bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatric role in physician-assisted death requests – a study protocol for a literature review
Authors: Barranha R. , Ferreira A. R. , Gonçalves E. , Fernandes L. 
Published: August 2023

IntroductionThe prospect of a medium-term approval of physician-assisted death in Portugal raises relevant ethical and deontological issues that need to be addressed, namely the framework of psychiatric assessments in this process. Such assessments are undermined by the lack of scientific precision in the methods used to determine decision-making capacity, making it possible for the final decision to be affected by psychiatrists’ personal beliefs. As such, outlining scientific evidence and legislation pieces defining the psychiatrists’ role and scope is of utmost importance to frame this debate.ObjectivesTo synthetize the accumulated evidence worldwide regarding the psychiatrists’ involvement in the global process of physician-assisted death requests by reviewing scientific literature, published protocols, official reports and international promulgated or amended legislation related to hasten death practices.MethodsPubMed, Scopus, Web of Science, PsycInfo and Google Scholar electronic bibliographic databases will be searched for eligible articles, as well as grey literature, using the following search terms: Psychiatry AND (Euthanasia OR (Suicide AND Assisted)). Official governments’ and countries health authorities’ websites will also be searched for relevant reports and legislation documents, as well as right-to-die organizations and akin associations. No language, date of publication, or geographical restrictions will be applied. The full text of potentially relevant results will be retrieved from the different sources for review after screening titles and abstracts. This two-stage process will be conducted independently by two researchers. Outcomes of interest will be the descriptions of psychiatric role in the process of physician-assisted death requests, assessment methods, and measurement techniques used.ResultsGiven the fact that physician-assisted death is legalized only in a few jurisdictions, we believe the number of eligible results will be limited. Data will be extracted and a descriptive summary of the evidence will be provided. We anticipate finding a significant variability, but also to identify points of consensus. The findings will be published in a peer-review indexed journal and presented at national and international conferences.ConclusionsTo our knowledge, this is the first review of both, scientific published literature, and international legislation on the role of psychiatrists in physician-assisted death requests. We hope to provide an international overview to frame the public debate by pinpointing the most consensual assessment methodology, allowing to design an optimized assessment protocol before the implementation of the law in Portugal.Disclosure of InterestNone Declared
Challenges in Treating Schizophrenia with LAIs – Analysis of Own Results
Authors: Todorov A. A. , Stoimenova M. Y. , Tzoneva T. R. , Tzankova V. S. 
Published: August 2023

IntroductionSchizophrenia is a multifactorial and multifarious disorder with an unidentified etiology and pathogenesis, various clinical symptoms, unpredictable course and definite social significance. It’s social significance manifests in the long inability to work, the decrement of qualification and the burdening of family and social services. Patients find following therapy difficult; they often stop it altogether, which leads to new exacerbations and maintaining a vicious cycle.ObjectivesTo present an analysis of the results of the treatment of patients with LAIs – Trevicta and Xeplion in General Psychiatry Ward of UMBAL "Dr. Georgi Stranski” - Pleven for the period October 2016 – October 2022.MethodsOur retrospective research includes 17 patients treated in General Psychiatry Ward of UMBAL “Dr. Georgi Stranski”- Pleven. A treatment with LAI’s – Trevicta and Xeplion (Paliperidone palmitate) had been initiated in these patients. In consideration of the correct applications of the medication, they are always made by qualified personnel who received training for that purpose in the Ward. For assessment of the patients’ condition are used: Positive and Negative Syndrome Scale (PANSS) and Personal Social Performance (PSP). Standard statistic methods are used for processing results.ResultsOur research includes 17 female patients as the Ward’s profile is such, with the average age of 38.65 years at the initiation of the treatment with Xeplion. Some were later introduced to Trevicta. Of all who participated in the research, 12 patients continue their treatment with regular applications, 2 have changed their address and by unreliable data still continue their treatment and for the other 3 we have no information of their status of treatment. The average count of admissions in the Ward before the initiation of treatment with LAI’s is 3.88 against 0.88 after the initiation. Regarding the PANSS scale – all score in the interval 75-100 points before initiation as opposed to the scores marked after the initiation of the medication that vary in the interval 34-48 points with definite distinctions in P and G items. Regarding the PSP scale – all participants score between 50 and 70 points before the initiation of the treatment as opposed to the scores of 89-95 points after the initiation. During the regular check-ups the patients report of subjective improvement, coupled with reports of objective and positive improvement by family.ConclusionsTreatment with LAIs – Xeplion and Trevicta has an unquestionable positive and lasting effect in the treatment of schizophrenia. Proof of that is the definite improvement of the symptoms, the increased social engagement and interpersonal communication. Everything mentioned is a valid reason to direct the treatment of schizophrenia in the direction of preservation of the personality of the patients.Disclosure of InterestNone Declared
Disentangling the multigenerational transmissions of socioeconomic disadvantages and mental health problems by gender and across lineages: Findings from the Stockholm Birth Cohort Multigenerational Study
Authors: Li B. , Almquist Y. B. , Liu C. , Berg L. 
