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Treatment Interruptions and Mortality among Puerto Rican Women with Gynecologic Cancers in Puerto Rico after Hurricanes Irma and María: A Retrospective Cohort Study
- Fabiola A. Rivera-Gastón, Sharee Umpierre-Catinchi, Jeslie M. Ramos-Cartagena, Karen J. Ortiz-Ortiz, Carlos R. Torres-Cintrón, Sandra I. García-Camacho, William A. Calo, Guillermo Tortolero-Luna, Liz M. Martínez Ocasio, Ana P. Ortiz
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- Journal:
- Disaster Medicine and Public Health Preparedness / Accepted manuscript
- Published online by Cambridge University Press:
- 21 May 2024, pp. 1-12
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Objective:
Cancer patients are among the most vulnerable populations during and after a disaster. We evaluated the impact of treatment interruption on the survival of women with gynecologic cancer in Puerto Rico following hurricanes Irma and María.
Methods:Retrospective cohort study among a clinic-based sample of women diagnosed between January 2016-September 2017 (n=112). Women were followed up from their diagnosis until December 2019, to assess vital status. Kaplan-Meier survival curves and Cox proportional hazards models were performed.
Results:Mean age was 56 (±12.3) years; corpus uteri (58.9%) was the most common gynecologic cancer. Predominant treatments were surgery (91.1%) and chemotherapy (44.6%). Overall, 75.9% were receiving treatment before the hurricanes, 16.1% experienced treatment interruptions and 8.9% died during the follow-up period. Factors associated with treatment interruption in bivariate analysis included younger age (≤55 years), having regional/distant disease, and receiving >1 cancer treatment (p<0.05). Crude analysis revealed an increased risk of death among women with treatment interruption (HR: 3.88, 95% CI=1.09-13.77), persisting after adjusting for age and cancer stage (HR: 2.49, 95% CI= 0.69-9.01).
Conclusions:Findings underscore the detrimental impact of treatment interruption on cancer survival in the aftermath of hurricanes, emphasizing the need for emergency response plans for this vulnerable population.
Comparison of body composition assessment tools in infancy
- J. Lyons-Reid, J.G.B. Derraik, B.B. Albert, T. Kenealy, W.S. Cutfield, L.C. Ward, M-T. Tint, S-Y. Chan, C.R. Monnard, J.M. Ramos Nieves, K.M. Godfrey
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- Journal:
- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E90
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The prevalence of childhood obesity is increasing globally(1). While BMI is commonly used to define obesity, it is unable to differentiate between fat and muscle mass, leading to calls to measure body composition specifically(2). While several tools are available to assess body composition in infancy, it is unclear if they are directly comparable. Among a subset of healthy infants born to mothers participating in a randomised controlled trial of a preconception and antenatal nutritional supplement(3), measurements were made at ages 6 weeks (n = 58) and 6 months (n = 70) using air displacement plethysmography (ADP), whole-body dual-energy X-ray absorptiometry (DXA), and bioelectrical impedance spectroscopy (BIS). Estimates of percentage fat mass (%FM) were compared using Cohen’s kappa statistic (κ) and Bland-Altman analysis (4,5). There was none to weak agreement when comparing tertiles of %FM (κ = 0.15–0.59). When comparing absolute values, the bias (i.e., mean difference) was smallest when comparing BIS to ADP at 6 weeks (+1.7%). A similar bias was observed at 6 months when comparing DXA to ADP (+1.8%). However, when comparing BIA to DXA at both ages, biases were much larger (+7.6% and +4.7% at 6 weeks and 6 months, respectively). Furthermore, there was wide interindividual variance (limits of agreement [LOA] i.e., ± 1.96 SD) for each comparison. At 6 weeks, LOA ranged from ± 4.8 to ± 6.5% for BIA vs. DXA and BIA vs. ADP, respectively. At 6 months, LOA were even wider, ranging from ± 7.3 to ± 8.1% (DXA vs. ADP and BIA vs. DXA, respectively). Proportional biases were apparent when comparing BIS to the other tools at both ages, with BIS generally overestimating %FM more among infants with low adiposity. In addition to differences according to tool type, within-tool factors impacted body composition estimation. For ADP measurements, the choice of FFM density reference (Fomon vs. Butte) had minimal impact; however, choice of DXA software version (GE Lunar enCORE basic vs. enhanced) and BIS analysis approach (empirical equation vs. mixture theory prediction) led to very different estimates of body composition. In conclusion, when comparing body composition assessment tools in infancy, there was limited agreement between three commonly used tools. Therefore, researchers and clinicians must be cautious when conducting longitudinal analyses or when comparing findings across studies, as estimates are not comparable across tools.
Bridging the gap: opportunities for transitions of care pharmacist review of outpatient parenteral antimicrobial therapy prescriptions prior to hospital discharge
- Sara Stashluk, Michelle Ramos, Tyla Carettini, James B. Cutrell, Seana Mathew, Marguerite Monogue, Jennifer Nguyen, James M. Sanders, Esther Y. Golnabi
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 4 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 18 April 2024, e50
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Purpose:
Pharmacist-led initiatives providing optimization of medications during transitions of care (TOC) have shown to have a positive impact on prescribing practices and patient outcomes. This study aims to evaluate the role and impact of TOC pharmacist review of outpatient parenteral antimicrobial therapy (OPAT) prescriptions prior to hospital discharge.
Methods:In a retrospective chart review, patients with OPAT prescriptions between November 1, 2022 and January 31, 2023 were evaluated using prescription-specific and intervention-specific data points. Prescription-specific data points included intravenous antimicrobials prescribed, indication, prescribing team, and time from OPAT prescription to TOC pharmacist review. Intervention-specific data points included antimicrobial optimization (dose/frequency, duration, and other), prescription clarification, and laboratory monitoring.
