bluuebunny/crossref_metadata_2025_split huggingface dataset:
Apathy - where do we find it and how to treat
Authors: Gomes R. , Santos C. , Descalço N. , Moutinho F. 
Published: September 2022

IntroductionAlthough defined heterogeneously within the literature apathy is classified as a multidimensional deficit with emotional, behavioral, and cognitive domains in which there is a decrease in self-motivated/goal-directed activity. Recently conceptualized as a syndrome but lacking a universal screening tool.ObjectivesReview current knowledge on apathy and its best therapeutic approach.MethodsNon-systematic review of literature through search on PubMed/MEDLINE following the terms “apathy”and“psychiatry”.ResultsApathy is amongst the most frequent symptoms of dementia and highly prevalent across different forms and stages of dementia, including mild cognitive impairment (MCI) as well as other neurodegenerative and psychiatric disorders such as Parkinson’s disease (PD), Schizophrenia, Depression and Brain Injury. Individuals with apathy have higher frequencies of cognitive impairment and are less likely to be compliant/respond to treatment for comorbid illnesses. Apathy reduces quality of life, increases mortality and leads to caregivers distress - often identified as the most burdensome symptom. Once treatment should favor dopaminergic neurotransmission, psychostimulants were considered. Methylphenidate showed encouraging results as well as dopamine agonists but both with limited evidence. Atypical antipsychotics(APs) seem beneficial compared to typical APs. Antidepressants did not improve symptoms and may even worsen them. Previously reported benefits of acetylcholinesterase inhibitors (AChEIs) were not replicated in recent studies except for rivastigmine in PD. Nonpharmacological interventions are also important.ConclusionsApathy occurs frequently in a broad range of neuropsychiatric conditions and considering its impact on patients´ quality of life more studies are needed to find an efficient treatment. A consensus regarding definition and screening tools would allow a better approach.DisclosureNo significant relationships.
Ketamine As A New Therapeutic Option For The Management Of Mental Disorders
Authors: Turki M. , Abidi O. , Ellouze S. , Ben Jmeaa R. , Nasri J. , Halouani N. , Aloulou J. 
Published: September 2022

IntroductionKetamine is routinely used for anesthetic induction because of its dissociative properties. Recently, it has attracted attention as a rapid-acting anti-depressant, but other studies have also reported its efficacy in the management of diverse psychiatric pathologies previously resistant to treatment.ObjectivesWe aimed to review the efficacity of ketamine in the management of mental disorders.MethodsWe conducted a litterature review through pubmed database, using the following keywords: “mental illness”; “ketamine”;”depression”;”anxiety disorders”;”eating disorders”;”substance use disorders”.ResultsKetamine has primarily been used in psychiatry for people with treatment-resistant depression. Its efficacy in reducing suicidal ideation has been previously reported. Furthermore, Ketamine may be a potential therapeutic option for patients with treatment-resistant anxiety disorders, especially obsessive compulsive disorder (OCD) and post-traumatic stress disorder. It has recently been reported a rapid onset anxiolytic activity in treatment-resistant social anxiety disorder and generalized anxiety disorder. Besides, Ketamine use in subjects suffering from eating disorders was associated with a complete remission of severe anorexia nervosa with a return to normal weight and a decrease in body preoccupations. The use of ketamine alone or in combination with other therapies was effective in reducing alcohol and substance use, prolonging abstinence, reducing craving and enhancing motivation. ketamine in combination with motivational enhancement therapy may be an effective pharmacotherapy for initiating and sustaining abstinence from alcoholicsConclusionsketamine shows great promise as a treatment for several mental disorders. However, its possible side effects and short duration of efficacy limit its use. Further studies exploring longer-term outcomes and administration protocols are needed.DisclosureNo significant relationships.
What is Resilience? A Case Report of a Fully-Functional Man with Corpus Callosum Agenesis
Authors: Ferry-Bolder E. , Mak E. , Ersche K. 
Published: September 2022

