bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of an Internet-Delivered Sound Healing Intervention on Chronic Non-Malignant Pain and Sleep Disturbances in Community Settings
Authors: Sharma N. , Walker D. , Prasad B. S. , Patel M.
Published: August 2024

Introduction

Chronic pain patients often contend with insomnia symptoms, creating a reciprocal relationship that adds complexity to their condition. Evaluating interventions targeting insomnia in this population becomes paramount, given the intertwined nature of pain and sleep disturbances.

Objectives

This retrospective pretest design aimed to assess the efficacy of an Internet-delivered sound healing intervention in reducing insomnia severity and addressing sleep- and pain-related parameters among individuals with chronic pain.

Methods

Conducted as a community-based project, Tuning for Health provided support to individuals grappling with long-term illnesses. The intervention involved the virtual delivery of a specially crafted sound track using tuning forks over a 6-week period, supervised by an experienced therapist and administered weekly for an hour. Participants were instructed to play the track daily at a time convenient for them. A total of 68 participants (mean age 59.3 years) completed the intervention. Outcome measures, including the Insomnia Severity Index (ISI), a sleep diary, and assessments for anxiety, depression, and pain-related parameters, were collected at the end of the 6-week intervention and repeated after a 6-month follow-up. Negative effects were monitored and reported.

Results

Significant immediate interaction effects (time by treatment) were observed for the pain severity, ISI and various sleep parameters, such as sleep efficiency, sleep onset latency, early morning awakenings, and wake time after sleep onset. A time effect for anxiety and depression was noted at the 6-month follow-up. The group exhibited highly significant improvements in pain-related parameters. At the 6-month follow-up, sustained enhancements in sleep parameters and mental health were reported, with no reported side effects.

Conclusions

These unique results suggest the potential efficacy of sound healing in alleviating chronic pain and associated insomnia. Further research with a larger sample size is warranted to validate these findings. Combining sound healing with other treatments may offer enhanced outcomes for individuals dealing with both chronic pain and comorbid insomnia. This study lays the groundwork for future investigations into the promising intersection of sound healing, chronic pain management, and sleep improvement.

Disclosure of Interest

None Declared
The problem of treatment gap in alcohol use disorder (AUD)
Authors: Bramness J. G.
Published: August 2024

Alcohol use and alcohol use disorder (AUD) is related to numerous somatic and psychiatric disorders resulting in a high contribution to global burden of disease and premature death. The need to identify and treat alcohol use disorder is high. Yet there is a large treatment gap. Too few people with AUD are recognized and are being offered treatment. In some countries well under 10 percent of those with a treatable AUD are ever offered treatment. Furthermore, there is a dearth of effective treatments and relapse rates remain high. This symposium will address some topics that may change this situation.

Disclosure of Interest

None Declared
Are direct costs in schizophrenia influenced by duration of illness? results from a restrospective follow-up study
Authors: Calzavara-Pinton I. , Nibbio G. , Cabassi B. , Invernizzi E. , Di Carlo D. , Necchini N. , Bertoni L. , Lisoni J. , Deste G. , Barlati S. , Vita A.
Published: August 2024

Introduction

In Italy, it was recently estimated that the total economic burden for schizophrenia is € 2.7 billions, of which around 50% is derived from direct costs and 81% of these are due to hospitalization, residential facilities and semi-residential facilities, whereas only 10% of direct costs is derived from pharmacotherapy (Marcellusi et al. BMJ Open 2018; 8, e018359). Considered the high economic burden that schizophrenia has on healthcare systems (estimated to be between 1.4 % and 3 % of the total), a better characterization of the clinical variables that mostly influence the costs represent a topic of great clinical interest (Altamura et al. 2014 Official Journal of the Italian Society of Psychopathology 2014; 20, 223–243).

Objectives

The aim of this study was to analyze whether duration of illness has an impact on the costs derived from the use of services (which account for the majority of the direct costs) in a cohort of subjects living with schizophrenia spectrum disorders (SSD).

Methods

A total of 496 subjects receiving treatment from the Community Mental Health Centers (CMHC) of Brescia (Italy) were included in the study: for each patient demographic data, data regarding the duration of illness (in months), and data related to the use of service between January 1st, 2022 and December 31st, 2022 were derived from the regional database of mental health (“SIPRL”). Data on the use of service were then converted to costs using the regional rate tables for outpatient services, residential and semi-residential facilities, and the Diagnosis-Related Groups (DRG)-driven rate tables for hospitalization data. Partial correlations analyses were performed between duration of illness, corrected for age, and cost-related variables. All analyses were performed through SPSS v28 and p values <0.05 were considered significant.

Results

A higher duration of illness was correlated with higher costs for outpatient non-pharmacological interventions (p=0.010), for residential facilities (p=0.025) and total costs, both including and excluding hospital admissions (p=0.005 and p=0.007, respectively), but not with hospitalization costs (p=0.773).

Conclusions

The total expenditure for people living with SSD is higher for people with a longer duration of illness. These findings raise an important issue, which is that the mental health system in Italy invests more in subjects with a longer history of disease: this is in contrast with the international guidelines which prompt to intervene early in the course of the disease in patients living with SSD with outpatient rehabilitation interventions.

