bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bipolar Disorder in the Elderly: Clinical Insights and Therapeutic Challenges
Authors: Borges A. F. , Domingues V. 
Published: August 2024

IntroductionBipolar Disorder (BD) is a mood disorder characterized by recurrent episodes of mania, hypomania, and depression. While it often manifests in early adulthood, it can persist or emerge in later life, posing unique diagnostic and therapeutic challenges in the elderly population. This abstract explores the clinical aspects, diagnostic intricacies, and therapeutic considerations of BD in older adults.ObjectivesThis study aims to shed light on the epidemiology and clinical presentation of BD in the elderly, discuss the diagnostic challenges, and address the complexities of treatment and management in this age group.Methods
A comprehensive review of the literature was conducted, encompassing epidemiological studies, clinical trials, case reports, and expert guidelines from the past decade. The search was performed using medical databases such as PubMed and Medline.Results
BD in the elderly presents with a range of clinical complexities that differentiate it from presentations in younger adults. These complexities include atypical features as elderly individuals may exhibit less overt manic or hypomanic symptoms, resembling irritability rather than euphoria; depressive episodes can be more prevalent and prolonged, leading to potential misdiagnosis as unipolar depression; medical comorbidities: older adults with BD often have more medical conditions, complicating treatment; cognitive impairment: cognitive decline, including mild cognitive impairment and dementia, is common and distinguishing it from neurodegenerative conditions requires specialized assessment; mixed episodes, in older adults may experience mixed episodes, requiring intensive treatment; diagnostic challenges: overlapping symptoms with other disorders make accurate diagnosis challenging. Treatment includes mood stabilizers like lithium, valproate, or lamotrigine, and atypical antipsychotics like quetiapine or aripiprazole. Treatment response varies, requiring consideration of age-related pharmacokinetics, pharmacodynamics, and drug interactions. Non-pharmacological interventions, including psychoeducation, tailored cognitive-behavioural therapies, and psychosocial support, are essential.ConclusionsIn summary, BD in the elderly demands a customized, multidisciplinary approach to navigate diagnostic complexities and optimize treatment, considering comorbidities and cognitive factors. Enhanced clinical awareness and holistic care are essential for effective management in this population.Disclosure of InterestNone Declared
Gender differences in the association of dementia symptoms severity and hospital anxiety
Authors: Bosak K. , Vuk Pisk S. , Grah M. , Folnegović Grošić P. , Bajić Ž. , Grošić V. 
Published: August 2024

IntroductionSymptoms of anxiety can worsen cognitive decline in people with dementia, and symptoms of dementia and fears of further cognitive decline can cause anxiety. Advanced dementia is not necessarily associated with a loss of emotion, which means that people may still experience anxiety, but their ability to cope in a healthy way is reduced. The problem is exacerbated by the fact that hospital care alone can contribute to the severity of anxiety symptoms due to change in routine of daily activities, unfamiliar surroundings, uncertainty about health status, prognosis and various medical procedures. There are differences between women and men in the prevalence, course and manifestation of both dementia and anxiety disorders.ObjectivesTo examine whether there are differences between women and men in the association of hospital anxiety with eight symptoms of dementia: difficulties with memory, orientation, judgement, problem solving, fulfilling social obligations, daily activities at home and with hobbies, or personal care, in patients with mild to moderate dementia.Methods
A cross-sectional study was conducted at Sveti Ivan Psychiatric Clinic in Zagreb in June 2023. The target population were hospitalised patients diagnosed with dementia, both genderes, aged 60-90 years, without psychotic disorder. Anxiety during hospitalisation was measured using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and the severity of dementia symptoms was measured using the Dementia Assessment Instrument (CDR). The hypothesis was tested using Wald test of differences between women and men in unstandardised linear regression coefficients of the HADS-A on individual dementia symptoms, after adjustment for age, education, presence of a married or stable non-marital partner and duration of current hospitalisation.ResultsWe enrolled 65 women and 35 men of comparable age. There were significant gender-related differences in the association between hospital anxiety and difficulties with judgement (P = 0.01), fulfilling social obligations (P < 0.001), difficulties with home and hobbies (P = 0.02), and personal care (P = 0.00). In women, more pronounced difficulties with judgement and with home and hobbies were associated with higher anxiety, and in men the presence of these two symptoms of dementia was associated with lower anxiety. Difficulties with fulfilling social obligations are associated with lower anxiety in women and higher anxiety in men. Difficulties with personal care were associated with lower anxiety in both genders, but this effect was stronger in men.ConclusionsThere are differences between women and men in the association between anxiety during hospital treatment and the severity of individual dementia symptoms. These differences are present in difficulties with judgement, fulfilling social obligations, home, hobbies and personal care.Disclosure of InterestNone Declared
Ketamine enhanced ECT in refractory recurrent depression.