IntroductionResilience has attracted much attention, not least since the pandemic. It is characterised by a person’s ability to bounce back from adversity. Although there is no exact definition of what adversity means, it assumes that the individual is aware of the event. Here, we would like to challenge this preconception by putting forward a case of an individual who shows remarkable resilience without being aware of his disadvantages.ObjectivesWe present a case of a fully-functioning middle-aged man with corpus callosum agenesis of which he has been unaware. We sought to demonstrate that personality traits which have been associated with resilience may not necessarily be characteristic of a resilient individual.MethodsT.C. is a 44-year-old individual who enrolled as a healthy participant in a research study at the University of Cambridge, which involved cognitive and personality assessments and a structural brain scan.ResultsT.C.’s psychological profile portrayed a well-balanced man who had attained a high level of education, stable employment, a healthy personal life and good community integration. T.C.’s cognitive performance fell well within normal ranges, but was superior in terms of self-control, as measured by the stop-signal task. To our surprise, he scored below-average on questionnaires of resilience and sense of coherence beliefs and reported subclinical tendencies of obsessive-compulsive behaviours.Conclusions
Resilience does not require awareness of adversity. Our case report shows that resilience may present itself fairly normally and may go unrecognised in daily life. Hardship should not be limited to traumatic events but also include brain abnormality.DisclosureNo significant relationships.
FALLING FOR FADS? Diagnostic and therapeutic fads in Psychiatry
Authors: Jesus S. , Costa A. , Simões G. , Alcafache J. , Garrido P. 
Published: September 2022

IntroductionPsychiatry is not immune to the effects of trends and fads, which are ideas that elicit short-lived enthusiasm, are quickly adopted, and abandoned when they fail to live up to expectations. Trends meet a deeply felt need to explain, or at least name, what would alternatively be unexplainable human suffering.ObjectivesThe authors aim to explore the trends and fads that have occurred in psychiatric diagnostic and treatment throughout history and assess if any modern trends can be identified as well as assessing the effects or consequences of these.MethodsThe authors conducted a non-systematized literature review with focus on those articles most pertinent to the topic in question.ResultsThe literature demonstrates that fads and trends not only plague fashion and diet, but also psychiatry. Trends in psychotherapeutic options can be observed by the swing from psychoanalysis to psychopharmacological focus. Overdiagnosis is one of the consequences of these trends, and can be seen from hysteria, schizophrenia, multiple personality disorder, attention-deficit and hyperactivity disorder to gender identity disorder. These trends impact the way diagnosis are made and the treatments implemented.ConclusionsFads in psychiatry have occurred not only on the edge, but in the very mainstream of theory and practice. A balance is called for, with caution needed in order not to fall into the temptation of the fad, however, an open mind should also be maintained when cutting-edge treatments and theories emerge. The sensible antidote to falling for fads and trends in psychiatry is commitment to evidence-based medicine.DisclosureNo significant relationships.
Clinical efficacy and tolerability of Esketamine: a case series
Authors: Passani C. , Ragone N. , Congedo C.M. , Barbini B. , Zanardi R. , Cavallini M.C. , Colombo C. 
Published: September 2022

IntroductionEsketamine is a novel antidepressant approved by the FDA in 2019 in the form of an intranasal spray, recommended for Treatment-Resistant Depression (TRD). The intranasal spray system appears to be more manageable than intravenous ketamine infusion. It contains ketamine’s S- isomer which is four-fold more potent for the NMDA receptor.ObjectivesThe aim of this case series is to describe our clinical experience in the use of Esketamine.Methods6 TRD patients (3 men; 3 women) were recruited in San Raffaele Turro Hospital from March 2021. All patients (2 bipolar and 4 unipolar) were diagnosed with a Major Depressive Episode according to DSM-5 criteria, resistant to at least two antidepressants. Initially, Esketamine was administrated twice weekly for one month; afterward, it was administrated once weekly for a month; finally, it was administrated once weekly or every two weeks for a month. Clinical scales (HAM-D, YMRS, SSI, HAM-A, MADRS, CADSS) were administrated to assess symptoms and sides effects before and after each administration on a weekly basis.Results
Three patients out of six showed an improvement in depressive symptoms: two patients had remission (final HAM-D score < 8); one patient had a clinical response (final HAM-D score < 50 % respect baseline value). Three patients withdrew the treatment: two for perceived inefficacy, after 16 and 19 administrations, one for personal reasons.ConclusionsThe use of Esketamine in our TRD patients showed good effectiveness and tolerability but randomized controlled clinical trials are needed to confirm our findings.DisclosureNo significant relationships.
Caring for carers: A virtual psychosocial supervision intervention to improve the quality and sustainability of mental health and psychosocial support in humanitarian contexts
Authors: Wells R. , Acartuk C. , Almeamari F. , Alokoud M. , Beetar A. , Eldardery H. , Elshazly M. , Faruk O. , Ginem M.R. , Hadzi-Pavlovic D. , Ilkkurşun Z. , Jahan S. , Joshi R. , Klein L. , Kurdi L. , Kurt G. , Mastrogiovanni C. , Mozumder M. , Lekkeh S. , Némorin S. , Nicholson Perry K. , Orabi M. , Qasim J. , Steel Z. , Tavakol M. , Ullah H. , Uygun E. , Wong S. , (Fischer) Yan L. , Said Yousself R. , Zarate A. , Rosenbaum S. 
Published: September 2022