Disclosure of Interest

None Declared
Psychiatry Pitstop: Enhancing Communication Skills of Medical Students in Mental Health Settings
Authors: Magalhaes D. , Martinho F. , Viegas F. , Cativo M. , Ferreira V. , Manuel C. , Martins S. , Bastos J. , Barata V. , Pimentel A. , Carvalho S. , Santos M. , Almeida D. , Fernandes L.
Published: August 2024

Introduction

Psychiatry Pitstop is a role-play-based program for medical students aimed to improve communication skills in the framework of mental health. The workshop involved amateur actors who simulated different clinical scenarios and psychiatry residents, who facilitated the sessions and provided constructive feedback following the Pendleton method. Psychiatry Pitstop was originally developed in the United Kingdom and it was expanded to Lisbon, Portugal, in 2019. The authors adapted the course to the Portuguese context, adjusting the number of sessions and altering the scenarios to match common clinical situations faced by junior doctors in Portugal. By now, we conducted four courses.

Objectives

Our study aims to describe the Portuguese adaptation of the program and to learn insights from the students feedback.

Methods

The course was assessed using satisfaction questionnaires, completed by the students after each session. These included a Likert scale ranging from 1 to 5, with items pertaining to Future Importance, Overall Quality, Theoretical Quality, and Practical Quality. Quantitative data was analyzed using Excel and standard descriptive statistics to summarize the results. The open questions invited students to articulate the main positive aspects, suggestions for improvement and future topics. A Natural Language Processing (NLP) software was used to evaluate open-ended responses and extract the main concepts.

Results

We obtained a total of 39 single-answers from 4 different courses. Evaluation results yielded a mean score of 4.7 for Future Importance, 4.9 for Overall Quality, 4.3 for Theoretical Teaching, and 4.9 for Practical Teaching. Notable positive aspects included students’ appreciation of the immersive interview environment, the dedication exhibited by actors and doctors, well-prepared case scenarios, and engaging interactions with participants. Suggestions for improvement encompass enhanced theoretical introductions, comprehensive topic coverage, universal participation in simulations, and expanded workshop days. Future prospects for the program include practicing interviews with other psychiatric diagnosis, addressing difficult patients, delivering bad news and covering topics related to sexuality, grief and moral dilemmas.

Conclusions

Our study shows that Psychiatry Pitstop adaptation to the Portuguese context was successful. Overall, the feedback from medical students has been consistently positive. Subsequent editions will draw upon the findings of this study to enhance overall program quality.

Disclosure of Interest

None Declared
HERV-E ƛ 4-1 activation in peripheral blood mononuclear cells of the recurrent depression patients under the influence of human recombinant IL-1β
Authors: Markova E. , Goldina I. , Goldin B.
Published: August 2024

Introduction

Mental disorders represent complex phenotypes and are the leading causes of global disease burden. Human endogenous retroviruses (HERVs) are ancient retroviral DNA sequences established into germline. Their tight regulation is mainly achieved by epigenetic mechanisms, which can be altered by environmental factors - viral infections, inflammation, leading to HERV activation. The aberrant expression of HERVs associates with neurological diseases and mood disorders. We showed earlier that HERV-E ƛ 4-1 activation is associated with the recurrent depression stage of exacerbation and are accompanied by a pronounced increase in the proinflammatory activity of the peripheral blood mononuclear cells (PBMC).

Objectives

The purpose of the study was to evaluate the activity of HERV-E ƛ 4-1 on PBMCs of patients with recurrent depression in remission, including under the influence of recombinant human IL-1β.

Methods

The study included 30 patients with an established diagnosis of recurrent depression (F 33.0) aged 26–45 years. PBMC were isolated using the Ficoll density gradient method and further cultured in the presence or absence of 1 mkg/ml of recombinant human IL-1β for 24 hours. HERV-E λ 4 – 1 env gene expression was determined by the PCR. Cells proliferative activity was determined by H3-thymidine incorporation. Cytokines content in culture supernatants was assessed by ELISA.

Results

It was shown that in all samples of PBMC cultured without IL-1β the HERV-E λ 4 – 1 env expression was not determined. After the PBMC cocultivation with recombinant human IL-1β, HERV-E λ 4 – 1 env gene expression was determined in 86,7% of cases. The HERV-E ƛ 4-1 activation in PBMC after IL-1β influence was accompanied by increased cells proliferative activity and production of IL-1β, IL-6.

Conclusions

Our data indicate that the HERV-E λ 4 – 1 env expression in PBMC of recurrent depression patients in the stage of remission induced by the influence of proinflammatory cytokines, such as IL-1β. This mechanism may be one of the possible regulators of HERV-E λ 4 – 1 activation in recurrent depression.

Disclosure of Interest

None Declared
Prevalence And Risk Factors Of Eating Disorders In The Tunisian General Population
Authors: Turki M. , Hadj Ali A. , Chakchouk G. , Ellouze S. , Halouani N. , Aloulou J.
Published: August 2024

Introduction

Eating disorders (ED) negatively affect physical, mental, and social well-being. The exact psychopathology of ED is still unknown, with research suggesting the interplay of a combination of factors.

