bluuebunny/crossref_metadata_2025_split huggingface dataset:
Promoting occupational justice policies in mental health organizations: A model based on the experiences of mental health rehabilitation consumers and employees
Authors: Cohen H. , Schreuer N. , Vashdi D. R. 
Published: August 2023

Introduction: Occupational justice (OJ) regards the human right to be engaged in meaningful life occupations (work, leisure, learning, house management etc.). It highlights the idea that all society members should be able to actively participate in all occupations as equals. Yet, people with mental health problems remain at the margins of society and struggle to fully participate in life activities. At the same time, such participation has been shown to lead to better functional abilities, higher quality of life, and better illness management among this population. It provides routine, connectedness, belonging, purpose, and identity. Moreover, impaired occupational participation due to mental health problems has resulted in functional impairment, symptomatic deterioration, loss of social roles, and a reduced sense of competence. Despite the importance of such participation, it is unclear in many mental health rehabilitation service organizations how to design policies that will achieve better occupational participation for their consumers.ObjectivesTo better understand the OJ concept and to create a conceptual model pertaining to the challenges and solutions, which may serve policy makers as a theoretical basis for enhancing OJ based policies.MethodsWe conducted a qualitative phenomenological study that included in-depth interviews with mental health rehabilitation consumers, to identify their experiences and perceptions in relation to OJ and focus groups with rehabilitation employees and managers. Data analysis was a multi-staged process using a systematic and inductive procedure.ResultsBased on our analysis, the three key themes clarifying the interviewees’ experiences with the OJ concept were a) the importance of and barriers for achieving meaningful participation, b) the required resources for implementing OJ, and c) principles for practice. These elements comprise a holistic OJ construct, affording a practical understanding of what a service that implements OJ means. Such a service would use the resources and practices discussed in this study and address meaningful participation as the desired outcome to achieve.ConclusionsUnlike other forms of justice, OJ emphasizes the need for flexible and tailor-made services that address the consumer’s changing needs and circumstances. It considers the consumers’ role as active rather than passive service recipients. Recently, the fields of health and rehabilitation have increasingly acknowledged the importance and applications of involving consumers. Their genuine involvement would enhance OJ and provide a basis for more accurate assessments and customized interventions.Disclosure of InterestNone Declared
Establishing priorities for a Mental Health strategy in Castilla y Leon: The cohesion of professionals and society
Authors: Pelayo-Terán J. M. , Zapico-Merayo Y. , Saez Aguado A. M. , Villa Carcedo R. , Álvaro Prieto Á. 
Published: August 2023

IntroductionThe reform of mental health care is a key health policy target. Mental health care provision in Spain is designed with national and regional strategies that stablish the objectives to develop. The Castilla y Leon regional strategy 2022-2026 aim to stabilsh the priorities for objectives and actions with stakeholders from th eregional society.ObjectivesTo evaluate priorities in the implementation of a Mental Health strategy with the consensus of professionals and society.MethodsAn initial consensus was achieved with the regional health goverment and local mental health representatives, considering the 2022-2026 national strategy and other mental health plans from nearby regions. Lines in the strategy included transversal lines (part of all the mental health scope) and action lines (priorities focused in one relevant field)Priorities were stablished by different representatives from mental health and other healthcare professionals, social and educational stakeholders, scientific societies, people with mental health disorders and families. After agreeing to participate in the process, they had to answer an online survey. For each line, they have to score from 0 to 10.Results500 subjects participated (44% Healthcare workers, 5.8% education or social services, 3.8% Justice, 8,6% workers for associations, 14% Mental Health Care users). All the lines were highly appreciated (mean score >7). Within the transversal lines, the highest score was for the Humanization line (8.81±1.43) and the lowest for the Digitalization line (7.18±1.92). In the Action Lines, the highest score was for Suicide (9.03±11.5) and the lowest for Elder people (8.04±1.94).Prevention line had higher scores by Education, Justice, Associations and Healthcare professionals and the lowest was for users (F: 2.754; p=0.012). In the Digitalization line the higher scores were in the health professionals and scientific societies and the lowest in the users (F:4.665; p<0.001). In the research, innovation and Training line, the higher scores were for professionals, societies and users and the lowest in the education and justice groups. The only differences found in the Action lines was for the Addiction line, with higher scores for societies, social services, professionals and users and lower in Associations and Justice (F:2.219; p=0,040)Image:Image 2:ConclusionsHighest transversal priority for the MH Strategy was Humanization of Mental Health Services, and the most critical action was Suicide prevention. Professionals, Scientific societies and Users considered more important research, innovation and training compared with other society groups, whereas the less important areas for the users were digitalization and prevention users. These priorities will help to design the implementation and schedule for the lines of the Mental Health Strategy in Castilla y León.Disclosure of InterestNone Declared
A Pragmatic Approach to define “DIFFICULT TO TREAT” patients
Authors: Nascimento M. , Lourenço A. , Falcão A. L. , Soares G. , Rodrigues C. , Petta J. , Oliveira C. 
Published: August 2023