Published: August 2023

IntroductionThere is a paucity of research examining the patterning of socioeconomic disadvantages and mental health problems across multiple generations. The significance of research on multigenerational processes is based on a concern with if and how (dis)advantages are generated and sustained across generations, and how socioeconomic, mental health, and gender inequalities evolve over a longer period of time.ObjectivesThe current study therefore aimed to investigate the interconnected transmissions of socioeconomic disadvantages and mental health problems from grandparents to grandchildren through the parents, as well as the extent to which these transmissions differ according to lineage (i.e., through matrilineal/patrilineal descent) and grandchild gender.MethodsDrawing on the Stockholm Birth Cohort Multigenerational Study, the sample included 21,416 unique lineages by grandchild gender centered around cohort members born in 1953 (parental generation) as well as their children (grandchild generation) and their parents (grandparental generation). Based on local and national register data, socioeconomic disadvantages were operationalized as low income, and mental health problems as psychiatric disorders. A series of path models based on structural equation modelling were applied to estimate the associations between low income and psychiatric disorders across generations and for each lineage-G2 gender combination.ResultsWe found a multigenerational transmission of low income through the patriline to grandchildren. Psychiatric disorders were transmitted through both the patriline and matriline, but only to grandsons. The patriline-grandson transmission of psychiatric disorders was partially operated via low income of the fathers. Furthermore, grandparents’ psychiatric disorders influenced their children’s and grandchildren’s income.ConclusionsWe conclude that there is evidence of transmissions of socioeconomic disadvantages and mental health problems across three generations, although these transmissions differ by lineage and grandchild gender. Our findings further highlight that grandparents’ mental health problems could cast a long shadow on their children’s and grandchildren’s socioeconomic outcomes, and that socioeconomic disadvantages in the intermediate generation may play an important role for the multigenerational transmission of mental health problems.Disclosure of InterestNone Declared
Evaluation of Vitamin D in the serum of in-hospital patients with psychosis. Retrospective study.
Authors: Kapiris E. , Laskos E. 
