bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiovascular and metabolic issues in the treatment of schizophrenia: focus on the management of negative symptoms
Authors: Falkai P. 
Published: August 2024

AbstractMortality from cardiovascular disease is increased in people with mental health disorders in general and schizophrenia in particular. The causes are multifactorial, but it is known that antipsychotic medication can cause cardiac side-effects beyond the traditional coronary risk factors. Schizophrenia itself is a contributor to an increased risk of cardiovascular mortality via cardiac autonomic dysfunction and a higher prevalence of metabolic syndrome, both contributing to a reduced life expectancy.Overall, management of cardiovascular risk within this population group must be multifaceted and nuanced to allow the most effective treatment of serious mental illness to be conducted within acceptable parameters of cardiovascular risk; some practical measures are presented for the clinical cardiologist.Disclosure of InterestNone Declared
Psychiatry on fire: Climate change and the role of mental healthcare
Authors: Poukhovski-Sheremetyev F. 
Published: August 2024

IntroductionWhat is the psychiatrist’s role on a burning planet? As our world faces the existential ramifications of irreversible climate change, clinicians are contending with what purpose a normalizing institution like psychiatry can have in increasingly abnormal times.Objectives
This presentation investigates the role of the modern mental health clinician by examining psychiatry’s current impotence in the face of climate crisis. It will be shown that current approaches are often complicit in psychiatry’s historical depoliticization of mental health and subsequent individualization of social concerns. It will be argued that the only way psychiatry can maintain its ethical obligations to its patients is by taking a courageous sociopolitical stance.MethodsEmerging from a multidisciplinary literature review on the relationship between psychiatry and social crises, this work examines our field’s response to climate change in particular. A focus is made on literature that explores psychiatry’s political obligations, current trends in climate psychiatry, and proposed social psychiatric approaches to the climate crisis.ResultsIt is shown that while ecological collapse tangibly affects our patients, psychiatry often fails to engage socio-politically with the crisis’ root causes. Framing intense reactions to climate change as trauma responses and developing neo-diagnoses such as “ecoanxiety” both risk individualizing inherently social experiences. However, Psychiatrists are also uniquely positioned to speak with authority about social crises and to articulate what a more comprehensive medical response to climate change might look like.ConclusionsGiven climate change’s disproportionate effects on disenfranchised populations, it is increasingly clear that health is inextricable from social circumstances. As a result, political inaction is incompatible with our ethical duty to serve patients’ health, both in the clinic and beyond it.Disclosure of InterestNone Declared
Ultrastructural analysis of synapses and mitochondria in the hippocampus of depressed patiens
Authors: Sebők-Tornai A. , Csabai D. , Szekeres-Paraczky C. , Maglóczky Z. , Simon M. , Stockmeier C. A. , Czéh B. 
Published: August 2024

IntroductionMajor depressive disorder (MDD) is a common multifactorial disorder, but the exact pathophysiology is still unknown. in vivo and post-mortem studies document volumetric and cellular changes in the hippocampus of depressed patients. Chemical synapses are key functional units of the central nervous system and earlier studies found reduced number of synapses in the prefrontal cortex of depressed patients (Kang HJ et al. Nature Medicine 2012;18(9):1413-1417). Mitochondria are intracellular powerhouses generating chemical energy for cellular biochemical reactions. Recent findings suggest that individuals with impaired mitochondrial function may be vulnerable to develop psychopathologies.ObjectivesWe investigated synapses and mitochondria in post-mortem hippocampal samples from psychiatric patients.MethodsThe three study groups were: 1) MDD patients (n=11); 2) patients with alcohol dependence (n=8) and 3) controls (n=10). Controls were individuals who accidentally deceased and had no neuropsychiatric disorders. Three sub-regions of the hippocampus (dentate gyrus, CA3 and CA1 areas were investigated. Ultrathin sections were examined, and photomicrographs were taken for further analysis using a JEOL JEM 1400 FLASH transmission electron microscope. Systematic quantitative analysis was conducted with the Neurolucida system using unbiased counting principles.ResultsWe could not detect any differences in synapse and mitochondria densities between the patients and controls subjects.ConclusionsOur preliminary data suggest that despite our expectations hippocampal synapse and mitochondrial densities are rather constant parameters which are not easily affected by psychopathology or alcohol consumption. Potential methodical limitations may also explain this negative finding.FUNDING:This research was founded by the Hungarian Brain Research Program 3 and by the TKP2021-EGA-16 project. A.S.T. was supported by the ÚNKP-23-3-I New National Excellence program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund.Disclosure of InterestNone Declared
Dual diagnosis of bipolar disorder and substance use disorder – type of substance used and its impact on treatment adherence and maintenance of abstinence
Authors: Silva I. A. , Silva C. , Faria I. , Melo V. S. 
Published: August 2024

