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193 Beyond Independence: The Empowering Potential of an Assistive Technology Web App to Enrich the Lives of Older Latinos with Functional Disabilities
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- Elsa M. Orellano-Colon, Wency Bonilla-Díaz, Radamés Revilla-Orellano, Jesús Mejías-Castro, Josí Torres-Irizarry, Nixmarie Figueroa-Alvira, Angelis M Fernández-Torres, Bernice Ortiz-Vélez, Gabriela A. Torres-Ferrer, Nina L. Rivera-Rivera
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- Journal:
- Journal of Clinical and Translational Science / Volume 8 / Issue s1 / April 2024
- Published online by Cambridge University Press:
- 03 April 2024, p. 59
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OBJECTIVES/GOALS: The use of assistive technology (AT) devices is known to improve older adults’ independence in daily activities. However, little is known about the impact of using an AT web app in older Latinos’ life. This study aims to evaluate the value and usefulness of the My Assistive Technology Guide web app among older Latinos with physical function disabilities. METHODS/STUDY POPULATION: We employed a convergent parallel mixed-method design with 12 community-living older Latinos from Puerto Rico. Researchers provided training in the use of My Assistive Technology Guide, a Spanish evidence-based web app with detailed information on 97 AT devices and videos of older people using them. Participants were encouraged to use it for 30 days. Afterward, we collected quantitative data using the subjective quality domain of the User Mobile Application Rating Scale (uMARS), followed by qualitative data through individual interviews. Quantitative data were analyzed with descriptive statistics and qualitative data with thematic content analysis. RESULTS/ANTICIPATED RESULTS: My Assistive Technology Guide web app received high ratings in the uMARS subjective quality domain (mean 4.5 [SD 0.5] out of 5), indicating that participants highly valued the usefulness of the web app. Qualitative data fell into four main categories: functional health, meaningful participation, autonomy, and personal growth. DISCUSSION/SIGNIFICANCE: The findings suggest that the AT knowledge provided by the My Assistive Technology Guide web app has the potential to enhance the quality of life of older Latinos in the face of the challenges posed by physical function disabilities as people age.
6 Back-To-Drive Project. Assessment of Fitness-To-Drive in Older and Cognitively Impaired Adult Drivers: Adaptation of the on-Road Driving Observation Schedule to Simulation-Based Environments
- Carolina Diaz-Piedra, Alban Kuqi, Rocio Fernandez-Mendez, Maria Jesus Caurcel, Riccardo Rossi, Leandro L Di Stasi
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 691-692
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Objective:
Cognitive, motor and sensory deficits associated with aging, and with some neurological conditions such as acquired brain injury, may lead to severe driving performance impairment. While rehabilitation and driver assistance technologies may improve driving performance, the assessment of the actual fitness-to-drive of these people is challenging. Office-based neuropsychological/physical tests are considered insufficient to understand one’s ability to drive. The gold standard is the on-road assessment with dual control cars, superior in ecological validity, but expensive, stressful, and potentially unsafe. Valid, more cost-effective solutions for a safer, more accurate, standardized assessment of fitness-to-drive are currently needed. Modern and sensorized driving simulators offer key advantages, such as the possibility of exposing drivers to several relevant driving scenarios, including hazard situations, and of assessing their driving performance without being physically at risk. However, the extraction and direct interpretation of existing simulator-produced data may require specialized data processing skills or simulation expertise. To overcome this, we have developed an easy-to-use, pencil-and-paper observational instrument. The Sim-DOS is an adaptation of the widely used instrument to assess “natural driving”, the Driving Observation Schedule (DOS; Vlahodimitrakou et al., 2013).
Participants and Methods:Via expert consensus, DOS targeted behaviors were adapted to a simulated-based environment (signaling, observation of environment, speed regulation, slow or unsafe reaction, distance interpretation, vehicle/lane positioning), and the Sim-DOS scores calculation (based on errors while doing such behaviors) was adapted from DOS to include hazard situations (HS, 0-100) and free driving (FD, 0-°°) scores. The instrument was then piloted with a sample of 35 older adults, along with the collection of simulator-produced data on number of harsh events and driving speed. Participants drove two consecutive 20-minutes long scenarios, with low and high traffic density (LTD, HTD). In each scenario, there were periods with and without potentially hazard situations.
Results:Assessments were performed by two independent trained observers, producing substantial inter-rater reliability (intra-class correlation coefficients above 0.94). Participants (70.7±4.1 years old, 60% male, 46.1±6.7 years of driving experience) were mostly regular drivers (74%). However, psychomotor skills of the majority were compromised, with only one participant being above the 80th percentile in the reaction times test of the national mandatory driving assessment. When exposed to hazard situations, most of the participants (94.1%) did not perform well, independently of traffic density, with average Sim-DOS-HS scores of 87.1±9.7 (out of 100, t-values>7.3, p-values<.05).
Compared to LTD scenarios, in HTD scenarios participants drove less smoothly (HTD:0.97±1.24 vs. LTD:0.33±0.58 of harsh events, Z=3.1, p<.05). However, they also drove slower (HTD:82.41±27.43 vs. LTD:103.55±14.61 km/h, t=5.2, p<.05), improving their ability to manage hazard situations, and therefore producing higher than expected Sim-DOS scores (HTD:87.05±10.28). During free driving, participants performed worse under LTD conditions (Sim-DOS-FD scores: HTD:11.68±6.20 vs. LTD:14.40±9.58, t=2.15, p<.05) as they drove at higher speed (HTD:85.01±24.28 vs. LTD:104.70±11.94 km/h, t=5.8, p<.05), although they did it more smoothly (HTD:1.94±3.74 vs. LTD:0.45±0.74 harsh events, Z=2.65, p<.05).
