bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of modified esophagectomy perioperative technique resection for patients with locally advanced esophageal cancer (tumor length > 8 cm): initial experience in 45 cases
Authors: Wu Yunfei , XuWu  , Zhang Junhua , Li Xiang , Liu Nanbo , Li Jun , Chen Xuyuan , Wei Lichun
Published: September 2022

Background

Patients with locally advanced esophageal cancer with a lesion length greater than 8 cm (LCWEC) are prone to high mortality in a short time due to esophagotracheal fistula (ETF) and esophagoaortic fistula (EAF). We tried to explore a safe salvage surgical method during the perioperative period to maximize the resection of the tumor on the premise of safety and reconstruction of the alimentary tract to avoid early death due to ETF and EAF.

Methods

From December 2007 to November 2018, forty-five LCWEC patients were treated using the modified Wu’s esophagectomy. Patient features, surgical techniques, postoperative complications, and pathology outcomes were analyzed.

Results

The average length of the tumors was 12.5 cm (range 8.1–22.5 cm), and the average transverse tumor diameter was 5.8 cm (range 4.5–7.8 cm). No complications like anastomotic leakage, anastomotic stenosis, chylothorax, delayed gastric emptying, vocal cord paralysis, dumping syndrome, and reflux were detected. The 30-day and in-hospital mortality rates were 0%. Complete (R0) resection was achieved in 38 (84.4%) cases. The resection margin rate of positive anastomosis was 0%. Until the death of the patients, no feeding failure due to gastrointestinal obstruction and early death due to ETF or EAF occurrence. During follow-up, the median time to death was 17.2 months for patients treated with surgery alone and 32 months for patients treated with postoperative multimodal treatment.

Conclusion

The modified Wu’s esophagectomy is a safe and feasible salvage surgical method for LCWEC resection.
Can C-reactive protein predict coagulation in off pump coronary artery bypass grafting? A cohort study
Authors: Liu Xiaojie , Yu Yang , Wang Lijuan , Wang Sudena , Gao Yuchen , Ao Hushan
Published: September 2022

Background

Previous study found that C-reactive protein (CRP) can predict bleeding after on-pump CABG. To evaluate whether preoperative C-reactive protein (CRP) can be a novel marker of postoperative bleeding in patients having off-pump coronary artery bypass grafting (CABG).

Methods

This is a retrospective cohort study. Multiple variable regression analyses were performed. 537 patients undergoing off-pump isolated primary CABG at Fuwai Hospital from September 2017 to July 2018 were recorded. The primary endpoint was bleeding volume within 24 h after surgery.

Results

Data of 537 patients undergoing off-pump isolated primary CABG at Fuwai Hospital were recorded. The correlations between bleeding volume within 24 h after surgery and preoperative data were analyzed with univariate and multivariate linear regression. Much more preoperative CRP concentration (B = −0.089, P < 0.05) was associated with less postoperative bleeding volume and fibrinogen (B = 0.594, p < 0.001).

Conclusions

Preoperative CRP concentration is independently correlated with the postoperative volume of bleeding within 24 h. CRP may become a novel coagulation index in coronary artery atherosclerotic disease.
Impact of stromal tumor-infiltrating lymphocytes (sTILs) on response to neoadjuvant chemotherapy in triple-negative early breast cancer in the WSG-ADAPT TN trial
Authors: Kolberg-Liedtke Cornelia , Feuerhake Friedrich , Garke Madlen , Christgen Matthias , Kates Ronald , Grischke Eva Maria , Forstbauer Helmut , Braun Michael , Warm Mathias , Hackmann John , Uleer Christoph , Aktas Bahriye , Schumacher Claudia , Kuemmel Sherko , Wuerstlein Rachel , Graeser Monika , Nitz Ulrike , Kreipe Hans , Gluz Oleg , Harbeck Nadia
Published: September 2022

Background

Higher density of stromal tumor-infiltrating lymphocytes (sTILs) at baseline has been associated with increased rates of pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) in triple-negative breast cancer (TNBC). While evidence supports favorable association of pCR with survival in TNBC, an independent impact of sTILs (after adjustment for pCR) on survival is not yet established. Moreover, the impact of sTIL dynamics during NACT on pCR and survival in TNBC is unknown.

Methods

The randomized WSG-ADAPT TN phase II trial compared efficacy of 12-week nab-paclitaxel with gemcitabine versus carboplatin. This preplanned translational analysis assessed impacts of sTIL measurements at baseline (sTIL-0) and after 3 weeks of chemotherapy (sTIL-3) on pCR and invasive disease-free survival (iDFS). Predictive performance of sTIL-0 and sTIL-3 for pCR was quantified by ROC analysis and logistic regression; Kaplan–Meier estimation and Cox regression (with mediation analysis) were used to determine their impact on iDFS.

Results

For prediction of pCR, the AUC statistics for sTIL-0 and sTIL-3 were 0.60 and 0.63, respectively, in all patients; AUC for sTIL-3 was higher in NP/G. The positive predictive value (PPV) of “lymphocyte-predominant” status (sTIL-0 ≥ 60%) at baseline was 59.3%, though only 13.0% of patients had this status. To predict non-pCR, the cut point sTIL-0 ≤ 10% yielded PPV = 69.5% while addressing 33.8% of patients.

