bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wernicke encephalopathy complicating catatonic schizophrenia
Authors: Rihab C. , Ellouze S. , Messedi N. , Turki M. , Ali F. Ben , Abid W. , Halouani M. , Aloulou J. 
Published: February 2022

IntroductionWernicke’s encephalopathy is a potentially fatal neurological emergency caused by thiamine deficiency. Although it is often associated with chronic alcoholism, it can also occur in all situations that lead to a thiamine deficiency such as undernutrition and exclusive artificial feeding.ObjectivesIn this work, we propose to study the clinical and treatment concerns of Wernicke’s encephalopathy complicating catatonic schizophrenia.MethodsWe retrospectively report the case of a patient who developed a Wernicke’s encephalopathy in the aftermath of catatonic schizophrenia.ResultsMr H.L, a 47-year-old-male has been followed in psychiatric hospital since the age of 27 for catatonic schizophrenia. He has been hospitalized in July 2020 because of oral intake refusal, social isolation and lack of self-care with a poor compliance to treatment. Examination of the patient revealed catalepsy, mutism and negativism. He was treated with antipsychotics drugs, benzodiazepines and parenteral nutrition. About six weeks after his hospitalization, the patient developed horizontal nystagmus and ataxic gait. Magnetic resonance imaging was consistent with Wernicke encephalopathy. Vitamin B1 dosage was 32nmol/l. Parenteral thiamine replacement therapy was initiated with clinical improvementConclusionsCatatonic schizophrenia can be associated with severe malnutrition and thus with thiamine deficiency and Wernicke’s encephalopathy. An early intervention by supplying prophylactic thiamine given parenterally in high-risk patients is crucial to avoid Korsakoff syndrome, as well as cardiovascular and neuropsychiatric complications associated with thiamine deficiency.
Preliminary analysis of different tools in emotional competence assessment in patients with schizotypal disorder
Authors: Vinogradova M. , Khokhlova O. , Oleichik I. , Ermusheva A. , Salikhianova N. 
Published: February 2022

IntroductionDysfunctional emotional competence is known as one of the key characteristics of patients with schizotypal disorder. Methods that aim to assess this problem are differently organized and might elicit these deficits differently. Therefore, there is a need in better understanding of scope of problems that might be assessed using different tools in patients with schizotypal disorder.ObjectivesTo examine the differences in affective empathy and perception of emotions in normal subjects and patients with schizotypal disorder.MethodsThe sample consisted of 14 patients with schizotypal disorder (F21) (M=19.07, SD=3.17) and 53 healthy individuals (M=22.98, SD=2.77) with equal educational level. Participants were given Affective Responsiveness Test (AR) and Emotional Perspective Taking (ERT) (Derntl et al, 2009) and “Reading the Mind in the Eyes” (RME) Test (Baron-Cohen et al., 2001).ResultsThere were significant differences in accuracy of ERT performance between patients with schizotypal disorder (M=80.64, SD=8.17) and healthy individuals (M = 86.62, SD = 8.67), t (65) = -2.32, p = .023. Patients were also found to give less correct answers than healthy controls while carrying out AR, and to need more time for both tasks. However, these differences were not statistically significant. Surprisingly, no significant differences were found for perception of emotions (RME) test, although patients in general gave less correct answers.ConclusionsIt might be assumed that EPT is the most sensitive tool in assessing emotional deficits in patients with schizotypal disorders. Further research is needed to understand the possible reasons for other tests not showing significant results.
COVID-19 and psychiatric education: From postgraduate to continuous medical education
Authors: Dias M. Casanova 
Published: February 2022