Conclusions:Our study provides a validated driving assessment tool for use in driving simulators that will allow a safer, more ecologic, holistic and informative evaluation of the fitness-to-drive of older adults and neurological patients.
8 Incident TBI among a Nationwide Cohort of US Older Adults
- Erica Kornblith, Kristine Yaffe, W. John Boscardin, L. Grisell Diaz-Ramirez, Raquel C. Gardner
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 120-121
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Objective:
Traumatic brain injury (TBI), very common in the United States (US) and occurring at highest rates in older adulthood, is a documented risk factor for cognitive impairment and dementia. However, the full scope of the problem is unknown, as comparative incidence of TBI among older adults is poorly characterized. Moreover, the effect of demographics (race/ethnicity, sex) and cognitive and medical status, as well as education, socioeconomic status, and other social determinants of health (SDOH) on TBI risk is not well understood. We aimed to explore the impact of demographics, cognitive and medical status, and SDOH on vulnerability to new TBIs among older adults.
Participants and Methods:Enrollees 65 and older in the nationally representative Health and Retirement Study (HRS) who consented to have their survey data linked to Medicare claims and had not experienced a head injury prior to HRS enrollment were studied. We used claims data 2000-2018 to obtain incident TBI diagnoses and harnessed the detailed demographic, cognitive, medical, and SDOH information available in the HRS. Incident TBI was defined using inpatient and outpatient International Classification of Disease (ICD 9 and 10) codes received the same day as an emergency room (ER) visit code and a computed tomography (CT) scan code, occurring after the enrollee’s baseline HRS interview. We calculated descriptive statistics and bivariate associations for TBI status with demographic and SDOH characteristics measured at baseline using sample weights to account for the complex survey design.
Results:Of respondents meeting inclusion criteria (n=9273) during the study follow-up period of 18 years, 8.9% received emergency room treatment for a TBI. Older adults who experienced TBI during the study period were more likely to be female (p=0.0006), and white (p=0.0001), to have normal cognition (vs. cognitive impairment or dementia, p=0.0011), higher education (p<0.0001), and higher income (p=0.01). Having lung disease (p=0.0003) or functional impairment (p=0.03) at baseline were protective against experiencing a TBI.
Conclusions:Our results suggest that almost 9% of US older adults received ER treatment for a new TBI during the 18-year study period, and that race, sex, and SDOH factors may increase risk for, or be protective against, TBI. This novel investigation into the impact of demographics and SDOH on incident TBI suggests access to care may impact who gets treatment for TBI. Further study is indicated and may lead to opportunities for both targeted intervention (e.g., primary TBI prevention) to groups most at risk as well as identification and mollification of the most relevant structural and contextual factors (e.g., access to care) to reduce risk of TBI among older adults.
27 Clinical Symptoms, Cognitive Functioning, and Brain Health in Agricultural Workers
- Jazmin M. Diaz, Stephen R. Kellam, Emily T. Sturm, Max Henneke, Emily Pehlke, John R. Duffy, Andrea Mendez-Colmenares, Agnieszka Z. Burzynska, Lorann Stallones, Michael L. Thomas
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 903
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Objective:
Agricultural workers are immersed in environments associated with increased risk for adverse psychiatric and neurological outcomes. Agricultural work-related risks to brain health include exposure to pesticides, heavy metals, and organic dust. Despite this, there is a gap in our understanding of the underlying brain systems impacted by these risks. This study explores clinical and cognitive domains, and functional brain activity in agricultural workers. We hypothesized that a history of agricultural work-related risks would be associated with poorer clinical and cognitive outcomes as well as changes in functional brain activity within cortico-striatal regions.
Participants and Methods:The sample comprised 17 agricultural workers and a comparison group of 45 non-agricultural workers recruited in the Northern Colorado area. All participants identified as White and non-Hispanic. The mean age of participants was 51.7 years (SD = 21.4, range 18-77), 60% identified as female, and 37% identified as male. Participants completed the National Institute of Health Toolbox (NIH Toolbox) and Montreal Cognitive Assessment (MoCA) on their first visit. During the second visit, they completed NIH Patient-Reported Outcomes Measurement Information System (PROMIS) measures and underwent functional magnetic resonance imaging (fMRI; N = 15 agriculture and N = 35 non-agriculture) while completing a working memory task (Sternberg). Blood oxygen-level dependent (BOLD) response was compared between participants. Given the small sample size, the whole brain voxel-wise group comparison threshold was set at alpha = .05, but not otherwise corrected for multiple comparisons. Cohen’s d effect sizes were estimated for all voxels.
Results:Analyses of cognitive scores showed significant deficits in episodic memory for the agricultural work group. Additionally, the agricultural work group scored higher on measures of self-reported anger, cognitive concerns, and social participation. Analyses of fMRI data showed increased BOLD activity around the orbitofrontal cortex (medium to large effects) and bilaterally in the entorhinal cortex (large effects) for the agricultural work group. The agricultural work group also showed decreased BOLD activity in the cerebellum and basal ganglia (medium to large effects).
Conclusions:To our knowledge, this study provides the first-ever evidence showing differences in brain activity associated with a history of working in agriculture. These findings of poorer memory, concerns about cognitive functioning, and increased anger suggest clinical relevance. Social participation associated with agricultural work should be explored as a potential protective factor for cognition and brain health. Brain imaging data analyses showed increased activation in areas associated with motor functioning, cognitive control, and emotion. These findings are limited by small sample size, lack of diversity in our sample, and coarsely defined risk. Despite these limitations, the results are consistent with an overall concern that risks associated with agricultural work can lead to cognitive and psychiatric harm via changes in brain health. Replications and future studies with larger sample sizes, more diverse participants, and more accurately defined risks (e.g., pesticide exposure) are needed.
