Fetal alcohol spectrum disorder (FASD) is a life-long condition, and few interventions have been developed to improve the neurodevelopmental course in this population. Early interventions targeting core neurocognitive deficits have the potential to confer long-term neurodevelopmental benefits. Time-targeted choline supplementation is one such intervention that has been shown to provide neurodevelopmental benefits that emerge with age during childhood. We present a long-term follow-up study evaluating the neurodevelopmental effects of early choline supplementation in children with FASD approximately 7 years on average after an initial efficacy trial. In this study, we examine treatment group differences in executive function (EF) outcomes and diffusion MRI of the corpus callosum using the Neurite Orientation Dispersion and Density Index (NODDI) biophysical model.

The initial study was a randomized, double-blind, placebo-controlled trial of choline vs. placebo in 2.5- to 5-year-olds with FASD. Participants in this long-term follow-up study included 18 children (9 placebo; 9 choline) seen 7 years on average following initial trial completion. The mean age at follow-up was 11 years old. Diagnoses were 28% fetal alcohol syndrome (FAS), 28% partial FAS, and 44% alcohol-related neurodevelopmental disorder. The follow-up evaluation included measures of executive functioning (WISC-V Picture Span and Digit Span; DKEFS subtests) and diffusion MRI (NODDI).

Children who received choline early in development outperformed those in the placebo group across a majority of EF tasks at long-term follow-up (effect sizes ranged from -0.09 to 1.27). Children in the choline group demonstrated significantly better performance on several tasks of lower-order executive function skills (i.e., DKEFS Color Naming [Cohen's d = 1.27], DKEFS Word Reading [Cohen's d = 1.13]) and showed potentially better white matter microstructure organization (as indicated by lower orientation dispersion; Cohen's d = -1.26) in the splenium of the corpus callosum compared to the placebo group. In addition, when collapsing across treatment groups, higher white matter microstructural organization was associated with better performance on several EF tasks (WISC-V Digit Span; DKEFS Number Sequencing and DKEFS Word Reading).

These findings highlight long-term benefits of choline as a neurodevelopmental intervention for FASD and suggest that changes in white matter organization may represent an important target of choline in this population. Unique to this study is the use of contemporary biophysical modeling of diffusion MRI data in youth with FASD. Findings suggest this neuroimaging approach may be particularly useful for identifying subtle white matter differences in FASD as well as neurobiological responses to early intervention associated with important cognitive functions.

Fetal alcohol spectrum disorder (FASD) is a common neurodevelopmental condition associated with deficits in cognitive functioning (executive functioning [EF], attention, working memory, etc.), behavioral impairments, and abnormalities in brain structure including cortical and subcortical volumes. Rates of comorbid attention-deficit/hyperactivity disorder (ADHD) are high in children with FASD and contribute to significant functional impairments. Sluggish cognitive tempo (SCT) includes a cluster of symptoms (e.g. underactive/slow-moving, confusion, fogginess, daydreaming) found to be related to but distinct from ADHD, and previous research suggests that it may be common in FASD. We explored SCT by examining the relationship between SCT and both brain volumes (corpus callosum, caudate, and hippocampus) and objective EF measures in children with FASD vs. typically developing controls.

This is a secondary analysis of a larger longitudinal CIFASD study that consisted of 35 children with prenatal alcohol exposure (PAE) and 30 controls between the ages of 9 to 18 at follow-up. Children completed a set of cognitive assessments (WISC-IV, DKEFS, & NIH Toolbox) and an MRI scan, while parents completed the Child Behavior Checklist (CBCL), which includes a SCT scale. We examined group differences between PAE and controls in relation to SCT symptoms, EF scores, and subcortical volumes. Then, we performed within-and between-group comparisons with and without controlling for total intracranial volume, age, attention problems, and ADHD problems between SCT and subcortical brain volumes. Finally, we performed correlations between SCT and EF measures for both groups.

Compared to controls, participants with PAE showed significantly more SCT symptoms on the CBCL (t [57] = 3.66, p = 0.0006), more parent-rated attention problems and ADHD symptoms, lower scores across several EF measures (DKEFS Trail-Making and Verbal Fluency; WISC-IV Digit Span, Symbol Search, and Coding; effect sizes ranging from 0.44 to 1.16), and smaller regional volumes in the caudate, hippocampus, and posterior areas of the corpus callosum. In the PAE group, a smaller hippocampus was associated with more SCT symptoms (controlling for parent-rated attention problems and ADHD problems, age, and intracranial volume). However, in the control group, a larger mid posterior and posterior corpus callosum were significantly associated with more SCT symptoms (controlling for parent-rated attention problems, intracranial volume, and age; r [24] = 0.499, p = 0.009; r [24] = 0.517, p = 0.007). In terms of executive functioning, children in the PAE group with more SCT symptoms performed worse on letter sequencing of the Trail-Making subtest (controlling attention problems & ADHD symptoms). In comparison, those in the control group with more SCT symptoms performed better on letter sequencing and combined number letter sequencing of the Trail-Making subtest (controlling attention problems).

Findings suggest that children with FASD experience elevated SCT symptoms compared to typically developing controls, which may be associated with worse performance on EF tasks and smaller subcortical volumes (hippocampus) when taking attention difficulties and ADHD symptoms into account. Additional research into the underlying causes and correlates of SCT in FASD could result in improved tailoring of interventions for this population.

To evaluate variables that affect risk of contamination for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound endoscopes.

Observational, quality improvement study.

University medical center with a gastrointestinal endoscopy service performing ∼1,000 endoscopic retrograde cholangiopancreatography and ∼1,000 endoscopic ultrasound endoscope procedures annually.

