bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘Main the gap!’ The view of healthcare professionals on gains and pitfalls of traditional and innovative models for providing mental health care to imprisoned persons with a severe mental illness in Spain
Authors: Antón Basanta J. , Paz Ruiz S. , Estévez Closas V. P. , López López Á. , Barrios L. F. , Calcedo-Barba A. 
Published: August 2023

IntroductionDifferent mental health care provision models coexist in prisons in Spain. The Ministry of Interior applies a traditional model to secure mental health care to 83% of the country imprisoned population. Three autonomous regions with acquired competencies for health care provision (17% of the imprisoned population) are implementing innovative care models.ObjectivesTo explore the views of healthcare professionals on models of mental health care provision for imprisoned persons with a serious mental illness (SMI) in Spain.Methods21 healthcare professionals (13 physicians, 5 nurses, 3 pharmacists) working in prisons, penitentiary psychiatric hospitals and a psychiatric in-prison unit took part in 5 online, 2 hours focus groups and one in-deep interview between 31st May and 20th July 2022. The moderator used open-ended questions to research into the characteristics of mental health care models and on the challenges for implementation. Focus groups were audiotape recorded and transcribed. Transcripts were analysed applying thematic analysis.ResultsHealthcare professionals reported that within the traditional model of healthcare provision, the psychiatric care of SMI imprisoners relies on correctional general practitioner physicians (GP). Psychiatrists act as external care providers. There are two psychiatric penitentiary hospitals with a strong correctional character for in-hospital care. Acute psychiatric care happens in prisons or at the local general hospital. Healthcare records remain within the penitentiary organization and outside the accesible healthcare information system. In consequence, there is fragmentation and delocalization of mental health care. An innovative approach consists of a dedicated mental healthcare unit within the prison with continuous psychiatric supervision of imprisoners with SMI and good quality psychiatric care. Schizophrenia and hyperactive attention deficit disorder persons benefit the most. Continued mental health care in the community remains a challenge. Another model of care is centred in the SMI imprisoned person. Acute and rehabilitation psychiatric penitentiary units operate within a network of mental health and social care resources in the community, coordinated by a liaison nurse. Individualised care plans keep SMI persons in their social environment. Costs of implementation are high. Clear definition of roles; investment in dedicated staff and shared information systems are challenges to overcome.ConclusionsInnovative models of mental health care are needed to benefit imprisoned persons with a SMI in Spain. A decided national and regional will is paramount to overcome challenges.Disclosure of InterestNone Declared
Social cohesion in psychiatry training in the UK More than a number game? – a secondary review
Authors: Sathyanarayanan V. , Azeem M. W. 
Published: August 2023

IntroductionWith the growing mental health concerns in the United Kingdom, it is undisputable that there will be a need for more mental health professionals, particularly psychiatrists. It has been estimated that there is 1 consultant psychiatrist per 12,567 people in England. The Royal College of Psychiatrists continue to call for a long term plan to address the mental health crisis by investing in psychiatric training and education.ObjectivesTo analyze the socio-demographic profile of doctors in training in psychiatry and change in demand over the last decade (2012-2021)MethodsWe carried out secondary review of the state of medical education and practice in the UK in 2021 report. We analyzed reference tables in the report pertaining to doctors in training in psychiatry by age group; gender; by ethnicity; and by place of primary medical qualification. The report included data for the period 2012-13 to 2020-21, which was analyzed. In addition, 5-year (2017-2021) and 10-year (2012-2021) trends were also available and included in our analysis.ResultsWhile in 2012, there were 1,370 doctors in training in psychiatry, the number had dropped marginally to 1,352 in 2021. While there has been an overall decline of 1.3% in the decade (2012-21), there has been a 11.1% increase (2017-21) in the last 5 years. A big change was noticed with respect to gender. While there were 670 male doctors in training in psychiatry in 2012, the number dwindled to 522 in 2021 (22.1% decline). A deeper analysis of the decline in the male psychiatry trainees reveals that the steepest decline has happened among male international medical graduates (389 to 131 or 58.1% to 25.1%). However, the 5-year trend for male doctors has been more favorable with a 10.6% increase between 2017 and 2021. Among female doctors on the other hand, there was a 18.6% increase from a baseline of 700 in 2012 to 830 in 2021. From an ethnicity perspective, there has been a sharp decline in the proportion of Asian or Asian British trainees, down by 33.9% (555 to 367) between 2012 and 21, compensated largely by White trainees, where a 50.1% increase (511 to 767) has been seen. There has been a significant fall in the proportion of international medical graduates taking up psychiatry training (down 53.5% from 677 to 315) in the UK. This has been compensated by a 58.2% (607 to 960) increase in those who had primary qualification from the UK.ConclusionsThe theme of the 31ST European Congress of Psychiatry: ‘social cohesion, a common goal of psychiatry’ blends well with what is needed in today’s psychiatry teaching and practice in the UK. With the role of culture and society well established in psychiatry, the pursuit for popularizing the profession should not be a ‘one size fits all’ approach but a more targeted approach to ensure that there is greater diversity among the available psychiatrists for patients to choose and benefit from.Disclosure of InterestNone Declared
Four Days Exposure And Reprocessing Therapy For PTSD
Authors: Duek O. , Levy I. , Harpaz-Rotem I. 
Published: August 2023