Independent and joint contributions of physical disability and chronic pain to incident opioid use disorder and opioid overdose among Medicaid patients
- Katherine L. Hoffman, Floriana Milazzo, Nicholas T. Williams, Hillary Samples, Mark Olfson, Ivan Diaz, Lisa Doan, Magdalena Cerda, Stephen Crystal, Kara E. Rudolph
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- Psychological Medicine / Volume 54 / Issue 7 / May 2024
- Published online by Cambridge University Press:
- 17 November 2023, pp. 1419-1430
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Background
Chronic pain has been extensively explored as a risk factor for opioid misuse, resulting in increased focus on opioid prescribing practices for individuals with such conditions. Physical disability sometimes co-occurs with chronic pain but may also represent an independent risk factor for opioid misuse. However, previous research has not disentangled whether disability contributes to risk independent of chronic pain.
MethodsHere, we estimate the independent and joint adjusted associations between having a physical disability and co-occurring chronic pain condition at time of Medicaid enrollment on subsequent 18-month risk of incident opioid use disorder (OUD) and non-fatal, unintentional opioid overdose among non-elderly, adult Medicaid beneficiaries (2016–2019).
ResultsWe find robust evidence that having a physical disability approximately doubles the risk of incident OUD or opioid overdose, and physical disability co-occurring with chronic pain increases the risks approximately sixfold as compared to having neither chronic pain nor disability. In absolute numbers, those with neither a physical disability nor chronic pain condition have a 1.8% adjusted risk of incident OUD over 18 months of follow-up, those with physical disability alone have an 2.9% incident risk, those with chronic pain alone have a 3.6% incident risk, and those with co-occurring physical disability and chronic pain have a 11.1% incident risk.
ConclusionsThese findings suggest that those with a physical disability should receive increased attention from the medical and healthcare communities to reduce their risk of opioid misuse and attendant negative outcomes.
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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- 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.
A causal roadmap for generating high-quality real-world evidence
- Lauren E. Dang, Susan Gruber, Hana Lee, Issa J. Dahabreh, Elizabeth A. Stuart, Brian D. Williamson, Richard Wyss, Iván Díaz, Debashis Ghosh, Emre Kıcıman, Demissie Alemayehu, Katherine L. Hoffman, Carla Y. Vossen, Raymond A. Huml, Henrik Ravn, Kajsa Kvist, Richard Pratley, Mei-Chiung Shih, Gene Pennello, David Martin, Salina P. Waddy, Charles E. Barr, Mouna Akacha, John B. Buse, Mark van der Laan, Maya Petersen
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- Journal of Clinical and Translational Science / Volume 7 / Issue 1 / 2023
- Published online by Cambridge University Press:
- 22 September 2023, e212
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Increasing emphasis on the use of real-world evidence (RWE) to support clinical policy and regulatory decision-making has led to a proliferation of guidance, advice, and frameworks from regulatory agencies, academia, professional societies, and industry. A broad spectrum of studies use real-world data (RWD) to produce RWE, ranging from randomized trials with outcomes assessed using RWD to fully observational studies. Yet, many proposals for generating RWE lack sufficient detail, and many analyses of RWD suffer from implausible assumptions, other methodological flaws, or inappropriate interpretations. The Causal Roadmap is an explicit, itemized, iterative process that guides investigators to prespecify study design and analysis plans; it addresses a wide range of guidance within a single framework. By supporting the transparent evaluation of causal assumptions and facilitating objective comparisons of design and analysis choices based on prespecified criteria, the Roadmap can help investigators to evaluate the quality of evidence that a given study is likely to produce, specify a study to generate high-quality RWE, and communicate effectively with regulatory agencies and other stakeholders. This paper aims to disseminate and extend the Causal Roadmap framework for use by clinical and translational researchers; three companion papers demonstrate applications of the Causal Roadmap for specific use cases.
The Effect of Genetic Predisposition to Alzheimer’s Disease and Related Traits on Recruitment Bias in a Study of Cognitive Aging
- Lina M. Gomez, Brittany L. Mitchell, Kerrie McAloney, Jessica Adsett, Natalie Garden, Madeline Wood, Santiago Diaz-Torres, Luis M. Garcia-Marin, Michael Breakspear, Nicholas G. Martin, Michelle K. Lupton
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- Twin Research and Human Genetics / Volume 26 / Issue 3 / June 2023
- Published online by Cambridge University Press:
- 21 July 2023, pp. 209-214
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The recruitment of participants for research studies may be subject to bias. The Prospective Imaging Study of Ageing (PISA) aims to characterize the phenotype and natural history of healthy adult Australians at high future risk of Alzheimer’s disease (AD). Participants approached to take part in PISA were selected from existing cohort studies with available genomewide genetic data for both successfully and unsuccessfully recruited participants, allowing us to investigate the genetic contribution to voluntary recruitment, including the genetic predisposition to AD. We use a polygenic risk score (PRS) approach to test to what extent the genetic risk for AD, and related risk factors predict participation in PISA. We did not identify a significant association of genetic risk for AD with study participation, but we did identify significant associations with PRS for key causal risk factors for AD, IQ, household income and years of education. We also found that older and female participants were more likely to take part in the study. Our findings highlight the importance of considering bias in key risk factors for AD in the recruitment of individuals for cohort studies.
Night-time/daytime Protein S100B serum levels in paranoid schizophrenic patients
- E. Diaz-Mesa, A. Morera-Fumero, L. Torres-Tejera, A. Crisostomo-Siverio, P. Abreu-Gonzalez, R. Zuñiga-Costa, S. Yelmo-Cruz, R. Cejas-Mendez, C. Rodriguez-Jimenez, L. Fernandez-Lopez, M. Henry-Benitez
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S445-S446
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Introduction
S100B is a calcium-binding astrocyte-specific cytokine, that is considered a biomarker of neurodegeneration; which may be involved in the imbalance of the inflammatory response observed in several brain disorders, including major depression and schizophrenia. Two meta-analyses have reported higher serum levels of S100B in patients with schizophrenia respect to healthy controls.