IntroductionSubstance use disorder is a common comorbidity with bipolar disorder, delaying its diagnosis and making treatment of both disorders more complex and challenging.ObjectivesWe aim to analyze the types of substances used by patients with bipolar disorder and to find if there’s a relationship between the substance used both with treatment adherence and maintenance of abstinence.MethodsWe collected, retrospectively, data from the hospital platform and analyzed it on SPSS Statistics 26, along with a literature review. Our study looks over 3 years, and all patients analyzed have a dual diagnosis of both bipolar disorder and substance use disorder and were hospitalized in the psychiatric ward of a tertiary university hospital.Results
There were 2384 hospitalizations in the Coimbra’s University Hospital psychiatric ward, and 88 hospitalizations were coded with a dual diagnosis of bipolar disorder and substance use disorder.Tobacco was the substance more consumed by the patients (53.4%), followed by alcohol (46.6%) and cannabinoids (30.7%). In 18.2% of the patients was identified consumption of cocaine and in 6.8% there was an abuse of opioids. It is important to highlight that 20.5% of the patients used 2 or more substances at the same time.Regarding adherence to treatment for both their bipolar disorder and substance use disorder, in 25% of the patients, there wasn’t a satisfactory compliance with the treatment prescribed.In the group of patients with polydrug use, half of them didn’t comply with the treatment. In the patients consuming only one substance, we found out that 30% of patients who use alcohol didn’t adhere to the treatment, while around 13% of the patients using cannabinoids didn’t comply with the suggested treatment.The relationship between the type of substance used and treatment adherence was statistically significant with a p=0.004 (considering p<0.05).Regarding abstinence from consumption, around 42% of the patients keep using at least one substance. In the group with polydrug use, around 65% of the patients were not abstinent in the last appointments, while in the cannabinoids users’ group around 50% of them were still using the drug. In the group with patients using alcohol, around 43% of them are not abstinent.The relationship between the type of substance used and maintenance of abstinence was found to be statistically significant with a p=0.037 (considering p<0.05).ConclusionsSubstance use disorder can have a huge impact on adherence to treatment, worsening the prognosis of the comorbid bipolar disorder. On the other hand, this dual diagnosis can impact the maintenance of abstinence.Early detection of both diagnosis and simultaneous treatment from an early phase are essential to improve the prognosis of both diseases.Disclosure of InterestNone Declared
Lithium Intoxication with Therapeutic Doses Following Laparoscopic Sleeve Gastrectomy: A Case Report and Review of the Literature
Authors: Kukurt S. , Dönmez Z. , Kilic O. , Dokuz G. , Coşkun F. , Yardımcı E. , Kırpınar I. 
Published: August 2024