IntroductionPost-traumatic stress disorder (PTSD) is a debilitating disorder affecting approximately 6% of the population. Current treatments have been shown to efficaciously reduce symptom burden between 30%-50%. However, due to the high intensity of treatment over a long period of time. drop-out rates are as high as 50%.ObjectivesAssess the effect of one-time ketamine infusion in subanasthetic dosage on PTSD psychotherapyAssess feasibility and effect of massed, four days, esposure focused psychotherapy for PTSdMethodsHere, we tested the efficacy of a four-day exposure and processing-focused psychotherapy at reducing PTSD severity. Twenty-seven participants with chronic PTSD were randomized to two groups, one receiving a one-time infusion of ketamine in a subanesthetic dose (0.5mg/kg for 40 minutes), the other receiving midazolam. Both groups underwent four 90-120 minutes of daily psychotherapy sessions a day after infusion, followed by in-vivo exposure practice. The severity of PTSD was assessed with the PCL-5 before and at the end of treatment, and at 30 and 90 days follow-up. Brain reactivation to the trauma reminders was measured using fMRIResultsPTSD severity in both treatment groups decreased by 13, 16, and 15 points on the PCL-5 at the end of treatment, 30 days follow-up, and 90 days respectively, surpassing the minimum clinical difference of 7.9 points. There was no significant difference in symptom reductions between the treatment groups. However, brain reactivation to trauma stories differed between the groups, with the ketamine group showing a decline in the amygdala and hippocampus reactivation compared to the midazolam group, at the end of treatment.Image:ConclusionsOur results imply comparable efficacy of this short-term intervention to standard trauma-focused psychotherapies, emphasizing its clinical usefulness as a short and effective intervention.Disclosure of InterestNone Declared
A randomized controlled trial on the effect of parenting intervention through “Care for Child Development guideline” on early child development and behaviors
Authors: Kelishadi R. , Yaghini O. 
Published: August 2023