Published: August 2023

IntroductionThe reduction of vitamin D (VitD) has often been associated with pathological cognitive processes and in general with various mental illnesses2,3. More frequent reports of reduced concentrations of VitD concern patients with schizophrenia, however it has not been clarified whether this concerns the pathology itself of the disorder or if nutritional factors are involved1.ObjectivesThe measurement of VitD in the serum of hospitalized patients with mental illness (schizophrenia) compared to the levels of people without mental illness.MethodsThe serum levels of VitD were measured in the serum of 45 psychiatric patients of psychiatric hospital “Dromokaiteion” (22 men and 23 women) mean age 59 ±14 years. The control group consisted of 49 healthy subjects (24 men and 25 women) with a mean age of 57 ±14 years (Table 1). Serum VitD levels were measured on the Architect ci4100 immunobiochemical analyzer, Abbott Laboratories Ltd, by the chemiluminescent microparticle immune assay (CMIA) method and according to the manufacturer’s instructions. The statistical analysis of the data was done with the software program SPSS V.25.ResultsMean values of Vit D (ng/ml) were 15.8±10.7 and 15.3±12.5 in male and female patients, respectively. For the control group the mean values were 22.4±7.9 in men and 26.4±13.9 in women. Vit D values in the psychiatric patients of both groups compared to the control group were statistically significantly different (men p=0.021 and women p=0.006). (Table2, 3).Image:Image 2:Image 3:ConclusionsThe findings of the study are consistent with those of similar studies confirming low concentrations of VitD in the serum of patients with mental illness. This parameter should be taken into account as its measurement is not included in the routine laboratory control to date. Further future studies should correlate VitD deficiency with specific demographic and clinical characteristics.1. Belvederi Murri M, Respino M, Masotti M, et al. Vitamin D and psychosis: mini meta-analysis. Schizophr Res. 2013;150(1):235-239. doi:10.1016/j.schres.2013.07.0172. Kalueff A, Minasyan A, Keisala T, Kuuslahti M, Miettinen S, Tuohimaa P. The vitamin D neuroendocrine system as a target for novel neurotropic drugs. CNS Neurol Disord Drug Targets. (2006) 5:363–71. doi: 10.2174/1871527067841115063. Oudshoorn C, Mattace-Raso FU, van der Velde N, Colin EM, van der Cammen TJ. Higher serum vitamin D3 levels are associated with better cognitive test performance in patients with Alzheimer’s disease. Dement Geriatr Cogn Disord. (2008) 25:539–43. doi: 10.1159/000134382Disclosure of InterestNone Declared
Management of comorbid schizophrenia with prolactinome (about a case)
Authors: Chamsi F. Z. , Aberbak H. , Radi S. , El Ammouri A. 
Published: August 2023

IntroductionProlactin adenoma, called “prolactinoma” is a benign neoplasm, it is the most common secreting pituitary tumor, and represents up to 40% of all pituitary adenomas. More than 90% are small intrasellar tumors which rarely increase in size.Objectivesthe problem of management lies in how to stabilize the patient on a psychiatric level without increasing the level of prolactin.MethodsWe report the case of a young woman who presented a comorbid schizophrenia with a prolactinoma. We will try through this clinical vignette to study the different pillars of management of such pathologies.At the same time, we did a literature review. The main search engines used were Pubmed, medline, and Science Direct. The keywords Prolatinoma schizophrenia olanzapineResultsThis is Mrs. N. Q., 39 years old She is single, an engineer but currently without a profession, from an average socio-economic level of a teacher father and a housewife mother. She is the 3rd of his siblings of 6 . She is currently hospitalized at Ar-razi Tanger hospital for treatment of decompensation of her chronic psychotic disorder. The patient would have been born following a premature delivery of 34 weeks. For her antecedent, she was followed for asthma since her childhood. Her mother and her maternal grandfather would have been psychotic. The history of the disease dates back to 2017. The patient suffered from headaches resistant to any treatment. The patient would have consulted a neurologist. Magnetic resonance brain imaging would have been requested, which objectified at the left latero-pituitary level a lesional process of 7 mm discretely intense in T2, hypo-intense in T1 and not enhanced by Gd reflecting a pituitary micro adenoma. The patient was put on Cabergoline (Dostinex®). So the psychiatric symptomatology dates back to the end of 2019, by behavioral problems, social withdrawal, she will have stopped all professional activity. At the same time, she will have stopped all medication (Cabergoline). In 2020, the patient would have been hospitalized for the first time at the Ar-razi Tangier psychiatric hospital. The diagnosis of schizophrenia was retained according to the DSM 5 criteria. After a stay of 5 weeks, the patient would be stabilized on olanzapine 20mg/d. Currently, and following non-compliance with treatment (because of adverse effects such as amenorrhea and galactorrhea), the patient has returned, suffering from a relapse, justifying her second hospitalization. During his stay, a check-up would have been requested to show hyperprolactinemia 3 times normal. We therefore switched to Aripiprazole.ConclusionsWe have proposed an approach to the management of patients with comorbid schizophrenia and prolactinoma, an approach that balances the benefits and risks of managing the psychiatric stability of the patient on antipsychotics with the management of prolactinoma and symptoms. of hyperprolactinemia.Disclosure of InterestNone Declared
The role of immune disfunction in schizophrenia pathogenesis
Authors: Azevedo Silva I. , Martins B. , Melo V. , Cardão J. , Matos A. , Agostinho C. 