Introduction
Lithium is a mood stabilizer often used as a first-line treatment for bipolar disorder. Its narrow therapeutic window and changes in the absorption, distribution, and elimination of the drug following bariatric surgery have important implications regarding patient safety.ObjectivesWe present a 51-year-old female patient with bipolar disorder and a medical history of morbid obesity, type 2 diabetes mellitus, hypothyroidism, hyperlipidemia, and essential hypertension. She was mentally stable on lithium 1200 mg/day, valproate 500 mg/day, and quetiapine 400 mg/day. She had undergone laparoscopic sleeve gastrectomy. After a month, she showed up to the emergency room (ER) with nausea, vomiting, diarrhea, and fatigue. Gastroenteritis was suspected until the patient started showing neurological symptoms such as delirium, dysarthria, ataxia, chorea, and athetosis.MethodsThe patient was monitored and received aggressive intravenous hydration (3000 cc of 0.9% serum isotonic) in the intensive care unit (ICU). She was prescribed intramuscular biperiden injection of 5 mg/ml/day, pheniramine 45.5 mg/2 ml/day, and lorazepam 1 mg/day. Her lithium levels were checked every six hours. She was agitated and disoriented for the first five days despite lithium levels being in the therapeutic range. On day six, her blood lithium levels dropped to 0.399 mmol/L. Her psychiatric examination revealed that she resumed cooperation and orientation, her dysarthria subsided. However, her thought content and attitude were grandiose, and she had a labile affect. We prescribed 5 mg/day of olanzapine routinely and 1 mg/day of lorazepam on a needed basis. The next day, her labile affect became calmer, and her sleep improved so she was discharged from the ICU and admitted to general surgery inpatient service, and olanzapine was titrated to 10 mg per day since she had elevated mood symptoms.ResultsAfter 7 days of intravenous hydration and supportive treatment, her neurological symptoms completely subsided except for a fine tremor, which lasted for another 3 days and then ceased. She was clinically stabilized without further need for intervention. Her lithium level was 0.206 mmol/L before her discharge.Conclusions
We believe it is of utmost importance to build a consensus in guidelines and inform physicians about lithium toxicity and its symptoms after bariatric surgeries. We recommend a careful follow-up of the patient pre-and postoperatively. Preoperative psychiatric intervention includes decreasing the lithium dose gradually and discontinuing it. After the operation, lithium can be started with a much lower dose and may be increased by checking lithium levels every week for at least 6 weeks after the operation until the patient can digest solid food again, and then every 2 weeks for 6 months, and thereafter every month for one year.Disclosure of InterestNone Declared
Pain, fatigability and cognitive impairment in log-COVID: a cohort study
Authors: Nadia B. , Mariem T. , Houda B. A. , Sahar E. , Wissal A. , Sameh M. , Samy K. , Najla H. , Jihen A. 
Published: August 2024

IntroductionSurvivors of the pandemic of COVID-19 suffered from multiple sequelae long time after recovery, such as tiredness and memory dysfunction, affecting daily life activities.ObjectivesTo assess fatigability, cognitive impairment and the severity of pain in long-COVID.MethodsWe conducted a prospective cohort study including 121 Tunisian COVID-19 inpatients who had been discharged alive from hospital. Each enrolled patient was asked about the period before the hospital stay, and the 6-9 month-period after hospital discharge, using the visual analog scale (VAS), self-completed
unidimensional scale and yes/ no question about fatigability and cognitive impairments.ResultsThe median age of participants was 59 years, with extreme values ranging from 18 to 80. Among them, 51.2% were females.Our findings showed a significant increase in VAS score after COVID infection (3.82 vs 1.69; p<0.001). Sixty-eight (56.2%) participants reported spontaneously fatigability after the infection and 52 (43%) reported spontaneously a deterioration in memory capacity either with or without previous memory dysfunction. Fatigability was statistically associated to cognitive impairment (55.9% vs 26.4%; P= 0.02). In addition, fatigability and cognitive impairment were statistically associated with pain (P=0.001 and P= 0.022 respectively).There was no significative association of fatigability nor cognitive impairment with the gender of the survivors.ConclusionsThe clinician should keep in mind to screen for possible somatic or psychological distress, in particular pain, fatigability and cognitive impairment even after resolution of the COVID infection, in order to guarantee a better quality of life.Disclosure of InterestNone Declared
Body satisfaction and sexuality in pregnant and postpartum women
Authors: Bader S. , Aloulou M. , Zran Z. , Abdelmoula A. , Bouaziz A. , Abbes W. 
Published: August 2024