IntroductionIt is suggested that parenting intervention programs can play a core component in early child development. Given the limited healthcare resources in developing countries, a group design intervention might be cost-effective.ObjectivesOur objective was to assess the effect of parenting interventions in a cost-effective setting through group sessions CCD interventions on children’s development and behaviors in a non-Western, low/middle income country.MethodsThis randomized controlled trial was conducted in a public Pediatrics clinic in Isfahan, Iran. We included 210 pregnant women in their third trimester, and then followed their children for 18 months. The intervention group underwent 5 educational group sessions. The main outcomes were the children’s development and behaviors based on Bayley Scales of Infant and Toddler Development-III (BSCID-III) at 12 months and Children Behavior Checklist (CBCL) at 18-month of age.ResultsData of 181 children were analyzed (80 in the intervention group and 101 controls. The adjusted median differences were significantly lower in the intervention group than in controls for attention problems (-3.38; SE=1.59; P=0.035), anxiety problems (-2.28; SE=1.03; P=0.007) and pervasive developmental problems (-5; SE= 1.16; P<0.001) based on CBCL results. However, the difference of proportions was not significant in none of the BSCID-III domains in the intervention and control groups.Table 1-Results of BSID-III in intervention and control groups at 12 months of age aIntervention(n=80)Median (IQR)Control(n=101)Median (IQR)PAdjusted median differencesbCoefficientSECognitive score105 (100-115)110 (100-120)0.099-4.222.510.095Language score112(103-118)112(103-118)0.444-1.922.520.446Motor score103(97-110)107(91-112)0.957-1.092.410.652ConclusionsWe found that parenting interventions through CCD group sessions were significantly effective on several child’s behavior domains, but not on children’s development. Future longitudinal studies are necessary in this field.Disclosure of InterestNone Declared
A case report of cognitive behavioural and emotional therapy for depression in an ultra-high risk patient
Authors: Ben Massoued R. , Aissa A. , Larnaout A. , Lansari R. , Ouali U. , Jomli R. 
Published: August 2023

IntroductionPsychotic disorders are associated with a degree of disability that is much more considerable if the duration of untreated psychosis is prolonged. This fact highlights the importance of early intervention strategies among individuals at ultra-high risk (UHR) for psychosis, often struggle with depressive symptoms.ObjectivesThe objective of this work was to evaluate the effectiveness of cognitive-behavioral and emotional therapy on depressive symptoms in a patient at high risk of psychosis.MethodsThis is a detailed case report of a young adult at UHR for psychosis who was referred to psychiatry department “A” at Razi Hospital for treatment of depression symptoms.The patient had benefited from 15 sessions of cognitive-behavioral and emotional psychotherapy, over eight months, from July 2021 to February 2022, at the rate of one 45-minute session per two weeks. The main psychotherapeutic techniques used were: behavioral activation, cognitive restructuring and relaxation.An initial and final assessment was performed by the Hamilton Depression Scale and by the comprehensive assessment of mental states at risk.ResultsThe clinical case illustrated concerns a 21-year-old female with a state of high risk of psychosis, suffering from depression symptoms that had been worsen since two years.As the therapy progressed, an improvement in depressive symptoms and functioning has been noticed, by a decrease in the score of the Hamilton scale, from 28 to 11, with a response estimated at 61% and a score for social functioning and professional, initially estimated between 21 and 30, to became between 41 and 50 after therapy.The active participation of the patient, and her assiduity were important factors in this success.ConclusionsCognitive-behavioral and emotional therapies for depressive symptoms could constitute an effective intervention approach for subjects at high risk of psychosis, allowing the improvement of the prognosis of psychotic disorders.Disclosure of InterestNone Declared
An update on the Pharmacological and Psychotherapeutic Management of Treatment Resistant OCD
Authors: Van Ameringen M. 
Published: August 2023

AbstractAlthough the rates of response to first-line pharmacological treatments (serotonin reuptake inhibitors – SRIs) are generally twice that of placebo, only 40-60% of patients respond sufficiently or are able to tolerate traditional first-line pharmacotherapy. Augmentation with dopamine antagonist medications is associated with the strongest evidence, yet dopamine antagonists benefit only a minority of those who try them and carry elevated risks of adverse effects. Based on evolving pathophysiologic models of OCD, a variety of agents targeting serotonin, dopamine, norepinephrine, glutamate, and anti-inflammatory pathways have been explored as alternative or adjunctive therapies for treatment-resistant OCD and have at least preliminary evidence of efficacy. Similarly, approximately 50% of patients do not respond optimally to first psychotherapeutic treatments including cognitive behavioural therapy (CBT) and exposure and response prevention (ERP), even when combined with pharmacotherapy. The psychotherapy outcome literature is heterogeneous and very few psychological strategies have been developed specifically to treat treatment resistant OCD. However, a recent systematic review concluded that CBT improved treatment response in individuals with pharmacotherapy resistance. This presentation will present an update on the pharmacological and psychotherapeutic treatment of refractory OCD including novel strategies such as the use of psychedelics.Disclosure of InterestM. Van Ameringen Grant / Research support from: Elvium, CIHR,Hamilton Academic Health Sciences Organization, Consultant of: Abbvie, Bausch Health, Boehringer Ingelheim, Elvium, Jazz, Vistagen, Speakers bureau of: Abbvie, Elvium (Purdue), Lundbeck, Otsuka, Sunovion, and Takeda
Alternative initiations with 6-monthly paliperidone palmitate. A retrospective study
Authors: Benavente López S. , Bolaño Mendoza S. , Parra González A. , Lara Fernández A. , Herencias Nevado A. , Baca García E. 
Published: August 2023