Higher sTIL levels (particularly at 3 weeks) were independently and favorably associated with better iDFS, even after adjusting for pCR. For example, the adjusted hazard ratio for 3-week sTILs ≥ 60% (vs. < 60%) was 0.48 [0.23–0.99]. Low cellularity in 3-week biopsies was the strongest individual predictor for pCR (in both therapy arms), but not for iDFS.

Conclusion

The independent impact of sTILs on iDFS suggests that favorable immune response can influence key tumor biological processes for long-term survival. The results suggest that the reliability of pCR following neoadjuvant therapy as a surrogate for survival could vary among subgroups in TNBC defined by immune response or other factors. Dynamic measurements of sTILs under NACT could support immune response-guided patient selection for individualized therapy approaches for both very low levels (more effective therapies) and very high levels (de-escalation concepts).

Trial registration: Clinical trials No: NCT01815242, retrospectively registered January 25, 2013.
Induced hepatic stem cells maintain self-renewal through the high expression of Myc coregulated by TET1 and CTCF
Authors: Wang Chen , Yu Xinlu , Ding Sai , Liu Yang , Zhang Hongxia , Fu Jingbo , Yu Bing , Zhu Haiying
Published: September 2022

Background

Induced hepatic stem cells (iHepSCs) with the capacities of self-renewal and bidifferentiation into hepatocytes and cholangiocytes were generated from mouse embryonic fibroblasts (MEFs) by lineage reprogramming in our previous research. However, the mechanism of iHepSC self-renewal has not been elucidated. Active demethylation regulated by Tet1 plays an important role in the self-renewal of stem cells, including pluripotent stem cells and adult stem cells. Here, we investigated the role and mechanism of Tet1-regulated demethylation in the self-renewal of iHepSCs.

Methods

The methylation levels and the expression of Tet1 in iHepSCs and MEFs were analyzed by immunofluorescent staining, quantitative reverse transcription PCR and western blotting. Then, the effects of Tet1 knockdown on the proliferation and self-renewal of iHepSCs were analyzed by CCK8, colony formation, and sphere formation assays. The mechanism by which Tet1 regulates the self-renewal of iHepSCs was investigated by chromatin immunoprecipitation, bisulfite sequence PCR, and methylation-sensitive restriction endonuclease-PCR.

Results

The high level of 5hmC and the low level of 5mC in iHepSCs were accompanied by high expression of Tet1. After Tet1 expression was knocked down by shRNA in iHepSCs, the proliferation and self-renewal capacities were inhibited, and the expression of Myc was also decreased. The higher expression level of Myc in iHepSCs maintained its self-renewal and was regulated by Tet1, which directly binds to CBS-1 and site A regions of the Myc promoter and demethylates the CpG cytosine. In addition, CTCF also binds to the CBS-1 and site A regions of the Myc promoter and regulates Myc expression along with TET1.

Conclusion

The self-renewal of iHepSCs was maintained by the higher expression of Myc, which was coregulated by TET1 and CTCF. This study may provide new insights into the self-renewal of stem cells, which can promote the research and application of ‘reprogrammed’ stem cells.
Implementation lessons learnt when trialling palliative care interventions in the intensive care unit: relationships between determinants, implementation strategies, and models of delivery—a systematic review protocol
Authors: Meddick-Dyson S. A. , Boland J. W. , Pearson M. , Greenley S. , Gambe R. , Budding J. R. , Murtagh F. E. M.
Published: September 2022

Background

Heterogeneity amongst palliative care interventions in the intensive care unit (ICU) and their outcomes has meant that, even when found to be effective, translation of evidence into practice is hindered. Previous evidence reviews have suggested that the field of ICU-based palliative care would benefit from well-designed, targeted interventions, with explicit knowledge translation research demonstrating valid implementation strategies. Reviewing effectiveness studies alongside process evaluations for these interventions will give insight into the implementation barriers or constraints identified, and the implementation strategies adopted.

Methods

A systematic review to identify and synthesise knowledge on how models of integrating palliative care into the ICU have been implemented and provide critical recommendations for successful future development and implementation of complex interventions in the field. The search will be carried out using MEDLINE, Embase, Cochrane, CINAHL, and PsycINFO. The search strategy will combine terms related to palliative care, intensive care, and implementation. Only full-text articles will be considered and conference abstracts excluded. There will be no date or language restrictions. The Implementation Research Logic Model will be used as a framework for synthesis. Findings will be reported following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Discussion

This review will provide understanding of implementation facilitators, barriers, and strategies, when employing palliative care interventions within the ICU. This will provide valuable recommendations for successful future development of complex interventions using implementation frameworks or theories. This can increase the potential for sustained change in practice, reduce heterogeneity in interventions, and therefore help produce measurable and comparable outcomes.

Systematic review registration

International Prospective Register of Systematic reviews PROSPERO (CRD42022311052)
Interpersonal Psychotherapy (IPT) for Posttraumatic stress disorder
Authors: De Jong J.
Published: September 2022

Introduction

Therapies focused on exposure like prolonged exposure (PE) or Eye Movement Desensitization and Reprocessing (EMDR) dominate the treatment of posttraumatic stress disorder (PTSD). There are many patients with PTSD who are not fully responding with exposure-therapies. or don’t want exposure therapies at all. Many patients don’t like to be confronted with elements of their traumatic experience. IPT has proven to be highly efficient in e.g. depression and bulimia and is promising as a treatment for PTSD while NOT using exposure. IPT aims to repair the damage trauma does to interpersonal trust and social functioning.