Published: August 2023

IntroductionIn the last years there has been increasing evidence that inflammation and autoimmunity may play a role in the pathogenesis of schizophrenia.Although the brain has been considered an immune-privileged site, we understand now that infections and inflammation interfere with the blood-brain barrier, making the brain vulnerable to antibodies, cytokines and infectious agents.ObjectivesTo understand the role of immune disfunction in schizophrenia pathogenesis, as well as the potential role of immunotherapy in its treatment.MethodsWe performed a narrative review of the evidence, using the following terms and their combinations “schizophrenia”, “autoimmunity” and “monoclonal antibodies”.ResultsIt is widely known that prenatal, perinatal and childhood exposure to infections, nutritional deficits and other environmental insults, acting on a background of genetic vulnerability, may lead to schizophrenia. In such cases, we can observe potent and enduring inflammatory responses, such as cytokines dysregulations.State markers, including IL-1β, IL-6 and TGF-β have increased levels during exacerbation of symptoms and stabilized levels when antipsychotics are administrated. Trait markers, such as IL-12, IFN-γ and TNF-α have systematically increased levels in acutely and chronically ill patients, even during clinical stability.Moreover, patients with schizophrenia have been showing abnormalities of the blood-brain barrier, signs of central nervous system inflammation and elevated autoantibody levels and reactivity.Several autoimmune diseases are associated with schizophrenia, such as celiac disease, Graves’ disease and psoriasis. On the other hand, it is known since the 1950’s that schizophrenia has a negative association with rheumatoid arthritis.There are case reports of people with psychosis that were treated with immunosuppressive agents (for concurrent autoimmune diseases) that showed improvement in their psychotic symptoms.NSAIDs, immunomodulators and several monoclonal antibodies have been tested as potential treatments for schizophrenia. The results were conflicting but promising. It is suggested that not every patient with schizophrenia may benefit from these treatments. Ideally, treatment targeting the immune system should be provided in earlier phases of disease, such as in prodromal psychosis and first episode psychosis, because these are related to irreversible grey matter loss which causes cognitive decline.ConclusionsImmune dysregulation may have an important etiological role in schizophrenia.Hence, specific therapeutic approaches targeting the immune system may lead to new ways of treating and even preventing psychotic disorders.Further investigation is necessary in order to provide more information on how aberrant antibody and cytokine production interferes with neuronal function and how it is expressed at the clinical level.Disclosure of InterestNone Declared
Folie a Deux in 2 Elderly Sisters - Challenges in Diagnosis and Management
Authors: Suhairi K. H. B. 
Published: August 2023

IntroductionFolie a deux is a rare psychiatric disorder where an identical or similar mental disorder affects two or more individuals usually with close emotional ties. Management of patients with folie a deux may require multiple types of treatment including separation, family therapy and antipsychotics.ObjectivesNarrative case of Folie a deux in 2 elderly sistersMethodsClinical case presentation through retrospective review of clinical notesResultsWe present a case of 2 sisters living together of 76 and 74 years of age. The elder sister, Sister A, presented to Singapore’s Institute of Mental Health on October 2021 after she was referred from court for disturbed behaviour with more than 10 years history of paranoid delusions against their neighbours, eventually extending to strangers in general. She was admitted and stayed in hospital from October 2021 to February 2022. She was referred to community psychiatric services to perform home visits due to her unwillingness to attend subsequent follow ups after discharge. During these home visits, it was determined that her sister, Sister B, was displaying delusional thinking as well. Sister A was started on antipsychotics while Sister B was managed non-pharmacologically. After commencement of antipsychotics, Sister A showed good response with improvement of symptoms, while Sister B continued to display delusional thinking. Discussion was made with the next-of-kin of both sisters, their nephew, and the decision was made to continue to observe these symptoms and monitor for their resolution with continued treatment of Sister A. A multidisciplinary approach was also used to attempt to reintegrate them into society to rebuild trust in the public. Currently both sisters still report vague paranoia of strangers in general and a multidisciplinary team is involved in improving their symptoms further.ConclusionsWith this case report, we hope to raise awareness of the different methods that are useful in the management of Folie a deux along with the challenges faced when managing these cases.Disclosure of InterestNone Declared
Neutrocytopenia associated with a lurasidon therapy in a patient with paranoid schizophrenia
Authors: Mielczarek Z. , Trędzbor B. , Krysta K. 