Introduction6-monthly paliperidone palmitate features an initiation regimen through 1-monthly paliperidone palmitate or 3-monthly paliperidone palmitate. Some patients do not have sufficient adherence to treatment and it is necessary at the clinical level to start directly with 6-monthly paliperidone palmitate. There is little clinical experience with these alternative initiations and through this work those that have been carried out for 12 months at the Hospital Universitario Infanta Elena are exposed.ObjectivesThe main objective of the study is to describe the alternative initiations performed with 6-monthly paliperidone palmitate in routine clinical practice, having opted for a regimen different from the standard for clinical reasons.MethodsA retrospective selection of patients will be made through non-probabilistic consecutive sampling, including all patients who have been administered 6-monthly paliperidone palmitate with a start different from the standard during the last 4 months. To do this, the electronic medical record will be used, first selecting the patients who have started 6-monthly paliperidone palmitate through the anonymized digital records and, later, including in the study only those who have followed an alternative initiation pattern. The variables studied will be the following: age, sex, diagnosis, dose of paliperidone palmitate, initiation regimen, consumption of toxic substances, absenteeism from 6-monthly paliperidone palmitate, and visits to the emergency room and admissions.ResultsThe study included a total of 20 patients (n: 20). 80% of the patients were male and 20% were female. The mean age was 39.7 years. 75% of the patients had an associated substance use disorder. The following alternate starting schedules were performed with biannual paliperidone palmitate: monthly paliperidone palmitate on days 1 and 8, and 6-monthly paliperidone palmitate on day 38 (n: 11); monthly paliperidone palmitate 150 mg together with semi-annual paliperidone palmitate both on day 1 (n: 5); biannual paliperidone palmitate on day 1 supplemented with oral paliperidone for 45 days (n:4). A total of 0 visits to the emergency department and 0 admissions were observed after the 6-monthly paliperidone palmitate regimen.ConclusionsAlternative initiations with 6-monthly paliperidone palmitate may be a useful and safe clinical alternative in patients with very low adherence who, due to clinical needs, require starting 6-monthly paliperidone palmitate earlier in order to guarantee adherence.Disclosure of InterestNone Declared
The effect of wearable technology on psychomotor agitation in patients with diagnostic patients with schizophrenia expansion and psychosis
Authors: Oflaz F. , Cetinay Aydin P. , Sahin Tokatlioglu T. , Eser E. , Zemen N. , Semiz B. , Hayirlioglu Y. Z. 
Published: August 2023

