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The diagnosis of Autism Spectrum Disorders is currently witnessing several changes, with direct consequences on the prevalence rates in the general population. However, little is known about ASD traits prevalence in clinical samples, and how much these traits interact with other mental health conditions, especially in young adults, a critical age for the outbreak of many psychiatric diseases.
Objectives
The aim of this study was to assess the prevalence of ASD traits in a sample of young adults (aged between 18 and 24 years old) referring to a specialized mental health outpatient clinic.
Methods
We administered to 259 patients the Autism Quotient (AQ) and the Ritvo Autism and Asperger Diagnostic Scale-Revised (RAADS‐R), along with a detailed sociodemographic and anamnestic interview.
Results
We found that 16.2% of our sample scored above the cut-off at both scales (a percentage that went down to 13.13% when restricting the RAADS-R cut-off at >119, as suggested for clinical samples).
Conclusions
This prevalence seems considerably higher than the one reported in the general population, and not negligible. The association with sociodemographic features such as sex assigned at birth, gender identity and employment status, and the validity of the screening tools we implemented, are discussed. In conclusion, we suggest that an assessment for autistic traits should be implemented in young adults seeking help for unspecified psychiatric symptoms and psychological suffering and that, despite the not unanimous consensus over self-report screening tools, a positivity to both the AQ and the RAADS-R should lead the clinician to conduct a full diagnostic evaluation with structured or semi-structured interviews.
Acute and transient psychoses (International Classification of Diseases) and Brief Psychotic Disorders (Diagnostic and Statistical Manual of Mental Disorders) constitute heterogeneous nosological groups, which have undergone successive reformulations in the past decades, remaining doubts regarding their diagnostic validity and independence.
Objectives
This work aims to review the nosological evolution of these complex and neglected groups.
Methods
A review of the literature was conducted using PubMed and The Cochrane Library. The following terms were used: “acute and transient psychoses”; “brief psychotic disorders”; “cycloid psychosis”; “reactive psychosis”.
Results
Since the early 20th century, a group of non-affective psychoses with acute onset and brief duration have been described in different countries and under various names, such as bouffeé delirante, reactive psychosis or cycloid psychosis, denominations still present in ICD-9. In presente-day classifications, as ICD-10 and DSM-IV, an effort was made to homogenise the various regional and national concepts creating the group of ‘Brief Psychoses’ (DSM) or ‘Acute and Transient Psychotic Disorders’ (ICD). The marked heterogeneity and low diagnostic stability of these groups, mainly based on temporal criteria, has posed significant obstacles to further research and conceptualization. Given these difficulties, the latest revision of the International Classification of Diseases (ICD-11) brought about a substantial change, restricting this diagnosis to polymorphic psychotic conditions of acute onset and rapid resolution, subgroup with greater diagnostic stability and characteristics distinct clinical features.
Conclusions
The relevance of a better clarification for this nosological group is evident in the successive changes over the last century. ICD 11, once again, substantially changed the diagnostic criteria and the scope of this nosological entity, leaving doubts about the independent nature of this group, its connection to schizophrenia, as an attenuated form (more common in women and in developing countries), or even as a form of psychosis that is closer to affective disorders (due to its clinical evolution). Although little explored, this issue remains a source of doubt and interest, calling into question the Kraepelinian dichotomy for the so-called endogenous psychoses.
Eating disorders have a key paper at the ongoing society. A key symptom of the Anorexia Nervosa and the Bulimia Nervosa is the alteration of the corporal image which observes that it continues being present after remitting the most flowery symptomatology. In terms of gender, we can observe that the esting disorders have a higher incidence in the feminine gender.
Objectives
Research how body image affects eating disorders and how the role of gender is a risk factor for developing Anorexia Nervosa or Bulimia Nervosa.
Methods
A systematic review was conducted using PubMed. Twelve studies were identified in order to do this review.