IntroductionPregnancy and postpartum is an important life event associated with profound physiognomic and psychosocial changes affecting the female body in all its physiological, psychic and affective reality. It might influence the sexual function in expectant mothers.ObjectivesTo investigate the relationship between the body satisfaction and perception and the sexual function among pregnant and postpartum women.MethodsIt was a cross-sectional study established over a period of 3 months from the June 1st, 2023 to August 31, 2023. This study focused on a population of pregnant and postpartum women recruited from outpatient consultations and inpatient of the obstetric gynecology department at the university hospital of Gabes. We used a pre-established sheet exploring socio-demographic data, medical and gyneco-obstetric history, the body mass index (BMI) and informations concerning the marital relationship and the woman’s sexual activity. We administered the validated Arabic version of the Arizona Sexual Experiences Scale (ASEX) to assess sexual functioning and we used the body satisfaction and global self-perception questionnaire (QSCPGS) to explore the body satisfaction and perception.ResultsFifty-eight women were included. The average age was 35.6±5.5 years; they were from an urban origin in 75%. They were pregnant in the first, second and third trimester in (15.6%, 15.6% and 25% respectively). They were in postpartum in 43.8% of cases with a cesarean delivery in 73.3% and breastfeeding in 56%. All women reported being on good terms with their spouses and satisfied with their sexuality. The usual frequency of sexual relations was (1/day: 22.6%, 1/week: 74.2%, 1/month: 3.2%) and 25% reported wanting to reduce the frequency. The mean ASEX score was 13 ± 4.3 and 47% of the sample had sexual dysfunction. For the total score of the QSCPGS, we observe a mean value of 33 ±28.3, which means that our sample has a good level of positive body satisfaction and self-perception. The mean value of the “body satisfaction” factor is higher (23.7 ± 10.4) than the mean value of the “self-perception” factor (11.4 ± 14.3). The mean value of BMI was 28.74 ± 4.4 wich means an overweigh. We found a significant association between the “body satisfaction” factor and the sexual dysfunction (p=0.03), insufficient lubrication (p=0.01) and difficulty reaching orgasm (p=0.001).ConclusionsWe found that body and physical changes among pregnant and postpartum women can negatively affects their body perception and it might deteriorate its global sexual function. Further researches are recommended to study other potential factors affecting sexual function during this period.Disclosure of InterestNone Declared
The primary motor cortex of schizophrenia patients show neuronal and subcellular impairments in the right hemisphere – postmortem study
Authors: Szocsics P. , Papp P. , Havas L. , Lőke J. , Maglóczky Z. 
Published: August 2024

Introduction
In mental disorders, very little is known about the cellular and subcellular mechanisms underlying the development of symptoms. Postmortem studies can contribute to understanding these. Our research group collects and studies cortical samples with short postmortem intervals from schizophrenia patients.Objectives
We investigated primary motor cortical brain samples, to understand the background of motor symptoms in schizophrenia.Methods
Both hemispheres of primary motor cortices of eight control- and eight subjects with schizophrenia were analysed by immunohistochemistry. We labelled pyramidal cells with SMI32 antibody, which binds to neurofilaments, and parvalbumin (PV) antibody, which labels one type of inhibitory input on these cells, axo-axonic and axo-somatic interneurons, and a proportion of giant pyramidal neurons (Betz cells). We were interested in the size and density of layer 3 and 5 pyramidal cells and Betz cells, the distribution of PV-labelled terminals and the PV expression of Betz cells. Results of the subjects were compared both as a whole and separately per hemisphere.ResultsMost changes were present in the primary motor cortices in the right hemisphere (presumably subdominant). Here, the density of Betz cells and their inhibitory inputs were also reduced. PV-expression of Betz cells was not dependent on the group studied, but we observed that it is decreasing with age. The other investigated characteristics show no significant differences.ConclusionsOur results suggest that the primary motor cortex may be involved in schizophrenia. Neurodevelopmental, pharmacological and neurodegenerative causes could be involved in this process. Network dysconnectivity is likely to underlie the stronger involvement of the subdominant side, and literature data point also in this direction. We believe that our research method is suitable for the study of the background of other symptoms and may lead to a better understanding of schizophrenia, especially if we could combine our results with clinical research.Disclosure of InterestNone Declared
Effectiveness and usability of an e-health system on depression among patients with somatic disorders
Authors: Vitcheva T. , Petros N.G. , Hadlaczky G. , Carli V. 
Published: August 2024

