT provides a Devaluation Sensitivity Index (DSI), a measure of the balance between relative goal-directed and habitual learning. Individuals with Obsessive-Compulsive Disorder (OCD) often engage in repetitive actions, suggesting a potential deficit in goal-directed control and an increased reliance on habitual learning. Previous literature has shown that medicated OCD adults performed worse on the SOAT task than healthy controls.

Objectives

To compare habit learning performance in an unmedicated sample:

-

Goal 1: Between OCD and Healthy Controls (HC)

-

Goal 2: Across four groups: adult OCD, adult HC, children OCD, and children HC

Methods

Participants: Eighty-three participants (44 OCD patients and 38 healthy controls) completed the study with usable task data. The 44 OCD patients comprised 17 adults (mean age: 26.76 years, SD: 8.61 years) and 27 children/adolescents (mean age: 12.84 years, SD: 2.59 years). The 38 healthy controls included 17 adults (mean age: 30 years, SD: 7.49 years) and 21 children/adolescents (mean age: 14.1 years, SD: 2.19 years). All participants were unmedicated. Measures: Participants completed an adapted version of the “Fabulous Fruit Game”, which included an instrumental training phase to learn Stimulus-Response-Outcomes (S-R-O) associations and a SOAT to assess the strength of learned S-R-O associations. DSI was calculated by subtracting the percentage of responses made toward devalued outcomes from the percentage of responses made toward still valuable outcomes. Behavioral Analyses: Student’s t-test comparing individuals with OCD to HC and a ONEWAY ANOVA to examine group differences across multiple categories.

Results

Goal 1: DSI comparison between individuals with OCD and HC revealed a significant difference, with HC demonstrating superior performance (t (60.9) = 2.60, p = .012, Cohen’s d = .546). Goal 2: The overall DSI comparison across adult OCD, adult HC, children OCD, and children HC showed a non-significant difference (F(3) = 3.407, p = 0.22). However, post hoc analysis revealed significant differences between Adult HC and Youth OCD (I-J Scheffe = 28.82, p = .033), indicating superior performance in adult HC.

Conclusions

This study highlights altered Habit Learning in unmedicated OCD individuals, supported by significant DSI differences compared to HC. Age-related distinctions were observed, emphasizing the need for age-sensitive interventions in understanding and addressing habit-related challenges in OCD.

Disclosure of Interest

None Declared
Sexuality of pregnant, postpartum and breast-feeding women
Authors: Bader S. , aloulou M. , Zran Z. , Abdelmoula A. , Bouaziz A. , Abbes W.
Published: August 2024

Introduction

Pregnancy and breast-feeding represents a period of psychological maturation for the woman who becomes a mother, a period of significant changes in women’s lives that affects their sexuality and intimacy.

Objectives

To investigate the quality of sexual function in pregnant, postpartum and breastfeeding women.

Methods

It was a cross-sectional study established over a period of 3 months from the June 1st, 2023 to August 31, 2023. This study focused on a population of pregnant, postpartum and breastfeeding women recruited from outpatient consultations and inpatient of the obstetric gynecology department at the university hospital of Gabes. We used a pre-established sheet exploring socio-demographic data, medical and gyneco-obstetric history and informations concerning the marital relationship and the woman’s sexual activity. We administered the validated Arabic version of the Arizona Sexual Experiences Scale (ASEX) to assess sexual functioning.

Results

Fifty-eight women were included. The average age was 35.6±5.5 years, they had a university level in 40%, secondary in 37.5%, and they were unemployed in 74.2%. From an urban origin in 75%. They were pregnant in the first, second and third trimester in (15.6%, 15.6% and 25% respectively). They were in postpartum in 43.8% of cases with a cesarean delivery in 73.3% and breastfeeding in 56%. All women reported being on good terms with their spouses and satisfied with their sexuality. The usual frequency of sexual relations (SR) was (1/day: 22.6%, 1/week: 74.2%, 1/month: 3.2%) and 25% reported wanting to reduce the frequency. Only 3.44% masturbated and 5.17% had sexual fantasies. The mean ASEX score was 13 ± 4.3 and 47%of the sample had sexual dysfunction. We found a significant association between the sexual dysfunction and the trimester of pregnancy (p=0.045).Highest score of sexual dysfunction during the first and third trimester compared to the second one (68.9%, 77.6% and 22.4% repectively). The areas of sexual dysfunction were difficulty reaching orgasm (81%), impaired sexual desire (65.5%), insufficient lubrication (60.3%), arousal (55.1%) and pain on penetration (50%).