Objectives

The aim of our study was to estimate the prevalence of ED in the Tunisian general population, and to identify associated risk factors.

Methods

We conducted a cross-sectional, descriptive and analytical study among Facebook group members, using an online questionnaire, over the period from February 17, 2023 to May 26, 2023. All respondents over the age of 18 were included in the study. All participants filled a socio-demographic questionnaire. The Eating Attitudes Test (EAT-26) was used to screen for those at risk of eating disorders.

Results

A total of 528 responses were included in the study. 33.3±11.95 years. The subjects were unmarried in 63.4% of cases, of low socio-economic level in 19.5%, with a university education in 75.2% and with a regular occupation in 56.1% of cases.

The mean EAT-26 score was 12.36±10.34. according to this scale, 12.3% of our population were at high risk of developing an ED.

In a multivariate analysis, the female gender (p = 0.006), the low economic status (p = 0.012), a psychiatric comorbidity (p < 0.001), and physical activity (p= 0,037) were strongly associated with ED.

Conclusions

This study highlighted the magnitude of the risk of disordered eating attitudes in the Tunisian population and the need for programs to prevent and control these disorders.

Disclosure of Interest

None Declared
Efficacy of transcranial direct current stimulation for controlling of food craving in subjects with overweight or obesity
Authors: Kim J. , Yang S.
Published: August 2024

Introduction

This study investigates the effects of transcranial direct current stimulation (tDCS) on food craving improvement and changes in brain function associated with craving in overweight and obese subjects.

Objectives

Food craving disregards the homeostatic mechanisms related to appetite and nullifies the rewarding effects of food, directly contributing to body weight and eventually leading to obesity. In this study, we aim to explore the effects of transcranial direct current stimulation (tDCS) on food craving improvement and changes in brain function associated with craving by conducting a total of 10 sessions of tDCS over a period of 2 weeks on overweight and obese subjects.

Methods

A total of 86 patients who were overweight or obese (BMI ≥ 23 kg/m2) during the study period were included. The tDCS montage involved placing the anode over the left and the cathode over the right DLPFC. Weight, BMI, neuropsychological variables, and food craving-related variables were assessed. We measured absolute and relative EEG power in 19 channels and analyzed QEEG according to the following frequency ranges: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), beta (12–25 Hz), high beta (25–30 Hz), and gamma (30–80 Hz).

Results

After the application of tDCS, there was no significant reduction observed in weight and BMI. However, all measures related to food and eating showed a decrease in the intensity of cravings, and there was also a significant reduction in depression, anxiety, and perceived stress. In quantitative EEG analysis, an increase in theta waves was observed in the left frontal area (F7 and F3), an increase in alpha waves in the right parietal area (P4), and a decrease in beta waves in the frontal area (FP2) and occipital area (O1).

Conclusions

This study investigated the effects of tDCS on food craving in overweight and obese individuals, and it was found that there were improvements in psychological factors such as depression and anxiety. Additionally, using quantitative EEG, neurophysiological changes were observed, including an increase in theta waves and a decrease in beta waves.

Disclosure of Interest

None Declared
Impact of intrinsic and extrinsic religiosity on cannabis use in adolescents: A structural equation modelling approach to data from the National Survey on Drug Use and Health (NSDUH) 2015–2019
Authors: Carrà G. , Bartoli F. , Canestro A. , Capogrosso C. A. , Bebbington P. E. , Crocamo C.
Published: August 2024

Introduction

Religiosity is believed to be a factor that may reduce the risk of addiction and substance use both in adults and in young people. It is a complex construct that is neither measurable nor objectifiable, thus it must be estimated from proxy characteristics. For this purpose, researchers differentiate between subjective religiosity (i.e., individual religious experience) and extrinsic religiosity, that is, participation to religious services (extrinsic-personal subtype) or to social activities consistent with religion-based principles (extrinsic-social subtype).

Objectives

This work aimed at exploring the role of different facets of religiosity – intrinsic (subjective), extrinsic-personal (service attendance), and extrinsic-social (church-based social activities) – in terms of deterring cannabis use among adolescents.

Methods

Aggregated data of NSDUH (2015-2019) on 68,263 adolescents between 12 and 17 years of age were analysed using a structural equation modelling (SEM) to determine pathways of intrinsic and extrinsic components of religiosity in cannabis use. Several covariates were considered in the analyses, including comorbid depression and civil volunteering activities.

Results

About 15% of participants admitted cannabis use in the previous year. Intrinsic and extrinsic-personal religiosity was reported by 66% and 25% of the sample, respectively. A percentage of fifty-seven of participants were involved in at least one faith-based activity, while 74% reported participation in secular community activities. Both intrinsic and extrinsic-personal religious components were likely to reduce cannabis use at the SEM regression model analysis controlling for putative confounders (cannabis use coeff.: -0.065, p=0.001; coeff.: -0.176, p<0.001, respectively). Considering the joint contribution of relevant covariates (community-based activities, lifetime MDE, sex, and poverty status), the outputs were similar. Cannabis use was not influenced by extrinsic-social component of religiosity, even though the involvement in non-faith based volunteering activities was protectively associated.

