Evaluate Department of Defense (DoD) antimicrobial stewardship programs (ASPs) by assessing the relationship between key clinical outcome metrics (antibiotic use, incidence of resistant pathogens, and incidence of Clostridioides difficile infections) and CDC Core Element (CE) adherence.

Retrospective, cross-sectional study of DoD hospitals in 2018 and 2021

National Healthcare Safety Network Standardized Antimicrobial Administration Ratios (SAARs) were used to measure antibiotic use and microbiology results to evaluate four types of pathogen incidence. A novel CE scoring approach used scores to quantitatively assess relationships with CE adherence and outcome metrics using correlation and regression models. Assessments were repeated with 2021 data for Priority CE adherence and to conduct adjusted regressions for CEs and Priority CEs controlling for categorical bed size.

Compared to 2022 national data, DoD hospitals in 2021 had a similar proportion of facilities with a SAAR statistically significantly > 1.0. Leadership, Action, and Tracking CEs followed a more normal score distribution, while Reporting and Education were somewhat left-skewed. Unadjusted models often showed a positive relationship with higher CE scores associated with worse outcomes for the SAAR and pathogen incidence. Adjusted models indicated that procedural CEs, particularly Priority Reporting, were associated with better ASP-related outcomes.

CEs should be more quantitatively assessed. Results provide initial evidence to prioritize procedural CE implementation within the DoD; however, additional investigation for structural CEs is needed. Patient outcome data should be collected as an important indicator of ASP performance.

Characterization and assessment of Department of Defense’s (DoD’s) Antibiotic Stewardship Programs (ASPs) to determine adherence to Centers for Disease Control and Prevention (CDC) Core Elements and compare to national adherence

Retrospective, observational with supplemental survey

Facility characteristics and CDC Core Elements (CE) adherence data for 2017–2021 were retrieved from the National Healthcare Safety Network’s (NHSN) annual hospital survey with DoD data from the Defense Health Agency and national data from the Antibiotic Resistance and Patient Safety Portal. An online supplemental survey was administered to DoD hospitals. Descriptive statistics and bivariate analyses were completed for facility characteristics and supplemental survey questions to determine correlations between variables. A framework analysis compared DoD ASPs to CEs and Priority Elements.

Supplemental surveys were completed for 85.1% of DoD’s hospitals. DoD’s hospitals were smaller on average than national hospitals. ASP leaders were assigned more often than volunteer and typically served in the role for less than four years. Staffing mix differed, with more equivalent proportions of civilian/contractor to military at larger hospitals in the U.S. Most DoD ASPs consisted of ≤ 25% pharmacists. ASP leaders were largely available on a daily basis; pharmacist leaders spent more time on ASP activities than physicians. CE adherence was high, but in 2021 DoD lagged national adherence in the structural CEs of Leadership, Accountability, and Pharmacy Expertise.

DoD hospitals lagged in national adherence to the structural CEs, presenting opportunities for ASP improvement. Refinement of CE adherence measurements, coupled with impact on health outcomes, could aid in better-identifying areas for improvement.

Bipolar disorder is a recurrent chronic disorder characterised by fluctuation of mood state. Recent studies focused on the involvement of adenosine and the purinergic system in the pathophysiology of bipolar disorder.

We aimed to investigate the difference in (SUA) levels between different phases of relapse and remission period.

For this aim a prospective study was conducted during six months at Razi psychiatric Hospital in Tunisia with patients diagnosed with BD The socio-demographic, clinical data were gathered from patient and a psychometric assessment using YMRS and Beck scale was employed. Uric acid level was studied during relapse and remission period.

Among 30 consentent patients included in the study : 65.7% were women, The age of the participants varied between 22 and 65 years old. Uric acid level at the relapse varied between 328 and 499 mmol/L and level of controlled value at the remission period which is eight weeks under treatment varied between 137 and 307 mmol/L. Patients under antipsychotic treatment were 55.9% the other were under lithium or mood stabilizer. There is no significant difference between patients with bipolar disorder type I or II neither for the molecule chosen for treatment (p<0.05).

Bipolar disorder is a chronic psychiatric disease which needs to be regulary controlled. Uric acid levels were higher in manic or depressive phases as compared with euthymia phase. Uric acid could be used as a trait marker in bipolar disorder and help psychiatrist to monitor patients and to adjust treatment in order to avoid relapsing.

No significant relationships.

Both public and private sector pharmacists were instrumental in containing this health crisis in Tunisia. The high workload had a considerable impact on their mental health during the outbreak of the Corona Virus.