Results:Of the 137 OPAT prescriptions evaluated, 67 required intervention by TOC pharmacists (48.9%). The General Infectious Disease Consult team placed 71.5% of OPAT prescriptions and required interventions less frequently (42.9%) compared to the other teams. Antimicrobial optimization interventions accounted for 54.2% of interventions, which were primarily related to medication dose and frequency.
Conclusion:The TOC pharmacists can play a key role in the evaluation of OPAT prescriptions at hospital discharge. This intervention demonstrated how TOC pharmacists can effectively collaborate with the OPAT team, which builds on prior evidence of the role and value of pharmacists in the transitional care setting.
Programmatic implementation of depression screening and remote mental health support sessions for persons recently diagnosed with TB in Lima, Peru during the COVID-19 pandemic
- Carmen Contreras, Janeth Santa Cruz, Jerome T. Galea, Alexander L. Chu, Daniela Puma, Lourdes Ramos, Marco Tovar, Jesús Peinado, Leonid Lecca, Salmaan Keshavjee, Courtney M. Yuen, Giuseppe Raviola
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- Journal:
- Cambridge Prisms: Global Mental Health / Volume 11 / 2024
- Published online by Cambridge University Press:
- 04 April 2024, e59
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Background
Few studies have explored a stepped care model for delivering mental health care to persons with tuberculosis (TB). Here, we evaluated depression screening and remote low-intensity mental health interventions for persons initiating TB treatment in Lima, Peru during the COVID-19 pandemic.
MethodsWe used the Patient Health Questionnaire 9 (PHQ-9) to screen participants for depressive symptoms (PHQ-9 ≥ 5). Participants with PHQ-9, 5–14 received remote Psychological First Aid (PFA) or Problem Management Plus (PM+). Participants were reevaluated 6 months after intervention completion. We then compared the change in median PHQ-9 scores before and after intervention completion. Those with PHQ-9 ≥ 15 were referred to higher-level care.
FindingsWe found that 62 (45.9%) of the 135 participants had PHQ-9 ≥ 5 at baseline. Then, 54 individuals with PHQ-9, 5–9 received PFA, of which 44 (81.5%) were reevaluated. We observed significant reductions in median PHQ-9 scores from 6 to 2 (r = 0.98; p < 0.001). Four participants with PHQ-9, 10–14 received PM+ but were unable to be reevaluated. Four participants with PHQ-9 ≥ 15 were referred to higher-level care.
ConclusionsDepressive symptoms were common among persons recently diagnosed with TB. We observed improvements in depressive symptoms 6 months later for most participants who received remote sessions of PFA.
The effects of exposure and explicit stereotypes on veracity judgments of Polish-accented English speech: A preregistered close replication and extension of Boduch-Grabka & Lev-Ari (2021)
- Samantha Barlow, Greg Beardsley, Zéta Bsharah, Robin Crofts, Carlos De La Rosa, Andrea Gutierrez, Carlie Highfill, Amy Gail Wade Johnson, Caroline Johnson, Jacob Johnson, Isaac Leyva Cardenas, Jordan Taylor Martinez, Nathaniel Todd Miller, Riley Monroe Murray, Sylvia Page, Taylor Petersen, Irina Ramos, Rayvin Rhodes, Phoebe Vainuku, Brenan M. Wednesday, Emma Corrine Farnsworth, Seung Kyung Kim, Rachel Hayes-Harb
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- Studies in Second Language Acquisition , First View
- Published online by Cambridge University Press:
- 22 March 2024, pp. 1-17
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Boduch-Grabka and Lev-Ari (2021) showed that so-called “native” British-English speakers judged statements produced by Polish-accented English speakers as less likely to be true than statements produced by “native” speakers and that prior exposure to Polish-accented English speech modulates this effect. Given the real-world consequences of this study, as well as our commitment to assessing and mitigating linguistic biases, we conducted a close replication, extending the work by collecting additional information about participants’ explicit biases towards Polish migrants in the UK. We did not reproduce the original pattern of results, observing no effect of speaker accent or exposure on comprehension or veracity. In addition, the measure of explicit bias did not predict differential veracity ratings for Polish- and British-accented speech. Although the current pattern of results differs from that of the original study, our finding that neither comprehension nor veracity were impacted by accent or exposure condition is not inconsistent with the Boduch-Grabka and Lev-Ari (2021) processing difficulty account of the accent-based veracity judgment effect. We explore possible explanations for the lack of replication and future directions for this work.
Naturally-Occurring Silicates as Carriers for Copper Catalysts used in Methanol Conversion
- M. R. Sun Kou, S. Mendioroz, J. L. G. Fierro, I. Rodriguez-Ramos, J. M. Palacios, A. Guerrero-Ruiz, A. M. De Andres
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- Clays and Clay Minerals / Volume 40 / Issue 2 / April 1992
- Published online by Cambridge University Press:
- 28 February 2024, pp. 167-174
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Bentonite- and sepiolite-supported copper catalysts have been prepared either by adsorption of Cu(II) from aqueous solutions of copper nitrate at pH ~4.5 or by adsorption of a [Cu(NH3)4]2+ complex from an ammonia solution of CuSO4 at pH ~9.5. The structure and composition of the calcined preparations have been studied by X-ray diffraction, chemical analysis, and energy dispersive X-rays. Textural characteristics have derived from the analysis of the adsorption-desorption isotherms of N2. All catalysts have been tested for the dehydrogenation of methanol to methyl formate. For this reaction, bentonite-based catalysts were found to have very little activity, which indicates that copper located in the inter-lamellar spaces is inaccessible to methanol molecules. On the contrary, copper-sepiolite catalysts showed a very high specific activity even for those catalysts with a very low copper content. The chemical state of copper in the catalysts on-stream has been revealed by X-ray photoelectron spectroscopy and X-ray-induced Auger techniques. In most of the catalysts Cu+ is the dominant copper species.