AbstractIntroductionAn increase in the prevalence of depressive symptoms can be seen in patients with severe somatic conditions, with a reduction in quality of life, an increase in sleep disturbances and an increased risk of suicide as some of the most serious consequences. However, few evidence-based interventions have been developed with the aim of reducing this comorbidity. The NEVERMIND system aims to address this issue by collecting psychometric and biomedical data via a smart shirt and a mobile app, which are used to predict patients’ depressive symptoms. Patients are then directed to personalised lifestyle behavioural advice, mindfulness-based therapy, and cognitive behavioural therapy.ObjectivesThe primary objective was to evaluate the effectiveness of the NEVERMIND system in reducing depressive symptoms in patients with somatic conditions compared to treatment as usual. Secondary objectives included the system’s effectiveness in preventing depressive symptoms, sustaining the effects at 24 weeks post-baseline, and reducing suicide ideation. Besides these, the usability, acceptability, and satisfaction of the system were examined in patients with breast or prostate cancer.MethodsFor this pragmatic randomised controlled trial, 425 patients diagnosed with myocardial infarction, breast or prostate cancer, kidney failure, or lower limb amputation were recruited from hospitals in Turin, Pisa and Lisbon. Data collection occurred at baseline, 12 weeks, and 24 weeks, with the primary outcome being depressive symptoms at week 12, measured by the Beck Depression Inventory II. Regarding the usability, acceptability and patient satisfaction, data from 288 patients was used.Results
The intervention group included 213 and the control group 212 patients, with the sample’s mean age being 59.41 (SD=10.70). Patients who used the system reported having statistically significant lower depressive symptoms at 12 weeks (mean difference=-3.05, p=0.004; 95%CI -5.12 to -0.99) compared to controls, with a clinically relevant effect size (Cohen’s d=0.41). Furthermore, significant reductions were found for suicide ideation (mean difference=-0.61, p=0.020; 95%CI -1.13 to -0.10) and incidence of depressive symptoms at week 12 (OR=0.43, p=0.019; 95%CI 0.22 to 0.87). The decrease in depressive symptoms was sustained at week 24 (mean difference=-1.34, p=0.015; 95%CI -2.41 to -0.26). The system was found to have good usability, with women rating the system more favourably than men and valuing its emotional support, while men used the system more frequently than women and valued the self-awareness that the system encouraged.Conclusions
The NEVERMIND system was shown to be superior to standard care in reducing and preventing depressive symptoms among the studied sample. A new project will be launched in the near future to continue the examination of the system’s effectiveness.Disclosure of InterestNone Declared
New approaches in the neuropsychological evaluation of aADHD
Authors: Birtalan L. I. , Bálint S. , Kilencz T. , Réthelyi J. M. 
Published: August 2024

IntroductionIn Hungary, the understanding and diagnosis of adult attention-deficit/hyperactivity disorder (aADHD) are influenced by a blend of international epidemiological data and the standardized criteria established in DSM-5. The diagnostic protocols at our aADHD Outpatient Clinic at Semmelweis University have been carefully adjusted and validated to align with the practical application of empirical evidence and the extensive clinical expertise of professionals. The current diagnostic protocol encompasses the use of diagnostic interviews (symptoms identification based on DSM criteria; SCID-5-PD; M.I.N.I.-PLUS-5.0), the Conners’ Adult ADHD Rating Scales–Self Report questionnaire (CAARS), heteroanamnesis with parents, a comprehensive neuropsychological instruments battery (including the Rey Auditory Verbal Learning Test, Stroop Test, Conners-CPT3, Trail Making Test) and WAIS-IV Intelligence Scale.ObjectivesA valid and appropriate diagnosis plays a crucial social role by legitimizing individuals’ attention/health issues, confirming their concerns, and addressing cultural and moral expectations. The primary objective of this work is to refine the diagnostic methodology by extensive review of the international literature and the analysis of our own data.MethodsWith the aim of aggregating and analyzing the collected data based on examinations of the Hungarian adult population, our assessment methods are employed to acquire detailed information regarding ADHD prevalence, symptoms, and the related neuropsychological profiles.ResultsWhile various diagnostic approaches generally demonstrated good alignment, in some cases, significant discrepancies between neuropsychological assessment and the rest of our tools were observed, indicating a number of instances of false positives or false negatives. Especially the relevance of Rey Auditory Verbal Learning Test and Trail Making Test are questionable.ConclusionsThe results highlight the necessity for more refined diagnostic criteria and a meticulous selection of neuropsychological techniques to enhance consistency between various approaches, ultimately enabling a more robust diagnostic accuracy.Disclosure of InterestNone Declared