bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental health mobile apps for patients: Psychiatrists’ concerns
Authors: Hanft-Robert S. , Tabi K. , Gill H. , Endres A. , Krausz R.M.
Published: February 2022

Introduction

The use of mobile apps aimed at supporting patients with a mental illness is rapidly increasing.

Objectives

The presented results explore psychiatrists’ concerns about mobile apps for patients with a mental illness. These results are part of a larger study that examines psychiatrists’ attitudes regarding the use and development of mobile apps.

Methods

In the qualitative exploratory study, semi-structured interviews were conducted with 18 psychiatrists in Czech Republic, Austria, and Slovakia. Psychiatrists were recruited via snowball sampling. The interviews were digitally recorded, transcribed verbatim, translated into English, and content analyzed using deductive and inductive category development.

Results

There were mixed feelings regarding mobile apps for patients with mental illness. While psychiatrists emphasized certain benefits (e.g. increasing patients’ treatment motivation and engagement), several concerns were also expressed, especially by psychiatrists who were generally unfamiliar with mobile apps. They feared being replaced; were afraid that patients would act as their own doctors, thereby damaging their health; stressed that mobile apps could not respond or be tailored to an individual the same way psychiatrists could tailor treatment to a patient.

Conclusions

The psychiatrists who were more likely to have concerns about mental health apps were those who were generally unfamiliar with the apps and/or thought the apps aim to replace, rather than support, face-to-face treatment. Thus, clinicians and patients should be familiarized with the use of such mobile apps and educated on how they could support the face-to-face treatment.
Transdiagnostic internet cbt for mixed anxiety and depressive: Results from a feasibility study in primary care
Authors: Roberge P. , Vasiliadis H.-M. , Lesage A. , Labelle R. , Haskelberg H. , Grenier J. , Drapeau M. , Provencher M.D.
Published: February 2022

Introduction

In response to the treatment gap for anxiety and depressive disorders, psychological treatments with innovative modalities and high implementation potential are essential. Internet CBT (iCBT) is a cost/effective approach that could improve access to a low-intensity evidence-based CBT intervention.

Objectives

To assess the feasibility and acceptability of the French adaptation of the physician-prescribed six-lesson This Way Up transdiagnostic iCBT program for mixed anxiety and depressive disorders developed in Australia.

Methods

Feasibility study with pre- post-intervention evaluations, including an embedded qualitative study in Family Medicine Groups (Quebec, Canada). Inclusion criteria comprise a family physician diagnosis of Major Depression, Panic Disorder, Agoraphobia, Social Anxiety Disorder or Generalized Anxiety Disorder. Primary self-reported outcomes: PHQ-9 (depression) and GAD-7 (anxiety); secondary measures include diagnostic-specific scales and health service utilisation.

Results

Family physicians (N=21) from five Family Medicine Groups prescribed iCBT to 45 patients (30 women, 15 men; mean age = 39.7), 31 initiated the program. To date, 20 patients completed 5 or 6 lessons, nine completed between 2 and 4. Intervention and post-treatment assessments are ongoing, results forthcoming. Results of semi-structured interviews with patients (N=15) and family physicians (ongoing) on iCBT acceptability indicate it is beneficial, practical and easy to use. Program adherence requires patient readiness and determination and could be fostered by motivational support from clinicians.

Conclusions

Results support this French iCBT program’s scaling-up potential to contribute to reducing the gap in evidence-based treatments for common mental disorders. Its implementation in primary care could improve the effectiveness, efficiency and equity to a rapidly accessible treatment.
Telepsychiatry care during the COVID-19 outbreak in young adults with a first episode of psychosis or entering schizophrenia
Authors: Kiesmann E. , Mallet J. , Charlot V. , Dubertret C.
Published: February 2022

Introduction

During the Covid Outbreak, the deployment of psychiatric phone-based consultations (PbC) became a large necessity.

Objectives

The main objective of our study was to assess, 4 months after the end of the lockdown, the degree of satisfaction of the PbCs compared to that of usual face-to-face consultations (FC) in young adults presenting a first episode of psychosis (FEP) or entering schizophrenia (SCZ).

Methods

All patients beneficiated from PbCs conducted by hospital care staff during lockdown. A 15-items questionnaire evaluating satisfaction was carried out remotely (score ranging from 1 to 10). Primary outcome was satisfaction with consultation allowing the comparison of a group preferring FC (FC+) against a group in favor or equivalent of PbC (PbC +).

Results

30 patients were recruited (mean age 26.93 years old (4.9 SD), Male 56%. Diagnoses were SCZ 60% and FEP 40%. 20/30 participants belonged to (FC+) group. Total scores of satisfaction for the PbC differed between the (PbC+) group (mean 9 (1.69 SD)) and (FC+) group (mean 6.80, (1.32 SD)) p < 0.05. The (FC+) group tends to have PbC more frequently (40%) than the (PbC+) group (10%) and to find the phone interface more stressfull (40%) than the PbC+ group (10%). The (FC+) group tends to less wish (40%) PbC follow up in future than the (PbC+) group (90%).