Goethite Dispersibility in Solutions of Variable Ionic Strength and Soluble Organic Matter Content
- A. C. Herrera Ramos, M. B. McBride
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- Clays and Clay Minerals / Volume 44 / Issue 2 / April 1996
- Published online by Cambridge University Press:
- 28 February 2024, pp. 286-296
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The degree of flocculation of aqueous suspensions of microcrystalline goethite was measured in salts of monovalent, divalent and trivalent cations at pH 6.0–6.5 over a range of ionic strengths using light scattering measurements at 650 nm. Varying concentrations of soluble humic material as well as the organic ligands, salicylate and citrate, were tested for their effect on flocculation. It was found that KCl and NaCl induced flocculation at lower ionic strength than CaCl2, while AlCl3 favored dispersion at all ionic strengths tested. The simple organic ligands promoted flocculation at low concentration, with citrate having a more pronounced effect than salicylate. At higher concentrations, these ligands reversed their effect, inducing a more dispersed state of the oxide. The organic ligand effect on dispersibility was modified by the particular metal cation present, with Ca2+ being more conducive to flocculation than K+. Soluble humic materials affected goethite flocculation in a qualitatively similar way to that of the simple organic ligands, that is low concentrations favored flocculation while high concentrations induced dispersion. This dispersing effect was partially suppressed by the presence of Ca2+, and completely suppressed by Al3+. Thus, soluble humic substances at relatively high concentrations appear to have a marked dispersing effect on goethite in the absence of polyvalent cations, and a strongly flocculating effect in their presence.
The results can be explained qualitatively by a simple oxide surface charge model, in which chemi-sorption of multivalent cations or organic ligands alters the surface charge. Reactions that increase the magnitude of positive or negative surface charge favor dispersion, while those that reduce the magnitude of charge favor flocculation.
The predictive role of symptoms in COVID-19 diagnostic models: A longitudinal insight
- Olivia Bird, Eva P. Galiza, David Neil Baxter, Marta Boffito, Duncan Browne, Fiona Burns, David R. Chadwick, Rebecca Clark, Catherine A. Cosgrove, James Galloway, Anna L. Goodman, Amardeep Heer, Andrew Higham, Shalini Iyengar, Christopher Jeanes, Philip A. Kalra, Christina Kyriakidou, Judy M. Bradley, Chigomezgo Munthali, Angela M. Minassian, Fiona McGill, Patrick Moore, Imrozia Munsoor, Helen Nicholls, Orod Osanlou, Jonathan Packham, Carol H. Pretswell, Alberto San Francisco Ramos, Dinesh Saralaya, Ray P. Sheridan, Richard Smith, Roy L. Soiza, Pauline A. Swift, Emma C. Thomson, Jeremy Turner, Marianne Elizabeth Viljoen, Paul T. Heath, Irina Chis Ster
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- Journal:
- Epidemiology & Infection / Volume 152 / 2024
- Published online by Cambridge University Press:
- 22 January 2024, e37
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To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.
Mental health research in South America: Psychiatrists and psychiatry trainees’ perceived resources and barriers
- Rodrigo Ramalho, Vanessa Chappe, Lisette Alvarez, Gianfranco C.A. Argomedo-Ramos, Guillermo Rivera Arroyo, Graciela L. Bonay, Javiera C. Libuy Mena, Miguel A. Cuellar Hoppe, Domenica N. Cevallos-Robalino, Jairo M. Gonzalez-Diaz
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- Journal:
- Cambridge Prisms: Global Mental Health / Volume 10 / 2023
- Published online by Cambridge University Press:
- 02 October 2023, e66
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As mental health issues continue to rise in Latin America, the need for research in this field becomes increasingly pressing. This study aimed to explore the perceived barriers and resources for research and publications among psychiatrists and psychiatry trainees from nine Spanish-speaking countries in South America. Data was collected through an anonymous online survey and analyzed using descriptive methods and the SPSS Statistical package. In total, 214 responses were analyzed. Among the participating psychiatrists, 61.8% reported having led a research project and 74.7% of them reported having led an academic publication. As for the psychiatry trainees, 26% reported having conducted research and 41.5% reported having published or attempted to publish an academic paper. When available, having access to research training, protected research time and mentorship opportunities were significant resources for research. Further support is needed in terms of funding, training, protected research time and mentorship opportunities. However, despite their efforts to participate in the global mental health discussion, Latin American psychiatrists and psychiatry trainees remain largely underrepresented in the literature.
Coronavirus disease 2019 is associated with long-term depressive symptoms in Spanish older adults with overweight/obesity and metabolic syndrome
- Sangeetha Shyam, Carlos Gómez-Martínez, Indira Paz-Graniel, José J. Gaforio, Miguel Ángel Martínez-González, Dolores Corella, Montserrat Fitó, J. Alfredo Martínez, Ángel M. Alonso-Gómez, Julia Wärnberg, Jesús Vioque, Dora Romaguera, José López-Miranda, Ramon Estruch, Francisco J. Tinahones, José Manuel Santos-Lozano, J. Luís Serra-Majem, Aurora Bueno-Cavanillas, Josep A. Tur, Vicente Martín Sánchez, Xavier Pintó, María Ortiz Ramos, Josep Vidal, Maria Mar Alcarria, Lidia Daimiel, Emilio Ros, Fernando Fernandez-Aranda, Stephanie K. Nishi, Oscar García Regata, Estefania Toledo, Jose V. Sorli, Olga Castañer, Antonio Garcia-Rios, Rafael Valls-Enguix, Napoleon Perez-Farinos, M. Angeles Zulet, Elena Rayó-Gago, Rosa Casas, Mario Rivera-Izquierdo, Lucas Tojal-Sierra, Miguel Damas-Fuentes, Pilar Buil-Cosiales, Rebeca Fernández-Carrion, Albert Goday, Patricia J. Peña-Orihuela, Laura Compañ-Gabucio, Javier Diez-Espino, Susanna Tello, Ana González-Pinto, Víctor de la O, Miguel Delgado-Rodríguez, Nancy Babio, Jordi Salas-Salvadó
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- Psychological Medicine / Volume 54 / Issue 3 / February 2024
- Published online by Cambridge University Press:
- 05 September 2023, pp. 620-630
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Background
The coronavirus disease 2019 (COVID-19) has serious physiological and psychological consequences. The long-term (>12 weeks post-infection) impact of COVID-19 on mental health, specifically in older adults, is unclear. We longitudinally assessed the association of COVID-19 with depression symptomatology in community-dwelling older adults with metabolic syndrome within the framework of the PREDIMED-Plus cohort.