COVID-19 has impacted psychiatric education at many levels from postgraduate training to Continuous Medical Education (CME). We invited participants at the European Union of Medical Specialists (UEMS) who are national representatives to share how COVID-19 has impacted postgraduate training and Continuous Professional Development (CPD) in their countries. They were asked to report the challenges but also the opportunities created by the pandemic and their answers were analysed. Several themes emerged. Challenges in postgraduate training have been absences caused by COVID, redeployment, reduced interactions and postponement of assessments. The mental health of trainees was affected, including burnout. Interestingly in some places, like Denmark, training was less impacted as psychiatry was designated as ‘critical’ and therefore no redeployment. Exams have moved online and there have been concerns about cheating in the new format. In countries where it is obligatory to be uptodate with CME/CPD to maintain medical registration, the usual requirements were waived. Conferences and live events have moved online and webinars became popular and widely accepted. Some positive developments included rapid adoption of technology, for consultations and training, increased relevance of CPD/CME, emphasis on team cohesion and recognition of the need for self-care and team support. The pandemic also fostered international collaboration, e.g. sharing guidelines for new ways of working. Some of the innovations described, mainly related to the adoption of technology and remote working will likely be taken in the future. However, the sentiment remains that live exchanges are valuable and should be resumed as soon as it is safe.DisclosureNo significant relationships.
Safety during polypharmacy: A post-hoc analysis examining the safety profile of cariprazine with other antipsychotics in the cross-titration phase
Authors: Vass G. , Barabássy Á. , Laszlovszky I. , Sebe B. , Dombi Z.B. , Szatmári B. , Németh G. 
Published: February 2022

IntroductionAlthough monotherapy is preferable, in every day clinical practice polypharmacy is often unavoidable due to the need of treatment enhancement or cross-titration phases with shorter or longer overlaps of two or more drugs. However, administration of more than one drug treatment is often associated with more side effects.ObjectivesThe aim of the present post-hoc analysis was to examine treatment emergent adverse events (TEAEs) during co-administration of cariprazine with other antipsychotics.MethodsTreatment emergent adverse event data (TEAE) from a randomized, double-blind, parallel-group, active-controlled study (EudraCT Number: 2012-005485-36) in adult patients with schizophrenia having predominant negative symptoms was examined in the first two weeks of the double-blind treatment period, where gradual cross-titration occurred between cariprazine (3-6 mg/day) and other antipsychotics (including amisulpride, aripiprazole, fluphenazine, haloperidol, olanzapine, paliperidone, quetiapine, and sertindole). Thereafter, 24 weeks of cariprazine monotherapy followed.ResultsDuring the cross-titration period, 17.83% of patients experienced at least one TEAE. The TEAEs were in line with the well-established safety data: nausea (2.61%), insomnia (2.17%), headache (2.17%), akathisia (1.74%) and restlessness (1.3%) were the most common. Most events were mild in severity (66.1% mild, 32.2% moderate, 1.7% severe (insomnia)).ConclusionsWhile not definitive, and limited by small sample size, the co-administration of cariprazine with other antipsychotics did not show an unexpected safety profile or overlapping toxicities. This is an important finding, if intermittent or longer co-administration of other antipsychotics are unavoidable with cariprazine treatment.Conflict of interestStudies were funded by Gedeon Richter Plc. and Allergan Plc (prior to its acquisition by AbbVie). Dr Vass, Dr Barabássy, Dr Laszlovszky, Dr Sebe, Dombi, Dr Szatmári and Dr Németh are employees of Gedeon Richter Plc.
Multivariate approach to identify electrophysiological markers for diagnosis and prognosis of schizophrenia
Authors: Giuliani L. , Koutsouleris N. , Koenig T. , Mucci A. , Vignapiano A. , Reuf A. , Altamura M. , Bellomo A. , Brugnoli R. , Corrivetti G. , Lorenzo G. Di , Girardi P. , Monteleone P. , Galderisi S. , Maj M. 
Published: February 2022

IntroductionDifferent electrophysiological indices have been investigated to identify diagnostic and prognostic markers of schizophrenia (SCZ). However, these indices have limited use in clinical practice, since both specificity and association with illness outcome remain unclear. In recent years, machine learning techniques, through the combination of multidimensional data, have been used to better characterize SCZ and to predict illness course.ObjectivesThe aim of the present study is to identify multimodal electrophysiological biomarkers that could be used in clinical practice in order to improve precision in diagnosis and prognosis of SCZ.MethodsIllness-related and functioning-related variables were measured at baseline in 113 subjects with SCZ and 57 healthy controls (HC), and after four-year follow-up in 61 SCZ. EEGs were recorded at baseline in resting-state condition and during two auditory tasks (MMN-P3a and N100-P3b). Through a Linear Support Vector Machine, using EEG data as predictors, four models were generated in order to classify SCZ and HC. Then, we combined unimodal classifiers’ scores through a stacking procedure. Pearson’s correlations between classifiers score with illness-related and functioning-related variables, at baseline and follow-up, were performed.ResultsEach EEG model produced significant classification (p < 0.05). Global classifier discriminated SCZ from HC with accuracy of 75.4% (p < 0.01). A significant correlation (r=0.40, p=0.002) between the global classifier scores with negative symptoms at follow-up was found. Within negative symptoms, blunted affect showed the strongest correlation.ConclusionsAbnormalities in electrophysiological indices might be considered trait markers of schizophrenia. Our results suggest that multimodal electrophysiological markers might have prognostic value for negative symptoms.
Assessment of hospitalizations in schizophrenia patients treated with paliperidone 1-monthly (PP1M), paliperidone 3-monthly (PP3M), aripiprazole once-monthly (AOM) and other oral antipsychotics (OAP) in clinical practice
Authors: Rojas L. Gutiérrez , Alonso S. Sánchez , Dorado M. García , Lopez P. 
Published: February 2022