Conclusions

This study shows that the PbCs were favorably evaluated by a third of the patients. The anxiety-inducing experience of the PbC in the (FC+) group could be explained by the severity of their pathology.
Mapping mental healthcare professionals’ journey towards digital mental health adoption: A qualitative study
Authors: Mendes-Santos C. , Nunes F. , Weiderpass E. , Santana R. , Andersson G.
Published: February 2022

Introduction

Digital Mental Health holds strategic potential in fulfilling populations’ mental healthcare unmet needs, enabling convenient and equitable access to mental healthcare. However, despite strong evidence of efficacy, uptake by mental healthcare providers remains low and little is known about factors influencing adoption and its interrelationship throughout the Digital Mental Health adoption process.

Objectives

This study aimed at gaining in-depth understanding of factors influencing adoption and mapping its interrelationship along different stages of the Digital Mental Health adoption process.

Methods

This work adopted a qualitative approach consisting of in-depth semi-structured interviews with 13 mental healthcare professionals, including both psychologists and psychiatrists. The interviews were transcribed and analysed thematically, following Braun and Clarke’s method.

Results

In this communication, we will describe how digital technology is currently used by clinicians to deliver mental healthcare. We identify potential factors influencing Digital Mental Health adoption and characterize the different identified stages inherent to this appropriation process: i) Pondering appropriate use; ii) Contractualizing the therapeutic relationship; iii) Performing online psychological assessment; iv) Adapting and/or developing interventions; v) Delivering Digital Mental Health interventions; and vi) Identifying training unmet needs. A discussion on how different factors and its interrelationship impact the adoption process will also be performed.

Conclusions

By characterizing mental healthcare providers journey throughout the Digital Mental Health adoption process, we intend to inform ecosystem stakeholders, such as researchers, policy makers, societies and industry, on key factors influencing adoption, so policies, programs and interventions are developed in compliance with this knowledge and technology is more easily integrated in clinical practice.
A comparative study reveals a similar validity of telepsychiatry and face-to-face psychiatric assessment in emergency room setting
Authors: Bistre M. , Eitan R. , Linkovsky O. , Barash I. , Juven-Wetzler A. , Katz G. , Kohn Y. , Argo D. , Teplitz R. , Fastovsky N. , Said M.-M.
Published: February 2022

Introduction

Telepsychiatry (TP) can provide an alternative to traditional face-to-face (FTF) assessments. However, TP in the emergency room setting is much less prevalent, probably due to lack of solid evidence about its effectiveness and acceptability.

Objectives

To directly compare traditional FTF and TP modalities in the emergency room setting.

Methods

Psychiatric patients (n=38) presented to the emergency room went through traditional in-person and videoconference TP interviews in varying order. Both FTF and TP interviewers that examined the patients as well as a third psychiatrist, acting as an observer for both modalities, determined the diagnosis, disposition recommendation and indication for involuntary admission.

Results

Rater decisions had a high matching on disposition and indication for involuntary admission (Cohen’s Kappa (CK) of 0.84/0.81, 0.95/0.87 and 0.89/0.94 for FTF-TP, Observer-FTF and Observer-TP, respectively). Although identical diagnosis matching between the raters was relatively low, the partial diagnosis matching was high (CK of 0.52/0.81, 0.52/0.85 and 0.56/0.85 for FTF-TP, Observer-FTF and Observer-TP, respectively). Telepsychiatry assessments had comparable acceptability in items such as psychiatrists’ certainty and interviewers’ and patients’ satisfaction.

Conclusions

TP and FTF psychiatric assessments in the emergency room settings have similar validity and acceptability. Implementation of TP in emergency room settings might improve the mental health services’ quality and access especially for remote populations. TP is especially important during the COVID-19 pandemic to enable treatment for epidemiologically isolated patients and to protect the medical personnel.
Changes in pornography use and sexual behaviour during lockdown
Authors: Koós M. , Bőthe B. , Király O. , Paksi B. , Demetrovics Z.
Published: February 2022

COVID-19 pandemic and the related restrictions had a significant impact on the living and working conditions as well as the everyday behavior and mental health condition. Aim of the current analysis was to examine the impact of the input-deprived circumstances on the sexual life characteristics. An online survey carried out after a few weeks of the first nation-wide lockdown was enacted in Hungary. 1,755 persons participated in the first wave (50.4% males). Relationship and sexual life satisfaction, sexual intercourse and masturbation frequency were assessed with additional single-item questions about the subjective change (5-pont Likert scale; 1=“decreased significantly”; 5=“increased significantly) in these characetristics since the epidemiological restrictions had been introduced. Furthermore, several potential protective and risk factors were measured (depressive symptoms, perceived stress, loneliness, general well being, intolerance of uncertainty, sensation seeking, and COVID-19 related health anxiety). Linear regression models were calculated to assess which of the former variables predict the subjective changes of one’s sexual life. The analyses resulted in weak standardized coefficients. The subjective change in relationship satisfaction (mean 3.20, SD 0.94) and sexual satisfaction (mean 2.82, SD 0.73) were predicted positively by general well-being (β=.11–0.25, p<.01), and negatively by loneliness (β=-.14-0.19, p<0.01). Loneliness predicted negatively the subjective change in sexual intercourses (mean 2.75, SD 0.89) and masturbation frequency (mean 2.89, SD 0.84) (β=- .10–.12, p<.01), while sensation seeking had no effect (β=-.09, p<.01). The COVID-19 related health anxiety predicted negatively only the change in sexual life frequency (β=-.07, p<.05). The explained variances were rather small (1.7%-11.8%).