This study aims to assess burnout and the psychological toll of the pandemic among pharmacists in Tunisia during covid-19.

258 Tunisian pharmacists working in the public and private sector participated in a questionnaire. Burnout was assessed by the Maslach burnout scale. Regression analysis was used to assess the impact of the pandemic on Tunisian pharmacists.

80% of the respondents were women. Participants ranged in age from 22 to 62, 60% were married, 57% had at least one child, and 42% had been working for less than five years. The burnout scale revealed 76% burnout among them. Univariate linear regression showed that female gender (p = 0.014 <0.05) was associated with the development of burnout.

The considerable prevalence of burnout among pharmacists during the COVID-19 pandemic in Tunisia can be attributed to the enormous and overwhelming responsibilities that any health care worker endured.

No significant relationships.

The COVID-19 pandemic affected today more than 76,000,000 worldwide, and more than half of humanity has been placed in quarantine. This pandemic affects mental health problems and influences the onset of symptoms.

The aim of this review is to analyze the impact of the COVID-19 pandemic on psychotic disorders and its interaction with the various risk factors.

We undertook a review of the impact of COVID-19 pandemic on psychosis. We carried out a systematic review of electronic databases using the keywords “COVID-19”, “pandemics”, “psychotic disorders”, and “delusions”. Relevant literature was limited to articles conducted around the world and published between January and December 2020.

We identified ten papers addressing incident cases of psychosis relapse linked to coronavirus pandemic. In multiple cases, psychotic symptoms were characterized by delusional thoughts about being infected by the coronavirus. The limited access to regular medications and psychosocial interventions was the main factor to psychotic relapse. This review included one cross-sectional clinical study comparing the impact of this pandemic on patients suffering from severe mental illness compared with healthy controls and they found that patients with mental disorders reacted to the pandemic and the lockdown restrictions with higher anxiety levels than the general public. Our study also revealed that elderly people suffering from psychosis and other chronic illness were the most vulnerable to relapse.

Psychotic disorders can relapse during stressful events like COVID-19 pandemic. Therefore, specific attention to these vulnerable subjects is crucial to prevent relapses in times of worldwide pandemic.

No significant relationships.

Post-traumatic stress disorder affects emotional, social and professional functioning. It can also affect physical and sexual health.

The aim of this study is to write down the prevalence of sexual dysfunction in men with PTSD and to economize on potential predictors of sexual dysfunction.

A total of 30 male patients with PTSD were included in this study. We collected socio-demographic and clinical data and we used Post-Traumatic Stress Disorder (PCLS) and International Erectile Function Index (IIEF15) scales.

The mean PTSD severity score was 65.43 ± 2.95. The mean score for revitalization, avoidance, cognitive and mood alteration, and hypervigilance were 15.80 ± 1.44, respectively; 8 ± 0; 24.07 ± 1.20 and 17.57 ± 2.95. The mean IIEF-15 score was 51.16 ± 6.82. The mean sub-scores were 3.93 ± 0.52 for sexual desire; 18.80 ± 5.68 for erectile function; 8.93 ± 8.97 for orgasmic function; 5.13 ± 1.10 for satisfaction with intercourses and 4.13 ± 1.16 for overall satisfaction. The IIEF15-EF score was negatively correlated with the presence of a personal medical history (p = 0.02) and the impairment cognitions and mood score (p = 0.023). The IIEF-OF score was significantly associated with reviviscence, hypervigilance, cognition and mood alterations (p = 0.015; 0.041; 0.045). The IIEF-15 SD score was negatively correlated with altered cognition and mood (p = 0.007).

Our study focused on the importance of assessing sexual function in men followed for PTSD and helps to understand the association of PTSD with different types of sexual dysfunction.

Forensic psychiatry is facing major challenges related to criminal responsibility with an increasing number of offenses and the entanglement of several factors affecting offenders differently.

The aim of this study is to determine the characteristics of offenders referred for forensic psychiatric examination.

We studied the medical files of all the offenders referred to the forensic psychiatry unit in Razi hospital for an examination between January 2010 and October 2020.