Authors: Arribas-Simon B. , Martinez.Gimeno P. , Calvo-Valcarcel M. , Alario-Ruiz C. , Martin-Santiago O. 
Published: August 2024

IntroductionRecurrent Depressive Disorder is a chronic condition that significantly impacts the quality of life. Despite various treatment options, some patients face severe and treatment-resistant relapses. This case is related to research on ketamine in Electroconvulsive Therapy (ECT) for RDD. One study highlighted the efficacy and safety of ketamine compared to other anaesthetic agents in ECT for major depression. Additionally, another study explored subanesthetic doses of ketamine before each ECT session to improve therapeutic outcomes and sleep quality in patients with major depressive disorder.ObjectivesTo present a clinical case of a patient with Recurrent Depressive Disorder (RDD) who improved following a change in the Electroconvulsive Therapy (ECT) protocol using ketamine as an anaesthetic inducer.Methods
We examined the patient’s medical records, including her medical history, previous treatments, and therapeutic responses.ResultsA 65-year-old childless woman with a history of stroke, bilateral carotid atheromatosis, and hypothyroidism suffered from RDD. Despite multiple prior treatments and ECT, she experienced a severe depressive relapse. Eight intensive ECT sessions were administered, with observed memory lapses. Due to the lack of response, the anaesthetic inducer etomidate was replaced with ketamine, resulting in a positive response. The patient continued pharmacological treatment with improved mood, but recent and evident memory alterations persisted, possibly related to anterograde amnesia.Conclusions
This case highlights the complexity of RDD in patients with comorbidities and treatment-resistant relapses. The change in the ECT protocol using ketamine was effective, emphasizing the importance of alternative therapeutic approaches in refractory cases. The successful treatment of RDD in this patient using ketamine in ECT underscores the need for personalized therapeutic options in treatment-resistant patients. These scientific resources reinforce the relevance of exploring therapeutic alternatives in contemporary clinical practice. We need more research to understand the underlying mechanisms and how this approach could be enhanced in similar cases.Disclosure of InterestNone Declared
From Loss to Healing: Navigating Perinatal Grief with Enhanced Psychological Care
Authors: Razki K. , Zgueb Y. , Ben Aissa S. , Najar C. , Ouali U. 