Results
At the twelve surveys included at the review we can observe that the incidence of Anorexia Nervosa and Bulimia Nervosa is higher in women than men. There are many facts that take part on the development of eating disorders, but there is consensus to understand them with a biopsicosocial point of view (interaction between the environment and biological facts). Body image disturbance takes part in both men and women, but it affects them in different ways.
Conclusions
Body image disturbances are a crucial factor when considering eating disorders’ symptomatology. One of the main components that affects its alteration is the internalization of standards of beauty. Women tend to focus on thin body types, meanwhile men’s attention tends to point to muscular and defined body types. Nevertheless, it must be taken into account that today’s gender conception may appear as one of the most important roles to understand Anorexia and Bulimia aetiology. Regarding gender, in nowadays society exists a dichotomy where masculinity and femininity lie in total opposites poles; but if the gender approach socially changed, Anorexia and Bulimia might take a different portrayal.
Addressing mental and physical health problems and promoting wellbeing in educational settings is a global priority. Teachers present a high risk of stress and burnout, which negatively impacts their professional performance as well as their mental and physical health. Compassion-based interventions have been found effective in promoting psychosocial and physiological wellbeing.
Objectives
The current paper presents preliminary findings of the impact of a 6-module Compassionate Mind Training intervention for Teachers (CMT-T) on immunological markers and the Conserved Transcriptional Response to Adversity (CTRA; a gene expression signature that involves a group of 53 genes: pro-inflammatory genes, type I interferon response and genes related to antibody synthesis).
Methods
A pilot non-controlled study was conducted in a sample of public-school teachers in Portugal (n=36). Participants were assessed at 4 time-points: 1) Extended Baseline Control_M0, in order to establish a within-subjects psychological and biophysiological baseline (8 weeks before the start of the CMT-T); 2) Pre-intervention_M1 (8-weeks after M0); 3) Post-intervention_M2 (8-weeks after M1); and 4) Follow-up_M3 (3 months after the CMT-T end). In all assessment moments, participants completed a set of psychological self-report measures and were assessed in immunological and epigenetic biological markers through the collection of blood. After M1, teachers completed the 8-week group CMT-T intervention and given access to its resources and materials. They were instructed to practice daily and incorporate the teachings in their personal and professional lives. All assessments and the CMT-T intervention took place at the schools.
Results
Preliminary data on the impact of CMT-T on Immune Response Profiling revealed that teachers’ Natural Killer (i.e., NK) cells were decreased after the CMT-T intervention. In regard to the CTRA gene expression, results showed that type one interferon response genes (e.g., IFI16, IFI27L2, IFITM2, IFITM3, IFITM4P) were decreased after the intervention. In addition, we observed that the gene c-Jun, a pro-inflammatory gene, had a decreased expression after the CMT-T intervention.
Conclusions
These preliminary findings seem to corroborate previous studies involving the type one interferon response, the pro-inflammatory genes and antibody synthesis genes in a signature involving 53 genes previously described as the CTRA gene signature. Furthermore, our results suggest that cultivating compassion using a compassion focused intervention may have a positive impact on markers of the immune system response, associated with how our bodies respond to stress, infection and cancer, as well as, on reducing the expression of genes related to our bodies’ response to stress and inflammation.
Although symptom presentation varies by gender, almost all eating disorder/ED instruments have been developed and validated on females. The Eating Disorder Assessment for Men (EDAM; Stanford & Lemberg 2012) is a male specific self-report measure, composed of four sub-scales, proved to be useful to assess gender differences in ED presentations (Nagata et al. 2021). The MD comprises 5 items about the overwhelming concern with muscularity and the false perception of having an underdeveloped body.
Objectives
Having already valid measures of body image and eating behaviors in men, we now aim to analyze the psychometric properties of the Portuguese version of MD, in order to have a quick and rigorous measure of this specific construct.
