bluuebunny/crossref_metadata_2025_split huggingface dataset:
Depressive episode as initial symptoms of Perry syndrome
Authors: Téllez Gómez A. , Pardo González C. , Sabater Ferragut A. , Ribes Cuenca J. 
Published: August 2023

IntroductionPerry syndrome is a rare neurological disorder, characterized by atypical parkinsonian symptoms, sleep disturbances, central hypoventilation, weight loss, and psychiatric symptoms, especially apathy or depression. This syndrome is due to a TDP-43 proteinopathy as a result of a mutation in the DCTN-1 gene.ObjectivesTo present the case of a patient with a mutation in the DCTN1 gene, related to Perry syndrome, who debuted with several depressive episodes, with apathy and weight loss.MethodsA non-systematic literature review was conducted on PubMed database on depressive episodes related to Perry´s syndrome. The clinical case report was prepared through the review of the clinical record of the patient.ResultsThe authors present the case of a 49-year-old man, who contacted psychiatry for the first time 10 years earlier due to depressive symptoms, suffering multiple episodes. These episodes consisted of hypothymic mood, apathy, anhedonia and marked irritability, together with suicidal ideation, leading to several drug overdoses. He also presented disruptive behaviors, such as abusive drinking and aggressiveness. These episodes responded to antidepressants at medium doses, although maintaining several relapses. Given this, it was decided to introduce valproic acid as a mood stabilizer, with good tolerance.In parallel, the patient’s mother, who had also suffered from depressive episodes, began with dementia symptoms, after which it was decided to request a genetic study. In this context, a mutation, similar in both patients, was observed in the DCTN1 gene, related to Perry syndrome.In the case of the patient presented, no other associated alterations were found, neither in the neurological examination or in the rest of the tests performed (polysomnography without notable alterations, functional imaging tests without pathological findings).ConclusionsNeurological diseases as Perry syndrome can show depressive symptoms and other behavioral changes at the beginning, developing the rest of the symptoms (parkinsonism, weight loss or central hypoventilation) several years after the onset of the symptoms. It must be taken into account in patients with a family history of mutations or atypical depressive symptoms. It should also be assessed in terms of genetic counseling.Disclosure of InterestNone Declared
Barriers to deprescribing anti-depressants in a primary care setting; an observational study - Are SSRI drugs of dependence and should these be re classified as schedule 3 drugs
Authors: Patel A. , Rasheed R. 
Published: August 2023

IntroductionThere has been an exponential rise in SSRI prescribing, between 2021 and 2022 there was a 5% increase. The majority of SSRI prescription initiation takes place in primary care. This is a national trend and mirrored internationally.ObjectivesThe study was undertaken to understand barriers to deprescribing both prescribing clinicians and patients and the potential of dependence caused by continued prescribing of SSRI and SNRI. We wanted to understand deprescribing challenges and both clinical anxiety and difficulty experienced and see if there is a correlation with the Drug use screening tool (DUST) tool.MethodsThose patients who were stable on SSRI were offered lowering of dose and deprescribing as part of routine medication reviews. During medication reviews patients were asked about willingness to embark on a deprescribing schedule. Patients were screened during medication reviews on the DUST to see if this can be used to predict difficulty with deprescribing. We designed a deprescribing difficult questionnaire to assess the difficulty experienced by clinicians during a deprescribing consultation. We were able to study the is a correlation with DUST scores and Clinician experience of difficulty and challenge in deprescribing of the SSRI and SNRI.ResultsCurrent alcohol drinkers and smokers were less likely to deprescribe from their antidepressants. Clinicals should do a risk assessment using the DUST screening tool checking for risk of dependence. There is an R value of 0.1586 (P-value is 0.018848) between the correlation of patients increased length time and increased DUST score causing an increased risk of dependence. The average R-score across the three practices between patient’s length of time being on medications and their DUST score is R= 0.18705 (P value of 0.01)ConclusionsInability to access IAPT therapies, shortened length of CBT sessions and lack of post IAPT support caused poor patient experience and contributed to reluctance to re-engage with IAPT services. Both cascade and incremental prescribing following lower doses without documentation of the limitations of medication results in unrealistic expectations generated from the prescribing. There is positive correlation between length of SSRI and SNRI prescribed, DUST scores, and Clinical challenge scores with patients’ unwillingness to be deprescribed. Patients should have a DUST score review prior to having been put onto any antidepressant as there is a potential link between increased DUST score and lower chances of willingness to deprescribe. Clinicians need to counsel patient of risk of dependence. The likelihood is these are drugs of dependence and clinicians should counsel patients of these risks and given review dates and offered deprescribing.Disclosure of InterestNone Declared
Measurement-based care vs. standard care for major depressive disorder in Pakistan: protocol for a randomized control trial
Authors: Husain I. , Umer M. , Nigah Z. , Kiran T. , Bukhsh A. , Ansari M. , Bhatia M. R. , Husain O. , Naqvi H. , Qadir A. , Saqib M. , Rajput A. H. , Zeb M. A. , Khan S. A. , Siddiqui K. M. S. , Sherzad S. , Mulsant B. , Chaudhry N. , Chaudhry I. , Husain N. 
Published: August 2023