Published: August 2023

IntroductionLurasidon is a relatively new, second-generation antypsychotic drug with an interesting receptor profile. It is considered safe and has a low risk of side effects. This drug is effecitve in reducing the productive symptoms of schizophrenia, but also has a positive effect on negative symptoms and cognitive functions. It is a medicine with a multi-receptor mechanism of action: it mainly blocks dopaminergic D2 and serotonergic 5-HT2A receptors. According to the Summary of Product Characteristics, adverse reactions such as leucopenia, neutropenia and anaemia were too rare to estimate their frequency.ObjectivesThis study describes case of neutrocytopenia and leukocytopenia that are likely to be related to lurasidone and have resolved after discontinuation of this medicinal product. The aim of the article is to highlight the risk of using second-generation antipsychotics in patients and the occurence of blood cells disorders in particular neutrocytopenia.MethodsAn analysis of the medical history records were done to describe the case report.Results39-years-old patient treated psychiatrically for 18 years, initially for mood disorders, irritability, behavioural disorders. In 2014 she was diagnosed with paranoid schizophrenia, herlast psychiatric hospitalization took place in 2021. The patient had a history of neutrocytopenia and leukocytopenia. In December 2020, the patient was admitted to the psychiatric ward on account of active aggression against her mother. She was discharged in January 2021 with the recommendation to take paliperidone intramusculary. Due to incomplete remission of psychotic symptoms, the patient received 37 mg of lurasidone since August 2021. The blood count, which was ordered upon admission to the Department of Psychiatric Rehabilitation, showed moderate neutrocytopenia. After discontinuation of lurasidone and the recommended supplementation, the results gradually improved and finally reached the normal range.
Blood cells type
23.09.2021 r.
04.10.2021 r.
14.10.2021 r.
28.10.2021 r.
10.11.2021 r.
24.11.2021 r.
08.12.2021 r.Leukocytes2,45 x 10^3/μl2,73 x 10^3/μl2,39 x 10^3/μl2,66 x 10^3/μl2,79 x 10^3/μl4,09 x 10^3/μl4,03 x 10^3/μlErythrocytes4,26 x 10^3/μl4,31 x 10^3/μl4,48 x 10^3/μl4,06 x 10^3/μl4,08 x 10^3/μl4,39 x 10^3/μl4,22 x 10^3/μlbNeutrocytes1,04 x 10^3/μl1,60 x 10^3/μl1,24 x 10^3/μl1,53 x 10^3/μl1,78 x 10^3/μl2,72 x 10^3/μl2,62 x 10^3/μlLymphocytes1,05 x 10^3/μl0,70 x 10^3/μl0,72 x 10^3/μl0,73 x 10^3/μl0,64 x 10^3/μl0,83 x 10^3/μl0,92 x 10^3/μlConclusionsThis case report shows the need for regular monitoring of blood cells parameters in patients treated with second generation antipsychotics, as there is a risk of neutrocytopenia or even agranulocitosis. If there is an obvious correlation, the dose should be reduced or switched to another medicinal product if possible and blood counts should monitored further.Disclosure of InterestNone Declared