Published: August 2024

IntroductionSeveral factors can influence the journey of perinatal grief in mothers, including the quality of care during this experience. The objective of our study was to investigate the factors influencing the perception of grieving women during the perinatal period and identify the role of medical and paramedical healthcare professionals in psychological support.ObjectivesTo determine the factors influencing the perception of fetal loss in grieving mothers.MethodsThis was a descriptive, longitudinal, retrospective study conducted between july 2021 and march 2022 at the Fetal Pathology Department of the Center for Maternity and Neonatology in Tunis, Tunisia. The study included women who experienced perinatal loss and underwent fetal pathology examination.The study was conducted in two stages: Initial consultation at the Fetal Pathology Department, five weeks after the date of expulsion, for perinatal grief counseling. Follow-up interview one year after the date of expulsion: The participants were contacted via telephone for an average duration of twenty minutes .The assessment of perinatal grief during both interviews was conducted using the shortened version of the Perinatal Grief Scale (PGS)Results
The mean age of the patients was 31.41 years (± 5.15). The average gravidity was 2.47 (± 1.43). More than half of the patients had no living children (n=41). The majority of patients had no notable pathological history. Six patients had been followed in psychiatry, and five had a history of subfertility. The majority of patients (n=61) reported having good marital relationships.Among the participants, 20% (n=14) had a high Perinatal Grief Scale (PGS) score (PGS >= 91) at five weeks post-loss and were subsequently referred for psychiatric consultation.At one year, all participants had a PGS score > 91, demonstrating the effectiveness of psychiatric management. Multivariate analysis identified four independent factors associated with a high PGS score at five weeks: absence of living children (OR=0.59; 95% CI [0.36-0.98]; p=0.04), quality of marital relationship (OR=1.2; 95% CI [1.1-3.9]; p=0.02), family support (OR=2.52; 95% CI [1.55-4.12]; p<0.001), and quality of loss disclosure (OR=2.52; 95% CI [1.32-3.77]; p=0.003).ConclusionsTo identify patients at high risk of developing complicated grief and improve the quality of psychological care, it is necessary to implement appropriate protocols, provide training to healthcare personnel, and establish well-equipped healthcare facilities.Disclosure of InterestNone Declared
Preliminary results of “Choose Life!” - a county-wide programme for suicide prevention and mental health awareness
Authors: Wernigg R. 
Published: August 2024

IntroductionSuicidality and depression awareness still remains a concern in Hungary. This programme, based on the principles of the European Union Against Depression, implemented its five steps, such as: 1. improving family doctors’ readiness to diagnose and treat depression, 2. increasing public awareness, 3. training stakeholders and community facilitators, 4. offering special help for risk groups, 5. facilitating self-help by the online tool “ifightdepression” in five of seven districts of Heves county from November 2014 until May 2016.ObjectivesWe aimed to look at some clinical outcome measures of the programme, like diagnosis density of depression in primary care before and after the intervention; diagnosis density of depression in outpatient services; suicide attempts in specialised care; and completed suicide rates.MethodsWe extracted patient turnover data from the joint database of the National Healthcare Fund and the National Directorate-General for Hospitals. Raw patient turnover data were divided by the total patient turnover in order to obtain diagnosis density. For the diagnosis of depression, we used the sum of the ICD-10 diagnoses of F32 (depressive episode) to F33 (recurrent depression) plus F4120 (mixed anxiety-depressive disorder), as family doctors tend to use these diagnoses interchangeably. For suicide attempts, we used the diagnoses X60 to X84, plus Y8700. For completed suicides we used the same diagnoses with the “deceased” flag. Diagnosis densities were compared with concurrent national data and were standardised to the long-term average. In the case of outpatient services, we only could retrieve monthly data, which we smoothed out with threemonthly moving averages.ResultsBaseline diagnosis density of depression in primary care was already 44% above the national average when the program started and after the kickoff, it shortly went up to 53,3% and remained over the baseline for as long as until 2019. Also, the recognition rates of depression with no comorbidities in primary care increased by 6%, and steadily remained over the national average until 2019. For outpatient psychiatry, there was an 8% increase in depression turnover throughout the duration of the programme. As regards to suicide attempts treated in hospital, the rates went 20% below the national averages for the duration of the programme, and mostly remained there until 2020. Fatal suicidal events accounted for five to seven deaths a year per county, therefore, simple statistical methods could not uncover significant differences.ConclusionsThese early results indicate that the programme may have been effective in terms of reinforcing the diagnostic and treatment capacities of primary care for recognising a treating depression adequately, thereby eliminating suicide risk. Further statistical exploration of the data is still needed to confirm the magnitude and the validity of these results.Disclosure of InterestNone Declared
Real-world effectiveness and safety of esketamine intranasal spray combined with treatment-as-usual in psychiatric inpatients
Authors: Kavakbasi E. , Yilmaz M. , Bulut Ö. , Berndt H. , Baune B. T. 