IntroductionMultiple definitions for “difficult to treat” patients (DTP) were given throughout the years. While most authors focus on diagnoses, others focus on clinical, social and demographic factors, which should be regarded as factors of bad prognosis and elevated costs for the healthcare systems.ObjectivesTo identify and haracterize DTP patients admitted in acute ward, based on practical criteria.MethodsThrough the hospital’s IT services, all acute inpatient episodes at Centro Hospitalar Psiquiátrico de Lisboa were collected, since 2017. Cluster analysis was performed, regarding number of previous admissions (PA) and days of admission. Descriptive and comparative statistics (with multiple comparisons) for the different clusters, regarding age, gender, diagnosis at discharge (according to ICD10), and, to the DTP, previous medical following, compliance to medication, and substance use at admission.ResultsThree clusters were identified: (C1, n=5861) a larger, uncharacteristic one; (C2, n=1168) with a higher number of PA (average of 8, versus less than 2 on the others); and (C3, n=1462) with higher number of days of admissions (58 versus less than 16). Statistical significance was found regarding age (higher in C3), gender (more men in C2), nationality (C1 with more foreigners). Regarding diagnosis at discharge, statistical difference was found between the 3 groups: C1 has significantly less patients with Schizophrenia (11% versus 30% in the others), but more depressive (21% versus 6% in C2 and 12% in C3) and neurotic disorders. C2 presented less dementias (0,5% versus 3% in C1 and 10% in C3) and delusional disorders, but more bipolar disorders (24% versus 15% in C1 and C3); C3 represented less episodes due to substance abuse (alcohol or others) and personality disorders. In both C2 and C3, no psychiatric consultation happened in the 3 months prior admission to around 40% of episodes, and 50% had stopped medication. The majority had only oral medication. Almost 24% of C2 tested positive for cannabinoids, with no differences regarding other substances.ConclusionsThese findings allow the definition of 2 kinds of DTP, which present unique characteristics but some common features (namely poor adherence to consultations and are in therapeutic compliance). An assertive multidisciplinary approach, focused on current treatment and relapse prevention (including social structures, more frequent clinical follow-up, and rehabilitation centers), will be the key to their treatment.Disclosure of InterestNone Declared
Depression, anger and coping strategies of students in polish medical faculties
Authors: Wizner M. H. , Kawalec A. , Rodak N. , Wilczyński K. M. , Janas-Kozik M. 
Published: August 2023