IntroductionIt has been shown that long-acting treatments can significantly improve adherence, control symptom, and reduce the risk of relapse compared to oral drugs. However, limited real world evidence is available as to whether there are differences among the various formulations marketed.ObjectivesThis study aims to assess the impact on several prognosis variables of PP1M,PP3M,AOM and OAP drugs.MethodsAll adults (≥18 years) with schizophrenia who were initiated on PP1M, PP3M, AOM, or OAP treatment (chlorpromazine,levomepromazine,fluphenazine,haloperidol,ziprasidone,zuclopenthixol,olanzapine,quetiapine,asenapine,amisulpride, risperidone,aripiprazole,paliperidone) between 2017 and 2018 were identified in IQVIA’s database(1.8M of inhabitants from 4 Spanish areas). The rate of hospitalizations, emergency room visits, and treatment persistence was calculated using the Kaplan-Meier method. Survival curves were compared using the log-rank test (Sidak-adjustment),and Cox´s Hazard Ratios (HR) were used for the comparison between groups.ResultsData from 2275 patients were analyzed (PP1M= 387;PP3M=490;AOM=75;OAP=1323).The mean age of patients was 46.8(14.95) years, and 62.9% were male. The hospitalization rate at 12 months was significantly lower (p<0.01) for PP3M (8.3%) than for AOM (21.2%), PP1M (22.1%),and OAP (29.4%).When compared with PP3M use, the HRs were 2.17 for PP1M, 2.22 for AOM,and 2.90 for OAP. Emergency room visits rate at 12 months was also significantly lower (p<0. 01) for PP3M (23%) than for PP1M (36.9%), OAP (43.5%),and AOM (46.2%). Persistence rates were higher for PP3M (91%) than for any other treatment (p<0.01).ConclusionsOur results outline that patients treated with PP3M experienced fewer relapses and decompensations compared to all other treatments analyzed, which might help improve the prognosis and quality of life of patients.Conflict of interestThis study was sponsored by Janssen. M. García and P. López are employees of Janssen.
Determination of cognitive domain involvement in a sample of patients diagnosed with schizophrenia and cardiovascular risk factors
Authors: Eslava J. García , Gutierrez A. Marzán , Molist N. Riera , Llobet S. Escoté , Foguet-Boreu Q. 
Published: February 2022

IntroductionSchizophrenia it’s a deteriorating illness, where the cognitive impairment it’s one of the predominant components in this process. Theory of neurodevelopment, the most widely recognized, explains that cognition will depend most of it, on premorbid development. However, other factors explain this impairment, such as the cardiovascular risk factors (CVRF).ObjectivesThe purpose of this study is to determine cognitive impairment and the domains affected in a sample of patients who suffered schizophrenia and almost one CVRF.MethodsCross-sectional study. Patients diagnosed with schizophrenia and at least one poorly controlled CVRF (diabetes, hypercholesterolemia, arterial hypertension or active smoking) were selected. Screen for Cognitive Impairment in Psychiatry (SCIP) scale was used to evaluate cognitive impairment and the domains affected.ResultsPreliminary data of twenty patients were included (60% men, mean age: 50 years). At CVRF in the sample, no diabetes was found, 75% had hypercholesterolemia, 15% arterial hypertension and 20% active smoking. SCIP scale showed deficits in word learning and delayed learning in 95% of the sample (n=19). The domain less affected was verbal fluency, affected in 55% of the sample (n=11). Additionally, moderate to severe cognitive impairment was observed in 65% of the sample (n=13).ConclusionsMore than half of the patients with schizophrenia and CVRF have a moderate to severe cognitive impairment. Intervention at CVRF could reduce the severity of cognitive impairment, improving functionality in these patients.
Schizoaffective disorder: Nosological controversies and absence of specific treatment guidelines
Authors: García M. Valtueña , Fescina R. Combina , González A. Vázquez , Ludwig C. , Suarez A. González , Fernández J. López , Lora C. Huergo , León S. Ocio , García L. Lago 
Published: February 2022