IntroductionLow and middle-income countries (LMICs) hold the majority of disease burden attributed to major depressive disorder (MDD). Despite this, there remains a substantial gap for access to evidence-based treatments for MDD in LMICs like Pakistan. Measurement-based care (MBC) incorporates systematic administration of validated outcome measures to guide treatment decision making and is considered a low-cost approach to optimise better clinical outcomes for individuals with MDD but there is a paucity of evidence on the efficacy of MBC in LMICs.ObjectivesThis protocol highlights a randomized trial which will include Pakistani outpatients with moderate to severe major depression.MethodsParticipants will be randomised to either MBC (guided by schedule), or standard treatment (guided by clinicians’ judgement), and will be prescribed with paroxetine (10–60mg/day) or mirtazapine (7.5–45mg/day) for 24 weeks. Outcomes will be evaluated by raters blind to study protocol and treatment.ResultsNational Bioethics Committee (NBC) of Pakistan has given full ethics approval. The trial is being conducted and reported as per recommendation of the CONSORT statement for RCTs.ConclusionsWith increasing evidence from high-income settings supporting the effectiveness of MBC for MDD, it is now necessary to explore its feasibility, utility. and efficacy in low-resource settings. The results of the proposed trial could inform the development of a low-cost and scalable approach to efficiently optimise outcomes for individuals with MDD in Pakistan.Disclosure of InterestNone Declared
Comparative Effectiveness of Daily Supportive Text Messages Versus Email Messages for Patients with Depression. Randomized Hybrid Type II Effectiveness-Implementation Trial
Authors: Adu M. K. , Shalaby R. , Eboreime E. , Agyapong V. 
Published: August 2023

Introduction: BackgroundMajor depressive disorder (MDD) is a global health problem accounting for about 40.5% of disability-adjusted life years caused by mental and substance use disorders. Barriers to accessing healthcare services have been reported, highlighting the need for innovative, accessible, and cost-effective psychological interventions. Several clinical trials have proven the effectiveness of supportive SMS text messaging in ameliorating depressive symptoms, however, this approach can only be accessible to individuals having cell phones.ObjectivesThis paper aims to evaluate the effectiveness, feasibility, and user satisfaction of daily supportive email messaging as a non-inferior intervention compared to daily supportive text messaging as an add-on treatment for patients with depression.MethodsThis trial will be carried out using a hybrid type II implementation-effectiveness design. In addition to the usual care, patients with depression will be randomized to receive either supportive text messages or supportive email messages. The messages in both groups will have the same content and will be provided daily for 6 months. The implementation evaluation will be guided by the Consolidated Framework for Implementation Research and the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Descriptive and inferential statistics will be employed in the analysis of the quantitative outcome measures, while thematic analysis will be used for Qualitative data.ResultsThe results are expected to be available 18 months after the start of recruitment. The results will highlight the feasibility, acceptability, and effectiveness of using automated emails as a strategy for delivering supportive messages to patients with depression as non-inferior to text messaging.ConclusionsThe outcome of this trial will have a translational impact on routine patient care and access to mental health, as well as potentially support mental health policy decision-making for health care resource allocation.Disclosure of InterestNone Declared
A Review of the Metabolism and Relevance to Form and Formulation of Ketamine
Authors: Chue P. , Andreiev A. , Chue J. , Chue J. , Tate M. 
Published: August 2023