Objectives

Learn more about IPT. Learn more about the way IPT is used in the treatment for patients with PTSD (adaptations).

Methods

Literature review focused on IPT for PTSD.

Results

Among the consequences of PTSD are affective numbing, interpersonal hypervigilance, and social withdrawal (1). Numbness, an avoidance particularly of negative affect, makes it hard to read one’s interpersonal environment. Thus in adapting IPT for PTSD, we devote the early part of treatment to affective reattunement: helping patients to identify their emotions and to recognize them as helpful social signals. Once patients can read their feelings, they can put them to use to handle relationships better, deciding whom they can trust and whom they can’t. IPT for PTSD tends to focus on role transitions, which are usually inherent having been traumatized (2).

Conclusions

In the past there has been several kinds of research that show that group IPT and individual IPT reduce PTSD and depression in traumatized patients with PTSD.

Disclosure

No significant relationships.
Psychological characteristics of men with arterial hypertension according to the MMPI test
Authors: Chernus N. , Sivkov A. , Gorenkov R. , Sivkov S. , Serdakova A. , Zolotovickaja A. , Savina T.
Published: September 2022

Introduction

The term hypertension means super-stress - psychoemotional. It is generally accepted that this condition is more inherent in men.

Objectives

Study psychological features of arterial hypertension patients depending on severity.

Methods

Examined 102 men, ages 31 to 62; the average age was 46.4 ± 0.32 years. Of these, with stage I AG 46 patients (1 group), with stage I AG 45 (2 group), with stage III AG 11 (3 group). Psychological status of patients was examined using the MMPI test.

Results

The averaged personality profile of patients showed that a profile exceeding 80 T points is typical for all comparison groups: 82,6%, 73,3%, 81,8%, in groups 1, 2 and 3, respectively. The first profile type in frequency was the profile with a leading peak on the first scale in combination with a moderate rise on the right scales: seventh-eighth: 63.7% of the total number of surveyed. This profile reflected mainly depressive tendencies. The second most frequent profile reflected alarming trends: an increase on the 2nd scale with the main peak at 7. Persons with depressive manifestations were characterized by a focus on compliance with the normative criteria of the social environment, with anxious manifestations, personal characteristics were manifested by hostility, irritability, chronic social maladaptation

Conclusions

Thus, the psychoemotional conditions identified are characterized by frustration, high levels of anxiety, interpersonal disorders, reduced performance, which may be considered mental health disorders

Disclosure

No significant relationships.
“Neural Network Responses to Traumatic Stress Predicting its Longterm Consequences”
Authors: Dirven B. , Negwer M. , Grandjean J. , Homberg J. , Kozicz T. , Henckens M.
Published: September 2022

Adaptive responding to severe stress or trauma requires an optimized reconfiguration in the activity of large-scale neural networks. In vulnerable individuals, this response can go awry, inducing long-term consequences on mental health, such as posttraumatic stress disorder (PTSD). Improved understanding of the neurobiological mechanisms underlying this maladaptive neural response to trauma might benefit early intervention (i.e., secondary prevention) options in stress-related psychopathology. Yet, because of obvious ethical limitations these acute responses to trauma are inaccessible in humans. Therefore, we here used a mouse model for PTSD to investigate adaptive vs. maladaptive neural responding to trauma, the latter leading to long-term behavioral consequences mimicking symptoms observed in PTSD patients. By using transgenic mice, we were able to fluorescently label all activated neurons during trauma exposure, and relate these activation patterns to later PTSD-like symptomatology. We observed increased neuronal activity in sensory-processing and memory-related areas of mice vulnerable to the long-term consequences of trauma exposure, compared to resilient mice. Moreover, vulnerable mice displayed increased functional connectivity between the default mode network and lateral cortical network (a proxy for the central executive network in humans) during trauma processing relative to resilient mice. As such, these findings provide first insight in how a maladaptive neural response to trauma can result in later symptoms of psychopathology.

Disclosure

No significant relationships.
Treatment methods for patients with psychosomatic illnesses
Authors: Boukdir A. , Khallouk A. , Rhaouti A. , Stati S. , Nafiaa H. , Ouanass A.
Published: September 2022

Introduction

Psychosomatic illnesses correspond to physical symptoms (with or without objectivable organic lesions), that psychological factors such as stress and personality type, would have a potential effect on their appearance, evolution and / or worsening. These psychosomatic conditions are quite common but difficult to diagnose. Doctors from different specialties are consulted by the patients and multiple examinations and investigations are run by specialists in order to get to the final diagnosis. These psychosomatic conditions may appear under different types of illnesses : respiratory (asthma), dermatological (psoriasis, eczema), digestive (gastric ulcer, ulcerative colitis, Crohn’s disease), cardiovascular (arterial hypertension, infarction), neurological (migraine)…

Objectives

Study management modalities of psychosomatic disorders through cases followed in consultation at the university psychiatric hospital Ar-razi of Salé in Morocco

Methods

through cases followed in consultation at the university psychiatric hospital Ar-razi of Salé in Morocco

Results

From the results observed in the patients recruited in this study, we retain the need for a bio-psycho-social approach, through a global approach of the patient in all its dimensions, not only biological, but also psychological and social ; we also retain the essential role of the psychiatrist in the management of these psychosomatic disorders, both in preventive and curative terms, by allowing a better understanding of the interactions between physical and mental health.