Methods
Participants were 227 male individuals (mean age=30.41 years±13.96; range: 14-73 years). They answered an online survey including the preliminary DM and the Portuguese validated versions of the Eating Disorder Examination Questionnaire (EDE-Q7) and the Body Image Concern Inventory (BICI).
Results
Confirmatory Factor Analysis showed that the unidimensional model presented good fit indexes (χ2/df=.6829; RMSEA=.0000; CFI=1.00 TLI=1.01, GFI=.995). Cronbach’s alfa was .891; all the items contributed to the internal consistency and had high internal validity. Pearson correlations of DM with EDE-Q7 and BICI were significant (p<.001) and moderate-high, respectively,.384 and .522.
Conclusions
The Portuguese preliminary version of DM-EDAM demonstrated validity (construct and convergent) and reliability. can be used for clinical and research purposes, namely in an ongoing project we have in progress, about body image, disordered eating, gender and age.
The mortality rate among individuals experiencing homelessness tends to be premature and is linked to mental disorders and chronic diseases. In Spain, there is a significant gap in the study of mortality among individuals in situations of residential exclusion with real clinical data.
Objectives
This study aims to analyze mortality among individuals experiencing homelessness and its relationship with mental disorders and chronic diseases.
Methods
An observational and prospective longitudinal study was conducted on a cohort of 855 homeless individuals in the province of Girona over a 15-year period. Sociodemographic variables, mental health conditions, chronic diseases, and infections were analyzed, employing descriptive and inferential analyses. A binary logistic regression model was created to establish explanatory relationships between mortality and associated variables.
Results
Among the participants, 87.7% were males with an average age of 53.03 years. A majority of 62.8% were foreign-born, mainly from Africa and Europe. It was identified that 40.8% had mental disorders, with substance dependencies (41.3%) and other disorders (36.4%) being the most prevalent. A total of 30.6% presented chronic diseases, notably hypertension (12.8%) and type 2 diabetes (10.9%). Furthermore, 22.3% had infections, with hepatitis C virus (8.7%) and HIV (4.7%) being the most common. During the follow-up period, 81 individuals (16.4%) passed away, with causes such as cancer (25%), suicide (21.7%), and heart conditions (11.7%).
The regression analysis demonstrated that age (OR = 0.915; 95% CI 0.884-0.947), alcohol addiction (OR = 2.354; 95% CI 1.486-3.731), and being born in Spain (OR = 2.906; 95% CI 1.594-5.299) were significantly associated with mortality in the homeless population.
Conclusions
This study highlights the high prevalence of mental disorders, chronic diseases, and infections among individuals experiencing homelessness. Mortality was associated with factors such as age, alcohol addiction, and place of birth. These findings underscore the importance of developing interventions aimed at enhancing the health and care of individuals experiencing homelessness, particularly within the immigrant population.
Electroconvulsive therapy (ECT) is a psychiatric intervention that has proven effectiveness and safety in various psychiatric conditions, such as major depressive disorder, prolonged or severe manic episodes and catatonia. Despite positive scientific evidence, ECT was always seen as controversial by patients, caregivers, and even some psychiatrists, which lead to a decrease in its use over the years.
Objective
To investigate the way young psychiatrists view the place of ECT in modern psychiatry by assessing their knowledge, attitude and access to training opportunities in ECT.
Methods
An anonymous survey was disseminated online among early career psychiatrists and psychiatric trainees. The questionnaire consisted of 36 multiple-choice and Likert scale questions.
Results
Most of our respondents consider ECT both an effective and a safe treatment option and would recommend ECT to their patients when indicated. Early career psychiatrists who had access to ECT training are more knowledgeable about the indications, precautions and side effects of this method, but more than half of the participants mentioned ECT training was unavailable during their residency programme. Almost all respondents stated that they are interested in enhancing their theoretical and practical competencies in ECT.
Conclusions
Early career psychiatrists have a positive attitude towards ECT but express the need of targeted education aimed at improving levels of knowledge about ECT.