Published: August 2024

IntroductionEsketamine intranasal spray has been approved in both the USA and EU as a novel treatment in patients with treatment-resistant major depression (TRD) and for the management of acute depressive emergencies during the course of major depressive disorder (MDD). Real-world data on the effectiveness and safety of esketamine nasal spray in clinical use are limited.ObjectivesTo investigate the clinical effects and safety of esketamine nasal spray on depression severity and suicidal ideation during inpatient treatment in n=76 patients in a German university hospital.MethodsIn this retrospective chart review, we analyzed the change in depression severity and safety after a treatment series with esketamine nasal spray combined with treatment-as-usual in patients with treatment-resistant depression (TRD) in inpatient treatment setting of a University Hospital. Depression severity has been rated with the Montgomery–Åsberg Depression Rating Scale (MADRS) as well as with the BDI-II (Beck Depression Inventory-Second Edition) before and after the treatment series. The intensity of suicidal ideation has been evaluated using MADRS item 10 on suicidal thoughts.Results
A total of 76 patients have been included (women 55.3, n=42) in this analysis. Mean BDI-II pre-treatment was 37.6 and mean MADRS was 33.6 corresponding to severe depression. Mean score on item-10 pre-treatment was 2.4 (median 2.0). On average patients received 10.9 sessions (standard deviation 4.2, median 11.0) of esketamine nasal spray (min 1, max. 19 sessions). There was clear improvement after the treatment series in both the BDI-II (mean change -10.1, p < 0.001) as well as in MADRS score (mean reduction -10.0, p < 0.001). Suicidal ideation on item-10 also decreased significantly (-0.9, p < 0.001). The effect sizes were large for all three measures: Cohen’s d 1.050 for BDI-II; 0.986 for MADRS and 0.742 for changes in suicidal ideation. Overall, esketamine treatment was well tolerated. In five cases esketamine treatment has been terminated early (after a mean of 3.4 sessions) due to dissociations (n=4; 5.3%) or due to non-response (n=1).Conclusions
Esketamine nasal spray is a novel effective and safe treatment option, which leads to significant decrease in depression severity as well as in suicidal ideation. More data from real-world patients are needed to position esketamine in the algorithm of depression treatment. Rate of treatment discontinuation due to side-effects in this study was comparable to those in other esketamine studies (4.2% in Reif et al, NEJM, 2023).Disclosure of InterestNone Declared
Suicide risk in patient with diabetes varies by the duration of diabetes: The Korea National Health and Nutrition Examination Survey
Authors: Kim Y.-C. , Um Y.-H. , Seo H.-J. , Jeong J.-H. 
Published: August 2024

IntroductionSuicide has a complex relationship with several factors, and it is known that identifying high-risk groups of suicide and managing crisis in advance can help prevent suicide. Moreover in a previous study, it showed that people with chronic diseases often suffer from psychological difficulties such as depression and anxiety, which can influence one to commit suicide. Based on many studies about the relationship between diabetes and depression, 10% of diabetic patients experience major depression, and diabetic patients experience twice as much depression as the general population. But, there are few studies examining the relationship between diabetes and suicide risk, and most of them were targeted for type 1 diabetes only.Objectives
The objectives of this study were to investigate the suicide risk in diabetic patients, and evaluate the suicide risk varies by the duration of diabetes, using a large population sample in South KoreaMethods
Using the 2019 Korea National Health and Nutrition Examination Survey data, 6,296 adults (aged 19 years or older) were included. Suicidal ideation, suicidal plan, and suicidal behavior of diabetic patients were compared with the general population. After classifying the patients into ≤ 1 year, 2 to 9 years, and 10 years ≤ for the duration of diabetes, we evaluated the relationship between the duration of diabetes and the risk of suicide.Results
Diabetic patients had higher prevalence of suicidal ideation (9.1%, P<0.001) and suicidal plan (3.6%, P<0.001) than general population. After adjusting for potential confounding factors, suicidal plan (aOR = 3.011, 95% CI = 1.392-6.512) was significantly associated with diabetes. In the 2 to 9 year group of diabetes, we found an increase in risk of suicidal ideation (aOR=2.068, 95% CI=1.219-3.510), suicidal plan (aOR=3.640, 95% CI=1.592-8.320), and suicidal behavior (aOR=6.222, 95% CI=1.759-22.008) after adjusting covariates. However, increase in suicide risk was not observed in the ≤1 year and 10 years ≤ groups after diagnosis of diabetes.ConclusionsIn adults, diabetes is associated with increase in suicide risk. Suicide risk in diabetic patients shows an ‘inverted U-shaped’ depending on the duration of diabetes.Disclosure of InterestNone Declared
Divergent risk of SARS-CoV-2 infection, severe COVID-19 and mortality across psychiatric disorders: analysis from electronic health records in Catalonia
Authors: Monistrol-Mula A. , Félez-Nobrega M. , Giné-Vázquez I. , Haro J. M. 