Disclosure

No significant relationships.
Equestrian vaulting as an innovative complementary intervention in eating disorders: A pilot study
Authors: Collacchi B. , Cirulli F. , Borgi M. , Monaci I. , Piccotti A. , Renga S. , Ragione L. Dalla , Ettorre M. , Biccheri G. , Rossetti F. , Cerino S.
Published: February 2022

Introduction

Anorexia is a disorder associated with severe disturbances in eating behaviors and related thoughts and emotions (distorted weight perception, body dissatisfaction). Multidimensional integrative treatment approaches are needed to act both on intrapersonal (e.g. nutritional and psychological) and interpersonal (e.g. behavioral and affective) processes.

Objectives

Aim of this pilot project was to develop a 3-months horse-assisted intervention based on Equestrian Vaulting (EV) and tests its suitability and acceptability in patients with anorexia nervosa. Preliminary observations were carried out to assess the effectiveness of this program on body image, interpersonal relationships and communication and in managing anxiety.

Methods

Seven patients in charge of public service specialized in eating disorder participated in the study. EV activities were performed in an Equestrian Centre included horse grooming, gym exercises and horseback sessions.Clinical and psychological tests (SF 36, IPAQ, EDI3, STAI, SCL90) were administered at baseline and at the end of the program.

Results

Increases in body fat and decreases in lean muscle mass were observed. These were accompained by an improvement in participants’ anxiety and relational skills and in the specific disease related symptoms.

Conclusions

Results indicate the potential of EV to help patients with eating disorder regaining awareness of themselves and their body, a critical element for their future reintegration in the contexts of everyday life and society. Although this is a pilot, the protocol developed represents an initial step to promote the application of EV in persons with eating disorders, informing feasibility in the design of larger controlled studies and suggesting critical variables to be targeted.
Dynamics of aggressive manifestations in eating disorders
Authors: Belokrylov I. , Bryukhin A. , Lineva T. , Okonishnikova E.
Published: February 2022

Introduction

Anorexia nervosa and bulimia nervosa are often accompanied by aggressive manifestations that undergo typical dynamics at different stages of the disease. The presence of aggressive phenomena in eating disorders can cause severe maladaptation of patients, cause difficulties in diagnosis, establishing compliance, and prevent the normalization of family relations.

Objectives

To study the varieties of aggressive manifestations and their changes in the treatment of anorexia nervosa and bulimia.

Methods

Psychopathological, anamnestic, psychological.

Results

The most pronounced aggressive symptoms in typical anorexia nervosa are verbal and physical aggression against relatives and close people; feeding younger siblings, parents; threats and suppression of the opinion of relatives in relation to patients. The above aggressive statements and actions occur at the stage of correction and in the initial period of the stage of exhaustion. With deep exhaustion (pronounced cachexia) and in the process of food rehabilitation, aggressive behavior is significantly reduced. In the future, there is criticism of their own aggressive symptoms. In bulimia nervosa, only verbal aggression toward loved ones is noted, especially when they interfere with purifying behavior and massive compulsive overeating. The degree of aggression in bulimia nervosa is significantly less.

Conclusions

Aggressive manifestations in eating disorders depend on the stage of the disease, the degree of exhaustion and undergo reverse development in the course of therapy. Aggressive phenomena in eating disorders have a significant impact on the clinic, dynamics, outcomes of diseases and the effectiveness of treatment tactics.

Conflict of interest

No significant relationships.
Integrating empathic and mentalizing abilities with interpersonal sensitivity in people with eating disorders: A network analysis approach
Authors: Patriciello G. , Marone L. , Vece A. , Barone E. , Monteleone A.M.
Published: February 2022

Introduction

Literature highlights that interpersonal sensitivity represents an important development and maintaining factor for Eating Disorder (ED). Mentalizing and empathy are two psychological constructs that play a crucial role in social functioning. However, the role of mentalizing and empathy in the socio-emotional processing deficits of ED patients has been under investigated.

Objectives

We aimed to assess the complex interactions between the sub-components of mentalizing and empathy and ED symptoms through a network analysis approach.

Methods

Seventy-seven women with EDs were included in our study. Eating disorder and affective symptomatology were investigated with self-report questionnaires. All patients underwent two computerized tasks: Movie for the Assessment of Social Cognition (MASC), assessing emotional and non-emotional mental state inferences; Empathic Accuracy Task-Revised (EAT-R), measuring accuracy in identifying and sharing others’ emotions. A partial correlation network and bridge function analyses were computed.

Results

In the partial correlation network inference of cognitive mental states and shape concern were the nodes with the highest strength centrality. Inference of emotional mental states was the node with the highest bridge strength in the cluster of social cognition functions. Empathic and mentalizing abilities were directly connected with each other and with ED symptoms.