Discrimination is known to have different effects on health. In particular the mental health of affected people diminishes. Although it is known that marginalized groups are discriminated against more, at present only research on gender and ethnicity has been done. Further diversity domains like socioeconomic status, care responsibilities, sexual orientation, disability, mental and physical health, and their intersections have been scarcely looked at.
Objectives
The aim of the study was to determine the effects of discrimination on the mental health for employees and students of a university hospital taking diversity domains into account.
Methods
A web-based survey between June 22 to October 23 was conducted using the PHQ-4 and WHO-5 as well as innovative Diversity Minimal Item set to measure different diversity domains.
Results
Preliminary data shows that discrimination among employees and students is common, widespread and most frequent based on gender, ethnicity and health. The mental health of those who feel discriminated against tends to be poorer, especially looking at the intersectionality of diversity domains.
Conclusions
The results of this study suggest that both more measures to prevent discrimination in a university hospital have to be implemented and individuals from marginalized groups need special psychosocial support to ensure a safer working environment. In addition, greater attention to diversity and inclusion in medical research is needed to develop appropriate responses and interventions, including diversity policies.
Low back pain (LBP) is common among electricians caused by work conditions. Even when symptoms are short-term and not medically serious, LBP can be associated with psychological distress.
Objectives
This study aimed to assess the link between LBP and psychological distress according to the job tenure among electricians.
Methods
The study was conducted in a group from a Tunisian Electricity society. Data were gathered between January-June 2022 using a self-administered questionnaire including socio-professional characteristics, the Nordic musculoskeletal questionnaire during the last 12 months and Kessler Psychological Distress Scale (K6). Our population was divided into two groups according to job tenure. The first group (G1) consisted of electricians with less than ten years of job tenure and the second (G2) consisted of electricians with more than ten years of seniority.
Results
G1 consisted of 10 participants with a mean age of 30.6 ± 6.7 years and with average job tenure of 3.3 ± 1.1 years. G2 consisted of 64 participants with a mean age of 40.7 ± 10.3 years and average job tenure of 17.4 ± 10.9 years. According to the Nordic musculoskeletal questionnaire, LBP during the last 12 months was present in the first and the second group in 30.8% and 14.3% of participants, respectively.
The proportion of respondents with high levels of psychological distress (K6 score of 13 or greater) in the first and the second groups was 10 % and 9.4% of participants, respectively. The presence of low back pain during the last 12 months was significantly associated with a high score of K6 in the second group (p < 0.05).
Conclusions
From the results of this study, we conclude that LBP was associated with psychological distress when the job tenure is high. Therefore, the prevention of LBP should go through programmes to build ergonomically safe working conditions to enhance the mental health of electricians.
As part of the intervention, patients with severe schizophrenia who are cared for in psychiatric rehabilitation units need psychological treatments. However, there is great variability within the psychotherapy alternatives that are proposed for rehabilitation in schizophrenia, and it is necessary to know which are the most efficient interventions in order to prioritize their inclusion in intervention programs.
Objectives
To know the level of evidence of the existing psychotherapy alternatives for the rehabilitation treatment in schizophrenia through the systematic review of recently published studies.
Methods
Consecutive systematic searches in the scientific literature were used in a sensitive and specific way, aimed at identifying the existence of documents in databases and clinical practice guidelines based on evidence of psychological treatment in schizophrenia. Psychosocial and social approaches and family members interventions were excluded, and the search was limited to the last 5 years. The PICO format has been used, and a subsequent critical reading using the AGREE II tool, considering the inclusion criteria of presenting a score >60% in 4 domains.
Results
The following interventions have been found to be therapeutically effective: Level 1B (Early intervention in Psychosis; Patient and Family psychoeducational intervention; Basic ando social skills training; Social cognition and Metakognition training; Cognitive Remediation; Cognitive Behavioral Individual Therapy; Assertive Community treatment; Supported employment). Level 2B (Family Problem Solving Therapy, Dynamic Psychotherapy; Cognitive Behavioral Group Therapy); Level 2C (Horticultural, Art, Music, Animals Therapies).