IntroductionMental health and psychosocial support (MHPSS) staff in humanitarian settings have limited access to clinical supervision and are at high risk of experiencing burnout. We previously piloted an online, peer-supervision program for MHPSS professionals working with displaced Rohingya (Bangladesh) and Syrian (Turkey and Northwest Syria) communities. Pilot evaluations demonstrated that online, peer-supervision is feasible, low-cost, and acceptable to MHPSS practitioners in humanitarian settings.Objectives
This project will determine the impact of online supervision on i) the wellbeing and burnout levels of local MHPSS practitioners, and ii) practitioner technical skills to improve beneficiary perceived service satisfaction, acceptability, and appropriateness.MethodsMHPSS practitioners in two contexts (Bangladesh and Turkey/Northwest Syria) will participate in 90-minute group-based online supervision, fortnightly for six months. Sessions will be run on zoom and will be co-facilitated by MHPSS practitioners and in-country research assistants. A quasi-experimental multiple-baseline design will enable a quantitative comparison of practitioner and beneficiary outcomes between control periods (12-months) and the intervention. Outcomes to be assessed include the Kessler-6, Harvard Trauma Questionnaire and Copenhagen Burnout Inventory and Client Satisfaction Questionnaire-8.ResultsA total of 80 MHPSS practitioners will complete 24 monthly online assessments from May 2022. Concurrently, 1920 people receiving MHPSS services will be randomly selected for post-session interviews (24 per practitioner).ConclusionsThis study will determine the impact of an online, peer-supervision program for MHPSS practitioners in humanitarian settings. Results from the baseline assessments, pilot evaluation, and theory of change model will be presented.DisclosureNo significant relationships.
Quality of life in patients with chronic hand eczema
Authors: Bouhamed M. , Sallemi R. , Sallemi K. , Feki I. , Masmoudi J. 
Published: September 2022

IntroductionChronic hand eczema (CHE) , inflammatory dermatitis, can lead to physical and psychosocial disability altering the quality of life of these patients.ObjectivesThe objective of this study was to examine the quality of life in patients with chronic hand eczemaMethodsDescriptive study collating patients who consulted for CHE, at the Dermatology Department of the CHU Hédi Chaker Sfax, during 3 years (2018-2020). A socio-demographic, clinic , and the Quality of life Questionnaire (DLQI) were administered in this study.ResultsOur study included 12 patients (8 men and 4 women). The mean age was 46.8±11.6 years. The patients were in professional activity in 86.8% of the cases. No patient was in early retirement or disability status. The average duration of the disease was 4.5 years (1- 9 years). All patients were in remission. The intensity of pruritus at the last attack was mild (25.77%), moderate (72.23%), and severe (2%). The impact of pruritus on sleep was noted in 100%. The mean total quality of life score (DLQI) was 6.8±5.5 which means a moderate impairment of quality of lifeConclusionsThis work highlights the importance of the impact of this dermatitis on the quality of life of these patients. Therefore, multidisciplinary dermatological and psychiatric management is considered necessaryDisclosureNo significant relationships.
MDD patients with early life stress deactivate the frontostriatal network during facial emotion recognition paradigm: A functional MRI study
Authors: Simon M. , Nagy S. , Kürtös Z. , Perlaki G. , Gálber M. , Czéh B. 
Published: September 2022