Conclusions

This is the first network analysis study which integrates self-reported symptoms and objective socio-cognitive performance in people with Eds. Our results provide evidence of the complex interactions between mentalizing, empathy and psychopathological symptoms in people with EDs. Therefore, confirm that the ability to infer others’ mental state may represent a useful target for clinical intervention in EDs.
Dysmorphophobia as a factor that worsens the affective state and the life quality of patients with eating disorders. The final data of the study
Authors: Okonishnikova E. , Bryukhin A. , Lineva T. , Belokrylov I.
Published: February 2022

Introduction

Anorexia nervosa (AN) and bulimia nervosa (BN) take one of the first places in the risk of fatal outcome among eating disorders, have a tendency to chronicity and high suicidal risk. Psychopathological basis for AN and BN is a dysmorfofobia or a pathological dissatisfaction with one’s body, characterized by intrusive, overvalued or delusional ideas of physical disability. Dysmorfofobia affects the formation of affective pathology and reduces the life quality.

Objectives

The study of the correlation between the degree of dissatisfaction with one’s bodies, affective disorders and life quality of patients with AN and BN.

Methods

130 female patients with AN and BN at the age of 13-44 years (the average age is 18). The disease duration from 6 months to 24 years. Validated Questionnaire image of one’s own body (QIOB) and the Scale of satisfaction with one’s body (SSOB); Hospital anxiety and depression scale (Zigmond A.); Questionnaire for the assessment of life quality (SF-36); Microsoft Excel standard correlation calculation.

Results

Dissatisfaction with one’s body based on QIOB and SSOB tests has a significant positive correlation with anxiety and depression, a significant correlation with the psychological component of health, a weak correlation with the physical component of health.

Conclusions

Dissatisfaction with one’s body or dysmorfofobia of patients with AN and BN significantly affects their affective state and psychological component of life quality which leads to a decrease in functioning up to social maladaptation and disability to social maladjustment. The publication was prepared with the support of the “RUDN University Program 5-100”.
Clinical manifestations of vomitomania in bulimia nervosa
Authors: Bryukhin A. , Okonishnikova E. , Lineva T. , Batyrev Y.
Published: February 2022

Introduction

In the dynamics of bulimia nervosa, a significant proportion of patients show a pathological attraction to purifying behavior in the form of artificially induced vomiting. This variant of the pathology of the drives significantly aggravates the symptoms, causes a severe degree of maladaptation of patients and great difficulties in the treatment of the disease.

Objectives

To identify and describe the manifestations of vomitomania in patients with bulimia nervosa, the impact on the outcome of the disease.

Methods

Clinico-psychopathological, psychological, catamnestic.

Results

120 patients with bulimia nervosa were examined: 112 women and 8 men aged 22-43 years. 86 of them (80 - women, 6 - men) were found to have vomitomania (a pathological urge to induce vomiting). Patients with pleasure, without feeling shy, awkward, described their own vomiting behavior - noted the expectation of vomiting, prepared for its implementation, observing complex rituals, imagined the vomiting act and its consequences in their minds, imagination. Describing vomiting, patients used superlative degrees of comparison, noted a sense of bliss, pleasure, “high” in the implementation of this irresistible desire. If it was impossible to induce vomiting, there was a feeling of depression, depressed mood, irritability, anger, physical distress - in fact, manifestations of withdrawal syndrome. Critical attitude to the above-described pathological behavior was absent in a significant part of cases.

Conclusions

Special pathological attraction to vomiting – vomitomania - is a widespread symptom of bulimia nervosa and drive disorders in this disease. It presents significant challenges for therapy especially in comorbid bulimia nervosa with personality disorders and schizotypal disorder.
Childhood traumatic experiences and functioning of both neurobiological components of the endogenous stress response system in adult people with eating disorders
Authors: Pellegrino F. , Cascino G. , Barone E. , Monteleone A.M.
Published: February 2022

Introduction

A large body of literature suggests that childhood trauma exposure is a non-specific risk factor for development of eating disorders (EDs) later in life. One potential mechanism through which early traumatic experiences may increase the risk for EDs is represented by long-lasting changes in the body stress response system.

Objectives

We investigated the activity of the hypothalamus-pituitary-adrenal axis and of the sympathetic nervous system in adult ED patients with or without a history of childhood trauma exposure.

Methods

We recruited 35 women with EDs, admitted to the Eating Disorders Center of the Department of Psychiatry of the University of Naples “Luigi Vanvitelli”. Participants filled in the Childhood Trauma Questionnaire (CTQ), to assess exposure to childhood trauma. They were instructed to collect saliva samples at awakening and after 15, 30 and 60 minutes, in order to measure cortisol levels and salivary alpha-amylase (sAA), a marker of the sympathetic nervous system activity.

Results

According to the CTQ cut-off scores, 21 ED women were classified as maltreated (Mal) participants and 14 women as no-maltreated (noMal) ED participants. Compared to noMal ED women, Mal ED participants showed significantly decreased cortisol awakening response (CAR) and sAA morning secretion.