Conclusions
Several psychotherapy alternatives are proposed for rehabilitation in schizophrenia, with known level of evidenca in order to prioritize their inclusion in intervention programs.
Studies of extinction typically focus on unintended losses of biodiversity and culture. This study, however, examines an attempt to induce extinction of a parasite: human hookworm (Necator americanus and Ancylostoma duodenale). Our interdisciplinary approach integrates medical history and epidemiology using records created by the Jamaica Hookworm Commission of 1919–1936. We show that the attempt to induce the extinction of hookworms was driven by its perceived effects on labour productivity and consequent status as an ideological and economic threat. We use spatial epidemiology to describe the relationships between parasites, environments and the working conditions of plantation labourers. Using data from 330 locations across Jamaica in which 169,380 individuals were tested for hookworm infection we show that the prevalence of hookworm infection was higher in districts surrounding plantations. Prevalence decreased with the temperature of the coldest month, increased with the amount of rainfall in the driest month, and increased with vegetation quantity (normalised difference vegetation index). Worm burden (and thus pathology) varied greatly between individuals, even those living together; hookworm infection varied between environments, socioeconomic conditions and individuals. Nevertheless, the conditions of labour shaped the distribution of hookworms. Plantations both spread and problematised hookworms, driving efforts to bring it to extinction.
The mental health for workers in the healthcare industry have been put through challenges.The first evaluation happened during the first wave of the pandemic, the second one, with grater sample size, have been conducted in Spring 2022.The healthcare system makes it less plausible to release stress adequately. The attitude of repression by the people makes the rise in stress-levels less knowledgeable This time the somatic symptoms makes the stress-levels steady shown. Our goal, to make visible, to categorise and recognise the somatic symptoms and the psychological symptoms, thus predicting the burn-out phase.
Objectives
The attitude of repression by the people makes the rise in stress-levels less knowledgeable This time the somatic symptoms makes the stress-levels steady shown. Our goal, to make visible, to categorise and recognise the somatic symptoms and the psychological symptoms, thus predicting the burn-out phase.
Methods
Methods:
Participants: 497 medic workers
- PPS - Perceived Stress Scale - Type d personality scale -
- Workplace Stress Questionnaire and Symptom List (Hungarian Hypertonia Society)
- Beck Depression Questionnaire (9-item)
- Oldenburg Burn-Out Questionnaire Results: From the questionnaire answers we counted
- WHO Well-being Scale (5-item)
Results
12% of the people reached levels above the significant stress-level and 26% reached the mild-depression level. The burn-out levels have been significantly higher in the region of disappointment. Regarding the results of the somatic symptoms, depression and stress levels it had a leading factor, which was exhaustion.
The most frequent co-occurences of the 20 somatic and psychological symptoms of the Hungarian Hypertension Society Symptom List were also used in this study to refine the analysis. The factor analysis highlited 3 sypmtom clusters out of the 20 symptoms with the following co-occurrences (fatigue, concentration disturbance, headache, feeling of tension, palpitation, dizziness, inner tremor, distressing thoughts, sweating and nausea) The symptoms formed a total of 6 factors, of which 2 were found to be predictive of burnout and depression. The factors of muscle tension, fatigue, lack of concentration, feeling tense showed the strongest correlation with the measured varibles (burnout r=0,447, depression r=0,343, D-scale, negative mood r=0,369, p=0,000 at significance levels.)
Conclusions
The attention for the somatic complaints have a high attention between the workers, it’s part of the work culture to give more and more sacrifices, to hide the psychological effects, and deem them as weaknesses. Regarding the health of the worker it’s necessary to be more informative, to show more bearable physical symptoms to define and prevent the burn-out periods.