IntroductionSchizoaffective disorder is a psychotic disorder of controversial nosological entity. Affective symptomatology and psychotic features of varying intensity coexist simultaneously in him throughout evolution. The lack of consensus on the existence of this entity determines its diagnostic delay and the absence of specific treatment guidelines.ObjectivesTo review the diagnostic criteria for schizoaffective disorder and the published scientific evidence on the efficacy and safety of the different therapeutic options available. To analyze the efficacy of a multidisciplinary treatment plan implemented in an intensive follow-up program, presenting the evolution of a clinical case.MethodsTo review the psychiatric history and psychopathological evolution of a patient diagnosed with schizoaffective disorder from the beginning of an intensive follow-up program in a day center to the present. Review the existing scientific evidence on the usefulness of the treatments used in this nosological entity.ResultsThis is a longitudinal and retrospective study of a clinical case in which the areas for improvement are analyzed before implementing a multidisciplinary therapeutic program and the favorable results obtained today. Currently, the patient is euthymic and attenuated and chronic positive and negative symptoms persist that do not interfere with his functionality.ConclusionsFrom the implementation of an individualized, personalized and multidisciplinary maintenance treatment plan, an overall improvement in psychopathological stability and functional recovery is observed. Among the psychopharmacological options in this patient, Paliperidone Long Acting Injection (PLAI) stands out for its long-term efficacy and safety.
Symptom-specific assessment of treatment efficacy: The potential of network estimation techniques
Authors: Boschloo L. 
Published: February 2022

Abstract BodyIntroduction: Most studies on the efficacy of psychiatric treatments consider overall scale scores as outcome measures. A focus on individual symptoms would, however, result in a more precise assessment of treatment efficacy and has potential in improving our understanding of the working mechanisms of treatment. Such an approach may also help in improving the identification of patients who are -based on their pretreatment symptomatology- the most likely to benefit from a particular treatment. Objectives: To show the potential of network estimation techniques in a) unraveling the diverse symptom-specific responses to various depression treatments and b) improving the identification of patients who are the most likely to benefit from these treatments. Methods: First, we combined patient-level data of multiple trials considering various depression treatments, such as antidepressant medication and (internet-based) cognitive-behavioral therapy. Network estimation techniques were used to determine the complex patterns in which symptom-specific responses to treatment were related. Results: Individual clinical symptoms differed substantially in their responses to treatment and these symptom-specific responses were related in a complex manner. Patients suffering from symptoms that were directly affected by a particular treatment were -by definition- the most likely to benefit from that treatment. Conclusions: Network estimation techniques were able to unravel the diverse symptom-specific responses to treatment and could help in improving our understanding of the chain of events leading to a clinical response. Information from the networks could also help in improving the identification of patients who were the most likely to benefit from a particular treatment.DisclosureNo significant relationships.
Natural catalytic immunoglobulins hydrolyzing histones as a link between inflammation and humoral immunity in schizophrenia
Authors: Ermakov E. , Buneva V. , Nevinsky G. 
Published: February 2022