IntroductionStress related to high expectations towards students, a large amount of knowledge necessary to assimilate in a brief period of time, and peer pressure are an important factor in the deterioration of the mental state of medical students. As a consequence, it can lead to burnout and even the development of mental disorders such as depression. Mechanisms of coping with difficulties play an extremely important role in moderating this risk. For this reason, it was of the interest what strategies medical students adopt in the face of everyday stress and how it affects their well-being and functioning.ObjectivesThe objective was to determine how medical studies impact mental health of students and what coping strategies are used by them to mitigate the negative influence of stress associated with high expectations, peer pressure and overwork.MethodsA cross-sectional study was conducted among students of polish medical faculties using an online questionnaire. Risk of depression was assessed using validated BDI inventory, aggression using STAXI inventory and evaluation of coping strategies was conducted with Brief-COPE inventory.ResultsStudy was conducted among 329 participants. The majority of respondents were female (71.4%; n=235) and average age in the whole population equaled 22.46 years (95%CI: 22.1-23.01). There was no statistically significant difference in age between females and males. Average outcome in BDI equaled 13.84 (95%CI: 12.8-14.8) with higher levels among females (13.84 vs. 12 p<0.05). 165 (49.6%) students had a score above threshold for the increased risk of depression while 32 (9.63%) for severe symptoms of it. In case of aggression average outcome of STAXI equaled 24.89 (95%CI: 22.6-27.1). There was a statistically significant correlation between STAXI and BDI (r=0.3; p<0.05). In terms of the coping mechanisms in terms of coping strategies, a clear advantage of approach strategies was observed (65.36% of respondents). In the multiple regression analyses coping strategies did not influence neither STAXI nor BDI outcomes.ConclusionsWhat draws attention are the high level of depression among the surveyed students, where over 50% show results above the cut-off point for an increased risk of a depressive episode. The advantage of approach strategies is also interesting, especially in terms of planning strategies and positive reformulation. Interestingly coping strategies in the analysed population did not constitute a significant protective factor in relation to the severity of the depressive symptoms and agression. Meanwhile, the sense of satisfaction and contentment with the chosen direction was a very good protective factor in terms of the severity of depressive symptoms.Disclosure of InterestNone Declared
Global signal topography of the depressive syndrome in bipolar disorder
Authors: Gulino G. , Scalabrini A. , Paolini M. , Palladini M. , Benedetti F. 
Published: August 2023

IntroductionPrevious findings show that the depressive state is characterized by a peculiar suppression of the resting state functional connectivity (rsFC) anti-correlation between resting-state networks (e.g., Default Mode Network) and task-positive networks (e.g., Sensory-Motor Network) in favor of an abnormal positive rsFC pattern. This suggests a large-scale functional disbalance in adaptively switching the attentional focus from an internal-oriented cognitive modality to an external-oriented processing modality. Yet, according to further evidence, such a functional inversion is primarily driven by the global signal (GS) (i.e., by an abnormal large-scale topographical reconfiguration) in major depressive disorder (MDD). However, it is not clear if similar alterations may affect bipolar disorder (BD) in depressive phase.ObjectivesInvestigation of the global topography of the depressive syndrome as a potential transnosographic endophenotype and evaluation of the GS on generating differences between groups.MethodsWe compared large-scale rsFC patterns in a group of healthy controls (HC) (n=70) and a group of patients with BD (n=70) during a depressive episode. In order to investigate the impact of the GS, we further performed all analyses both with and without GS regression (GSR).ResultsCompared to HC, patients with an ongoing major depressive episode exhibit specific resting-state changes that are only observed when analysis is performed without regressing GS. Patients were found to exhibit an (i) abnormally strong GS contribution within an extended cluster comprising regions known to be part of highly interconnected hubs (i.e., transmodal networks) and showing functional relations’ core along the cortical midline and a (ii) diminished influence of the GS in correspondence of frontoparietal and occipitotemporal regions. Notably, no traces of such changes -differentiating the global topography of patients from HC- held when applying GSR.ConclusionsOur results (i) suggest that rsFC alterations detected stem from a global rather than a local source and (ii) corroborate the impact GS can exert on generating within and between-networks differences. Hence, we underline the necessity that future investigations on groups with expected altered topographical distribution include GS within data-analysis and a proper evaluation of its involvement. Nonetheless, our results are in line with previous evidence of altered global topography in MDD. Hence, we interpreted this finding as a benchmark of a whole-brain functional disbalance toward self-oriented cognition characterizing the transnosographic depressive syndrome.Disclosure of InterestNone Declared
Telephone-Delivered Interventions for Suicide Prevention in Schizophrenia and Related Disorders: A Systematic Review
Authors: Comendador Vázquez L. , Cebrià A. I. , Sanz A. , Pérez V. , Palao D. J. 
Published: August 2023