IntroductionKetamine is a phenylcyclohexylamine derivative comprising a racemic mixture of S- and R-ketamine that possesses anesthetic, analgesic, anti-inflammatory, and antidepressant activity. Oral (including extended release [PO]), intravenous (IV) sublingual (SL), transmucosal (TM), intranasal (IN), intramuscular (IM), rectal (PR), and subcutaneous (SC) formulations have been developed since its commercialization in 1970.ObjectivesTo review and understand the impact of different forms and formulations on the pharmacokinetics of ketamine.MethodsThe extant literature on ketamine metabolism and formulations was reviewed and discussed.ResultsIV (racemic) ketamine (KET) has been shown to improve depressed mood within 4 hours with maximal effect at 24 hours. KET is a chiral molecule with two optimal isomers, R- and S-KET. KET is stereoselectively metabolized by CYP2B6 and CYP3A4 initially via nitrogen demethylation to active metabolite, norketamine (NK); there is no interconversion between R- and S-KET. NK is further metabolized to hydroxynorketamine (HNK) by CYP3A4 and CYP3A5; and dehydronorketamine (DHNK) by CYP2B6. Additional metabolic pathways exist including a direct enantioselective hydroxylation of KET to 6-hydroxyketamine (HK). Bioavailablity is greatest (100%) with the IV racemic KET formulation, but as low as 8% for oral S-KET due to extensive first-pass metabolism; the KET: NK ratio is a measure of first pass metabolism. NK plasma levels are higher with oral S-KET than KET as a result of local intestinal metabolism effects. Additionally, greater plasma concentrations are noted with IV bolus doses of S-KET vs. racemic KET or R-KET. S-KET possesses a longer elimination half-life than racemic KET due to inhibition by R-KET. KET is primarily renally eliminated and twice as fast in children vs. adults.ConclusionsComplex interactions are reported between ketamine form (racemic/enantiomer), formulation, dose, and route of administration that impact on clinical variables and thus, outcome.Disclosure of InterestNone Declared
Suicidal ideation in older people, a public health matter
Authors: Cohen R. B. , Pereira I. M. , Garrido M. M. , Ferreira B. V. , Sousa M. C. 
Published: August 2023

IntroductionSuicide in older people is a critical public and mental health issue which requires attention, given that the ageing population is increasing.Multiple factors, including biological, psychological, and social stressors increase suicidal susceptibility. Unfortunately, elderly are more susceptible to these, such as psychiatric disturbances, physical comorbidities, prior suicide-related behaviours, lack of social support, grief, and increased difficulty in problem-solvingObjectivesIn order to review the risk and protective factors, assessment and prevention of suicide in older adults.MethodsBibliographic research through PubMed and Web of Science.ResultsOlder people can be subdivided into three age groups (from “young old” at 65 years old to “oldest old” after 85 years of age), with suicide being more prevalent in the oldest-old, and overall in men above 75 years old.Previous psychiatric background, suicidal attempts, substance abuse, poor physical health or disability, family psychiatric history, low social support or isolation, and finantial stress most frequently predispose to suicidal ideation, suicide attempts or death by suicide in this community.Besides this, ageing relates to a tendency to cognitive impairment, which affects coping mechanisms, leading to deficits in reasoning and decision-making under stressful circumstances during depressive episodes. This can mediate suicidal ideation and associates to greater lethality methods. Geriatric suicidal attempters have been shown to have greater degrees of cortical and subcortical cerebral areas, including the frontal, parietal and temporal regions, as well as significant loss of volume in the dorsomedial prefrontal cortex, insula, midbrain, cerebellum, lentiform nucleus and putamen. Abnormalities in these regions can impair executive and cognitive function, attention, problem solving and ultimately be responsible for suicidal behaviour.On the other hand, there are suicide protective elements such as physical and cognitive fitness, quality of life and life satisfaction, marital status, religiousness and social support. A prompt identification of modifiable risk factors and strengthening the protective ones by health professionals can reduce this prospect.Conclusions
Suicidal ideation in older people is a multifactorial public health concern given the very high frequency of completed suicides in this population. Therefore, it is urgent to review and further research to build more effective suicide prevention strategies.Disclosure of InterestNone Declared
Self-esteem is associated with loss of autonomy and depression in the elderly
Authors: Bouali W. , Kacem M. , Haouari W. , Zarrouk L. 
Published: August 2023