MethodsParticipants (n = 5486) aged 55–75 years were included in this longitudinal cohort. COVID-19 status (positive/negative) determined by tests (e.g. polymerase chain reaction severe acute respiratory syndrome coronavirus 2, IgG) was confirmed via event adjudication (410 cases). Pre- and post-COVID-19 depressive symptomatology was ascertained from annual assessments conducted using a validated 21-item Spanish Beck Depression Inventory-II (BDI-II). Multivariable linear and logistic regression models assessed the association between COVID-19 and depression symptomatology.
ResultsCOVID-19 in older adults was associated with higher post-COVID-19 BDI-II scores measured at a median (interquartile range) of 29 (15–40) weeks post-infection [fully adjusted β = 0.65 points, 95% confidence interval (CI) 0.15–1.15; p = 0.011]. This association was particularly prominent in women (β = 1.38 points, 95% CI 0.44–2.33, p = 0.004). COVID-19 was associated with 62% increased odds of elevated depression risk (BDI-II ≥ 14) post-COVID-19 when adjusted for confounders (odds ratio; 95% CI 1.13–2.30, p = 0.008).
ConclusionsCOVID-19 was associated with long-term depression risk in older adults with overweight/obesity and metabolic syndrome, particularly in women. Thus, long-term evaluations of the impact of COVID-19 on mental health and preventive public health initiatives are warranted in older adults.
The use of Polygenic Scores in a family design of First Episode Psychosis
- N. Murillo-Garcia, S. Papiol, S. Barrio-Martínez, M. Sevilla-Ramos, R. Magdaleno-Herrero, Á. Yorca-Ruiz, V. Ortíz-García de la Foz, M. Miguel-Corredera, M. Fatjó-Vilas, R. Ayesa-Arriola
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S631
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Introduction
A wide variety of traits is heritable and has genetic loading, including schizophrenia spectrum disorders (SSDs) and its associated neurocognitive features. The genetic architecture of SSDs is polygenic, with the contribution of thousands of single nucleotide polymorphisms of small effect with an estimated SNP-heritability of 24%. The same occurs with neurocognitive phenotypes such as intelligence or educational attainment. Therefore, the method of polygenic risk scores (PRS) is useful in estimating the genetic burden of such traits. Moreover, the use of PRS in a sample of genetically related individuals would allow analyzing the contribution of genetic and environmental factors involved in the development of the disorder and its candidate endophenotypes.
ObjectivesTo estimate PRS for schizophrenia, and polygenic scores for intelligence and educational attainment in patients with First Episode Psychosis (FEP), their first-degree relatives (siblings and parents), and a group of healthy controls.
MethodsThe sample is comprised of 579 participants of the PAFIP-FAMILIAS project in Santander, Spain (133 FEP patients, their 244 first-degree relatives, and 202 healthy controls). All provided sociodemographic information and completed the same neuropsychological battery. Participants’ DNA was extracted from venous blood samples, and genotyping was performed at the Centro Nacional de Investigaciones Oncológicas (CeGen) by the Global Screening Array v.3.0 panel (Illumina). Data quality control, imputation, calculation of PRS, and genetic association analysis are being performed using PLINK, SHAPEIT, IMPUTE2, SPSS and R.
ResultsData analysis is currently in progress, at the quality analysis stage, in collaboration with the Institute of Psychiatric Phenomics and Genomics (IPPG) in Munich, Germany. We expect to find higher PRS for schizophrenia in FEP patients, while their first-degree relatives will potentially show intermediate risk scores between patients and healthy controls. A similar finding is expected regarding intelligence and educational attainment, as FEP patients may show more genetic burden for low intelligence and education.
ConclusionsThe estimation of PRS has demonstrated to be valuable in studying complex traits such as schizophrenia. We believe that by applying this method in a family design can provide interesting insights on the development of SSDs and its potential endophenotypes, and potentially useful in their prevention.
Disclosure of InterestNone Declared
Association between adverse childhood experiences and the number of suicide attempts in lifetime
- J. Andreo-Jover, E. Fernandez-Jimenez, J. Curto-Ramos, N. Angarita-Osorio, N. Roberto, A. De la Torre-Luque, A. Cebria, M. Diaz-Marsa, M. Ruiz-Veguillla, J. B. Bobes Garcia, M. Fe Bravo Ortiz, V. Perez Solá
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S561-S562
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Introduction
Adverse childhood experiences (ACEs), defined as abuse, neglect, or a dysfunctional household in childhood, have been associated with suicidality (Fjeldsted et al., 2020). Every type of ACE has a direct impact on suicide ideation, self-harm and/or suicide attempt (Angelakis et al., 2019).
ObjectivesWe aim to quantify the association between types of ACEs (including emotional, physical, sexual abuse, and emotional and physical neglect) and the number of suicide attempts in lifetime.