Conclusions

From a policy-makers perspective, the reduction of cannabis use among young people may be obtained by supporting secular volunteering programs, which seem to be a cost-effective strategy. Moreover, whilst promoting religiosity is beyond the scope of any preventive programs, religious practices should be considered relevant protective factors.

Disclosure of Interest

None Declared
The complex dynamics of therapeutic leave in Psychiatry
Authors: Pinto Â. S. , Soares T. P. , Marques A.
Published: August 2024

Introduction

Therapeutic leave, the temporary and authorized absence of a patient from a psychiatric inpatient facility, is a practice rooted in the shift of mental illness towards more humane and recovery oriented care. This shift began to gain momentum in the mid-20th century, with the deinstitutionalization movement, which sought to treat psychiatric patients in less restrictive environments and facilitate their integration into the community. Today, therapeutic leave remains relevant in general psychiatry inpatient treatment facilities, and on an international level. It’s additionally used as a way to assess the progress and the stability of the patient outside the controlled environment that is the hospital, and to provide a gradual transition back into independent living and potential stressors of the outside world. But it is administered more on tradition and perceived benefits than on solid scientific grounding, reflecting a practice guided by clinical experience rather than empirical data or guidelines.

Objectives

Our review aims to evaluate the existing body of research on therapeutic leave in general psychiatry inpatient units. We intend to identify the outcomes that have been studied, and assess the extent and nature of their impact.

Methods

This scoping review was conducted through a comprehensive search of academic databases, including Google Scholar, PubMed, Embase, Cochrane Library, and PsycINFO. Search terms were carefully selected to capture relevant publications, and the results were screened for their pertinence to the review’s aims. Studies focused on forensic settings were excluded.

Results

The literature on therapeutic leave is notably limited, and the prevalence of its utilization in clinical practice remains unclear. Scientific publications primarily address readmission rates, with two indicating an increased risk in patients granted leave during their inpatient treatment. However, one report suggested a potential reduction. Length of stay (LOS) was negatively impacted, with prolonged hospitalization in these patients shown in one report. Post-discharge emergency room visits seem unaffected. A rise in readmission rates and LOS typically suggests higher subsequent healthcare costs. However, findings from another study contradict this expectation, with reduction of costs post-initial inpatient treatment. The literature also explores the hazards linked to therapeutic leave, highlighting that a significant portion, between 30 to 80%, of inpatient suicides transpire during such leave. Additional concerns extend to non-fatal self-harm, as well as the possibility of patients causing harm to others or to property.

Conclusions

Our review reveals a significant research gap in therapeutic leave’s effects, with a reduced number of outcomes studied and inconclusive findings. Future studies should aim to clarify these outcomes and eventually define therapeutic leave protocols.

Disclosure of Interest

None Declared
A scoping review of the literature on interventions to reduce stress and burnout among teachers.
Authors: Belinda A. , Wei Y.
Published: August 2024

Introduction

Experience of chronic stress among professionals is a risk factor for poor mental and physical well-being. There is limited knowledge regarding the kinds of interventions, and outcomes achieved using different modalities to address stress and burnout among teachers.

Objectives

To undertake a scoping review of recent literature to determine psychological interventions and reported outcomes related to stress and burnout among teachers.

Methods

The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was followed. Relevant search terms were used to determine different interventions adopted to reduce teachers’ stress and burnout. Articles published between 2018 and 2022 were identified using five bibliographic databases. Relevant articles were extracted, reviewed, collated, and thematically analyzed, and findings s were summarized.

Results

Forty studies conducted in Asia, North America, Oceania, Europe, and Africa, met the inclusion criteria. Sixteen kinds of burnout and stress-reduction interventions were identified. The most popularly studied intervention were Mindfulness-Based Interventions alone or in combination with yoga or Cognitive Behavioural Therapy (CBT), followed by Rational Emotive Behavioral Therapy (REBT). Mindfulness-Based Interventions led to decreased overall Teacher Stress Inventory (TSI) and emotional exhaustion subscale scores. REBT, primarily used with special education teachers, especially in Africa, has also shown positive results. Other interventions reporting positive outcomes include Inquiry-Based Stress Reduction (IBSR), the Stress Management and Resiliency Training Program (SMART), Cyclic Meditation, Group Sandplay, Progressive Muscle Relaxation, Autogenic Training, Sport-Based Physical Activity, Emotional Intelligence Ability Models and Christian Prayer and Prayer-Reflection

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Conclusions

Stress and burnout can have a negative impact on teachers and, very often, on the students they teach. Implementing suitable school-based interventions are necessary to improve teachers’ stress-coping ability, reduce the likelihood of burnout and improve general well-being. Policymakers, governments, school boards and administrators should prioritize the implementation of school-based awareness and intervention programs to mitigate teacher stress and burnout.