Conclusions

Present findings confirm that childhood trauma exposure impairs the CAR of adult patients with EDs and show that also the morning secretion of sAA is decreased in childhood maltreated adult ED patients. Therefore, our study shows for the first time a dampening in the basal activity of both components of the endogenous stress response system in childhood maltreated adult ED women.
Eating disorders and diabetes: A meta-analysis
Authors: Mastellari T. , Speciani M. , Gelati F.F. , De Ronchi D. , Panariello F. , Atti A.R.
Published: February 2022

Introduction

Diabetic patients are asked to focus on their eating habits and calories intake. Together with individual factors, this could increase the risk of developing Eating Disorders (ED) associated with diabetes. A score of 20 points at the Diabetes Eating Problem Survey-Revised (DEPS-R) scale is considered as a valid threshold to identify Disordered Eating Behaviours (DEB) in diabetic patients. DEB can be considered as altered eating behaviours not fully meeting criteria for ED. As DEB are not formally recognised as specific ED in DSM-5, there is a great risk of not detecting them, thus underestimate their consequences.

Objectives

To meta-analyse literature on ED and DEB, when in comorbidity with Type 1 and Type 2 Diabetes Mellitus, focusing on pathological medical consequences.

Methods

PRISMA guidelines were followed for this meta-analysis. Articles were identified in literature by searching into PubMed, PsycINFO and Embase.

Results

1141 records were identified through database search. Figure 1 shows six studies comparing HbA1c % values for 2857 diabetic patients versus 752 diabetic patients with DEB. HbA1c % levels appear to be higher in patients with DEPS-R ≥ 20, compared to those with DESP-R scores below 20.

Conclusions

Routine screening for DEB using DEPS-R scale could favour early identification of diabetic individuals, at risk for progression into a proper ED. Clinicians should be vigilant about potential DEB when patients show poor long-term glycaemic control; similarly, patients with a DEPS-R score over 20 points may require more frequent glycaemic checks. This could help prevent serious medical complications.
Eating disorder examination-questionnaire – 7: Construct validity in a sample of portuguese overweight women
Authors: Pereira A.T. , Peixoto C. , Martins H. , Marques C. , Carvalho F. , Macedo A.
Published: February 2022

Introduction

Although the Eating Disorder Examination Questionnaire (EDEQ; Fairburn et al. 2008) is the most used instrument worldwide for the assessment of eating disorders symptoms, its factorial structure considerably varies, which limits its construct validity. Using exploratory factor analisys in data from a sample of overweight women, our group found a three-factors structure of the EDEQ Portuguese version (Peixoto et al. 2013), Although it was in accordance with other psychometric studies (eg. Peterson et al 2007), it was different from the original matrix. Further investigation regarding its factor structure has been conducted, with studies supporting a modified seven-item-three-factors structure (dietary restraint, shape/weight overvaluation, body dissatisfaction) with improved psychometric properties (Grilo et al. 2013, 2015), including with Portuguese samples (Machado et al. 2018; Santos et al. 2019).

Objectives

To analyze if the EDEQ version composed of seven items and three factors is replicated in a Portuguese sample of overweight women.

Methods

The EDEQ was administered to an outpatient sample of 276 women (Mean age= 43.85±11.89 years; Mean BMI=32.82±5.43 Kg/height2) attending a weight loss treatment consultation in a public hospital.

Results

Confirmatory factor analysis (CFA) revealed an adequate fit of the EDEQ-7 second order model with three dimensions (χ2/df=1.5497; RMSEA=.0452, CFI=.9955, TLI=.9914, GFI=.xxx; p<.001). The EDEQ7 Cronbach’s alphas for the total and its dimensions were α<.70.

Conclusions

Given its good psychometric properties, the overlap of the measurement model with those found with different samples and the reduced number of items, the EDEQ7 will be very useful both in research and clinical settings with/for overweight women.
Factors of psychiatric emergencies affecting boarding time in the emergency department
Authors: Avanoğlu K.B. , Gürel Ş.
Published: February 2022

Introduction

Psychiatric emergencies are acute disturbances in thought, behavior or mood which require immediate medical intervention. As a substantial number of patients with mental illness present as psychiatric emergencies, the sustainability and management of psychiatric emergency services becomes significant.

Objectives

In this study we aimed to examine the factors associated with psychiatric emergency care, taking the boarding time in the emergency department as primary outcome measure.

Methods

Charts of 466 psychiatric emergency cases admitted to the Hacettepe University Emergency Department (ED) between December 2018 – September 2019 were evaluated. Boarding time (BT) in the ED, presence of self-harm, psychotic symptoms and agitation were noted.

Results

In the examined period, number of patients admitted increased with time significantly (r= 0.562, p <0.01). However, increase in the number of patients was not correlated with an increase in BT. Patients with psychotic symptoms had greater BT compared to non-psychotic patients (7.01 hours vs. 11.24 hours, T= -2.796 df = 182.717 p <0.01). Patients with self-harm also had greater BT (7.47 hours vs. 9.85 hours, T = -2.013 df = 433 p <0.05). Patients with self-harm in relation with previous suicidal ideation displayed significantly a longer BT when compared with patients admitted due to self-harm without any suicidal plan (U=2572,5 p<0.01).