MethodsWe included 748 patients who attempted suicide at least once. They were asked to complete the Columbia-Suicide Severity Rating Scale (CSSRS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Logistic regression models were run to assess the association between each ACE type and the number of suicide attempts.
ResultsPoisson univariate regression analyses show a linear trend in the relationship between having a higher number of suicide attempts and having suffered every ACE type in childhood (p<0.05). Our results show a lower percentage of previous suicide attempts among participants without ACEs, and an increasing tendency among patients with various types of ACEs. The rate of ACEs types is significantly higher in the group with previous suicide attempts than in the first-attempt group (p=0.000).
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ConclusionsThis study contributes to clarify the role of childhood trauma in the number of suicide attempts in lifetime. This has important implications for reducing suicide rates, and preventing future re-attempts. Further studies analysing every construct of childhood trauma may contribute to the detection of suicidal behaviour.
FundingsThis work was supported by the Instituto de Salud Carlos III (grant number: PI19/00941 SURVIVE) and co-funded by the European Union (grant numbers: COV20/00988, PI17/00768), the European Union’s Horizon 2020 research and innovation programme Societal Challenges (grant number: 101016127), and the Fundación Española de Psiquiatría y Salud Mental
AcknowledgementsSURVIVE project (PI19/00941)
KeywordsSuicide attempt, Adverse Childhood Experiences
ReferencesAngelakis, I., Gillespie, E. L., & Panagioti, M. (2019). Childhood maltreatment and adult suicidality: A comprehensive systematic review with meta-analysis. Psychological Medicine, 49(7), 1057-1078. https://doi.org/10.1017/S0033291718003823
Fjeldsted, R., Teasdale, T. W., & Bach, B. (2020). Childhood trauma, stressful life events, and suicidality in Danish psychiatric outpatients. Nordic Journal of Psychiatry, 74(4), 280-286. https://doi.org/10.1080/08039488.2019.1702096
Disclosure of InterestNone Declared
Attention-deficit/hyperactivity disorder and dementia – is there a link?
- C. Pinheiro Ramos, M. Magalhães, C. Baptista, R. Ribeiro, A. Gamito
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S239-S240
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Introduction
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by cognitive deficits and/or behavioral disturbances. The symptoms begin before 12 years and must cause an impact in different contexts. It is now recognized that in 40–60% of cases, ADHD symptoms persist into adulthood and old age, representing nearly 4% of adults and seniors.
Executive and memory deficits have been described in other neurodevelopmental disorders, such as autism, and older adults with these disorders are observed, later in life, with mild cognitive impairment (MCI) or dementia.
MCI is conceptualized as a prodromal stage of a neurodegenerative process, for which the pathological processes are not yet known. The term “MCI” is currently used to designate subjective complaints and performance below expected levels, in any cognitive domain.
There is, therefore, an overlap between ADHD and MCI in older adults, related to cognitive and behavioral symptoms. This overlap makes both syndromes difficult to distinguish, particularly in older patients.
ObjectivesTo highlight the importance of understanding the key processes of ADHD and MCI and how these entities may be related to each other.
MethodsNon-systematic review of the literature using Pubmed database. Papers were selected according to their relevance.
ResultsSleep disturbances are present in about 70% of adults with ADHD, and 59% of those with MCI. Depression and anxiety, respectively, are observed in about 44% and 35% of adults with ADHD, and 27% and 14% of those with MCI.
In the literature, the relationship between ADHD and MCI/Dementia remains unclear, although there are some hypotheses: (a) ADHD and MCI represent two points along a single pathophysiological continuum; (b) ADHD increases the risk for MCI and dementia (through an unrelated mediator); (c) ADHD and MCI manifest highly similar neurobehavioral symptoms through fundamentally distinct mechanisms (are unrelated). However, these three hypotheses are not mutually exclusive, i.e. ADHD may share common antecedent causal factors with MCI/Dementia and also increase the risk of MCI/Dementia through an unrelated mediator.
Neuroimaging evidence tends to support the hypothesis that neurobehavioral symptoms in ADHD and MCI manifest via distinct processes within the brain, with frontostriatal, frontal-temporo-parietal, and fronto-cerebellar abnormal networks in ADHD and progressive neurodegeneration in MCI.
ConclusionsWhether or not ADHD is a phase of a neurodegenerative process, the current criteria for the diagnosis of MCI or Dementia may not be appropriate or valid in individuals with a premorbid history of ADHD.
The criteria for the diagnosis of MCI/Dementia in adults with a previous diagnosis of ADHD should therefore be revised to rely more on functional outcomes.
Future neurobiological and epidemiological studies are needed, to explore the relationship between MCI/Dementia and ADHD, in older adults.
Disclosure of InterestNone Declared
Chemsex behaviours, sexual response and sexual health
- J. Curto Ramos, I. Azqueta, M. T. Heredia, R. Molina Prado, I. De Ema López
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S644
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Introduction
The intentional use of drugs before or during sexual intercourse (chemsex) is a phenomenon of special importance in the MSM (men who have sex with men) population due to its impact on mental, physical and sexual health. Sexual health issues related to chemsex practice have been described such as difficulties in achieving sober sex, erectile dysfunction or problems with sexual desire.
ObjectivesThe objective of this study was to understand the impact of chemsex on sexual health and sexual response by the participantes of a sexual health program for chemsex users in two Substance Use Disorder Clinics in Madrid.
MethodsQualitative research approach. We analyze an anonymous survey with chemsex users with open answer questions about the impact of chemsex practice on sexual response and sexual health. Data analysis was based on thematic analysis of content.