Published: August 2024

IntroductionPeople with psychiatric disorders are particularly vulnerable to SARS-CoV-2 infection and its associated complications. However, current literature show that not all psychiatric disorders are equally vulnerable to COVID-19.ObjectivesThis study aimed to assess whether individuals with distinct psychiatric disorders exhibit different risk of SARS-CoV-2 infection, COVID-19 hospitalization, and mortality.MethodsWe conducted a case-control study using data of electronic health records from Catalonia. Cases included adults with a hospital admission between 2017 and 2019 for non-affective psychosis, bipolar disorder, depressive disorder, stress-related disorders, neurotic/somatoform disorders, and substance misuse. These were matched to patients without a diagnosis by sex, 5-year age band, and living area. Outcomes included SARS-CoV-2 infection, hospitalization, and COVID-19-related death up to December 2021. Logistic regression analysis were employed to test the association between the six groups of psychiatric disorders and COVID-19 outcomes, controlling for age, sex, smoking, being in a nursing home, and physical comorbidities.Results785,378 subjects were included. Preliminary findings showed that patients diagnosed with psychosis and bipolar disorder had lower risk of infection [OR: 0.85 (95% CI: 0.79-0.92), p<0.001; OR: 0.84 (95% CI: 0.76-0.92), p<0.001], whereas individuals with stress-related and neurotic/somatoform disorders had higher risk of infection [OR: 1.08 (95% CI: 1.04-1.14), p<0.001; OR: 1.06 (95% CI: 1.03-1.10), p<0.001]. People with depressive, stress-related, and neurotic/somatoform disorders had lower risk of COVID-19 hospitalization [OR: 0.87 (95% CI: 0.78-0.97), p = 0.01; OR: 0.71 (95% CI: 0.61-0.84), p<0.001; OR: 0.67 (95% CI: 0.60-0.76), p<0.001]. In line with these results, individuals with stress-related disorders also experienced lower mortality [0.49 (95% CI: 0.33-0.70), p<0.001]. Conversely, people with psychosis, bipolar disorder, and substance misuse exhibited higher risk of COVID-19-related death [OR: 2.9 (95% CI: 1.68-3.1), p<0.001; OR: 1.95 (95% CI: 1.30-2.81), p<0.001; OR: 1.82 (95% CI: 1.49-2.20), p<0.001].ConclusionsWe found different risks of SARS-CoV-2 infection, COVID-19 hospitalization, and COVID-19 mortality for psychiatric disorder groups. Differences in vulnerability to COVID-19 among people with psychiatric disorders might be explained by factors such as shared living facilities, physical comorbidities, psychotropic medications, and difficulties in accessing high-intensity medical care. Special attention should be directed towards individuals with psychosis, bipolar disorder, and substance misuse.Disclosure of InterestNone Declared