IntroductionEarly life stress (ELS) is a significant risk factor for major depressive disorder (MDD) in adults. Functional magnetic resonance imaging (fMRI) studies using face emotion processing paradigms have found altered blood-oxygen-level-dependent (BOLD) responses in the cortico-limbic network both in individuals exposed to ELS and in patients with MDD. Thus, early life stress may have a long-lasting impact on brain areas responsible for the processing of socio-affective
cues.ObjectivesBy applying a facial emotion recognition (FER) fMRI paradigm, we examined the long-term effect of childhood adversity on brain activity in MDD patients with and without ELS.MethodsMDD patients without ELS (MDD, N=19), those with ELS (MDD+ELS, N=21), and healthy controls (HC, N=21) matched for age, sex, and intelligence quotient underwent fMRI scanning while performing a block design FER task with faces expressing negative emotions. The severity of ELS was assessed with the 28-item Childhood Trauma Questionnaire.Results
Both MDD and MDD+ELS patients were slightly impaired in recognizing sad faces. Statistical analysis of brain activity found that MDD+ELS patients had significantly reduced negative BOLD responses in the right anterior paracingulate gyrus, subcallosal cortex accumbens compared to HCs. Moreover, the MDD+ELS group had a significantly increased negative BOLD signal in the right postcentral and precentral gyri relative to the HC group. MDD+ELS patients had reduced negative BOLD response in their anterior paracingulate gyrus compared to the MDD group.Conclusions
Our results support that adult MDD patients with significant ELS are impaired in facial emotion recognition and they display functional alterations in the frontostriatal circuits.DisclosureThis work was financially supported by the Hungarian Brain Research Program (2017-1.2.1-NKP-2017-00002)
Dual disorders in liaison-consultation psychiatry. A descriptive study of patients with substance use disorder admitted to a general hospital
Authors: Dinamarca Cáceres F. , Garcia M. , Casanovas F. , Oller Canet S. , Sauras R. , Fonseca F. , Torrens M. 
Published: September 2022

Introduction
Several studies describe that the coexistence of a substance use disorder with another psychiatric condition or “dual disorder” (DD) is associated with a worse evolution at all levels, including a greater burden of medical illnesses and greater mortality.ObjectivesTo describe the presence of DD and related factors in patients admitted to a General Hospital that required assessment by a psychiatry service.MethodsA descriptive study that includes patients admitted to the Hospital del Mar in Barcelona for all medical-surgical reasons and attended by the specific addiction psychiatry consultation service between January 2016 and October 2021. Sociodemographic and clinical data are collected including the history of consumption and the diagnosis of dual disorder. Chi-square test was used for comparison between groups.ResultsThe sample was 1796 patients (Women: 345. Mean age: 50.3 years; SD: 12.6). 43.7% of the sample presented DD, with axis 1 disorders being the most frequent. There was an association of DD to factors as: being woman (54 vs 41.2% p <0.001), HIV positive serologies (54 vs 42.7% p <0.001), being homeless (49 vs 31.7% p <0.001) and cocaine consumption compared to other substances (53.4 vs 39.8% p <0.001).ConclusionsIn our sample, almost half of patients had DD. The representation of women was significantly lower, however they presented a higher proportion of DD. In this study we describe an association of DD with other biopsychosocial problems, and further studies are necessary to determine in which sense they are related and optimize patient care.DisclosureNo significant relationships.
Comparative efficacy and safety of escitalopram, desvenlafaxine, and vortioxetine in the acute treatment of anxious depression: A randomized rater-blinded, 6-week clinical trial
Authors: Oh K.-S. , Jeon S.W. 
Published: September 2022