Conclusions

psychosomatic conditions are quite common but difficult to diagnose and the need for a bio-psycho-social approach, through a global approach of the patient in all its dimensions, not only biological, but also psychological and social is crucial.

Disclosure

No significant relationships.
The effects of lithium and inflammation on the atherosclerosis of older bipolar patients at high risk for cardiovascular disease
Authors: Tsai S.
Published: September 2022

Introduction

Atherosclerosis can result in serious cardiovascular disease (CVD) and is associated with inflammation and psychopharmacological treatment in bipolar disorder.

Objectives

We attempt to investigate the effects of lithium and inflammation on the atherosclerotic development in older bipolar adults at high risk for cardiovascular disease.

Methods

The euthymic out-patients with bipolar I disorder aged over 45 years and concurrent endocrine or cardiovascular disease were recruited to measure their bilateral carotid intima media thickness (CIMT) and circulating levels of lithium, valproate, sTNF-R1, sIL-6R, and lipid profile. All clinical information were obtained by directly interviewing patients and reviewing all medical records.

Results

Forty eight patients with mean 48.3 years old and mean 27.2 years of age at illness onset were recruited. After controlling for the body mass index, multivariate regression analyses showed that older age, lower lithium level, and higher plasma sTNF-R1 level were associated with higher CIMT and collectively accounting for 33.1% of the variance in CIMT. Blood level of low density lipid or valproate has none relationship with CIMT.

Conclusions

Lithium treatment may protect older bipolar patient, even those at high risk for CVD, from atherosclerotic development. Furthermore, persistent inflammatory activation, particularly macrophage activation, may be associated with the accelerating development of atherosclerosis.

Disclosure

No significant relationships.
Childhood trauma and comorbid anxiety disorders in patients with bipolar disorder
Authors: Bougacha D. , Ellouze S. , Jenhani R. , Ghachem R.
Published: September 2022

Introduction

A history of childhood trauma and Comorbid anxiety disorders have each been identified as potential predictors of unfavorable outcomes in patients with bipolar disorder. Nevertheless, the relationship between these two prognostic features has been little studied.

Objectives

In the present study, we aim to explore the relationship between childhood trauma and comorbid anxiety disorders in bipolar patients.

Methods

We conducted a cross-sectional, descriptive, and analytical study. Sixty-one euthymic patients with bipolar disorder were recruited in the department of psychiatry B of Razi Hospital, during their follow-up. We assessed history of childhood traumatic experiences with the Childhood Trauma Questionnaire (CTQ) and current diagnosis of anxiety disorders with the M.I.N.I. International Neuropsychiatric Interview.

Results

The mean age of patients was 43.4. The sex ratio was 2.4. Almost two-thirds of patients (64%) had experienced at least one type of childhood trauma. Twenty-one percent of participants had one anxiety disorder and 12% participants had two or more current anxiety disorders. Of the anxiety disorders, social anxiety disorder was significantly associated with emotional abuse subscale (p=0.002). Generalized anxiety disorder was significantly associated with the physical abuse subscale (p=0.025) and the number of severe childhood trauma per patient (p=). A statistically significant association was found between the number of current anxiety disorders and the emotional abuse sub score (p=0.021).

Conclusions

Exposure to childhood traumatic experiences is associated with more common comorbid anxiety disorders among bipolar patients. These prognostic features should systematically be a part of clinical assessment and taken into account in the management of these patients.

Disclosure

No significant relationships.
Lithium: more than a mood stabilizier
Authors: Fraga A. , Mesquita B. , Facucho-Oliveira J. , Albuquerque M. , Espada-Santos P. , Cintra P. , Paulino S. , Moutinho A.
Published: September 2022

Introduction

Bipolar disorder (BD) is characterized by episodic changes in affect, motivation, cognition and behavior. This severe mental disorder has a prevalence of at least 1% and a high heritability of 60%-80%. The pathophysiology is still poorly understood but evidence indicate that the disorder relates to disturbances in front-limbic networks relevant for emotion processing and regulation. New techniques have been used to study BD and showed aberrante white matter (WM) microstructure in the corpus callosum and from-limbic pathways. However, lithium, a mood stabilizier, it looks like has celular and neuromodulatory effects.

Objectives

The authors elaborate a narrative literature review to identify the existing clinical evidence of lithium’s effect on the WM from BD patients.

Methods

Pubmed databased searched using the therms “bipolar disorder”, “white matter” and “lithium”.

Results

Lithium is a bipolar medication that confers treatment and long-term prophylaxis and been reported as having neuroprotective effects.

Studies that used new techniques such diffusion tensor imaging measures to assess white matter integrity reported a positive effect of lithium on the integrity of WM of BD patients and suggest that response to lithium treatment in BD patients is associated with normalization of WM microstructure in regions associated with emotion processing.