The number of people who have undergone a forensic psychiatric examination was 256. Three files were not usable due to lacking data. The offenders were men in 95.7% (242) of the cases. Their average age was 35 years with a range of 17-53 years. They were mostly single (64%) with primary education (58.1%). Forty percent of the studied population were unemployed and 70% of them lived with their parents. Drug abuse was found in half of the cases and the average number of taken drugs is two illicit substances per person. A criminal record was found in 43% of the cases with an average number of two offenses per person. Offenders were found to suffer from schizophrenia in 29% of the cases, personality disorder in 17% of the cases and from intellectual disability in 16.6% of the cases. No psychiatric disorder was found in 24% of the cases

Despite having in common many vulnerability factors, such as low educational level, unemployment and drug abuse, an important number of offenders referred for forensic psychiatric examination weren’t affected by a psychiatric disorder.

No significant relationships.

Various therapeutic approaches for post-traumatic stress disorder have been the subject of numerous studies. Antidepressants are sometimes used in PTSD. They improve the symptoms of PTSD. But their effect is not clear on the sexual dysfunctions that accompany this disorder.

The aim of this study is to display the effect of antidepressants on sexual dysfunctions in men with PTSD.

A total of 30 male patients with PTSD were included in this study. The International Erectile Function Index (IIEF15) was used to assess sexual dysfunction in participants before treatment and two months after starting antidepressant treatment.

Half of the patients (50%) used sertraline, 23% paroxetine, 20% fluoxetine and 7% escitalopram.The mean IIEF-15 score was 51.16 ± 6.82 in patients with PTSD before initiation of treatment. The average scores of the areas of sexuality studied by this scale were 3.93 ± 0.52 for sexual desire; 18.80 ± 5.68 for erectile function; 8.93 ± 8.97 for orgasmic function; 5.13 ± 1.10 for satisfaction with intercourse and 4.13 ± 1.16 for overall satisfaction. After 2 months of use of the antidepressant treatment, there was a statistically significant improvement in sexual functions: significant increase in the total score of the IIEF15 (p <0.001), and in the mean scores of the areas of sexuality.

Antidepressant treatment could, by improving post-traumatic symptoms, improve sexual dysfunction.

Exposure to extreme traumatic events can lead to post-traumatic stress disorder (PTSD). This disorder affects emotional, social and professional functioning. Recent studies suggest that it can lead to sexual dysfunction.

The aim of this study is to compare the level of sexual dysfunction between men with PTSD and control subjects.

A total of 30 male PTSD patients and 30 controls were included in this study. We used the Post-Traumatic Stress Disorder Check Scale (PCLS) to assess the intensity of PTSD symptoms and the International Erectile Function Index (IIEF15) to assess sexual dysfunction of both patients and controls.

The mean IIEF-15 score was 51.16 ± 6.82 in patients followed for PTSD versus 77.33 ± 2.02 in healthy controls with a non-significant difference (p = 0.26). Three patients (10%) had an alteration of desire while the control reported only dysfunction but there was no significant difference between the mean scores of IIEF-SD (p = 0.22). No patient or control had erectile dysfunction and there was no significant difference between the IIEF-EF sub-scores in the 2 groups (p = 0.20). The mean sexual intercourse satisfaction (SD) score in the patients was 5.13 ± 1.10 versus 8.86 ± 0.40 with a non-significant difference (p = 0.09). Altered satisfaction with intercourse was noted in 15% (n = 5) of subjects with PTSD versus a single control.

It is important that practitioners address the subject of sexuality in patients followed for PTSD and refer their patients, if necessary, to a sexology consultation.

The rapid spread of the SARS‐CoV‐2 pandemic among the world poses challenges to the management of both physical and mental health. This unexpected situation could predict an exacerbation of anxiety, depressions, obsessions, and even multiple cases of psychosis.

The aim of this literature review is to identify and analyze studies conducted in 2020 that investigate the incidence of psychotic disorders, related to COVID-19 pandemic and describe its symptoms.

A systematic search in the PubMed electronic database was performed using keywords “COVID-19”, “pandemics”, “psychotic symptoms”, and “ first episode of psychosis” Relevant literature was limited to articles describing studies conducted and published in 2020.

9 papers met the inclusion criteria. The selected studies reported 20 cases of psychosis in patients with no psychiatric history, directly triggered by stress derived from the COVID-19 pandemic and by social distancing and quarantine. All cases were characterized by sudden behavioral changes out of character, increased concern about coronavirus risk infection, anxiety, psychomotor agitation, and insomnia. In multiple cases, psychotic symptoms were characterized by thoughts of reference, persecution, and structured delusional. 5 patients were convinced that COVID-19 Pandemic was part of a conspiracy and that someone was trying to infect them by diffusing the COVID-19 or other pollutants. Half of the patients had the delusional conviction that they got infected and they were contagious.