Conclusions

A significant increase in BT with psychosis and self-harm due to a suicidal plan supports the need of intermediate facilities between the ED and inpatient units, as such facilities would create a positive impact in the care of psychotic and suicidal patients.
Self-amputation: Case report
Authors: Iñiguez I. Cuevas , Lietor M.D.C. Molina
Published: February 2022

Introduction

Self-amputation, the most severe form of self-mutilation, is unusual. In most cases, self-mutilation is related to psychiatric disorders, mainly psychotic spectrum disorders and substance abuse.

Objectives

This case report aims to describe a case of unusual self-amputation in a man with a psychiatric history.

Methods

Case report and literature review.

Results

A 35 years old man patient, divorced, unemployed, with 15 years of treatment history for anxiety and low mood. The patient reported history of childhood trauma. He was inpatient (2019) after a suicide attempt. The psychiatrist who was treating him did not give a diagnosis (referral diagnosis). The patient mentioned several times that he desired feet amputation, without planification, in context of high anxiety. He was distressed by the shape and noise of his ankles. The patient was not diagnosed with genuine hallucinations or delusions. Four months after his divorce he amputated his feet with an electric saw. He denied any intention to commit suicide by committing this act. He admitted that he wanted to get rid of discomfort. Despite this drastic action, his mood did not improve.

Conclusions

Self-amputation is not a common condition. Although some cases of self-amputation have been reported, this case illustrates not only the difficulty of making a differential diagnosis (psychosis, dissociation, trauma, dysmorphophobia, body identity integrity disorder…) but also the challenge of a multidisciplinary approach in the treatment of patients with self-amputations.
Trends in involuntary admissions for observation in malta
Authors: Zammit M.A. , Agius M. , Cutajar J. , Trigona B. Micallef
Published: February 2022

Introduction

Schedule II of the 2013 Mental Health Act is part of the legal framework for involuntary admission to a licensed mental healthcare facility in Malta (Mount Carmel Hospital) for observation.

Objectives

To identify trends in presenting features cited by registered specialists in psychiatry in Schedule II applications as well as impact of time of day on involuntary admission.

Methods

Schedule II forms relating to all involuntary admissions to Mount Carmel Hospital between 01 June 2018 and 01 June 2019 were retrieved from paper files (n=364). Details relating to reason for using this legal framework were recorded and processed through custom linguistic analysis. Timings of application were also assessed. Data Protection permissions to retrospectively access patient files were obtained. All data collected was de-identified at source.

Results

The commonest reason for use of Schedule II was psychosis (n=139). Substance abuse was recorded in 68 cases, with alcohol and cannabinoids the commonest substances cited. 155 instances relate to situations of increased risk, the commonest being aggressive behaviour (n=74). 61 cases recorded suicidal intent. Peak use of this schedule occurs between 17:00 and 18:00, which is outside normal working hours.

Conclusions

Predominance of psychosis as a reason for involuntary admission concurs with trends reported internationally, including recent German, Irish and Dutch reports, as does increased use of involuntary admission with out-of-hours presentations. Practices relating to involuntary admission to a mental healthcare facility in Malta appear to reflect general trends in other European cohorts, despite differing legal frameworks.
Psychiatric admissions from the emergency department: An observational, retrospective study and recommendations for improved patient care and use of resources
Authors: Pirotta J. Ellul , Saliba E. , Cassar M.R.
Published: February 2022

Introduction

Psychiatric patients visiting the Emergency Department (ED) often require ‘medical clearance’. We aim to review patient work-up in the ED to facilitate the management of these patients.

Objectives

- To identify common demographic variables, diagnoses and mental health legislative status of patients presenting to the ED requiring psychiatric admission - To assess whether patients underwent a medical work-up in the ED, and what investigations were carried out - To produce a hospital proforma for the management of psychiatric patients presenting at the ED

Methods

Data on adult psychiatric patients visiting the ED over a six month period was collected retrospectively, which was then analysed accordingly.

Results

473 patient admissions were reviewed. 32.8% were admitted to a non-psychiatric specialty before being accepted to psychiatry, with the most common reasons being due to overdose (30.3%), alcohol-related problems (19.4%), and medical complaints (18.7%). 63.2% of all patients were investigated in the ED, including 23.5% undergoing CT Brain imaging. The majority had a final diagnosis falling under F10-19 (30.2%) and F30-39 (30.9%) chapter categories of the ICD-10, with the former having the highest absolute number of patients undergoing testing in the ED. The F20-29 group (13.7%) was highest in total patients investigated (75.4%), CT brain imaging (56.9%), and rate of involuntary admissions (33.8%), suggesting they are the most resource intensive group.

Conclusions

Patients with acute mental disorders present significant challenges to emergency physicians. Staff education and an inter-departmentally agreed upon proforma, taking into account the results of this study, may facilitate management of these patients within the ED.
Crowding analysis for patients with intossication and substance abuse during the first pandemic wave of 2019 coronavirus epidemic (COVID-19) at a lombardy ED
Authors: Savioli G. , Pesenti S. , Ceresa I. , Oddone E. , Bressan M.A.
Published: February 2022

Introduction

The 2019 coronavirus epidemic (CoViD-19) in Italy originated in Lombardy, on February 21, 2020. Crowding has been defined as a worldwide problem as cause of reduced quality of care and patient satisfaction. It is due and identified by three orders of factors: those at the access (input); those related to the patient’s process (throughput); and those at the exit from the ED (output).