Drug addiction, also called substance use disorder, is a disease that affects a person’s brain and behavior and leads to an inability to control the use of a legal or illegal drug or medicine. there is a complex interplay of neurobiology, genetics, and the environment --nature and nurture-- that play into the development of addiction, alcohol, and other drug use disorder.Substances such as alcohol, marijuana and nicotine also are considered drugs.
Research has shown that women often use drugs differently, respond to drugs differently, andcan have unique obstacles to effective treatment as simple as not being able to find child care orbeing prescribed treatment that has not been adequately tested on women.
Objectives
describe the socio-demographic and clinical characteristics of female patients admitted to the addictology department of Arrazi Hospital in Salé
Methods
Retrospective study with descriptive and analytical aims on the files of women who were admitted to the addictology service since its opening in 2000, with the aim of specifying the prevalence and the characteristics of addictive behaviors in the female population.
This case study emphasizes the significance of considering unrecognized adult-onset ADHD, particularly in patients with chronic forgetfulness and occupational inefficiencies refractory to standard treatment options. The case outlined involves a 33-year-old male with enduring cognitive impairments, leading to Extreme Anxiety Disorder with detrimental consequences on his professional progression and personal well-being.
Objectives
This necessitates the need for advanced research initiatives and broader awareness programs to facilitate improved diagnostic accuracy and optimization of therapeutic outcomes. Emphasizing ADHD as a potential cause of such symptomatology in adults and integrating effective treatment options can potentially pave the way to personalized therapeutic protocols.
Methods
The patient was approached via meticulous reconsideration of previous unsuccessful treatment paradigms that primarily included antidepressants and anxiolytics, which yielded cyclical patterns of negligible amelioration, compounded by intermittent emergence of suicidal ideation. Given the limited response, a differential diagnosis of Adult-Onset ADHD was entertained.
Results
The therapeutic intervention involving Methylphenidate administration led to a remarkable enhancement in the patient’s mental health and occupational efficiency. Progress was also evidenced in the patient’s improved confidence and self-esteem, with critical implications for his professional and personal life dynamics.
Conclusions
This case study underscores the transformative potential of precise ADHD management in adults with chronic cognitive impairments. Further research studies involving larger cohorts are warranted to enhance the understanding of adult ADHD, its prevalence, and therapeutic strategies, which could serve as key elements in improving the overall quality of life for these patients.
The negative impact of obstructive sleep apnea syndrome (OSA) on the quality of life of affected individuals is one of the serious consequences of this pathology. Consideration of this quality of life as one of the therapeutic objectives is essential.
Objectives
to evaluate the impact of the severity of OSA on quality of life in affected patients
Methods
We conducted a cross-sectional study involving 40 patients diagnosed with OSA by polysomnography in the Sleep unit, department of Neurophysilogy at Sahloul university hospital in Sousse, Tunisia. This study was based on a generic questionnaire (SF-12) to assess the quality of life.
Results
The mean age was 49.7 ± 7.87 years with a sex ratio of 1.10. The mean apnea-hypopnea index (AHI) was 29.72. OSA was mild, moderate and severe in 40%, 22.5% and 37.5% of cases respectively. The majority of our patients had an impaired quality of life with an ave[1]rage score of 42.78. There was a positive linear relationship between physical and mental components of the SF-12 and AHI (p= 0.026 and p=0.019 respectively). Mental component of the SF-12 was significantly associated with treatment with CPAP (continuous positive airway pressure) (p=0.014).
Conclusions
Our study has shown that the severity of OSA has an impact on different domains of quality of life. The management of this disease should not be limited to controlling the disease but should aim for overall patient satisfaction.