Conclusions

Lithium appears to positively influence the evolution of the white matter abnormalities described in BD patients however further investigation is required to strongly reinforce this potential and safety.

Disclosure

No significant relationships.
Manic patients and sleep management: the role of polysomnography in clinical practice
Authors: Pacchioni F. , Cavallini M.C. , Fregna L. , Sarzetto A. , Attanasio F. , Barbini B. , Colombo C.
Published: September 2022

Introduction

Sleep plays a key role in the pathogenesis and clinic of mood disorders. However, few studies have investigated electroencephalographic sleep parameters during the manic phases of Bipolar Disorder (BD).

Objectives

Sleep management is a priority objective in the treatment of the manic phases of BD and the polysomnographic investigation can be a valid tool both in the diagnostic phase and in monitoring clinical progress.

Methods

Twenty-one patients affected by BD, manic phase, were subjected to sleep monitoring via PSG in the acute phase (at the entrance to the ward) and in the resolution phase (near discharge). All participants were also clinically evaluated using Young Manic Rating Scale (YMRS) Pittsburgh Sleep Quality Index (PSQI), Morningness-eveningness Questionnaire (MEQ) at different timepoints.

Results

Over the hospitalization time frame there was an increase in quantity (Total Sleep Time) and an improvement in the quality and effectiveness of sleep (Sleep Efficiency). In addition, from the point of view of the EEG structure, clinical improvement was accompanied by an increase in the percentage of REM sleep.

Conclusions

Sleep monitoring by PSG can be a valuable tool in the clinical setting both in the diagnostic phase, “objectively” ascertaining the amount of sleep, and in the prognostic phase, identifying electroencephalographic characteristics that can predict the patient’s progress and response to drug therapy. The improvement in effectiveness and continuity of sleep and the change in its structure that accompanies the resolution of manic symptoms also testifies how the regularization of the sleep-wake rhythm is to be considered a priority in treating manic phases.

Disclosure

No significant relationships.
Comparison of prevalence, clinical evolution and vaccination rate against COVID 19 in a population of patients diagnosed with Dual Bipolar disorder and Non-dual bipolar disorder
Authors: Losilla Rodríguez B. , Palermo Zeballos F. , Ortiz Jiménez M.
Published: September 2022

Introduction

Since the beginning of the pandemic, 4,745,519 cases, 396,878 hospitalizations and 82,884 deaths with COVID-19 have been reported in Spain. As of August 24, 2021, 76.4% of Andalusians over 12 years of age have the complete vaccination regimen.

Objectives

Main: to calculate the prevalence of COVID 19 infection, clinical evolution, and vaccination rate in a population of patients diagnosed with dual bipolar disorder. Secondary: compare these data with those obtained inpatients diagnosed with non-dual bipolar disorder.

Methods

Retrospective descriptive study. The study population is made up of patients diagnosed with dual bipolar disorder and non-dual bipolar disorder (according to DSM 5 criteria). Infection, admission, death, and vaccination data were obtained from the patient’s medical history.

Results

Of the 7 patients diagnosed with dual bipolar disorder, the prevalence of COVID 19 infection, since the beginning of the pandemic is 0% and of the 21 patients diagnosed with non-dual bipolar disorder the prevalence is 9.51% (2/21). Of the patients with COVID 19 infection, none required hospital admission and no deaths occurred. The vaccination rate in the group of patients with dual bipolar disorder is 85,71% (6/7) and in the group of non-dual bipolar disorder is 61.91% (13/21), no finding statistically significant differences between both groups.

Conclusions

In our study the prevalence of COVID 19 infection inpatients diagnosed with dual bipolar disorder is 0% and the vaccination rate is 85.71%. While in patients with non-dual bipolar disorder the prevalence is 9.51%, there were no admissions, no deaths and the vaccination rate is 61.91%.

Disclosure

No significant relationships.
Hyperprolactinemia with antipsychotics and the need for magnetic resonance imaging
Authors: Molina Liétor M.D.C. , Cuevas Iñiguez I.
Published: September 2022

Introduction

Hyperprolactinemia is a frequent medical condition in daily clinical practice. In most laboratories, normal prolactin (PRL) concentrations are less than 25ng / ml in women and less than 20ng / ml in men. The causes of hyperprolactinemia can be physiological or secondary, among which a differential diagnosis must be made.

Objectives

The causes of hyperprolactinemia are reviewed on the basis of a clinical case.

Methods

Bibliographic review and presentation of a clinical case.

Results

The case of a 17-year-old patient is presented, who comes to the Emergency Department due to a picture of agitation at home. Her relatives comment that two months ago, they began to notice her strange, very active and without the need to sleep. During the examination, the patient presents with verbiage, flight of ideas, and megalomanic thoughts. A manic episode was diagnosed and the patient was admitted to the psychiatric hospital. She was prescribed risperidone up to 4mg / day, carrying out prolactin determination after a few days. The baseline prolactin determination was 140 ng / ml and 130 ng/ml at twenty minutes. Due to the very high levels, the question arises as to whether the cause of hyperprolactinemia is due to treatment or hypothalamic damage. The MRI: “slight asymmetry in the pituitary gland, being discreetly more globular the adenohypophyseal LD, which could be in relation to underlying microadenoma”. As there were no previous data, the decision was made to withdraw risperidone with the introduction of aripiprazole and imaging tests periodically.