Objectives

We evaluated all the population who went to ED for intossication and substance abuse. Due to the high level of care needed by these, an excessive duration of LOS (length of Stay) can be counterproductive.

Methods

We evaluated all patients accessing our ED for intossication and substance abuse from February 22 to May 1, 2020 and during the same period of the previous year.

Results

We enrolled 142 patients. The Crowding input factors are lower in the pandemic period: reduced attenders (41 vs 101) and reduced average waiting times (59 min vs 86 min). The Crowding throughput factors have instead worsened: LOS for both the visit rooms (810 vs 544 min) and the holding area (1205 min vs 947 min). The Crowding output factors also worsened: the percentage of access block is higher during the pandemic (10% vs 5%). The Total Access Block Time is significantly higher in the CoViD period for the holding area (1053 vs 930 min).

Conclusions

The pandemic period presented a worsened crowding for these patients due to the Access Block.
Between the first and second wave of the 2019 coronavirus pandemic (COVID-19): Presentation and crowding of attenders for mentale disorder and intossication/substance abuse
Authors: Savioli G. , Pesenti S. , Ceresa I. , Oddone E. , Bressan M.A.
Published: February 2022

Introduction

During the 1st wave of CoViD-19 pandemic there was a drastic reduction in total number of accesses, with more serious cases and a exorbitant increase in crowding, due to access block.

Objectives

evaluate population who went to ED for (1) mental disorders requesting a psychiatric visit and for (2) intossication and substance abuse, between the first and second wave of the coronavirus pandemic

Methods

We enrolled all patients who went at our ED from May 1 to October 20, 2020 and during the same period of 2019. We analized: vital parameters, age, sex, exit severity codes, hospitalization rate, Crowding input factors (number of access, waiting time, priority time to doc), Crowding throughput factors (LOS: Length Of ED Stay), Crowding output factors (percentage of access block; Total Access Block Time).

Results

The results are shown in table 1Table 1Mental-disorderintossication/substance-abuseMay1-October 20,2020May1- October 20,2019May1-October 20,2020May1- October 20, 2019number of ED access543564182254higher (yellow and red) priority time to doc (%)28%29%50%39%worse exit severity codes (%)10%6%16%11%rate of hospitalization (%)26%20%16%9%average waiting times (min)60647679LOS lenght of stay (min)369326629506access block (%)3%2%5%4%Total Access Block Time: examination rooms (min)11.5388.3848.0598.889Total Access Block Time: holding area (min)8.3823.963182254

Conclusions

We would like to thank all employees of the IRCCS Policlinico San Matteo Foundation for their extraordinary efforts during the pandemic.
Management of acute disturbance: The intravenous route
Authors: Castro M. , Butler M. , Thompson A. , Gee S. , Posporelis S.
Published: February 2022

Introduction

The intravenous (IV) is one of the main parenteral routes for drug administration. Rapid onset of action, precise titration, patient-specific dosing and bypass of liver metabolism are a few of its advantages, while hypersensitivity reactions, adverse effects, infection risk and a higher overall cost some of its most debated downsides. Unlike other areas of Medicine, IV has been significantly under-utilized in Psychiatry.

Objectives

This systematic review analyzed the evidence for effectiveness and safety behind the use of IV medication used for the management of acute disturbance.

Methods

APA PsycINFO, MEDLINE, and EMBASE databases were searched for eligible studies. Studies were included if they used IV medication to treat acute disturbance, in English language, had participants aged >18. The quality of the included studies was assessed using the National Institutes of Health quality checklist.

Results

17 studies were deemed eligible. Data analysis was limited to narrative synthesis since primary outcome measures varied significantly between each study. Findings showed strong evidence for efficacy and safety of dexmedetomidine, droperidol, midazolam, and olanzapine. These medications displayed a short time to sedation, reduction in agitation levels, or large percentage of patients adequately sedated with a low number of adverse events. Results did not provide enough evidence for the use of IV ketamine, haloperidol, diazepam, lorazepam, and promethazine.

Conclusions

This review supports dexmedetomidine, droperidol, midazolam, and olanzapine as safe and efficacious options for managing acute disturbance via the intravenous route, particularly in special clinical settings where trained staff, optimal monitoring, resuscitation equipment and ventilators are all at hand.
Evaluation of a newly implemented crisis-resolution and home-treatment team in munich – a mixed-methods-analysis
Authors: Boyens J. , Brieger P. , Hamann J.
Published: February 2022

Introduction

Challenged by the lack of collaboration between treatment sectors in psychiatric care in Germany, a legal basis for the implementation of Stationsäquivalente Behandlung (StäB), a programme for crisis resolution and home treatment (CRHT), was formed in 2017. It offers intensive care to patients with severe mental illness in their own living environments, carried out by a team of diverse professionals.

Objectives

The present analysis is the first to evaluate the CRHT-program that has been established in the greater Munich area in 2018.