IntroductionDue to the exacerbation of psychotic processes in acute psychiatric services, patients may exhibit risky behaviors for themselves and others. Especially, psycho-motor agitation seen in schizophrenia may result in some harmful behaviors towards him/her self or other individuals in patient. Physical restrain, or chemical restrain with psychotropic drugs can be used for ensuring the safety of the patient with a tendency toward violent behavior and to prevent harm to himself and others. These restrain methods are usually applied when they showed aggressive or violent behaviors, that is after the observed warning signs or real violent behaviors.There is no system that can evaluate and notice agitation or tendency of violence before the obvious behaviors. By using a wearable sensor system to be able to measure some biological change and to evaluate of the sensors’ ability to obtain quantitative and objective data may help the health professionals to prevent the damage in advance.ObjectivesThe aim of this pilot study was to evaluate the changes in measurements of the four wearable sensors which applied to persons with schizophrenia.MethodsTen patients who restrained in the observation room, selected for this pilot study. On the first day (13:00), which meets the criteria for inclusion in the study and the end of the insulation process (the COVID test result is negative), the first measurement was before the noon treatment. The patients’ second measurements were taken on the day they switched from parenteral to oral treatment. For measurement, the sensor circuits developed at the Physiological Analysis and Wearable Systems Research Laboratory of Koç University were connected to various parts of the body to collect the non-invasive data detailed below. In addition, including the clinical status of the patient in the experimentation process, and a positive-negative syndrome scale was also used. The data from the patient was obtained under the supervision of the clinical chief nurse for 10 minutes. Sensors were electrocardiogram (ECG) photoplethysmogram (PPG), seismocardiography (SCG), body temperature.ResultsSince some recording errors observed in two patients’ records, the data of eight patients were evaluated. Aside from one of the eight patients evaluated, the signal deviation and strength of other patients’ data increased in general. This result imply that signal deviations and strengths may be reduced during the psychomotor agitation. These deviations may suggest that this sensor system is capable to evaluate some biological changes in patients.ConclusionsConsidering the results of the pilot study, it is planned to carry out future studies with a larger sample size and longer records. With these studies, it is thought that psychomotor agitation in patients can be determined in an objective and measurable way without risk.Disclosure of InterestNone Declared
More bipolar than bipolar disorder – a polygenic risk score analysis of postpartum psychosis
Authors: Hörbeck E. A. , Jonsson L. , Pålsson E. , Landén M. 
Published: August 2023

IntroductionPostpartum psychosis is a rare psychiatric emergency, occurring days to weeks after 1-2 per 1000 deliveries. Its low prevalence makes it difficult to recruit enough participants to investigate the underlying pathophysiology. It is epidemiologically linked to bipolar disorder, which one study also found it to resemble in genetic susceptibility for psychiatric disorders (Di Florio et al. Lancet Psych 2021; 8: 1045–52).ObjectivesIn this study we aim to investigate polygenic liability for psychiatric disorders in two new Swedish postpartum psychosis cohorts.MethodsCases with postpartum psychosis, defined as a psychiatric hospitalization within 6 weeks after delivery, and/or receiving a diagnosis of F53.1 (ICD 10) or 294.40 (ICD 8.), parous women with severe mental illness without postpartum psychosis, and healthy parous controls were identified in two Swedish genetic studies: the Swedish bipolar collection (SWEBIC) and Predictors for ECT (PREFECT). Polygenic risk scores (PRS) were calculated from summary statistics from genome wide studies on bipolar disorder (Mullins et al. Nat Genet 2021; 53 817-829), schizophrenia (Trubetskoy et al. Nature 2022; 604 502-508) and major depression (Wray et al. Nat Genet. 2018; 50 668-681). The p-value thresholds best predicting their respective phenotype were used in logistic regression analyses with the first six principal components and genotyping platform as confounders.ResultsWe identified 176 patients with postpartum psychosis and genetic information (N(SWEBIC)=126, N(PREFECT)=50). Compared with healthy parous women, patients with postpartum psychosis had significantly higher PRS for bipolar disorder (SWEBIC: odds ratio [OR] 2.6 (95% confidence interval [CI] 1.9-3.5), PREFECT: OR 2.4 (95% CI 1.8-3.2), Figure 1.) and schizophrenia (SWEBIC: OR 1.6 (95% CI 1.2-2.2), PREFECT: OR 1.8 (95%; CI 1.3-2.5)). Patients with postpartum psychosis had significantly higher PRS for bipolar disorder (SWEBIC: OR 1.4 (95% CI 1.2-1.8), PREFECT: OR 1.5 (95% CI 1.1-2)) compared with parous women with severe mental illness without postpartum psychosis. We found no associations with major depression PRS in either cohort.Image:ConclusionsWe replicated previous findings of significantly higher PRS for bipolar disorder and schizophrenia in postpartum psychosis compared with healthy controls. In contrast to previous research, we find postpartum psychosis cases to have higher PRS for bipolar disorder than bipolar disorder cases. Our findings highlight the genetic influence in postpartum psychosis and support previous genetic and epidemiological evidence that postpartum psychosis lies on the bipolar spectrum.Disclosure of InterestNone Declared