Conclusions

Differential diagnosis of the cause of hyperprolactinemia is important.

Disclosure

No significant relationships.
“Pre-Existing and New-Onset Cognitive Impairment in Patients with COVID-19”
Authors: Krysta K.
Published: September 2022

Recently, many reports have been available related to neuropsychiatric complications in the course of COVID-19 infection, and its long-term consequences. Many of them are related to psychological factors, such as: isolation, change of existing habits, fear of getting sick and dying, fear of losing a job and fears related to the financial situation, which resulted in an increase in the occurrence of diseases and mental disorders such as adaptation and anxiety disorders, depression. t has been also reported that treatment in conditions of intensive care unit lead to high prevalence of psychiatric disorders like PTSD in discharged patients. In our own studies we observed that patients with new appearing psychiatric symptoms were mostly those, who were professionally active, but did not work remotely. The time the patients spent at home had a negative impact on their well-being, they generally felt worse, their family life suffered more frequently. The most common cognitive symptoms, which are reported embrace: problems with short- and long-term memory, lack of mental clarity, feeling eclipsed, lightheaded, poor concentration, mental fatigue. We also present here a series of post-acute COVID cases from the examined population and provide a concise comparison of observed symptomatology with previous reports.

Disclosure

No significant relationships.
“I’ve discovered the COVID-19 vaccine”. Approach of a bipolar disorder clinical case in the Mental Health Day Hospital of Salamanca during the pandemic
Authors: Gonzalez-Mota A. , Fombellida Velasco C. , Gonzalez Gil A. , Gómez Hernández P. , Vicente Torres I. , Covacho Gonzalez M. , Payo-Rodriguez C. , Beltran-Mercado E. , Roncero C.
Published: September 2022

Introduction

A 21-year-old woman diagnosed with bipolar disorder was hospitalized in the Mental Health Day Hospital of Salamanca during the Covid pandemic. The patient engaged with 4 different jobs and a master’s degree, beginning with verbose speech, dysphoria, global insomnia, grandiose delusions, extremely high energy and thinking she has the vaccine. She works the following objectives:illness insight, risk factors, psychopathological stabilization, social skills, slowing down of activities and taking responsibilities.

Objectives

The objective is do a follow-up of the patient during her hospitalization in the Mental Health Day Hospital and to carry out a structured search in PubMed and Up-to-Date about psychotherapy and bipolar disorder.

Methods

3-month follow-up of a 21-year-old woman diagnosed with bipolar disorder during her hospitalization in the Mental Health Day Hospital in Salamanca and a structured search in PubMed and Up-to-Date in April 2021 in English, French and Spanish, including the last 10 years with the keywords “psychotherapy”, “psychotherapies” and “bipolar disorder “.77 studies were analyzed: 12 included, 65 excluded.

Results

Several randomized trials highlight the efficacy of group psychoeducation and cognitive-behavioural therapy in relapse prevention, improving illness insight, medical adherence and less hospitalizations. Therapeutic alliance plays a significant role in the process. Our patient improved her knowledge of her illness and treatment, her social skills and reconnected with her relatives and slowed down her activity. She then was referred to her community mental heath center psychiatrist.

Conclusions

The insight in bipolar disorder plays an important role in medical adherence and prevention of relapses. Therapeutic alliance improves their insight, their functionality in their daily life and enables close monitoring. Medical treatment should be accompanied by psychotherapy for a complete approach of the treatment.

Disclosure

No significant relationships.
Treatment-resistant Bipolar Disorder and Thyroid Cancer
Authors: Jemli H. , Ouali U. , Aissa A. , Zgueb Y. , Jomli R.
Published: September 2022

Introduction

Bipolar disorder (BD) is a chronic and recurrent illness frequently associated with functional deterioration and treatment challenges. High rates of thyroid dysfunction have been found in patients with BD, compared to the general population.

Objectives

To illustrate through a case-report the therapeutic challenges of treatment-resistant bipolar disorder and its relationship with thyroid dysfunction.

Methods

Case report of a 41-year-old male patient with BD and comorbid anxiety disorders who has been diagnosed with thyroid cancer and underwent total thyroidectomy.

Results

Mr B is a 41 year old patient diagnosed with BD and comorbid anxiety disorders (panic disorder, social anxiety disorder and generalized anxiety disorder) at age 18. He has presented in total 17 relapses and was hospitalized 7 times between the ages of 18 and 24. He experienced predominantly major depressive episodes with mixed features and debilitating anxiety symptoms. He was put on several treatments including a combination of mood stabilizers, antidepressants and benzodiazepines. Due to unsatisfactory treatment response, he was put on clozapine 150mg to 175mg/d combined with valproic acid, clonazepam. In 2009, the patient developed a nodular goiter caused by papillary thyroid carcinoma and underwent total thyroidectomy and radioactive iodine therapy. Following the surgical operation and stabilization of thyroid functioning, a decrease in the number of relapses and the severity of mood and anxiety symptoms have been noted.

Conclusions

This case reports highlights the importance of thyroid function assessment in patients with bipolar disorder and the possible correlation to treatment resistance and symptom severity.