IntroductionSchizophrenia pathogenesis is known to be associated with chronic low-grade inflammation. Inflammation can be caused by extracellular histones that are released from cells due to apoptosis dysfunction. It can also be accompanied by the formation of natural catalytic immunoglobulins that bind and hydrolyze histones.ObjectivesTo investigate the ability to hydrolyze various histones by polyclonal IgGs from serum of patients with schizophrenia.MethodsWe recruited 50 patients (28 men and 22 women) with a verified diagnosis of paranoid or simple schizophrenia and 25 healthy individuals (13 men and 12 women) in our study. IgG preparations were obtained by affinity chromatography and analyzed by SDS-PAGE and MALDI MS. Catalytic activity of IgGs were revealed by the degree of hydrolysis of five histones using SDS-PAGE. To prove that antibodies exhibit histone-hydrolyzing activity, we used rigorous generally accepted criteria. Statistical analysis was performed in Origin 2019.ResultsIgGs of patients are shown to bind and hydrolyze various histones with high efficiencies. The IgGs histone-hydrolyzing activity level, depending on the type of histone (H1, H2a, H2b, H3, H4), was statistically significantly 6–20 times higher than that of healthy individuals (Fig. 1). However, only 21% of patients with schizophrenia had IgGs with very high activity. The IgGs activity level correlated with PANSS General scale.Fig.1. Histone-hydrolyzing activity of IgG.ConclusionsWe suggest that histone-hydrolyzing antibodies may play a compensatory role in schizophrenia because removal of extracellular histones minimizes the inflammatory responses. Therefore, such IgGs may be the link between inflammation and humoral immunity, and also be a promising biomarker.Conflict of interestThis work was supported by Russian Foundation for Basic Research under grant 20-015-00156. E.A.E. is the recipient of the fellowship of the President of the Russian Federation (SP-2258.2019.4).
Homophobia: Is it a heterosexual “privilege”?
Authors: Kourtesis I. 
Published: February 2022

IntroductionThe context of stigma, in which many homosexuals live, exposes them to discrimination/stigmatization and promotes the internalization of negative attitudes about sexuality. Battle feelings of rejection and isolation may lead to the development of internalized homophobia (IH).ObjectivesTo elucidate the risk factors of IH and how the latter affects mental health.MethodsLiterature review (PubMed).ResultsIH has been associated with lower levels of emotional stability, rejection sensitivity, impairments in emotion regulation and a tendency to turn against the self. Studies have connected IH to depression, poor self/relationship wellbeing, sexual discrimination, addictions, shame, body dissatisfaction, suicidal ideation, binge eating/drinking, partner violence and victimization. Higher levels of attachment anxiety and avoidance, outness, religiosity and internalized stigma were correlated with higher IH levels. The key factors relating to suicide include lack of acceptance by family and/or self, negative feelings about sexuality/gender and appearance dissatisfaction. In traditional/religious societies, heterosexual orientation is a strong norm and homosexuality is considered unacceptable leading LGBT individuals to report higher depressive symptoms and increased levels of IH. Due to heterosexist ideals, IH is a predictor for heterosexual marital intention, protests against LGBT and use of masculinity as a compensatory strategy.ConclusionsPolicies in support of individuals who have recently come out should be improved to reduce the development/effects of IH and take the social and sexual environments of rural gay men into account considering ways to increase service accessibility (e.g internet). Future research is needed to further understand the association between IH and mental health, social and cognitive mechanisms.
A remarkable benefit of group psychotherapies with gender dysphoric adults among a case study
Authors: Can H.N. , Polat A. 
Published: February 2022

IntroductionA person who has gender dysphoria can experience some difficulties in his/her/their life (as we can see even in language). These difficulties are mostly because of the binary gender system. Especially in countries like Turkey, homophobia is very common. Because of that, a homosexual person can think that he/she/they is a transgender.ObjectivesAt this point, group psychotherapies are worthwhile, especially for differantial diagnosis. These individuals can share their experiences about the process. On this way, they can also explore themselves.MethodsWe have a monthly group psychotherapy for transgender and gender nonconforming adults in our clinic. We accept the individuals who have problems about gender identity. All trans adults who apply to us and are considered to be suitable are directed to the support group.ResultsAn individual, aged 20, who defines herself as a FtM trans has joined to the group for 4-5 months. She was in hurry and had decided to go under surgery for gender transition. She was referred to surgery by another clinic which didn’t have a group psychotherapy. So she applied to our clinic. During the group psychotherapy, she realized that she was homosexual and gived up gender transition.ConclusionsGroup psychotherapy is helpful for trans individuals to reduce psychological distress and manage their process. This study shows that it is not the only benefit of group support psychotherapy. It also helps the individuals to explore themselves, like our case. Its benefit can be as major as saving themselves from an irreversible step and its consequences.