Methods

Qualitative and quantitative data were collected within the framework of a mixed-methods-analysis. Records of all patients (N=139) included in the CRHT over a thirteen-month period (’18–’19) were examined regarding sociodemographic, clinical parameters, and treatment data. A focus group with StäB-employees (N=8) and individual interviews with patients (N=10) were conducted, then transcribed, and analysed using thematic analysis.

Results

139 patients (74% female) were treated in 164 cases for 38 days on average. Main diagnoses were schizophrenic diseases (43%) and mood disorders (35%), with patients ranging from markedly to severely ill (mean CGI-S: 5.8). 9.4% were in postpartum. Qualitative analysis is still in progress. Preliminary results demonstrate positive responses to individual treatment and environmental integration, whereas frequently changing contacts and the logistical effort were seen critically.

Conclusions

Work is still in progress. We expect StäB to be an adequate alternative to inpatient treatment for women in puerperium and a new opportunity for patients who need intensive treatment but refuse hospitalisation.
The landscape of schizophrenia on twitter
Authors: Rodrigues T. , Guimarães N. , Monteiro J.
Published: February 2022

Introduction

People with schizophrenia experience higher levels of stigma compared with other diseases. The analysis of social media content is a tool of great importance to understand the public opinion toward a particular topic.

Objectives

The aim of this study is to analyse the content of social media on schizophrenia and the most prevalent sentiments towards this disorder.

Methods

Tweets were retrieved using Twitter’s Application Programming Interface and the keyword “schizophrenia”. Parameters were set to allow the retrieval of recent and popular tweets on the topic and no restrictions were made in terms of geolocation. Analysis of 8 basic emotions (anger, anticipation, disgust, fear, joy, sadness, surprise, and trust) was conducted automatically using a lexicon-based approach and the NRC Word-Emotion Association Lexicon.

Results

Tweets on schizophrenia were heterogeneous. The most prevalent sentiments on the topic were mainly negative, namely anger, fear, sadness and disgust. Qualitative analyses of the most retweeted posts added insight into the nature of the public dialogue on schizophrenia.

Conclusions

Analyses of social media content can add value to the research on stigma toward psychiatric disorders. This tool is of growing importance in many fields and further research in mental health can help the development of public health strategies in order to decrease the stigma towards psychiatric disorders.
Burnout syndrome among brazilian medical students under different educational models
Authors: Prata T. , Calcides D. , Vasconcelhos E. , Carvalho A. , De Melo E. , Costa E.
Published: February 2022

Introduction

Medical students are exposed to many stressors which may contribute to the onset of Burnout Syndrome (BS). It consists of a triad of emotional exhaustion, cynicism and low professional efficacy. As a result, BS may reduce academic performance, quality of life and damage future professional life.

Objectives

Estimate the prevalence and recognize associated factors of BS among medical students from two different medical schools form the same Brazilian Public University with different teaching models: School 1, with a traditional model, and School 2, with Problem-Based Learning model.

Methods

A cross-sectional study was performed with randomly selected students between April and June 2019. A structured questionnaire on socio-demographic characteristics and the educational process in addition to The Maslach Burnout Inventory/Student Survey (MBI-SS) were used. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis.

Results

Study included 213 students, with an average age of 23±3.77, 50,2% were male and 62,5% belong to School 1. Among this sample, 21,6% of the students fit tridimensional criteria for BS. Burnout levels were higher in those people who rarely get emotional support they need in the course (OR=3,98, CI 95%, 1,75-9,06), who considered abandoning the course (OR= 2,88, CI 95% 1,29-6,43) and who consider their academic performance regular or weak (OR= 12,1, CI 95%, 4-36,5).

Conclusions

Results suggest a high prevalence of BS with factors associated with the psychosocial and educational sphere of medical students. In our research, the teaching model was not a factor associated with BS.
Prevalence and associated factors of common mental disorders among medical students at a university in Brazil
Authors: Prata T. , Vasconcelhos E. , Calcides D. , Carvalho A. , De Melo E. , Costa E.
Published: February 2022

Introduction

Common Mental Disorders (CMD) are minor manifestations of depressive, anxious or somatoform symptoms, which do not fit the diagnostic criteria of the International Code of Diseases (ICD). In medical students, this panorama can generate even more repercussions given the complexity of the medical education process.

Objectives

Estimate the prevalence and recognize associated factors of CMD among medical at the Federal University of Sergipe, Brazil.

Methods

A cross-sectional study was performed with randomly selected students between April and June 2019. The Self Report Questionnaire (SRQ-20) were used, along with a questionnaire about socioeconomic and demographic characteristics, personal aspects and educational process, prepared by the authors and previously tested in a pilot study. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis.

Results

The study included 80 students, equivalent to 22.59% of the total population of the studied Campus. There was an age average of 23.2 years (± 4.12), mostly female (52.5%) and single individuals (35%). The prevalence of CMD was 50% and an association was observed with the following factors: feeling of dissatisfaction with the course (p = 0.034); consider their own academic performance poor or regular (p = 0.12); lack of physical activity (p = 0.043); being anxious when not using a cell phone (p = 0.007); and the retraction pattern in the face of conflict situations in their interpersonal relationships (p = 0.025).

Conclusions

Results suggest a high prevalence of CDM, associated mainly with the personal perspective about the educational process and personal habits.