Light stimulation can realise the remote control of the deformation of the specific position of 4D printing structure. Shape-memory polymer–carbon nanotube (CNT) composite materials, with outstanding near-infrared photothermal conversion rate and shape-memory ability, is one type of the most popular light responsive smart materials. However, current studies focused on the photothermal effect and shape-memory applications of light-responsive shape-memory polymer composite (SMPC) sheet structures, and there is no research on the photothermal effect in the depth direction of light-responsive SMPC three-dimensional structures. Here, we prepared a UV curable, mechanically robust, and highly deformable shape-memory polymer (IBBA) as the matrix of light responsive SMPC. CNTs were added as photothermal conversion materials. We explore the photothermal effect of near-infrared laser on the surface and depth of IBBA–CNT composites cube. Shape-memory experiments show that different folded shapes can be obtained by selective near-infrared laser programming. Selective near-infrared laser programming three-dimensional movable type plate shows a programming application in depth direction of three-dimensional light-responsive intelligent structure. This research extends the application of near-infrared laser in 4D printing to the depth direction of intelligent structures, which will bring more complex and interesting 4D printing structures in the future.
The literature has emphasized the importance of implementing evidence-based occupational therapy teleinterventions to enhance work participation in adults with attention-deficit/hyperactivity disorder (ADHD).
Objectives
This study aimed to evaluate the efficacy of an innovative metacognitive self-tailored teleintervention for adults with ADHD performance at work enhancement (Work-MAP). The outcome measures were efficacy of and satisfaction with the performance of self-selected work goals (Canadian Occupational Performance Measure), executive functions (Behavior Rating Inventory of Executive Function-Adult), and quality of life (Adult ADHD Quality of Life Questionnaire).
Methods
In this randomized controlled trial, participants were 46 adults with ADHD. Group A (n = 31) received the synchronous, hybrid-telehealth intervention in 11 weekly 1-hour individual sessions, while Group B (n = 15) completed the same intervention after a waiting phase.
Results
Following the intervention, participants demonstrated and maintained significant improvements in all outcome measures (strong-to-moderate significant effects) to the 3-month follow-up.
Conclusions
Work-MAP seems to be effective intervention for enhancing work participation (i.e., performance at work), executive functions, and quality of life of adults with ADHD. Future studies with larger samples and additional objective measures are needed to further validate these findings.
Fahr’s Disease, also known as Fahr’s Syndrome, is a rare genetically dominant disease, characterized by the abnormal accumulation of calcium deposits, or calcifications, in various areas of the brain, particularly the basal ganglia. These calcifications, which are typically bilateral and symmetrical, can lead to a wide range of neurological and psychiatric symptoms, making diagnosis and management challenging. It usually manifests between the ages of 40 and 60, primarily after the age of 30.
Objectives
To contribute to the medical literature by sharing this rare case, thereby increasing awareness and knowledge about Fahr’s Disease among healthcare professionals.
Methods
Non systematic review of the literature and access to the medical history of the patient.
Results
We present a case of a 42 year old woman, who came to our hospital with behavior changes, with increasing confusion and new mystical beliefs, insomnia and agitation.
According to the patient’s husband, the patient sounded confused and inappropriate in her speech. The patient was admitted for evaluation of altered mental status. The patient was alert and oriented to person, place, time, and situation in the emergency department, with shudder while neurologically intact. The patient was unpolite, agitated.
Psychiatry was consulted for evaluation. We decided to admit the patient and did a posterior study with a CT scan and MRI. The MRI, as well as CT scan revealed “dense calcification of the dentate nuclei and the basal ganglia”, highly suggestive of Fahr’s syndrome. The patient’s phosphorus level was 3.5 mg/dl (normal level: 2.5-4.5 mg/dl). Parathyroid hormone (PTH) intact was 53 pg/ml (normal level: 15-65 pg/ml), and calcium level was 10,3 mg/dl (normal level: 8.4-10.5 mg/dl). The vitamin D 25-hydroxy concentration was 43,5 ng/ml (normal level: 30-60 ng/ml).