IntroductionSuicide is a health concern among individuals diagnosed with schizophrenia. Telehealth technology has become an emerging intervention that may afford opportunities for reaching this at-risk group. Consideration of the implementation of telehealth systems in the treatment of patients diagnosed with schizophrenia and suicidal behavior calls for a review of the evidence.ObjectivesThe present aim was to explore the literature on the effectiveness of suicide prevention telephone delivered interventions among patients with schizophrenia and related disorders.MethodsThe bibliographic search was performed in the electronic databases PubMed, PsycInfo, Scopus, and Web of Science following PRISMA guidelines. Two reviewers independently conduct screenings, data extraction and methodological quality assessment. A total of 352 articles were retrieved, of which five studies met the eligibility criteria.ResultsBased on the limited data available, the use of modalities involving telephone contacts appears to be feasible in patients with schizophrenia and suicidal behaviors. In addition, preliminary evidence suggests this system appears to reduce suicidal ideation.ConclusionsThe current data presented here reflect an early stage of effectiveness of telephone-delivered interventions targeted at suicide prevention in patients with schizophrenia. Further research is needed to design evidence-based future interventions and to determine whether this approach can improve patient outcomes.Fundings: This work was supported by the Instituto de Salud Carlos III (grant number: PI19/01484 SURVIVE).Acknowledgements: SURVIVE project (PI19/01484).Keywords: schizophrenia, suicide, telehealth, monitoring.Disclosure of InterestNone Declared
Individual psychotherapy may help to reduce suicidal ideation in first episode psychosis: results from a 2-year Italian follow-up study
Authors: Pelizza L. , Leuci E. , Quattrone E. 
Published: August 2023

IntroductionSuicidal thinking is relevant in patients with First Episode Psychosis (FEP). However, longitudinal studies specifically examining treatment response for suicidal ideation in FEP are still relatively scarce, especially with long-term design and in real-world clinical settings.ObjectivesThe aims of this research were (A) to longitudinally assess suicidal thoughts in people with FEP along a 2-year follow-up period and (B) to overtime investigate any significant association of suicidal ideation levels with the specific treatment components of an ‘Early Intervention in Psychosis’ (EIP) protocol along the 2 years of follow-up.MethodsAt entry, 232 FEP participants (aged 12–35 years) completed the Brief Psychiatric Rating Scale (BPRS), including a ‘Suicidality’ item subscore. Multiple linear regression analysis was then performed.ResultsAcross the follow-up, FEP subjects showed a relevant decrease in suicidal thinking levels overtime. This was specifically predicted by the total number of individual psychotherapy sessions offered within the 2-year EIP protocol and antidepressant dose (at least as regards the first year of our intervention).Image:ConclusionsSuicidal ideation is clinically relevant in FEP but seems to improve overtime together with the provision of specific, patient-tailored and integrated EIP treatments, especially individual psychotherapy.Disclosure of InterestNone Declared
Influence of smoking reduction on depressive and anxiety symptoms and quality of life in smokers with type 2 diabetes: a study focusing on the role of gender
Authors: Tzartzas K. , Chappuis A. , Clair C. 
Published: August 2023