Different studies have described circadian and seasonal variations of biological variables, such as melatonin or cortisol. It has been reported that there is not circadian rhythm of S100B blood levels in healthy subjects. However, it is not known whether there are circadian oscillations in S100B blood concentrations in patients with schizophrenia.
ObjectivesThe aim of this study is to describe S100B serum levels in patients with schizophrenia and to analyse whether they follow a circadian rhythm.
MethodsOur sample consists in 47 patients in acute phase and stabilized status. Blood samples were collected at 12:00 and 00:00 hours by venipuncture. Serum levels of Protein S100B were measured three times: at admission, discharge and three months after discharge. Protein S100B was measured by means of ELISA (Enzyme-linked immunosorbent assay) techniques.
Results12:00 24:00 P ADMISSION 132,95±199,27 85,85±121,44 0,004 DISCHARGE 73,65±71,744 75,80±123,628 0,070 CONTROL 43,49±34,60 40,14±23,08 0,47 P global P Admission Vs. Discharge P Admission Vs. Control P Discharge Vs. Control 0,97 There is a significance difference between 12:00 and 24:00 at admission for the Protein S100B.However, these difference did not occur at discharge and at three months after discharge.It can be interpreted as there is a circadian rhythm of Protein S100B when the patient has got a psychotic outbreak and disappears at discharge and when is psychopathologically stable.
ConclusionsWith respect to our results we can hypothesize that schizophrenic patients in acute relapse present circadian S100B rhythm that is not present when the patients are clinically stable.Furthermore, the decrease of serum protein S100B levels at discharge is indicative of a reduction of the cerebral inflammation, thus it can be a biomarker of cerebral inflammation and this reduction can be the effect of the treatment. Finally, its circadianity could be a guide of this process and clinical improvement.
Disclosure of InterestNone Declared
Thyroid Stimulating Hormone circadian variations in paranoid schizophrenic psychosis between acute and stable phases. A comparative study.
- A. Marcos-Rodrigo, A. L. Morera-Fumero, P. Abreu-Gonzalez, E. Diaz-Mesa, L. Fernandez-Lopez, J. J. Tascon-Cervera
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S186
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Introduction
Day-night changes in several molecules are studied as biomarkers of circadian rhytms (Morera-Fumero, A. L. et al. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2017; 75 207-212). Circadian rhythmicity of the pituitary-thyroid axis has been proven in healthy individuals, with a Thyroid Stimulating Hormone (TSH) peak in serum around midnight and peaks during day hours (Bellastella, G. et al. Life 2021; 11(5), 426). A recent meta-analysis has reported differences in serum TSH levels between first-episode psychosis and multiple-episode schizophrenia (Misiak, B. et al. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2021; 111, 110402). However, studies assessing quantitative circadian variations on TSH serum in schizophrenic patients are scant.
ObjectivesComparing serum TSH levels at two different times of the day (12:00 and 24:00 hours) and the differences between the acute (hospital admission) and recovered phase (hospital discharge) of the disease.
MethodsFourteen male patients (age 26,8±9,3 years) with the diagnosis of paranoid schizophrenia psychosis according to the DSM-IV partake in the study. Patients were admitted to the University Hospital of the Canary Islands psychiatric room because of acute relapse. Blood samples were taken in the first 24 h of admission and at 24 h. before discharge. All patients gave written consent to participate in the research study. Serum TSH was determined by ELISA methods. Paired sample t-tests were performed between TSH serum levels at admission and discharge at 12:00 and 24:00 hours. Statistical analyses were performed using IBM® SPSS® Statistics 25 software for MAC (IBM Corporation 1989, 2017).
ResultsThere were statistical differences between the 12:00 h and the 24:00 h of the TSH serum levels at admission (12:00: 145,856±156,961vs. 00:00: 192,006± 122,757, p = 0.04); TSH discharge, (12:00: 134,483±72,882vs 00:00: 244,214±148,697, p = 0.002). There were no statistical differences between the 12:00 TSH levels at admission and discharge (145,856±156,961 vs. 134,483± 72,882, p = 0.66). The 24:00 h comparison of TSH levels neither elicited significant results (admission: 192,006±122,757 vs. discharge: 244,214± 148,697, p = 0.15).
ConclusionsSchizophrenic patients undergo TSH serum changes in a circadian pattern during the acute and stable phases of the disease; nevertheless, they experience smaller deviations during the acute phase. Higher levels of TSH were observed around midnight, as it happens in healthy individuals, with higher peaks during the stable phase compared to the acute one.
Disclosure of InterestNone Declared
The Positive and Negative Syndrome Scale for Schizophrenia Autism Severity Scale (PAUSS) in a sample of early-onset psychosis
- J. Suárez Campayo, L. Pina-Camacho, J. Merchán-Naranjo, C. Ordas, V. Cavone, R. Panadero, G. Sugranyes, I. Baeza, J. Castro-Fornieles, E. de la Serna, C. Arango, C. M. Diaz Caneja
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S443-S444
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Introduction
The Positive and Negative Syndrome Scale for Schizophrenia Autism Severity Scale (PAUSS) scale can be derived from the Positive and Negative Schizophrenia Syndrome Scale, enabling an assessment of psychotic and autistic dimensions with a single tool.
ObjectivesThe aim of the study was to investigate the prevalence of autistic traits and the diagnostic, developmental, clinical, and functional correlates of this phenotype in a sample of early-onset psychosis (onset before age 18 years; EOP).