Conclusions
In conclusion, Fahr’s Disease is a rare and complex neurological disorder characterized by idiopathic calcification of the bilateral basal ganglia, resulting in a diverse range of neurological and psychiatric symptoms. Diagnosis involves clinical evaluation and neuroimaging, while treatment is primarily symptomatic. Further research is needed to better understand the underlying genetic and biochemical mechanisms driving calcification in the brain and to develop more effective therapeutic strategies for this challenging condition.
Cannabis use is very common worldwide. Its consumption could be explained by recreational purposes as it can be motivated by some psychiatric disorders such as depression, anxiety or low self-esteem.
Objectives
This study aims to explore the relationship between cannabis use, depression, anxiety and self-esteem among a population of Tunisian adults living abroad.
Methods
A cross-sectional online survey was carried out using a self-administered questionnaire on young Tunisians people who have completed their secondary studies at the pilot high school of Sfax and currently residing abroad. The survey questionnaire was designed on Google Forms. It included a data collection sheet and psychometric scales “Cannabis Abuse Screening Test” (CAST), “Hospital Anxiety and Depression Scale” (HADS) and”Rosenberg’s self-esteem scale”.
Results
The sample consisted of 35 Tunisian young adults. 17 participants (48.6%) reported a cannabis use behavior. It was done with friends in a festive setting in 88% of cases (N=15). According to the CAST, 17,6% (N=3) of cannabis users were at high risk of cannabis dependence. Anxiety was present in 17,6% (N=3) and depression in 17,6% (N=3) of participants. Self-esteem was low in 23,53% (N=4) of participants.
Cannabis use was not associated with the presence of current emotional disorders such as anxiety and depression (p=0.894 and p=0.933 respectively). It was also not associated with lower self-esteem (p=0.585).
Conclusions
Cannabis use is relatively common among young Tunisian emigrants without evolving towards dependence inseveral cases. This behavior seems to be more influenced by social factors and misrepresentations about cannabis than by psychological disturbance.
Pregnancy is a high-risk period for major affective disorders and can lead to a destabilizing period for our patients. Standard pharmacological strategies must be carefully evaluated due to potential teratogenic or side effects. We present a case of bipolar disorder type I with challenging-to-control maniac episodes during pregnancy, which has required Electroconvulsive Therapy for its management.
Objectives
Presenting maintenance electroconvulsive therapy (ECT) as a safe and effective therapeutic strategy during pregnancy, with the presentation of a case in which it has been administered every 3 weeks from the second trimester until the baby’s birth at 37 weeks
Methods
This concerns a 28-year-old immigrant woman, married, with a 10-year-old child. She was diagnosed with bipolar disorder type I at the age of 16 when she experienced her first manic episode in her country of origin. Subsequently, during her first pregnancy, she required hospitalization for electroconvulsive therapy (ECT) treatment, with a positive response after a single session. She remained stable for several years without maintenance pharmacological treatment or follow-up until the ninth week of her second pregnancy when she experienced a manic episode requiring hospitalization.
Results
She was initially treated with Olanzapine and Lorazepam with a positive response, but three weeks later, she was readmitted with a similar episode. These decompensations occurred almost monthly, leading to the consideration of introducing mood stabilizers after the first trimester. However, due to the patient’s severe hyperemesis gravidarum, this stabilizing treatment was ruled out due to the difficulty in controlling its blood levels and the associated risk of intoxication. During the fifth admission at the 20th week of gestation, the decision was made to initiate ECT treatment, which yielded an excellent response and subsequent maintenance.
Conclusions
The indications for electroconvulsive therapy (ECT) during pregnancy are the same as in the rest of adult patients. In individuals with a psychiatric history, it is possible for a relapse of mental illness to occur during pregnancy, although the risk is considerably higher during the postpartum period. ECT is considered an effective and safe treatment option in all three trimesters of pregnancy and the postpartum period. During the informed consent process, patients should be informed about the potential impact of ECT as well as alternative treatment options.