Disclosure

No significant relationships.
The Effects of Emotional Dysregulation and Impulsivity on Suicidality in Patients with Bipolar Disorder
Authors: Kulacaoglu F. , Izci F.
Published: September 2022

Introduction

Bipolar disorder (BD) is a prevalent, often severe, and disabling illness that affects about 1-5% of the general population and has the highest risk of suicide among psychiatric disorders. Impulsivity and, emotion dysregulation have been emphasized due to their role in facilitating suicide acts among those with suicide ideation.

Objectives

This study aimed to examine the relationship between emotional dysregulation, impulsivity, and suicidality in patients with bipolar disorder by comparing bipolar patients with healthy individuals

Methods

The study included 85 patients (59 women, 26 men) with bipolar disorder and education and age-matched 65 (44 women, 21 men) healthy volunteers. The patient group was divided into 3 subgroups according to have suicide attempt history, have suicide ideation without attempt, and have neither suicide attempt nor ideation. Sociodemographic Form, The Difficulties in Emotion Regulation Scale (DERS), Barratt Impulsivity Scale (BIS-11), Scale for Suicide Ideation, Suicide Behaviors Questionnaire scales were applied to the participants.

Results

Patients with bipolar disorder had significantly higher scores for emotion dysregulation and impulsivity than the healthy control group. A statistically significant correlation was found between emotion dysregulation, impulsivity, suicide ideation, and suicide behavior scores. DERS Total and Barratt Total scores were found higher for bipolar patients with suicide attempts than bipolar patients with suicide ideation and bipolar patients with neither attempt nor ideation. The hierarchical regression analysis has indicated that strategies, clarity, and non-planing impulsiveness were the predictors of suicide ideation in bipolar patients.

Conclusions

The results suggested a strong association between emotional dysregulation, impulsivity with suicide ideation, and behavior in patients with bipolar disorder.

Disclosure

No significant relationships.
Comorbidity of CRHR2 gene variants in type 2 diabetes and depression
Authors: Amin M. , Ott J. , Wu R. , Postolache T. , Vergare M. , Gragnoli C.
Published: September 2022

Introduction

The corticotropin-releasing hormone receptor 2 (CRHR2) gene encodes CRHR2, which is an important element in the hypothalamic-pituitary-adrenal physiologic response towards stress culminating in hyperglycemia, insulin resistance, mood disorders and depression (MDD). CRHR2-/- mice are hypersensitive to stress, and the CRHR2 locus in humans has been linked to type 2 diabetes (T2D) and MDD.

Objectives

Several variants in the CRHR2 gene have been reported in patients with bipolar disorder, post-traumatic stress disorder, and T2D, but variants in the gene have not been investigated in families with T2D and MDD.

Methods

We genotyped 212 Italian families with T2D and MDD. We tested 17 SNPs in the CRHR2 gene using two-point parametric-linkage and linkage-disequilibrium (LD) analysis with the following models: dominant with complete-penetrance (D1), dominant with incomplete-penetrance (D2), recessive with complete-penetrance (R1) and recessive with incomplete-penetrance (R2).

Results

We detected linkage to and/or LD with: MDD for 3 SNPs/D1, 2 SNPs/D2, 3 SNPs/R1, and 3 SNPs/R2; and, T2D for 3 SNPs/D1, 2 SNPs/D2, 2 SNPs/R1 and 1 SNP/R2. Two independent SNPs were comorbid. Interestingly, the variants linked to or in LD with MDD had in general higher statistical significance level than the variants linked to T2D, despite that the families were primarily ascertained for T2D.

Conclusions

Our study shows for the first time that the CRHR2 gene which encodes CRHR2 is in linkage to and linkage disequilibrium with MDD and T2D, thereby contributing, in families with T2D, to both disorders and underlying the shared genetic pathogenesis of their comorbidity

Disclosure

No significant relationships.
A Case of Ruminative Hypomania Induced by High Dose Venlafaxine
Authors: Yıldızhan E. , Ünlü Çilesiz M. , Ekici E. , Tomruk N.
Published: September 2022

Introduction

Obsessive phenomena, when present, are usually seen in the depressive phase of bipolar disorder.

Objectives

The peculiar case with aggravation in ruminative and obsessive thinking with simultaneous hypomania may widen our understanding of the phenomenology of antidepressant induced hypomanic symptoms.

Methods

We present a case of ruminative hypomania induced by high dose venlafaxine. Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D) and Yale Brown Obsessive Compulsive Scale (YBOCS) were used for symptom ratings.

Results

The patient was 30 years old and she had treatment history of depression for 3 months. She had two consecutive suicide attempts with drugs in the week before she was hospitalized for suicidal risk. She was using venlafaxine 300 mg/day and olanzapin 2,5 mg/day; continuous ruminative thinking about the past and imaginary sexual affairs with former friends were apparent with an unremitting pattern, leading to intense psychomotor agitation and suicide attempts. Irritable mood, and increased energy was observed with continuous ruminations. She was diagnosed with bipolar-II-disorder, with mixed features and anxious distress (YMRS:17, HAM-D:22, YBOCS:34). After discontinuing venlafaxine and starting anti-manic treatment with haloperidol 10 mg/day in the first week, both affective symptoms and ruminations were improved (YMRS:2, HAM-D:4, YBOCS:8). Aripiprazol 20 mg/day and quetiapine 100 mg/day which were given for continuation treatment were also effective for preserving full remission.