Disclosure of Interest

None Declared
Theta-burst rTMS in schizophrenia to ameliorate negative and cognitive symptoms: a double-blind, sham-controlled, randomized clinical trial
Authors: Orban Szigeti B. , Farkas K. , Herman L. , Zsigmond R. , Rethelyi J. , Csukly G.
Published: August 2024

Introduction

Schizophrenia is a major mental disorder that affects approximately 1% of the population worldwide. Social cognition impairments and negative symptoms such as blunted affect or emotional withdrawal strongly contribute to the psychosocial functioning deficits and long-term disability in schizophrenia. The state-like and trait-like components of social cognition are impaired in schizophrenia

Objectives

Treatment effects of conventional approaches with antipsychotics or psychosocial interventions are limited when it comes to reducing negative and cognitive symptoms in schizophrenia. While there is emerging clinical evidence that new, augmented protocols based on theta-burst stimulation can increase rTMS efficacy dramatically in depression, data on similar augmented therapies are very limited in schizophrenia. The different patterns of network impairments in subjects may underlie that some but not all patients responded to given stimulation locations.

Methods

Therefore, we propose an augmented theta-burst stimulation protocol in schizophrenia by stimulating both locations connected to negative symptoms, namely the vermis of the cerebellum and the left Dorsolateral Prefrontal Cortex (DLPFC). Ninety subjects with schizophrenia presenting negative symptoms and aging between 18-50 years will be randomized to active and sham stimulation in a 1:1 ratio. The TBS parameters we adopted follow the standard TBS protocols, with 3-pulse 50-Hz bursts given every 200 ms (at 5 Hz) and an intensity of 100% active motor threshold. We plan to deliver 1800 stimuli to the vermis and 1800 stimuli to the left DLPFC daily in two 9.5-minute blocks for four weeks.

Results

The primary endpoint is the change in negative symptom severity measured by the Positive and Negative Syndrome Scale (PANSS). Secondary efficacy endpoints are the change in cognitive flexibility measured by the Wisconsin Card Sorting Test and the change in social cognition assessed by the ‘Reading the Mind in the Eyes’, facial emotion recognition, and the ‘Faux pas’ tests. The safety outcome is the number serious adverse events.

Conclusions

In conlucion the aim of our study is to proove the safety and efficacy of theta burst stimulation for treating negativ sympotoms of schizophrenia.

Disclosure of Interest

None Declared
Predictors of admission to an assertive outreach service for psychosis in Lebanon
Authors: Kassir G. , El Hayek S. , Charara R. , Cherro M. , Itani H. , El Khoury J.
Published: August 2024

Introduction

Schizophrenia is a chronic, debilitating mental illness that contributes significantly to the global burden of disease. Assertive outreach treatment for patients with schizophrenia and psychotic disorders has been implemented to improve treatment adherence and outcomes.The suitability of this model of care outside the western context has not been fully established. The Psychosis Recovery Outreach Program (PROP),staffed by a multidisciplinary team that applies principles of early intervention and assertive outreach, was initiated in February 2016 at a leading psychiatric facility in Lebanon.

Objectives

The aim of this study is to identify and analyze clinical and demographic variables associated with patient enrollment in PROP, out of a typical clinical population attending a psychiatric outpatient department.

Methods

This retrospective study included patients above 18 y.o. at time of first point of care with a primary diagnosis of psychosis according to the International Classi-fication of Diseases 10 (ICD-10), and who presented to the outpatient psychiatry department at the American University of Beirut Medical Center (AUBMC) and were following up in PROP. We collected twelve-month data and used logistic regression models to identify predictor variables for enrollment in the service compared to those receiving standard treatment.

Results

In total, 45 patients participated in the study. Patients were mostly males (77.8%), younger than 39 years (80%), of college or higher education (68.2%), and diagnosed with schizophrenia (46.7%) or schizoaffective disorder (48.9%). About one-quarter (22.7%) had a comorbid cannabis use disorder. A majority received more than one oral antipsychotic (75.6%) while half (51.1%) were maintained on a long-acting injectable (LAI) antipsychotic.The following variables were significant predictors of enrollment in PROP: having a comorbid cannabis use disorder (OR 2.83 [1.25 – 6.37]), being prescribed a LAI antipsychotic (OR 9.99 [4.93-20.24]) or more than one oral antipsychotic (OR 4.57 [2.22-9.39]), visiting the emergency department more than once (OR 8.7 [2.64-28.68]), and admission to the psychiatry unit (OR 13.91[3.17-60.94]). In addition, those following up in PROP were younger and less likely to be in the oldest age group (over 54 years) [OR 0.11 (0.01-0.93)], less likely to be females (OR0.39 [0.18-0.81]), and less likely to be diagnosed with “other psychotic disorder” as com-pared to schizophrenia (OR 0.14 [0.03 – 0.62]).

Conclusions

PROP was the first community treatment program to use the principles of assertive outreachin Lebanon. Our findings highlight that the assertive out-reach model of care is applicable to its target population in the context of psychiatric care in Lebanon, namely young individuals with psychosis, higher comorbidities and a severe course of illness.