MethodsProspective observational 2 year- follow-up study in a sample of young people with a first-episode of EOP. Demographic, perinatal, developmental, cognitive, clinical, and functional data were collected. PAUSS total scores and socio-communication and repetitive behaviors subscores were calculated. We used the proposed cut-off points for adult populations to define prevalence of autistic traits (PAUSS≥30). Subgroups of patients with and without autistic traits were identified based on the total PAUSS terciles. We used the Cronbach’s alpha test to assess the PAUSS internal consistency. Linear mixed models were performed to compare changes in PAUSS during follow-up between diagnostic subgroups [i.e., non-affective psychosis (including schizophrenia and schizophreniform disorder), affective psychosis (including bipolar disorder, schizoaffective disorder and major depressive disorder with psychotic features), and other psychosis (including brief psychotic disorder and psychosis not otherwise specified)]. Developmental, clinical, and functional variables were compared between subgroups with and without autistic traits with logistic regression analysis.
Results248 patients with PIT were included (age 15.69 ± 1.86 years, 38.65% female). The prevalence of autistic traits in EOP was 7.04%, with significantly higher prevalence in the group of patients with non-affective psychosis (15.20%) than in other diagnostic groups. PAUSS scores significantly decreased over time, with no significant differences in the trajectories of the total PAUSS and its subscores among the three diagnostic subgroups during the 2-year follow-up. The PAUSS showed good internal consistency at all visits (Cronbach’s alpha > 0,88). Patients with autistic traits presented longer duration of untreated psychosis, longer duration of the first inpatient admission, poorer social adjustment in childhood, poorer functionality, greater clinical severity, and poorer response to treatment during follow-up than patients without autistic traits.
ConclusionsThe PAUSS is an easy-to-apply tool that can be useful to differentiate psychosis subgroups with worse prognosis.
Disclosure of InterestJ. Suárez Campayo: None Declared, L. Pina-Camacho: None Declared, J. Merchán-Naranjo: None Declared, C. Ordas: None Declared, V. Cavone: None Declared, R. Panadero: None Declared, G. Sugranyes: None Declared, I. Baeza: None Declared, J. Castro-Fornieles: None Declared, E. de la Serna: None Declared, C. Arango Consultant of: Acadia, Angelini, Gedeon Richter, Janssen Cilag, Lundbeck, Minerva, Otsuka, Roche, Sage, Servier, Shire, Schering Plough, Sumitomo Dainippon Pharma, Sunovion and Takeda, C. Diaz Caneja Grant / Research support from: Exeltis and Angelini
Characteristics of early and late onset pediatric depression
- L. Díaz-Castro, K. L. Hoffman
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S729
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Introduction
Depression, anxiety and suicide are serious psychiatric conditions that affect Mexican youth (Institute for Health Metrics and Evaluation, IHME, 2022), with depression showing a prevalence greater than 16%. Suicide ranks as the second most important cause of deathin this age group, (6/100,000 deaths), the first being violent deaths by firearms (15/100,000 deaths;IHME, 2022).
ObjectivesTo identify factors related to age of onset of pediatric depression.
MethodsA cross-sectional study was carried out during 2018-2020 in two Children’s Psychiatric Hospitals in Mexico City. Data were collected using a survey method. All participants signed an informed consent form. We applied Cox hazard analysis, with the hazard event being the onset of psychiatric symptoms.
ResultsData from 400 patients were analyzed, 148 girls (37%) and 252 boys (63%). Mean patient age was 12 years, and mean age of symptom onset was 8 years. The most common diagnoses were hyperkinetic disorder (51%), depression (34%), and anxiety (7.8%). Age of depression onset was significantly reduced in association with male sex (HR=1.46), family history of psychiatric disorder (familial depression HR=2.34; hyperkinetic disorder HR=2.67; psychoactive substance abuse HR=5.09), and certain medical comorbidities (asthma HR=6.41; enuresis HR=3.03). These same covariates were not associated with age of onset of hyperkinetic disorder or anxiety.
ConclusionsThese analyses indicate that a subgroup of pediatric depression has an early onset and is associated with familial hyperkinetic disorder and depression, the male sex, and certain medical comorbidities.
Disclosure of InterestNone Declared
A clinical case of anosognosia in a CADASIL disease.
- E. Talaya Navarro, L. Gallardo Borge, E. Gómez Fernández, R. Fernández Díaz, L. Al Chaal Marcos, E. Rybak Koite
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1000-S1001
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Introduction
CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is a cerebrovascular disease, tht appears in 1.98/100,000. It´s caused by a mutation of the Notch3 gene and is characterized by accumulation of granular osmiophilic material in the middle layer of the small and median sized cerebral arteries.
Sypmtoms are migraine, recurrent cerebral ischemic episodes, dementia, neuropsychiatric disorders (anosognosia, character disorders, apathy and cognitive impairment). It usually appears between 30-60 years, although there is an important variability. There is no curative treatment, only palliative.
ObjectivesClinical review of anosognosia and its presence in CADASIL disease.
MethodsClinical case and literatura review.
ResultsWe presented the clinical case of a 68-year-old man, who was diagnosed with CADASIL after a stroke 3 years earlier. In his family, his brother was diagnosed also with CADASIL. The patient had previously presented disturbances in impulse control (hyperorality) and important executive failures. He currently presented anosognosia, deficits in verbal memory, spatial perception and executive functions, in addition to behavioral alterations and apathy. Due to these deficits he was prohibited from certain activities (driving, hunting).
The patient was not aware of these deficits and becouse of his “no knowledge of his illness”, he disagreed with these prohibitions, so he showed rage and anger at the impotence of not understanding why certain actions are prohibited.