Conclusions

We found that sexual function is problematic among women during pregnancy especially in the first and third trimester also in postpartum and breastfeeding period. So what factors are associated with this sexual dysfunction?

Disclosure of Interest

None Declared
Cannabinoid syndrome in cannabis dependence: a case report
Authors: Pichilingue Reto C. , Jose Rojo A. M. , Carrillo Reche M. B.
Published: August 2024

Introduction

A 36-year-old man with a history of cannabis use disorder since age 16, consuming 8-10 units/day, experienced irritability and tremors upon reducing consumption. His psychiatric issues emerged in 2020, marked by anxiety, abdominal pain, and severe vomiting, leading to a dyspepsia diagnosis. Subsequently, he received psychiatric care at CAS Hospitalet, diagnosed with severe cannabis use disorder. No prior inpatient admissions occurred.

Objectives

Our project aims to show a case report and summarize the available evidence on cannabinoid hyperemesis syndrome (CHS).

Methods

In May 2023, he voluntarily sought admission to Barcelona’s “Hospital Sant Pau,” aiming for cannabis detox and treatment of cannabinoid hyperemesis. He’d endured years of intense abdominal pain, nausea, and vomiting, worsening over the last two years, with uncontrollable vomiting hindering daily life. Admission saw reduced cannabis use to 3-4 units/day. Inpatient care revealed anticipatory anxiety, rumination, and somatic anxiety, accompanied by distal tremors and internal restlessness due to abdominal discomfort, partially alleviated by 5-10 mg of diazepam.

Results

Treatment included domperidone 10mg/8h, haloperidol drops (5-10 drops/8h), capsaicin ointment, hot showers, and cryotherapy, resulting in gradual relief from abdominal pain. Moderate cravings for tobacco and cannabis led to acetylcysteine 600mg/12h and gabapentin up to 1200mg/8h. Gastric discomfort with SSRIs led to vortioxetine 10 mg/day, well-tolerated with a positive response. Consultation with the GI department confirmed the treatment’s efficacy, emphasizing cannabis abstinence. Upon discharge, cannabinoid hyperemesis symptoms markedly improved, and the patient was referred to “Hospital de Dia.”

Conclusions

CHS is a cyclic vomiting syndrome, preceded by daily to weekly chronic longstanding use of cannabis that can be difficult to diagnose and treat(1,3,4). It is unique in presentation, because of the cannabis’s biphasic effect as anti-emetic at low doses and pro-emetic at higher doses, and the association with pathological hot water bathing (2). The major characteristics are as follows: history of regular cannabis for any duration of time (100%), cyclic nausea and vomiting (100%), resolution of symptoms after stopping cannabis (96.8%), compulsive hot baths with symptom relief (92.3%), male predominance (72.9%), abdominal pain (85.1%), and at least weekly cannabis use (97.4%)(1). Treatments such as topical capsaicin, haloperidol, benzodiazepines, and propranolol have shown symptom relief (3) whereas opioids should be avoided (4). Cannabis cessation appears to be the best treatment (1,3).

References

1.

Sorensen et al. Journal of Medical Toxicology 13 (2017):71-87.

2.

Perisetti et al. Annals of gastroenterology 33.6 (2020):571.

3.

Senderovich et al. Medical Principles and Practice 31.1 (2022):29-38.

4.

Leu, et al. Journal of Emergency Nursing 47.3 (2021): 483-486

Disclosure of Interest

None Declared