Disclosure of Interest

None Declared
The Role of Partial Agonists and Specifically Cariprazine in Dual Disorders
Authors: Barabássy Á. , Dombi Z. B. , Csehi R. , Djuric D. , Németh G.
Published: August 2024

Introduction

The treatment of dual disorders, the co-occurrence of a major psychiatric disorder and a substance use disorder, represents a great challenge. Recent articles recommend antipsychotics with a dopamine partial agonism as first line treatment for these patients. Studies also postulate that drugs targeting the dopamine D3 receptors specifically might have an advantage, as these receptors are involved in drug-related reward, drug-seeking, and drug-intake behaviour. One compound that has both, partial agonist- and D3- activity is cariprazine.

Objectives

To evaluate the real-world evidence of the effectiveness of cariprazine in patients with dual disorders.

Methods

We performed a systematic literature search on PubMed, looking for English language articles published between January 2017 - September 2023 with the following search terms: (cariprazine) AND (psychosis OR schizophrenia OR schizoaffective OR bipolar depression OR bipolar mania OR bipolar disorder OR major depressive disorder) AND (“substance use disorder” OR cocaine OR alcohol OR cannabis OR heroin OR “double diagnosis” OR “dual diagnosis”) NOT (animal OR rat OR mouse) NOT (review or meta-analysis). An additional targeted hand search of congress reports, posters, and case reports was also conducted.

Results

The search yielded 8 articles with 11 case reports. Mental health disorders included psychosis, schizophrenia, schizoaffective disorder, PTSD, and bipolar disorder while the abused substances were methamphetamine, cannabis, alcohol, and cocaine. All case reports described an improvement in both the symptoms of mental and substance use disorder with reduced craving and drug use and in some cases even ceasing drug use all together.

Conclusions

In summary, evidence suggests that cariprazine seem to be a potential candidate for dual disorders as it improves symptoms of both mental and substance use disorders.

Disclosure of Interest

Á. Barabássy Employee of: Gedeon Richter Plc., Z. Dombi Employee of: Gedeon Richter Plc., R. Csehi Employee of: Gedeon Richter Plc., D. Djuric Employee of: Gedeon Richter Plc., G. Németh Employee of: Gedeon Richter Plc.
Unmasking the Dual Threat of Fentanyl and Xylazine Abuse in America
Authors: Bicho M. S. , Coelho J. M. , Peixoto B. , Cruz C. , Baião P. , Ferreira I.
Published: August 2024

Introduction

The United States of America are currently facing a public health crisis characterized by the abuse of synthetic opioids, notably Fentanyl, and the veterinary sedative Xylazine. While each of these substances has been associated with significant risks, their current misuse presents a formidable challenge to healthcare professionals, law enforcement agencies and policymakers. While the opioid epidemic has long held the nation in its grip, the emergence of Xylazine as complementary agent in substance abuse has added a disturbing layer of complexity to an already terrible situation, due to its cost-cutting, an increase in its addictive properties and its ability to extend the duration of the opioid with which it is combined.

Objectives

The authors intend to review the relevant and current literature in order to extend the knowledge about this condition and find the best conducts for clinical practice.

Methods

Non-systematic literature review

Results

Various regions of the United States are facing a troubling surge in the co-abuse of Fentanyl, a potent synthetic opioid many times more potent than morphine, and Xylazine, a veterinary sedative and muscle relaxant, particularly in urban areas. The motivations for this combination appear to vary, ranging from the enhanced euphoria to cost-saving measures, further fueling its prevalence. However, the consequences are devastating. Both substances depress the central nervous system, with a sharp increase in overdose deaths and emergency medical services are strained to their limits in responding to these crises. Law enforcement agencies are facing a daunting task in curtailing the distribution of these substances, often grappling with clandestine networks that exploit the accessibility of these drugs.

Conclusions

The concurrent abuse of Fentanyl and Xylazine represents a critical public health challenge in the United States of America, demanding immediate attention and a multidisciplinary response. Failure to address this issue comprehensively will have profound implications for the well-being of individuals, families and communities across the nation. It is imperative to mobilize resources, foster interdisciplinary collaboration and develop evidence-based policies to combat this dual-threat crisis. Novel intervention strategies, including community education programs, targeted outreach efforts, and supervised consumption facilities, are urgently needed to address this complex issue.

Disclosure of Interest

None Declared
An LC-MS/MS method for the determination of W18 in urine samples
Authors: Quraishi R. , Kumar A.
Published: August 2024

Introduction

Synthetic drugs pose one of the most significant drug problems worldwide. In this category, W18 emerges as a potent drug of abuse chemically related to fentanyl. W18 has an analgesic potency 10,000 times greater than morphine. Recent in-vitro studies reported no activity of W18 towards opioid receptors. However, its presence in seized drug samples indicates its use as a precursor in fentanyl synthesis. This emphasizes the need to develop methods for its detection in developing countries dealing with emerging new drugs.

Objectives

To develop an analytical method for the determination of W18 in urine samples.