In the consultation, mnesic errors and in naming objects were also objectified, for which it was recommended to carry out cognitive stimulation on a daily basis. In addition, he presented failures of sphincter incontinence, especially of urine and occasionally also of the anal sphincter. He had previously had episodes of myoclonus or fasciculations.
A genetic study by massive sequencing confirmed the heterozygous presence of the pathogenic variant c.1819C>T p.(Arg607Cys) in the NOTCH3 gene, a CADASIL disease.
ConclusionsThe anosognosia that many patients with CADASIL disease present constitutes a problem because it contributes to the delay in consultation and, therefore, the delay in the adequate diagnostic approach, therapeutic possibilities and family genetic counseling. Due in part to anosognosia, CADASIL is considered an underdiagnosed entity. Due to the lack of awareness and the consequent lack of recognition of the deficit, these people are often seen as stubborn and difficult to deal with by people in their immediate environment.
In addition, there is general difficulty in the rehabilitation process, since patients do not think the neccesity to be treated. This can generate frustration and despair both in their relatives and in the health personnel.
For all these reasons, both in anosognosia and in CADASIL disease, adequate psychological support is needed for both those affected and their families.
Disclosure of InterestNone Declared
Study of mentalizing ability in borderline personality disorder: relationship with impulsivity
- A. Galvez-Merlin, P. de la Higuera-Gonzalez, J. M. Lopez-Villatoro, A. de la Torre-Luque, M. Diaz-Marsa, J. L. Carrasco
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S114
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Introduction
Borderline personality disorder (BPD) is a severe mental disorder characterized by affective, behavioral and relational instability, along with interpersonal hypersensitivity and unstable affective relationships (APA 2013). Poor interpersonal functioning could be associated with critical deficits in the ability to mentalize in these patients, together with high levels of impulsivity. Although most studies have described hypermentalization deficits among BPD patients (Bora Psychol Med 2021;51 2541-2551), existing literature is still scarce on this aspect, as well as its relationship with the impulsive behavior.
Objectives1) to assess specific mentalizing deficits in BPD compared to healthy controls in a complex ecological mentalization task; 2) evaluate the relationship between mentalization and impulsivity in BPD.
Methods63 patients diagnosed with borderline personality disorder and 31 control subjects were studied using the Movie for the Assessment of Social Cognition -MASC- (Dziobeck et al. J Autism Dev Disord 2006; 36 623-636) and the Barratt Impulsivity Scale -BIS-11- (Patton et al. J Clin Psychol 1995; 51 768-774), as well as other sociodemographic and clinical factors. The clinical research study was approved by the Clinical Research Ethics Committee of the Hospital Clínico San Carlos (Madrid, Spain).
ResultsThe results showed significant differences in the scores related to correct mentalization, hypomentalization, and non-mentalizing responses between patients and controls, with BPD patients showing worse performance. A significant negative relationship was also observed between impulsivity scores and correct mentalizing responses in BPD patients.
ConclusionsThe results showed a deficit in the ability to mentalize in BPD patients, compared to control subjects, characterized by a hypomentalization and an absence of mentalization. Likewise, this deficit in mentalization ability was related to greater impulsive behavior in patients. These results would be consistent with the hyperarousal hypothesis in BPD, which would reduce inhibitory control, causing mentalization deficits (Euler et al. J Pers Disord. 2021; 35 177-193). Future studies will try to associate specific impulsive behaviors associated with the characteristics of hypomentalization and absence of mentalization observed in our results.
Disclosure of InterestNone Declared
Daytime/nighttime levels of serum IL-33 in schizophrenia at hospital admission and before discharge
- J. J. Tascon-Cervera, A. Morera-Fumero, P. Abreu-Gonzalez, E. Diaz-Mesa, M. R. Cejas-Mendez, S. Yelmo-Cruz, L. Fernandez-Lopez, A. Marcos-Rodrigo
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1062-S1063
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Introduction
It has been reported an inflammatory state in schizophrenia, with altered levels of some cytokines (Zhou et al. Cytokine 2021; 141:155441). Recent publications have shown the importance of IL- 33, a member of the IL-1 cytokine family which acts as an alarmin (Han et al. Neurosci Bull 2011; 27, 351-357). The role of this cytokine as a biomarker has been investigated in schizophrenia (Koricanac et al. Front Psychiatry 2022; 13, 925757). However, results are controversial. Some studies have not found significant associations between IL-33 and chronic schizophrenia (Campos-Carli et al. Compr Psychiatry 2017; 74 96-101), while other papers have reported increased levels (Kozlowska et. al. J Psychiatr Res. 2021; 138 380-387). In all these studies, levels of IL-33 were measured in a single daily measure, so that it has not been studied if IL-33 has changes during hospitalization.
ObjectivesTo study the serum level of IL-33 at 12:00 and 00:00 hours in schizophrenia patients at admission and before hospital discharge.
MethodsFifteen inpatients with diagnosis of paranoid schizophrenia according to ICD-10 criteria were studied. Patients were hospitalized at the University Hospital of the Canary Islands psychiatric ward because of an acute relapse. A total of four blood samples were taken from each patient: at 12:00 and 00:00 hours the day after admission and at 12:00 and 00:00 hours the day before discharge. Serum IL-33 levels were measured by ELISA techniques. Daytime and nighttime IL-33 serum levels at admission and discharge were compared using a non-parametric Wilcoxon signed-rank test.
ResultsIn table 1 the results of the comparison of IL-33 at admission and discharge are presented. There is a significant reduction of IL-33 levels at 00:00 h. at discharge in comparison with the IL-33 levels at 00:00 h. at admission (p=0.028). No other statistically significant differences were observed.