COVID-19 pandemic appears to be the trigger for precipitating psychosis which has a high risk of suicidal behavior. During pandemics, mental health professionals should carry out more focused diagnostic and therapeutic strategies.

No significant relationships.

Efficacy of lithium is well documented in the literature, making it the gold standard treatment. However, its use declines with the advent of anticonvulsants. This raises the question about monitoring of mood stabilizers in practice.

The aims of this study were to determine the prophylactic lithium response in patients followed for bipolar disorder and compared to those of anticonvulsants and assess the mood stabilizers monitoring procedures in clinical practice.

A retrospective study was conducted, over a period of six months, with patients followed for bipolar disorder stabilized under the same mood stabilizer (lithium or anticonvulsant) for at least one year. The participants were divided into two groups according to the mood stabilizing treatment. The two groups were compared according to socio-demographic, clinical and evolutionary profiles as well as the prophylactic response to treatment.

Patients included were 64 in the study, 28 received lithium and 36 received anticonvulsants. The socio-demographic profile and clinical characteristics were similar in two groups, except for the average total number of mood episodes. Retrospective evaluation of the prophylactic response by ALDA scale showed a significantly higher mean total score in patients receiving lithium (5.9 ± 2.8 versus 2.58 ± 2.4, p = 0.025).). Ten of them were in compliance with the recommendations; while 19.44% received anticonvulsants had all the monitoring parameters within the recommended time frame.

Thymoregulators significantly modify the disease’s prognosis. Practitioners will attach particular special attention to distinguish the therapeutic efficacy of the side effects which are numerous and sometimes serious.

The health sector has long been recognized to be a very stressful work environment for teams that can lead to “burnout”. Geriatric institutions are no exception to this observation; this state has deleterious effects on health care as on the quality of care.

Measure the burnout rate among caregivers in geriatric institutions and identify associated factors and coping strategies specific to this population in order to provide the necessary preventive measures.

Subjects and method A cross-sectional study, conducted among caregivers exercising at the shelter for aged subjects of Manouba, Tunisia. We used a pre-survey exploring the socio-demographic data associated with two validated scales: the Maslach Burnout Inventory assessing the level of burnout and the Brief COPE assessing coping strategies.

Thirty-one subjects were recruited. The prevalence of burnout was 45.16%. Respectively 32.26%, 25.80% and 45.16% of the respondents had high scores in dimensions emotional exhaustion, depersonalization and personal accomplishment at work. The analytical study revealed that seniority in work increased the risk of burnout. The coping strategies of caregivers in geriatric institution facing burnout were mainly centered on emotion. The number of years of experience has been associated with burnout in our study.

This work reaffirms that the population of caregivers in geriatric institution is at risk of burnout and allows to identify predictors. The establishment of individual and collective measures is essential for appropriate treatment references (In the body text, a publication should be referred to by a consecutive number between bracket)

The authors have not supplied their declaration of competing interest.

For a long time, antidepressants sexual side effects have been neglected. Currently, no reliable scientific data is available regarding the nature and frequency of sexual dysfunction induced by antidepressants. The aim of our study was to evaluate the prevalence and type of sexual dysfunction induced by antidepressants, and to identify factors associated with the occurrence of these disorders.

A descriptive and analytical cross-sectional study extending over a period of two week. For the purpose of this research, a socio-demographic card, the Arizona Sexual Experiences Scale (ASEX) and the Psychotropic-Related Sexual Dysfunction Questionnaire (SALSEX) were used.

Fifty-five patients were recruited. The diagnosis of major depressive episodes was dominant (49.1%). Moreover, fluoxetine and tricyclic were in top of the list of antidepressants with respective proportions of 41.8% and 38.2% and respective dose 20.86 mg/24 h and 72.38 mg/24 h. The score using the ASEX scale was 14.63 ± 5.23. Using the SALSEX scale, 47.3% of patients claimed to have had sexual disorders secondary to antidepressants with a moderate score of 9.19 ± 2.56. Furthermore, sexual disorders were more common in the elderly aged of 45 (66.66%) as well as in patients started on paroxetine (66.66%) and on sertraline (66.66%) (P ≤ 0.05).

The sexual side effects of antidepressants have a major impact on the quality of life and adherence to treatment. They also represent an important risk factor for relapse and recurrence in major depression, in this context, the prescription of an antidepressant.

The authors have not supplied their declaration of competing interest.

Overweight and obesity, despite their comorbidities and mortality, could deteriorate the quality of life of people with bipolar disorder.