Methods

Standards with W18 concentrations ranging from 5-500 ng/ml were prepared in negative urine along with deuterated internal standard. The samples were diluted with methanol, centrifuged and the supernatant was subjected to Liquid chromatography-tandem mass spectrometry (LC-MS-MS) with time of flight (QTOF) analysis. For chromatographic separation, a C18 column with 50 degrees oven temperature was used. The mobile phase consists of formic acid, water, and acetonitrile. The TOF MS was operated in positive ion mode and multiple reaction monitoring was used for quantification.

Results

The retention time of W18 was obtained at 9.57 minutes. The parent ion with molecular weight 422.1 along with precursor ions Q1-273, Q2-111.0, Q3-150.0 g/mol were measured. The area of the standards ranges from 1 to 9.0 log 5 with R square of 0.99. The limit of detection (LOD) and quantitation were 5 and 20 ng/ml respectively. The recovery of W18 was estimated to be 96% from the from spiked urine standards.

Conclusions

The developed method is able to detect W18 presence in urine samples. This method has the potential to be used in clinical and research studies.

Disclosure of Interest

None Declared
Covid-19 pandemics effects on postpartum depression in the Hungarian Baby-Mother-Father Unit
Authors: Mező G. M. , Budinszki C. , Kurimay T.
Published: August 2024

Introduction

Our Baby-Mother-Father Unit program in Saint John’s Central Hospital (Budapest) offers mothers and fathers a unique opportunity to get better, receive psychiatric care (hospitalization or outpatient) without being separated from their babies. The Covid-19 pandemic had a strong impact on the whole population, including the parents of babies. During everyday operation the whole team experienced the increased need for health care, but we were not aware of the exact number of this change.

Postpartum psychiatric conditions have two main categories that stand out: postpartum psychosis and postpartum depression. As there are better quantifiable tools for measuring depression and strong scientific evidence supporting that the pandemic having increased mood disorders’ intensity and numbers (Chen et al., 2022; Harrison et al., 2023), postpartum depression was chosen as the locus of investigation. Due to the respectively high numbers of parents with babies showing up at our Unit, we wished to get a clearer picture on pandemics effects on these people.

Objectives

Getting a more clear picture of pandemics effects on our Baby-Mother-Father Unit care. Defining numbers of patients, interactions and comparing test results of depression scales before and after the pandemic.

Methods

A retrospective study of years 2019 and 2022 was performed. The total number of patients (2019: 173, 2022: 278) and the total number of documented patient-doctor/psychologist interactions (2019: 963, 2022: 1919) were measured. Depression scales’ (BDI, EPDS, PHQ-9), hopelessness scales (HS) results were compared. Due to our samples not showing normal distribution, a deeper analysis of test result categories was carried out by using Mann-Whitney
test.

Results

The results showed that depression (BDI: W=3165,5 p=0,17; EPDS: W=1693, p=0,42; PHQ-9: W=2502, p=0,39) and hopelessness (RS: W=976,5, p=0,52) average points seem quite constant regardless of the pandemic and showed no significant differences. More detailed data analysis of result categories revealed pattern-like differences, which might tell us more about the subjective experiences of the individuals. The number of patients and patient-doctor/psychologists interactions increased dramatically. Furthermore the number of individual therapeutic sessions rose greatly (2019: 359; 2022: 1182), along with parents receiving therapeutic care (2019: 40, 2022: 95).

Conclusions

From our findings, assumptions can be made that besides the obvious rise of numbers of patients and interactions, during the pandemic postpartum depression’s and hopelessness’ structure changed.

Disclosure of Interest

None Declared
Psychotrophic Medication Prescriptions and Polypharmacy in Geriatric Patients Followed up in a Home-based Health Care Setting
Authors: Tanyeri Kayahan S. , Kayahan A.
Published: August 2024

Introduction

By 2050, one out of every six people in the world will be 65 years or older. Chronic diseases and associated multiple drug use are common in elderly. The use of five or more drugs is called polypharmacy and it’s reported between 40-90% in the elderly. The Beers Criteria is the American Geriatrics Association’s guide to current recommendations regarding the safety of pharmacotherapy in older age. Being a part of community-based health services in Türkiye since 2005, “Home-based Health Care Services” is a program in which patients, who are mostly elderly and have difficulty in accessing health institutions, access medical services at their homes.

Objectives

In our study, it was aimed to examine the chronic disease diagnoses and prescriptions of patients aged 65 and over, registered in a home-based health care unit, in terms of psychotropic drugs and polypharmacy, and to evaluate the compliance of their psychiatric prescriptions with the Beers Criteria.

Methods

Sociodemographic, psychiatric diagnosis and treatment prescription and home-based health service-specific data were collected from the electronic files of home-based health care unit patients. Chronic diseases were scored according to the Modified Charlson Comorbidity Index (mCCI). The last 6-month prescriptions obtained from the electronic patient files were scanned and included in the analysis. In statistical analysis using SPSS Version 25, a p-value of significance <.05 was determined.