ResultsSeveral differences were identifed between chemsex and sober sex. In sober sex it can take longer to feel aroused, sexual desire is more context-dependent and more easyly controled. They connect easily with other people needs when they had sober sex. They described difficulties with consent with some sexual practices when they were on drugs. Shame and guilt was associated with chemsex. They describe more arousal, more independent of the erotic context, longer sexual intercourse and delayed ejaculation when they had sex under the influence of drugs.
ConclusionsChemsex is a phenomenon that needs a multidisciplinary approach and mental and sexual health must be taken into account including sexological perspective. Interventions that provide sexual counselling and sexual therapy for chemsex users must be developped.
Disclosure of InterestNone Declared
“Unspecified organic personality and behavioral disorder due to brain damage from HHV-6 encephalitis in child. case report and literature review”
- A. Oliva Lozano, M. A. Morillas Romerosa, P. Herrero Ortega, J. Garde Gonzalez, B. Orgaz Álvarez, J. Curto Ramos, M. Alcamí Pertejo
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S143-S144
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Introduction
We present a case of a 15 year-old boy diagnosed with Unspecified Personality and Beheavioral Disorder Due to Brain Damage from a Human Herpes Virus-6 Encephalitis.
ObjectivesTo describe a case of an Unspecified Organic Personality and Behavioral Disorder secondary to brain damage from Human Herpes Virus-6 (HHV-6) Encephalitis in an 11 year-old childand to review recent literature, in order to improve clinical practice.
MethodsClinical case report and brief review of literature. A bibliographic research was made in the database PubMed, using the terms “Viral Encephalitis” AND “Neuropsychiatric symptoms”; “Viral Encephalitis” AND “Behavioral Disorder”; “Long-Term Neurological Morbidity” AND “Viral Encephalitis”.
Results15 year-old boy diagnosed with Unspecified Personality and Beheavioral Disorder Due to Brain Damage from a Human Herpes Virus-6 Encephalitis, secondary to immunosupression in the context of haematopoietic progenitor transplantation (HPT) at 11 years old. MRI showed supratentorial ventriculomegaly, atrophic changes in encephalon and right hippocampus with subcortical retraction secondary to previous encephalitis. Clinically, main changes appeared in behavior, presenting a serious frontal syndrome with high disinhibition, what implied severe social and academic difficulties. During the outpatient follow-up, the behavioural disorder is being pharmacologically treated with Risperidone 1,5mg per day with a partially favorable evolution. The patient presented intolerance to olanzapine, with an episode of low level of conciuosness after taking it.
Bibliographic research results indicate that the gold standard treatment for behavioral disturbances are antipsychotics. Risperdidone is proven save for treatment in children. Results point out also the importance of an early multidisciplinar intervention, involving family training, rehabilitation resources and curricular adaptations.
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ConclusionsViral encephalitis may have serious neuropsychiatric consequences, especially during childhood while the brain development is not finished. When the neurological damage affects the frontal lobes of the brain, behavioural and personality disturbances are expected and an early multidisciplinar intervention should be considered. Antypsichotics are the gold standard pharmacological treatment for behavioural disturbances. During the scholar period, special curricular adaptations should be done in order to reduce study-related stress.
Disclosure of InterestNone Declared
Rapid improvements in MADRS with zuranolone in major depressive disorder and postpartum depression: results from the LANDSCAPE/NEST clinical development programmes
- A. H. Clayton, K. M. Deligiannidis, J. A. Ramos-Quiroga, R. Lasser, A. J. Sankoh, B. Leclair, M. Kotecha, J. Doherty
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S93-S94
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Introduction
Rapid-acting therapies remain an unmet need in the treatment of major depressive disorder (MDD) and postpartum depression (PPD). Zuranolone (ZRN) is being evaluated as a once-daily, oral, 14-day treatment for adult patients with MDD and PPD.
ObjectivesTo evaluate the efficacy (assessed by Montgomery–Åsberg Depression Rating Scale [MADRS]) and safety of ZRN versus placebo across clinical studies with MDD and PPD.
MethodsIn 5 completed Phase 2/3 placebo-controlled randomised studies of once-daily ZRN 30 or 50 mg in adults with MDD or PPD, improvement in depressive symptoms was assessed at Day 15 (end of 14-day treatment) by change from baseline in MADRS total score and the percentage of patients achieving MADRS response (≥ 50% improvement from baseline in total score) and remission (total score ≤ 10). Safety was assessed throughout.
ResultsPatients in the ZRN arm achieved improvements in depressive symptoms, as assessed by MADRS. Improvements in MADRS total score at Day 15 were observed in all 5 studies and were nominally significant (p < 0.05) versus placebo in 4 studies (Fig. 1). Percentage of patients achieving response and/or remission in the ZRN arm was numerically greater than placebo in all MDD studies and significantly greater than placebo in the PPD studies (Fig. 2 and 3). ZRN was generally well tolerated with consistent safety and tolerability profiles across studies. The most common treatment-emergent adverse events (≥5 % in ZRN treatment arm) were headache, somnolence, dizziness, nausea, sedation, diarrhea, upper respiratory tract infection, fatigue, and COVID-19.
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ConclusionsIn the 5 completed clinical studies, rapid improvement in depressive symptoms assessed by MADRS was observed across studies of adults with MDD and PPD who received a 14-day treatment of once-daily ZRN. In all studies, ZRN was generally well tolerated. These data support further development of ZRN as a potential oral, rapid-acting treatment for patients with MDD or PPD.
FundingThe MDD-201B, MOUNTAIN, and ROBIN studies were sponsored by Sage Therapeutics, Inc.; the WATERFALL and SKYLARK studies were sponsored by Sage Therapeutics, Inc. and Biogen Inc. Medical writing and editorial support were provided by MediTech Media, Ltd, and funded by Sage Therapeutics, Inc. and Biogen Inc.