Conclusions

When prescribing high dose venlafaxine for treatment resistant depression, it should be remembered that this may induce hypomanic symptoms and prominent ruminative thinking which can be ameliorated with anti-manic treatment.

Disclosure

No significant relationships.
Retinal Thickness as a biomarker of cognitive impairment in bipolar disorder
Authors: García-Corres E. , Alberich S. , Rementeria L. , Pérez-Landaluce I. , González-Pinto A.M.
Published: September 2022

Introduction

Ocular Coherence Tomography (OCT) to measure retinal thickness is the current method to observe neurological impairment in neurodegenerative diseases [1] and in mental disorders [2] due to the composition of the retina itself as an anatomic extension of the brain.There can be found some factors to improve the resilience like the years of study.

Objectives

Our aim is to evaluate cognitive and clinical impairment in Bipolar Disorder and see the correlation to the retinal thinning.

Methods

Twenty-seven patients diagnosed with Bipolar Disorder were assessed in the context of the FINEXT programme (3). Selective attention, executive functions and verbal memory were measured among other variables. Using the OCT technique, we measured the thickness of the ppRNFL, the RFNL, GCL and IPL layers in the macula in both eyes through several radial segments. Partial correlations were performed with Bonferroni correction (p≤0.006) adjusted for age and academic status except for the variable years of study which was adjusted for age.

Results

Significant direct correlations were observed between:

- The study-years and the thickness of the retina in the NO and RFNL. -Selective attention and GCL and RFNL layers. -Executive function and the GCL and IPL.

Conclusions

We can observe some preliminar results showing a significant correlation between some layers of the retina, upper segments more frequently, and the outcomes of the neurocognitive assessment. We can see a relationship as well between years of study and the thickness of the Retinal Nerve Fibre Layer in the retina and optic nerve head, the axons of the neurons in the eye.

Disclosure

No significant relationships.
Impact of sunlight exposure on the age of onset of bipolar disorder
Authors: Arfaoui N. , Hamdoun J. , Bougacha D. , Ben Ammar H. , El Hechmi Z.
Published: September 2022

Introduction

Bipolar disorder is a multifactorial disorder influenced by multiple genetic and environmental factors.There is limited understanding of how non-genetic factors may impact the age of onset of bipolar disorder

Objectives

To study the age of onset of bipolar disease in Tunisia (where the average duration of sunshine is 8 hours/day) and compare it to the age of onset in countries with a lower duration of sunshine (Germany 0.17h/day; Norway 1.40h/day).

Methods

We conducted a retrospective study of 100 patients with bipolar disorder type I followed at the psychiatric department Aziza Othmana at Razi hospital.The data collection was done using a pre-established paper form exploring sociodemographic and clinical data.The duration of sunshine was estimated according to the average number of hours of sunshine per day in each country collected through meteorological sites.

Results

Our population was predominantly male (60%) with a mean age of 48.7 years.The first episode was manic in 76% of cases. The mean age of onset in our sample was 25.86 years, with extremes ranging from 13 to 49 years.An early onset (threshold age=21 years) was found in 36% of the Tunisian population. The age of onset was earlier in patients with a family history of bipolar disorder: 22.76 years vs 28.23 years. A late onset (threshold age=37 years) was found in 13% of the Tunisian population.

Conclusions

The study confirmed that there is an inverse relationship between the degree of sunlight and the age of onset of the disease, especially in the presence of a family history of mood disorders

Disclosure

No significant relationships.
Evaluation of empathy among euthymic bipolar patients
Authors: Mhiri E. , Ben Thabet J. , Smaoui N. , Gassara I. , Feki R. , Zouari L. , Omri S. , Charfi N. , Maalej M. , Maalej M.
Published: September 2022

Introduction

Bipolar disorder (BD) is a mental illness marked by extreme swings in the mood, energy, and thinking. Although it’s not an official symptom of the disease, some research suggests that it also may affect the empathy.

Objectives

To investigate empathic responding in patients with BD in euthymic state of illness and to determine associated factors.

Methods

A cross-sectional and descriptive study of 78 patients followed for bipolar disorder, during euthymia, at the psychiatric outpatient clinic at CHU Hédi Chaker in Sfax. We used a socio-demographic and clinical data sheet and the Questionnaire of Cognitive And Affective Empathy (QCAE) to assess empathy with its two dimensions : “Affective empathy” and “Cognitive empathy”.

Results

The average age was 36.27 years, the sex ratio was 5.5. Bipolar I disorder was diagnosed in 88.5% of patients. The mean age of onset was 27.73 years, and the mean duration of illness was 8.4 years. 78.2% of patients had a good adherence to treatment. 60.3% of them had residual depressive symptoms during eutymia. QCAE total score was 72.49. (Maximum possible score 124) Cognitive empathy score was 43.21. (Maximum possible score 76) Affective empathy score was 29.36. (Maximum possible score 48) Affective empathy was associated with female gender (p=0), good adherence to treatment (p=0.01) and residual depressive symptoms (p=0.001).

Conclusions

Our study shows that bipolar patients have fairly good levels of empathy. However, in order to better substantiate empathy in BD, comparative studies seem necessary.

Disclosure

No significant relationships.