IntroductionSelf-esteem is an important aspect of adaptive processes at all ages of life and particularly in older adults: it is linked to the quality of adaptation, well-being, life satisfaction and health.Objectivesstudy the links between self-esteem, autonomy and depression in the elderlyMethodsThis is a descriptive and analytical study carried out over four months in the offices of three doctors. The population of the study were the consultants whose age was over 65 years the study was made using a pre-established sheet with certain socio-demographic characteristics, the pathological antecedents of subjects. We assessed self-esteem using the Rosenberg scale, autonomy using the activities of daily living scale (KATZ index), and depression using the mini GDS. The analysis of the results was carried out using SPSS 17 software.ResultsOur sample is made up of 54 consultants. The average age was 68 years old. The sex ratio was equal to 0.875. Negative self-esteem, loss of autonomy, depression were observed respectively in 40%, 56.7%, 36.7% of cases. We found an association between negative self-esteem and loss of autonomy (p=0.01) on the one hand, and depression (p<0.0001) on the other.ConclusionsOur work showed an association between loss of autonomy, depression and negative self-esteem. Depression and negative self-esteem could be a consequence of the loss of autonomy or contributing factors?Disclosure of InterestNone Declared
Gastric bezoar in a patient hospitalized in an eating disorder unit. Case report
Authors: Torres Cortés J. , Esteban Avendaño I. , González del Valle J. B. , González Lucas R. , Padín Calo J. J. , Morillo González J. P. 
Published: August 2023

IntroductionIt is well known that eating disorders are related to comorbidity. At least, half of these patients have other mental disorders and, in addition to it, the presence of physical comorbidity (cardiovascular, kidney, nervous system, digestive tract, metabolic or endocrine disorders) comes with a decline in life expectancy.ObjectivesDescription of a patient with a diagnosis of anorexia nervosa (AN) who developed a gastric bezoar during hospitalization.MethodsCase treated in a specific Eating Disorder Unit in a Third-Level Hospital.Results26 years old woman with a diagnosis of AN hospitalized in General Psychiatric Unit with BMI of 11,78 kg/m2. Nasogastric tube was necessary and, after 1 month with a progressive weight recovery (BMI 13,84 kg/m2), the patient was transferred to the Eating Disorder Unit in order to follow specific psychological therapy. No incidence related to physical exploration or clinical analyses happened during this month apart from pancytopenia due to malnutrition.However, 8 days after, patient developed nausea and had 3 vomit episodes, constant abdominal pain at hipogastrium (moderate intensity), dizziness, instability and constipation. The patient refused possibility of pregnancy. The physical exam showed bowel sounds augmented but no mass or peritoneal irritation appeared. Blood test results were normal. Abdominal X-Ray showed gastric dilatation with small bowel faeces sign, which suggested diagnosis of gastric bezoar.The treatment was the dissolution of the bezoar by Coca-Cola, solving the symptoms completely.The patient refused having eaten hair or any other kind of object or indigestible material but admitted to be following a strict vegan diet. Finally, after an endoscopy was done, the patient was diagnosed of phytobezoar.ConclusionsBased on literature, bezoars are rare in AN, being phytobezoars the most common between the types of bezoars. Nevertheless, there are some risk factors, such as delayed gastric emptying, dehydration or, in the case of phytobezoar, ingestion of food containing high amount of cellulose, hemi-cellulose, lignin, and tannins (celery, pumpkin, grape skins, prunes, raisins and, in particular, persimmons). Some of the symptoms caused by phytobezoar can be similar to those of the AN (abdominal pain, intestinal obstruction, poor appetite, vomiting, malnutrition, weight loss). Therefore, gastric bezoar could be an underdiagnosed or even undiagnosed disease in this group of patients. Taking this into account could reduce time until diagnosis and treatment, decreasing the risks associated.Disclosure of InterestNone Declared
TELEPSICHOLOGYY AND OTHER CUTTING-EDGE TECHNOLOGIES IN COVID-19 PANDEMIC: BRIDGING THE DISTANCE IN MENTAL HEALTH ASSISTANCE
Authors: Lancia I. S. , Festa G. M. , Mancini M. 
Published: August 2023