Serum IL-33 Admission Mean±sd Discharge Mean±sd Z P value 12:00 h. 191.0±348.7 247.0±378.2 -0.166 0.868 00:00 h. 218.8±370.3 153.6±275.7 -2.203 0.028 ConclusionsThe decrease of serum IL-33 at 00:00 at discharge compared to the 00:00 IL-33 serum level at admission points to the utility of this biomarker as a surrogate of brain inflammation.
Disclosure of InterestNone Declared
Anorexia nervosa and Wernicke-Korsakoff syndrome: case report an literature review
- S. Yelmo-Cruz, J. J. Tascon-Cervera, I. Perez-Sagaseta, C. Cardenes-Moreno, L. Torres-Tejera, A. Crisostomo-Siverio, E. Diaz-Mesa, J. Dorta-Gonzalez, M. Paniagua-Gonzalez, S. Canessa, A. L. Morera-Fumero, M. R. Cejas-Mendez
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S424
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Introduction
Wenicke-Korsakoff syndrome (WKS) is a neurological disorder caused by thiamine deficiency. Wernicke Encephalopathy (WE) is the acute phase and the chronic phase is called Korsakoff-syndrome (KS).
ObjectivesTo review the current literature on the management of WKS in a patient with anorexia nervosa.
MethodsWe report the case of a 63-year-old woman admitted to the Psychiatry Unit after weight loss in the last 3 months (from 39 kg to 33,500 kg). She only made one meal a day. By exploration and analysis, neoplastic disease is ruled out (thoraco-abdomino-pelvic CT without pathological findings). She has maintained restrictive intakes for more than 30 years. A long-term anorexia nervosa (AN) is suspected, with a worsening of restrictive behavior in recent months. Upon admission, she has a weight of 33,500 kg and a BMI of 14,10. She has a left palpebral ptosis and an alteration of the anterograde memory as well as affectation of executive functions. Progressive oral diet is started, and due to the suspicion of a WKS, thiamine ev is started for a week and then continued with oral thiamine. Thiamine levels are extracted once the ev treatment has begun, so we do not have previous levels to know if they were decreased. Brain MRI shows bilateral hyperintensities in white matter and at supratentorial level in T2 and FLAIR. After a month and a half of admission, the patient has progressively regained weight, has managed to make adequate intakes and has improvement in memory.
ResultsAn adverse consequence of severe malnutrition in AN due to severe food restriction and purging behavior is thiamine deficiency, and also global cerebral atrophy and concomitant cognitive deficits can be found. Thiamine deficiency occurs in 38% of individuals with AN and is often unrecognized. WKS is caused by thiamine deficiency, and WE is the acute phase of this syndrome (presentation of triad can vary). The chronic phase is KS and consists in amnesia with confabulations. WKS typically develops after malnourishment in alcoholic patients but can be associated in nonalcoholic such as prolonged intravenous feeding, hyperemesis, anorexia nervosa, refeeding after starvation, thyrotoxicosis, malabsorption syndromes; hemodialysis; peritoneal dialysis; AIDS; malignancy. WKS is a clinical diagnosis, and no specific abnormalities have been found in cerebrospinal fluid, brain imaging or electroencephalograms. MRI has a sensitivity of 53%, but high specificity of 93%, and shows an increased signal in T2 and FLAIR sequences, bilaterally symmetrical in the paraventricular regions of the thalamus, the hypothalamus, mamillary bodies, the periaquedutal region, the floor of the fourth ventricle and midline cerebellum.
ConclusionsIf the disorder is suspected, thiamine should be initiated immediately in order to prevent irreversible brain damage, with an estimated mortality rate of about 20%, or to the chronic form of the WE in up to 85% of survivors
Disclosure of InterestNone Declared
Tobacco use in first-episode psychosis, a multinational EU-GEI study
- T. Sánchez-Gutiérrez, E. Rodríguez-Toscano, L. Roldán, L. Ferraro, M. Parellada, A. Calvo, G. López, M. Rapado-Castro, D. La Barbera, C. La Cascia, G. Tripoli, M. Di Forti, R. M. Murray, D. Quattrone, C. Morgan, J. van Os, P. García-Portilla, S. Al-Halabí, J. Bobes, L. de Haan, M. Bernardo, J. L. Santos, J. Sanjuán, M. Arrojo, A. Ferchiou, A. Szoke, B. P. Rutten, S. Stilo, G. D'Andrea, I. Tarricone, EU-GEI WP2 Group, C. M. Díaz-Caneja, C. Arango
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- Psychological Medicine / Volume 53 / Issue 15 / November 2023
- Published online by Cambridge University Press:
- 26 April 2023, pp. 7265-7276
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Background
Tobacco is a highly prevalent substance of abuse in patients with psychosis. Previous studies have reported an association between tobacco use and schizophrenia. The aim of this study was to analyze the relationship between tobacco use and first-episode psychosis (FEP), age at onset of psychosis, and specific diagnosis of psychosis.
MethodsThe sample consisted of 1105 FEP patients and 1355 controls from the European Network of National Schizophrenia Networks Studying Gene–Environment Interactions (EU-GEI) study. We assessed substance use with the Tobacco and Alcohol Questionnaire and performed a series of regression analyses using case-control status, age of onset of psychosis, and diagnosis as outcomes and tobacco use and frequency of tobacco use as predictors. Analyses were adjusted for sociodemographic characteristics, alcohol, and cannabis use.
ResultsAfter controlling for cannabis use, FEP patients were 2.6 times more likely to use tobacco [p ⩽ 0.001; adjusted odds ratio (AOR) 2.6; 95% confidence interval (CI) [2.1–3.2]] and 1.7 times more likely to smoke 20 or more cigarettes a day (p = 0.003; AOR 1.7; 95% CI [1.2–2.4]) than controls. Tobacco use was associated with an earlier age at psychosis onset (β = −2.3; p ⩽ 0.001; 95% CI [−3.7 to −0.9]) and was 1.3 times more frequent in FEP patients with a diagnosis of schizophrenia than in other diagnoses of psychosis (AOR 1.3; 95% CI [1.0–1.8]); however, these results were no longer significant after controlling for cannabis use.