The objective of this study is to evaluate the quality of life among patients with bipolar disorder and investigate a possible interaction between obesity and deterioration of the quality of life.

This study aims to highlight the importance of preventing overweight and obesity in people with bipolar disorder to obtain an adequate quality of life subsequently an acceptable control of the illness.

Fifty euthymic bipolar patients (Hamilton Depression Scale score ≤ 8, and Young Mania Rating Scale score ≤ 6) received the Medical Outcomes Study 36-Item Short-Form Health Survey in Arabic validated version in order to investigate the quality of life.

We examined 50 euthymic bipolar patients (60% men, 40% women). The average age was 46, 5 years (23–70). Most patients (69%) were over weighted (BMI ≥ 25.0 kg/m2) (body mass index), of whom 40% were obese (BMI ≥ 30.0 kg/m2). Seventy-two percent of the investigated patients had an affected quality of life (score < 66.7). The mental items were deteriorated in 80% of the cases. An affected quality of life was correlated with obesity. The BMI was significantly and negatively correlated with the scores of dimensions D4 (mental health) and D8 (perceived health) (P < 0.01).

The investigation of quality of life in people with mental disorder enables to reveal the social handicap caused by these illnesses consequently emphasizes health care in mental affections.

The authors have not supplied their declaration of competing interest.

Major depressive disorder (MDD) is a common mood disorder, with a heritability of around 34%. Molecular genetic studies made significant progress and identified genetic markers associated with the risk of MDD; however, progress is slowed down by substantial heterogeneity as MDD is assessed differently across international cohorts. Here, we used a standardized online approach to measure MDD in multiple cohorts in the Netherlands and evaluated whether this approach can be used in epidemiological and genetic association studies of depression.

Within the Biobank Netherlands Internet Collaboration (BIONIC) project, we collected MDD data in eight cohorts involving 31 936 participants, using the online Lifetime Depression Assessment Self-report (LIDAS), and estimated the prevalence of current and lifetime MDD in 22 623 unrelated individuals. In a large Netherlands Twin Register (NTR) twin-family dataset (n ≈ 18 000), we estimated the heritability of MDD, and the prediction of MDD in a subset (n = 4782) through Polygenic Risk Score (PRS).

Estimates of current and lifetime MDD prevalence were 6.7% and 18.1%, respectively, in line with population estimates based on validated psychiatric interviews. In the NTR heritability estimates were 0.34/0.30 (s.e. = 0.02/0.02) for current/lifetime MDD, respectively, showing that the LIDAS gives similar heritability rates for MDD as reported in the literature. The PRS predicted risk of MDD (OR 1.23, 95% CI 1.15–1.32, R2 = 1.47%).

By assessing MDD status in the Netherlands using the LIDAS instrument, we were able to confirm previously reported MDD prevalence and heritability estimates, which suggests that this instrument can be used in epidemiological and genetic association studies of depression.

Despite established clinical associations among major depression (MD), alcohol dependence (AD), and alcohol consumption (AC), the nature of the causal relationship between them is not completely understood. We leveraged genome-wide data from the Psychiatric Genomics Consortium (PGC) and UK Biobank to test for the presence of shared genetic mechanisms and causal relationships among MD, AD, and AC.

Linkage disequilibrium score regression and Mendelian randomization (MR) were performed using genome-wide data from the PGC (MD: 135 458 cases and 344 901 controls; AD: 10 206 cases and 28 480 controls) and UK Biobank (AC-frequency: 438 308 individuals; AC-quantity: 307 098 individuals).

Positive genetic correlation was observed between MD and AD (rgMD−AD = + 0.47, P = 6.6 × 10−10). AC-quantity showed positive genetic correlation with both AD (rgAD−AC quantity = + 0.75, P = 1.8 × 10−14) and MD (rgMD−AC quantity = + 0.14, P = 2.9 × 10−7), while there was negative correlation of AC-frequency with MD (rgMD−AC frequency = −0.17, P = 1.5 × 10−10) and a non-significant result with AD. MR analyses confirmed the presence of pleiotropy among these four traits. However, the MD-AD results reflect a mediated-pleiotropy mechanism (i.e. causal relationship) with an effect of MD on AD (beta = 0.28, P = 1.29 × 10−6). There was no evidence for reverse causation.

This study supports a causal role for genetic liability of MD on AD based on genetic datasets including thousands of individuals. Understanding mechanisms underlying MD-AD comorbidity addresses important public health concerns and has the potential to facilitate prevention and intervention efforts.