Results

As of February 2023, 229(83.2%) of 275 patients aged 65 and over constituted the research sample. The mean age of the sample, half of whom were considered as oldest-old(85 years and older), was 83±7.97(median=86,IQR=10.75), 69.9%(n=160) were women and 97.8%(n=224) were diagnosed with at least one chronic disease. The mean mCCI scores were 5.30±1.11(median=5.50, IQR=1.0). Polypharmacy was detected in 78.6% of the sample(n=180), among half(n=114) of whom at least one psychotropic was prescribed, drugs not recommended to be prescribed according to the Beers Criteria in elderly patients were 46%(n=52). Prescription rates were as follows: anti-dementia- 21.5%(n=49), antidepressants- 31.1%(n=71), antipsychotics- 21.5%(49) and benzodiazepines- 5.3%. Most frequently prescribed antidepressant was escitalopram 49.2%, while most frequently prescribed antipsychotic was quetiapine 29.4%. The frequency of quetiapine prescription increased significantly in patients with dementia (Χ²(1)=29.54, p<.001) and insomnia (Χ²(1)=13.11,p<.001).

Conclusions

The frequency of polypharmacy was found to be closer to the higher values reported previously. Almost half of the sample had a prescription for psychotropic drugs, and one out of two of these prescriptions did not meet the Beers Criteria. Considering the aging population, it will be of great importance for clinicans to carefully evaluate psychotropic prescriptions and polypharmacy.

Disclosure of Interest

None Declared
Juxtaventricular and periventricular white matter hyperintensities (WMH) are associated with cognitive dysfunction in Patients with Alzheimer’s Disease
Authors: Park J. H. , Yang H. J. , Song J. M.
Published: August 2024

Introduction

White matter hyperintensities (WMH) is common among the elderly. WMH are associated with accelerated cognitive dysfunction and increased risk for Alzheimer`s disease (AD). Although WMHs play a key role in lowering the threshold for the clinical expression of dementia in AD-related pathology, the clinical significance of their location is not fully understood.

Objectives

The aim of this study was twofold: 1) To investigate the quantitative association between WMH and cognitive function in AD; 2) To investigate whether there is any difference in the association between subclassified WMH and cognitive function in AD.

Methods

A total of 171 patients with AD underwent clinical evaluations including volumetric brain MRI study and neuropsychological tests using the CERAD-K neuropsychological assessment battery. WMH volume was calculated using automated quantification method with SPM and MATLAB image processing software. According to the distance from the lateral ventricular surface, WMH within 3 mm, WMH within 3-13 mm, and WMH over 13 mm were classified as juxtaventricular WMH (JVWMH), periventricular WMH (PVWMH) and deep WMH (DWMH), respectively. WMH volume data was logarithmically transformed because it was right-skewed.

Results

WMH volume in AD was 20.7 ± 18.2 ml. Total WMH volume was associated with poor performance in categorical verbal fluency test (p = 0.008) and word list memory test (p = 0.023). JVWMH volume was associated with poor performances on categorical verbal fluency test (p = 0.013) and forward digit span test (p = 0.037). PVWMH volume was associated with poor performances on categorical verbal fluency test (p = 0.011) and word list memory test (p = 0.021), whereas DWMH volume showed no association with cognitive tests. Total WMH and PVWMH volume were also related to Clinical Dementia Rating scale sum of boxes score (p=0.022).

Image:

Conclusions

Greater JVWMH and PVWMH are related with concurrent impairments in semantic memory and frontal function independent of the hippocampal volume. However, DWMH volume is not associated with any cognitive function. Only PVWMH among subclassified WMH are related to the severity of AD.

Disclosure of Interest

None Declared
Prolactin level changes according to atypical antipsychotics use: a study based on Clinical Data Warehouse
Authors: Sohn I. , Jeong J.-H.
Published: August 2024

Introduction

Antipsychotics are associated with increased serum prolactin. It depends on the type of the antipsychotics and gender. There are previous studies, but it is necessary to compare them including new drugs.

Objectives

Antipsychotic drugs are known as the major cause of non-neoplastic hyperprolactinemia. This study aimed to investigate the levels of serum prolactin elevation depending on the use of antipsychotic drugs in patients through the Clinical Data Warehouse

Methods

Our study included 118 subjects who were all diagnosed according to ICD-10 for schizophrenia, schizotypal and delusional disorders, manic episodes, and bipolar affective disorders. All the subjects were taking one of risperidone, blonanserin, amisulpride, and olanzapine. They had prolactin blood tests collected retrospectively through CDW.

Results

Among the 118 subjects included in the analysis, the mean serum prolactin level was 65.1± 54.7ng/ml. Serum prolactin levels were significantly higher in subjects taking risperidone or amisulpride compared to blonanserin and olanzapine. The female subjects who took amisulpride or olanzapine had significantly higher prolactin levels, but there was no difference in prolactin levels between the sex in the subjects who took risperidone or blonanserin.

Conclusions

This study suggests the need for regular monitoring of serum prolactin levels in patients who are taking antipsychotics, especially in female patients. Further studies on the subjects with controlled confounding variables and larger sample groups are needed.

Disclosure of Interest

None Declared