IntroductionBackground: At the end of 2019, a novel coronavirus (COVID-19) was identified in China. The high potential of human-to-human transmission led to subsequent COVID-19 global pandemic. Public health strategies, including reduced social contact and lockdown have been adopted in many countries. Nonetheless, social distancing and isolation could also represent risk factors for mental disorders, resulting in loneliness, reduced social support and under-detection of mental health needs. Along with this, social distancing determines a relevant obstacle for direct access to psychiatric care services. The pandemic generates the urgent need for integrating technology into innovative models of mental healthcare.ObjectivesIn this paper, we discuss the potential role of Telepsichologyy (TP) and other cutting-edge technologies in the management of mental health assistance.MethodsWe narratively review the literature to examine the advantages and risks related to the extensive application of these new therapeutic settings, along with the possible limitations and ethical concerns.ResultsTelemental health services may be particularly flexible and appropriate for the support of patients, family members and healthcare providers during this COVID-19 pandemic. The integration of TP with other technological innovations (eg, mobile apps, virtual reality, big data and artificial intelligence (AI)) opens up interesting future perspectives for the improvement of mental health assistance.ConclusionsTelepsichologyy is a promising and growing way to deliver mental health services; but it is still underused. The COVID-19 pandemic may serve as an opportunity to introduce and promote, among numerous mental health professionals, the knowledge of the possibilities offered by the digital era.Disclosure of InterestNone Declared
TELEPSYCHOLOGY WITH ITS INNOVATIONS IN PSYCHOTHERAPY AND PSYCHODIAGNOSTICS
Authors: Lancia I. S. , Festa G. M. , Sisinna M. L. , Ciarrocchi M. 
Published: August 2023

IntroductionThe types of Electronic-Based Therapy & Intervention are spreading rapidly, especially after the onset of COVID, and several authors are dealing specifically with digital psychology and psychiatry, implementing new techniques and methodologies (Festa, Martinotti, 2022).The latest technological innovations related to metaverse and holography are emerging as new digital mediums and a reflection on their potential in the psychological field is urgent. Telepsychology, which currently uses text, audio and video-based communication as a medium, will see the way to relate to the patient with the “new digital presence” amplified at 360 degrees. This will of course revolutionize some aspects of classic psychological intervention: “physical proximity” will have a completely different meaning. New technologies through the digital medium have the power to cancel space, thus allowing the intervention to be separated from the sharing of the same physical environment. The first great epochal upheaval produced by new technologies in the field of the psychological profession is precisely this: psychological intervention no longer necessarily coincides with the sharing of the same physical space, space and intervention becoming independent.ObjectivesWe will soon and increasingly refer to associations, national and international professional associations and institutions that deal with the subject, such as the American Psychological Association, the International Society for Mental Health Online, the Online Therapy Institute, to have guidelines on best practice with respect to psychological performance online. This will be accompanied by specific training courses for clinicians who decide to work using technological tools and courses related to telepsychology and the development of a professional online identity.MethodsHolographic technology will revolutionize our “internal and external world”, and it is the task of psychological science to cultivate questions and provide answers both on the impact that this technology will have on the life of the average man and on the possibilities of use for our profession. The distance of the real world from the digital one is getting smaller with each passing day.ResultsOur habits, our way of working, having fun have changed in different ways and in a very short time. Our physical, cognitive and sensory boundaries have expanded and our way of life has “evolved”.ConclusionsWe find ourselves passing through and going through a phase, which began in the 1980s, which is not without shadows and settles into mass cultural aspects. The contradictions, abnormal uses and abuses of technology, but which accompany every innovative transformation and which we should gradually manage wisely, are also typical of this phase. We will see what the future holds!Disclosure of InterestNone Declared