Disclosure of InterestA. Clayton Shareolder of: Royalties from Ballantine Books/Random House, the Changes in Sexual Functioning Questionnaire, and Guilford Publications; and restricted stock in Euthymics, Mediflix LLC, and S1 Biopharma., Grant / Research support from: Daré Bioscience, Janssen, Otsuka, Praxis Precision Medicines, Relmada Therapeutics, Inc., and Sage Therapeutics, Inc, Consultant of: AbbVie, Inc., Brii Biosciences, Inc., Fabre-Kramer, Janssen Research & Development, LLC, Mind Cure Health, Ovoca Bio plc, Praxis Precision Medicines, PureTech Health, Reunion Neuroscience (formerly Field Trip Health) S1 Biopharma, Sage Therapeutics, Inc., Takeda/Lundbeck, Vella Bioscience, Inc., and WCG MedAvante-ProPhase, K. Deligiannidis Shareolder of: Royalties from an NIH employee invention outside of the submitted work. , Grant / Research support from: Received grants from from NIH and Vorso Corporation. Grants awarded to Zucker Hillside Hospital/Feinstein Institutes for Medical Research during the conduct of the brexanolone injection and zuranolone clinical trials (Sage Therapeutics), Consultant of: Sage Therapeutics, Inc., Brii Biosciences, Inc., and GH Research Ireland Limited, J. A. Ramos-Quiroga Grant / Research support from: The Department of Mental Health chaired by him received unrestricted educational and research support from the following companies in the last 3 years: Janssen-Cilag, Shire, Oryzon, Roche, Psious, and Rubió. Dr Ramos-QuirogaReceived travel awards (air tickets + hotel) for taking part in psychiatric meetings from Janssen-Cilag, Rubió, Shire, Takeda, Shionogi, Bial, and Medice., Consultant of: Was on the speaker’s bureau and/or acted as consultant for Janssen-Cilag, Novartis, Shire, Takeda, Bial, Shionogi, Sincrolab, Novartis, BMS, Medice, Technofarma, Rubió and Raffo in the last 3 years., Speakers bureau of: Was on the speaker’s bureau and/or acted as consultant for Janssen-Cilag, Novartis, Shire, Takeda, Bial, Shionogi, Sincrolab, Novartis, BMS, Medice, Technofarma, Rubió and Raffo in the last 3 years., R. Lasser Shareolder of: May hold stock and/or stock options of Sage Therapeutics, Inc. , Employee of: Employee of Sage Therapeutics, Inc., A. Sankoh Shareolder of: May hold stock and/or stock options of Sage Therapeutics, Inc., Employee of: Employee of Sage Therapeutics, Inc. , B. Leclair Shareolder of: May hold stock of Biogen Inc., Employee of: Employee of Biogen Inc., M. Kotecha Shareolder of: May hold stock of Biogen Inc., Employee of: Employee of Biogen Inc., J. Doherty Shareolder of: May hold stock and/or stock options of Sage Therapeutics, Inc., Employee of: Employee of Sage Therapeutics, Inc.
Psychopharmacology In Myasthenia Gravis Patients: A Case Study
- T. M. Afonso, F. Ferreira, C. Cativo, S. Martins, A. Ramos, M. Pinto
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S274
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Introduction
Myasthenia gravis (MG) is an autoimmune disease that affects the neuromuscular junction. It causes generalized muscle weakness that may include the respiratory muscles, potentially leading to a medical emergency known as a myasthenic crisis. Several medications, including some antipsychotics, have been shown to worsen myasthenia gravis symptoms.
ObjectivesWe aim to summarize the current knowledge on the use of psychopharmacological treatments in patients with MG.
MethodsNon-systematic review of the literature was performed in PubMed/Medscape database. Case report of a patient who was admitted and treated in our inward patient unit.
ResultsWe present a clinical case of a 64-year-old man diagnosed with Bipolar Disease at the age of 18 and recently diagnosed with MG (he was hospitalized in Neurology Department, pyridostigmine was introduced and lithium was reduced to half dose). Three months later he was admitted to the emergency department due to behavior and speech disorganization, persecutory delusional ideas, insomnia and caregiver exhaustion. During his hospitalization lithium was increased to 1200 mg. At day 8 of admission the patient started to show weakness of neck extensor muscles, due to that he was evaluated by neurology, lithium was stopped and haloperidol was increased resulting in clinical improvement.
ConclusionsPsychotropic choice in patients with MG can be challenging due to their anticholinergic properties that can exacerbate MG symptoms with potential deterioration to a myasthenic crisis. There is a great need for evidence-based data on the safety and efficacy of psychotropic medications in MG.
Disclosure of InterestNone Declared
Virtual self-conversation to support people living with obesity when starting their change process towards a healthier lifestyle: Preliminary results of a longitudinal study
- P. Lusilla, D. Anastasiadou, P. Herrero, J. Vazquez, B. Spanlang, M. Slater, J. A. Ramos, G. Parramon, A. Ciudin, M. Comas
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S110
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Introduction
People living with obesity (PLWO) often experience ambivalence when starting their change process towards a healthier lifestyle. Psychological treatments for obesity should resolve this ambivalence and help PLWO to explore their own reasons for change in line with their needs and values, as well as promote self-efficacy. Following the Motivational Interviewing (MI) principles, the SOCRATES project proposes a “virtual self-conversation” to help PLWO to address some of the psychological aspects associated with obesity, such as the lack of awareness about their condition, the impact of the internalization of weight stigma, and the lack of self-efficacy.
ObjectivesWith the current longitudinal study, we aim to explore how the participants’ process of lifestyle change, and how their eating habits and dysfunctional eating patterns change before and after the virtual intervention.