ConclusionsTobacco and heavy-tobacco use are associated with increased odds of FEP. These findings further support the relevance of tobacco prevention in young populations.
Methoprene treatment and its effect on male reproductive organ size and female remating in a fruit fly
- L. A. Giudice, V. Díaz, A. Moyano, D. Pérez-Staples, S. Abraham
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- Journal:
- Bulletin of Entomological Research / Volume 113 / Issue 3 / June 2023
- Published online by Cambridge University Press:
- 20 January 2023, pp. 347-354
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Methoprene, a juvenile hormone analog, is used to accelerate sexual maturation in males of species of economic importance in support to the sterile insect technique (SIT). In the SIT, mass-reared sterile males are released into the field and need to survive until they reach sexual maturation, find a wild female, mate with her and then induce female sexual refractoriness, so she will not remate with a wild counterpart. The use of methoprene shortens the time between release and copulation. However, in South American fruit flies, Anastrepha fraterculus, the ability of methoprene-treated males to inhibit female remating has been shown to be lower than wild males, when methoprene was applied by pupal immersion or topical application. Here we evaluated the possibility of incorporating methoprene into the male diet at different doses and the ability of those males to inhibit female remating, as well as the effect of methoprene on male reproductive organ size, due to the possible correlation between male accessory gland size and their content, and the role of male accessory gland proteins in female inhibition. We found that A. fraterculus males fed with methoprene in the adult protein diet at doses as high as 1% were less likely to inhibit female remating, however, at all other lower doses males had the same ability as untreated males to inhibit female remating. Males fed with methoprene had bigger male accessory glands and testes compared to methoprene-deprived males. We demonstrate that the incorporation of methoprene in adult male diets is possible in this species and potentially useful as a post-teneral, pre-release supplement at doses as low as 0.01%. Even at higher doses, the percentage of females remating after 48 h from the first copulation is sufficiently low in this species so as not compromise the efficiency of the SIT.
Serum s100b protein levels as a neuroinflammatory biomarker of acutely relapsed paranoid schizophrenia patients
- Armando L. Morera-Fumero, Estefania Diaz-Mesa, Lourdes Fernandez-Lopez, Pedro Abreu-Gonzalez, Manuel S. Henry-Benitez
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- Journal:
- Acta Neuropsychiatrica / Volume 35 / Issue 3 / June 2023
- Published online by Cambridge University Press:
- 12 December 2022, pp. 138-146
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Objective:
The s100b inflammatory protein is involved in schizophrenia pathophysiology. We aim at studying the evolution of the s100b serum levels in acutely relapsed paranoid schizophrenia patients at three different time points (admission, discharge and 3 months after hospital discharge 3MAHD).
Methods:Twenty-three paranoid schizophrenia inpatients meeting DSM-IV criteria participated in the research. Twenty-three healthy subjects matched by age, gender and season acted as the control group. Psychopathology was measured with the Positive and Negative Syndrome Scale (PANSS). Serum s100b levels were determined at 12:00 and 24:00 h with an enzyme-linked immunoassay kit.
Results:Patients had significant higher serum s100b levels at admission and discharge (12:00 h) than the group of healthy subjects. At admission and discharge, s100b serum levels at 24 h had decreased compared to the 24:00 h s100b levels of the healthy subjects. At 3MAHD patients and healthy subjects had similar levels of serum s100b protein. Positive and negative PANSS scores decreased significantly between admission and discharge. Positive and negative PANSS scores decreased between discharge and 3MAHD, but these changes had no statistical significance.
Conclusions:Our study confirms that the acute inflammatory response produced in acutely relapsed patients is reversed after 3 month of hospital discharge. The variations of serum s100b concentrations when the patients suffer from an acute relapse may be a useful predictor of disease evolution.
Assessment of the performance of assertive community treatment: the case of Bizkaia (Spain)
- D. Díaz-Milanés, N. Almeda, C. García-Alonso, L. Salvador-Carulla
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S342
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Introduction
A mental health (MH) assertive community treatment (ACT) is always designed expecting for a decrease in the pressure (visits and readmissions) in inpatient services and to increase care quality. An appropriate management of ACT provision can be crucial to develop a balanced community-based MH ecosystems.
ObjectivesTo assess the impact of the ACT on the performance of the MH ecosystem of Bizkaia (Basque Country, Spain).
MethodsThe ecosystem is structured by 19 MH areas, supported by 5 ACT teams. Here ACT provides high intensity mobile outpatient care to people suffering from severe mental disorders. The impact of these teams on the ecosystem performance was assessed by Monte-Carlo simulation, the Data Envelopment Analysis (DEA) and fuzzy inference. The input variables were the availability, number of psychiatrics, nurses and total of professionals of ACT services in each area. The outputs were: frequentation, incidence and prevalence of ACT services in each MH area. Performance indicators were: relative technical efficiency (RTE), statistical stability and entropy.
ResultsThe global ecosystem performance was high (RTE on average=0.799 -input DEA orientation- and 0.825 -output orientation- up to 1, the maximum), the stability was medium-low (respectively 38,67% and 13.64% up to 100%, the maximum) and the entropy was medium-high (respectively 70,41% and 65.9% up to 100%, the maximum).
ConclusionsResults highlighted a positive impact of ACT in Bizkaia. Nevertheless, stability and entropy levels showed the existence of a high structural variability in ACT services due to the necessity of adjusting them to the user’s specific needs.
DisclosureNo significant relationships.