IntroductionThis study is about the clinical uses of three antidepressants( escitalopram, desvenlafaxine, vortioxetine) in the treatment of anxioun depression.ObjectivesThe purpose of this study was to compare the efficacy and safety of escitalopram, desvenlafaxine, vortioxetine, and aripiprazole augmentation with escitalopram in the acute treatment of anxious depression.Methods
Patients (n=189) with DSM5 major depression and high levels of anxiety were evenly randomized to escitalopram, desvenlafaxine, vortioxetine, and aripiprazole augmentation with escitalopram in a six-week, randomized, rater-blinded, head to head comparative trial. Changes in overall depressive and anxiety symptoms were assessed.Results
Patients demonstrated similar baseline-to-endpoint improvement in HAMD and HAMA total scores. Patients also demonstrated similar response rate and remission rate in HAMD and HAMA. In analysis of individual HAMD and HAMA items, desvenlafaxine had greatly reduced scores for anxiety somatic (p=0.013), hypochondriasis (p=0.014), cardiovascular symptoms (p=0.005), respiratory symptoms (p=0.013) compared to escitalopram or vortioxetine. Each treatment were well tolerated with no significant differences.ConclusionsThese results showed no significant differences in efficacy and tolerability of escitalopram, desvenlafaxine, vortioxetine, and aripiprazole augmentation with escitalopram in this subtype of patients with anxious depression during the acute phase treatment.DisclosureNo significant relationships.
Clinical Efficacy of a 2-Week Treatment Course of Zuranolone for the Treatment of Major Depressive Disorder and Postpartum Depression: Outcomes From the Clinical Development Program
Authors: Clayton A. , Cutler A.J. , Deligiannidis K.M. , Lasser R. , Sankoh A.J. , Doherty J. , Kotecha M. 
Published: September 2022

IntroductionAntidepressants that offer a rapid onset of action without requiring chronic use are greatly needed in both major depressive disorder (MDD) and postpartum depression (PPD). Zuranolone is an investigational, oral, neuroactive steroid and GABAA receptor positive allosteric modulator in clinical development as a 2-week treatment course for MDD and PPD.ObjectivesTo present the efficacy and safety of zuranolone vs placebo in Phase 2 and 3 trials.MethodsIn the studies presented (Table 1), improvements in depressive symptoms were assessed by least-squares mean (LSM) using a mixed-effects model for repeated measures on the change from baseline (CFB) at Day 15 in the 17-item Hamilton Rating Scale for Depression total score (HAMD-17; primary endpoint for all trials) and the Montgomery–Åsberg Depression Rating Scale (MADRS; secondary endpoint) following a 14-day treatment course of once-daily zuranolone.ResultsCompared with placebo, zuranolone treatment led to rapid improvements in depressive symptoms across clinical trials, with significant improvements (LSM treatment difference [SE] in CFB) in HAMD-17 and MADRS scores at Day 15 in 3 of the 4 trials (Table 2). Common treatment-emergent adverse events (≥5% in zuranolone treatment arms) were headache, somnolence, dizziness, nausea, sedation, diarrhea, upper respiratory tract infection, and fatigue (Table 3). No incidences of loss of consciousness or excessive sedation were observed.ConclusionsAcross the completed studies in the zuranolone clinical trial program, patients receiving zuranolone consistently experienced improvement in depressive symptoms following a 2-week treatment course. Treatment with zuranolone was generally well tolerated with a consistent safety and tolerability profile.DisclosureThe MDD-201B, MOUNTAIN, and ROBIN studies were sponsored by Sage Therapeutics, Inc; the WATERFALL study was sponsored by Sage Therapeutics, Inc, and Biogen. Medical writing and editorial support were provided by MediTech Media, Ltd, and funded by Biogen.
Giving a leg up part 2: the ethical challenges of Body Integrity Dysphoria
Authors: Dumais-Lévesque G. , Pham Thi-Desmarteau S. 
Published: September 2022

IntroductionBody Integrity Dysphoria (BID) is a diagnosis, newly described in ICD-11, “characterised by an intense and persistent desire to become physically disabled in a significant way… accompanied by persistent discomfort, or intense feelings of inappropriateness concerning current non-disabled body configuration”. Patients with BID may request the amputation of healthy limbs but this raises multiple ethical challenges.ObjectivesBy the end of the presentation, participants 1) will better understand the new diagnosis of Body Integrity Dysphoria; 2) will be able to have some landmarks to evaluate and manage this rare condition 3) will discern the ethical challenges raised by an elective or emergent amputation request.Methods
We present a complex case we faced in Quebec City, Canada. A young adult admitted to the intensive care and burn unit was referred to our Consultation Liaison (CL) team. For the second time in a year, the individual deliberately burned his leg, with the intention of having an amputation. Based on the available literature and our experience, we explore the ethical aspects of this case.ResultsFor this situation, the multidisciplinary team faced uncertainty and ambivalence toward the best treatment options. Deontological concerns and ethical issues emerged from the patient’s request for amputation.ConclusionsWe outline how ethical concepts helped us to gain a shared comprehension of the patient’s extraordinary request, both during treatment and afterwards.DisclosureNo significant relationships.