MethodsForty-eight patients with obesity from the Vall d’Hebron University Hospital (Mean age = 19.7 years) were assigned to 3 groups. The Experimental Group 1 (EG1) (N = 21), after completing an intensive training on MI, received a virtual intervention using the “motivational self-conversation” technique. The Experimental Group 2 (EG2) (N = 17) underwent a virtual intervention with a pre-registered psychoeducational dialogue, and the Control Group (CG) (N = 10) followed treatment-as-usual. All participants completed self-reported questionnaires on their motivation to change lifestyle [(Readiness Rulers (RR), Processes of Change questionnaire in weight management (P-W)], eating habits (Habits questionnaire) and dysfunctional eating patterns (Three Factor Eating Questionnaire-18) at baseline (T0), post-intervention (T1), and 4 weeks follow-up (T2). Repeated measures ANOVA was performed for all the questionnaires.
ResultsStatistically significant results were shown regarding motivation to change through the RR and the “evaluation of the consequences of their weight” subscale of P-W across time for the EG1 (p < .05). These results suggest that participants’ motivation to eat healthier and do more exercise, as well as self-awareness about the negative consequences of their condition increased after the virtual intervention.
ConclusionsThe present study showed that this novel virtual intervention might be an effective tool in helping PLWO resolve their ambivalence to change lifestyle and acquire self-awareness about their condition. However, the intervention did not lead to significant changes in other psychological variables, such as lifestyle habits or dysfunctional eating patterns; domains that may be less sensitive to changes over the time, and which may take place once motivation is well-established.
Disclosure of InterestNone Declared
LATE ONSET PSYCHOSIS AND VERY LATE ONSET PSYCHOSIS: WHAT ARE THE POSSIBLE ETHIOLOGIES?
- A. C. Ramos, S. C. Martins, T. M. Afonso, N. B. Santos, P. Gonçalves, T. Maia
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1039
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Introduction
Psychotic symptoms have long been known to show up earlier in life, typically during adolescence and early adulthood. Late Onset Psychosis (LOP), in which symptoms start between 40 and 60 years of age, and Very Late Onset Psychosis (VLOP), in which onset of symptoms happens after 60 years of age, although classically rare, have had a growing prevalence in the last decades.
ObjectivesTo access the definition and main etiologies of LOP and VLOP, based on the current literature.
MethodsNon-systematic review of literature using the terms “late onset psychosis” and “very late onset psychosis”. Case report of a patient who was admitted and treated in our inward patient field.
Results51-year-old female patient. She is divorced (two previous marriages) and has two daughters (26 and 16, respectively). She was brought by police officers because of behavior problems at the shelter where she was living. She was evicted from the house she was living in because of delay in paying the rent. On observation, she verbalizes persecutory and prejudicial delusions and auditory hallucinations on the 2nd and 3rd person (commenting voices) with at least 5 years of duration. She was hospitalized for almost 3 months, with slow but progressive clinical improvement on haloperidol 7,5mg/day. At the date of discharge, she did not spontaneously verbalize her symptoms, although she did not recognize them as delusional. Recent studies have shown that the prevalence of Schizophrenia in the typical age range is 75-80%, which means that an important proportion of diagnosis is made after that age span. Primary causes of LOP and VLOP are schizophrenia (of late onset), schizophrenia-like very late onset psychosis, delusion disorder, unipolar depression with psychotic symptoms and bipolar disorder. Secondary causes should also be considered, such as delirium, dementia (Alzheimer’s, Lewi bodies and vascular), and substances abuse; even more rare, other conditions should be considered, as cerebrovascular accident, encephalitis, epilepsy, and multiple sclerosis.
ConclusionsLOP and VLOP have been a growing diagnosis in the past decades. In the assessment of these patients, we must consider the importance of secondary etiologies besides the primary psychiatric ones. Primary psychosis is a diagnosis of exclusion, and the clinician must rule out secondary causes. Recent data point out these symptoms as markers for an increased risk of dementia in these patients. Further research involving individuals with LOP and VLOPs is required to increase the evidence base for treatment and improve outcomes of care.
Disclosure of InterestNone Declared
Changes in the characteristics of Suicide Attempts during COVID-19 pandemic
- J. Curto Ramos, N. Kishanchandani Chandiramani, M. Torrijos, J. Andreo-Jover, B. Orgaz-Alvarez, M. Velasco, D. García Martínez, G. Juárez, S. Cebolla, P. Aguirre, B. Rodríguez Vega
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S405
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Introduction
Different studies indicate high prevalence’s of suicidal behaviour, anxiety, depression, insomnia, and PTSD associated with the COVID-19 pandemic. There is currently not enough scientific evidence available to analyze the impact that the COVID-19 pandemic has had on the rate of suicide attempts and their characteristics.
ObjectivesTo analyze and compare the characteristics of suicidal behavior (in terms of method, severity, medical damage produced and need for hospitalization) of patients attended during the COVID-19 pandemic compared to previous years.
MethodsA retrospective study was performed based on a standardized data collection of patients attending the University Hospital La Paz between April 2018 and November 2021. 581 patients who attempted suicide at least once were included in this study. We compared the severity using the Beck Suicide Intent Scale. Chi-square ant Student’s t were used to compare clinical characteristics such as medical damage, method of suicide attempt and indication for admission after the attempt, between suicide attempts during the COVID-19 pandemic and previous years.
ResultsOur results suggest that during the COVID-19 pandemic suicide attempts caused more medical damage (p<0.001), had higher severity (p<0.000), and required more admission in Intensive Care Units, General Internal Medicine and Psychiatry compared with pre-Covid years (p<0.000).
ConclusionsThis is the first study in Spain analysing the changes in characteristics of suicide attempts during the COVID-19 pandemic. This has important implications for reducing suicide rates, preventing future attempts, and enabling us to design specific treatments of Suicidal Behaviour.
Disclosure of InterestNone Declared