IntroductionThere is a complex relationship between smoking, mental health and diabetes. On one side, there is a bidirectional relationship between tobacco and depression: smokers are more at risk to suffer from depression compared with non-smokers and smoking cessation is associated with mood improvement. Moreover, persons with depressive disorders may be particularly vulnerable to nicotine addiction and are less likely to quit smoking. On the other side, a strong association is observed between depression and diabetes. Gender and sex have also been described as influencing the associations between these different pathologies.ObjectivesOur aim was to determine if and how this relationship exist in a population with diabetes and to assess the impact of smoking reduction on depressive, anxiety symptoms and a health assessment score. We tried also to highlight the potential differences that we find between men and women.MethodsData were collected from a randomized controlled trial evaluating the 1-year efficacy of smoking cessation interventions in a population of smokers with type 2 diabetes. PHQ-9, GAD-7 and SF12 scores were used to assess depressive, anxiety symptoms and health assessment. We used STATA to perform data analysis.Results48 participants were recruited in this study. Women represent 60,4% of the population and men 39,6%. The mean age was 61,9 years old (SD 9.93). The mean depression, anxiety and health assessment scores were 4.1 (SD 4.55), 3.4 (SD 4.83) and 3.0 (SD 0.69) respectively. There were no significant differences between women and men scores. Women tended to have higher depression and anxiety scores, whether they reduced their consumption or not. Men who decreased their smoking consumption (reducers) tended to have better mental health scores than women at baseline. In both genders, we found a trend toward improvement in depressive, anxiety and health assessment scores of participants that reduced their tobacco consumption. We assessed a loss of 1.8 (SD 2.58, p-value= 0.424 ) and 1.7 (SD 3.20, p-value=0.448 ) points to their depressive and anxiety scores respectively while non-reducers only lost 0.6 (SD 4.03*) and 0.7 (SD 2.88**) points respectively.ConclusionsOur study suggests that differences between genders exist and that there are improvement differences in scores of people who reduced their tobacco consumption compared to people who didn’t reduce their consumption. However, none of our results were significant. A study with a greater number of participants and with more strength should be done to confirm our hypotheses.Disclosure of InterestNone Declared
Losing psychiatric or psychological follow-up during the first COVID-19 confinement in Portugal: outcomes in mental health
Authors: Gomes M. , Silva Moreira P. , Ferreira S. , Couto B. , Machado-Sousa M. , Raposo-Lima C. , Sousa N. , Picó-Pérez M. , Morgado P. 
Published: August 2023

IntroductionThe COVID-19 outbreak imposed several periods of lockdown to stop the pandemic, with a determinant impact on access to mental health services. In Portugal, the first State of Emergency was declared on the 18th of March 2020, with the obligation of mandatory confinement and circulation restriction. Restrictive measures were alleviated on the 2nd of May 2020.ObjectivesWe aimed to investigate the impact of the first confinement on the maintenance or loss of psychiatric and psychological follow-up. Also, we aimed to explore the outcomes in the mental health of losing psychiatric or psychological consultations.MethodsWe conducted an online survey among the Portuguese population to evaluate demographic, clinical and mental health variables (STAI, DASS-21, PHQ, OCI-R, Quality of Life [QoL] and PSS). Individuals were invited to answer the survey at two timepoints: third week of March 2020 and third week of May 2020. Concerning the first timepoint, we used independent t-tests to compare the mental health variables in the individuals who loss and who did not lose consultations. Then, we evaluated the impact of losing consultations across time in those individuals who continued responding in the second timepoint, through a Linear Fixed Model. All the analyses were performed using JASP software.ResultsFrom the total sample (n=2040), 334 individuals (84.4% female gender) had psychiatric and/or psychological consultations previously to the confinement. In March 2020, the individuals who maintained the consultations (35.0%) showed best mental health indicators in the QoL Self Evaluation (p=0.002), QoL Satisfaction (p=0.037), STAI State (p<0.001), DASS-21 (p=0.001), PHQ (p<0.001), OCI-R (p=0.002) and PSS (p<0.001). Among the matched individuals who answered the survey in May 2020 (n=93), we found that the group who maintained follow-up (n=24) did not improve significantly more than the other group (n=69) for any of the mental health variables in study.ConclusionsThe results indicate that stopping psychiatric and psychological follow-up represented worse mental health outcomes at the beginning of the first confinement. However, anxiety feelings improved at the end of the first confinement, which happened independently of psychiatric/ psychological follow-up.Disclosure of InterestNone Declared