Duodenoscope and linear echoendoscope sampling (from the elevator mechanism and instrument channel) was performed from June 2020 through September 2021. Operational changes during this period included standard reprocessing with high-level disinfection with ethylene oxide gas sterilization (HLD–ETO) was switched to double high-level disinfection (dHLD) (June 16, 2020–July 15, 2020), and duodenoscopes changed to disposable tip model (March 2021). The frequency of contamination for the co-primary outcomes were characterized by calculated risk ratios.

The overall pathogenic contamination rate was 4.72% (6 of 127). Compared to duodenoscopes, linear echoendoscopes had a contamination risk ratio of 3.64 (95% confidence interval [CI], 0.69–19.1). Reprocessing using HLD-ETO was associated with a contamination risk ratio of 0.29 (95% CI, 0.06–1.54). Linear echoendoscopes undergoing dHLD had the highest risk of contamination (2 of 18, 11.1%), and duodenoscopes undergoing HLD-ETO and the lowest risk of contamination (0 of 53, 0%). Duodenoscopes with a disposable tip had a 0% contamination rate (0 of 27).

We did not detect a significant reduction in endoscope contamination using HLD-ETO versus dHLD reprocessing. Linear echoendoscopes have a risk of contamination similar to that of duodenoscopes. Disposable tips may reduce the risk of duodenoscope contamination.

During the COVID-19 pandemic people experience higher levels of negative emotions, as well as face many negative and intense emotions felt by others. Thus, it is important to look for risk and protective factors that allow and help individuals to regulate these negative emotions and adapt to the hardships of the COVID-19 pandemic.

The main aims of the study were to (i) test how empathic dimensions (perspective taking, empathic concern and personal distress) and emotion regulation abilities were related to intensity of depressive symptoms during the COVID-19 lockdown in Poland, as well as to (ii) check if emotion regulation difficulties and personal distress predicted slower decrease in depressive symptoms over the two months in which the number of COVID-19 cases declined in Poland.

A total of 792 participants took part in the three-wave panel study. The sample was representative of the Polish population in terms of gender, age, and place of residence. Participants completed the following online questionnaires: The Patient Health Questionnaire-9, The Difficulties in Emotion Regulation Scale Short Form, and Brief version of the Empathic Sensitivity.

Significant positive correlations were found between depressive symptoms and both personal distress and emotion regulation difficulties during the lockdown. Moreover, emotion regulation difficulties were the only significant predictor of slower decrease in depressive symptoms over time during the COVID-19 pandemic.

It seems that interventions focused on improvement of emotion regulation abilities could be particularly beneficial in reducing depressive symptoms during the pandemic and preventing potential negative long-term outcomes.

Coronary-artery bypass graft (CABG) surgery is known to improve cardiac function and decrease mortality, albeit, this method of treatment is associated with a high risk of postoperative delirium. The pathophysiology of delirium after cardiac surgery is largely unknown.

To investigate whether oxidative stress reflected by decreased preoperative and postoperative plasma antioxidant capacity (AC) is independently associated with delirium after cardiac surgery. Furthermore, to assess whether the association between AC and the level of soluble receptor for advanced glycation end-products (sRAGE) exists.

The patients were examined 1 day preoperatively with the Mini International Neuropsychiatric Interview and MMSE test to screen for depression, anxiety disorders, and for cognitive impairment, respectively. Blood samples for AC and sRAGE levels were collected both preopertively and postoperatively. The CAM ICU and MDAS were used within the first 5 days postoperatively to screen for a diagnosis of delirium.

Postoperative delirium developed in 34% (61 of 177) of participants. Multivariate stepwise logistic regression analysis revealed that patients with low baseline AC are at significantly increased risk of developing delirium. Moreover, preoperative AC levels were inversly correlated with postoperative sRAGE concentrations (Spearman’s Rank Correlation -0.198; p<0.05). The most optimal cutoff values of the preoperative and postoperative AC that predict the development of delirium were 1.720 mM and 1.893 mM, respectively.

Decreased plasma AC levels are associated with delirium after cardiac surgery and inversly correlated with post-surgery sRAGE concentration. This may be an important pathophysiological consideration in the increased risk of postoperative delirium seen in cardiac surgery patients.

Delirium is a frequent and serious complication of cardiac surgery. However, the knowledge regarding pathogenesis of postoperative delirium is limited.

To investigate whether increased levels of monocyte chemoattractant protein-1 (MCP-1) and hyper-sensitive C-Reactive Protein (hsCRP) are associated with postoperative delirium in cardiac surgery patients.

Patients were examined and screened for major depressive disorder (MDD) and cognitive impairment one day preoperatively, using the Mini International Neuropsychiatric Interview and The Mini-Mental State Examination Test. Blood samples were collected pre- and postoperatively for hsCRP and chemokine levels. Following surgical interventions, the Confusion Assessment Method for the Intensive Care Unit and the Memorial Delirium Assessment Scale with the cut-off score 10 were used to diagnose delirium.

Postoperative delirium screening was found positive in 34% (61 of 177) of patients. Both, pre- and postoperative hsCRP, and preoperative MCP-1 levels were associated with postoperative delirium in univariate comparisons; p=0.001; p=0.0004; p < 0.001, respectively. However, according to a multivariate stepwise logistic regression analysis only MCP-1 concentration raised before surgery was independently associated with postoperative delirium, and related to advancing age of participants (Spearman’s Rank Correlation 0.192; p=0.0103). According to ROC analysis, the most optimal cut-off for MCP-1 concentration in predicting the development of delirium was 371.81 ng/ml with sensitivity of 77.0% and specificity of 58.6%.

The present study suggests that raised preoperative MCP-1 concentration is independently associated with delirium after cardiac surgery. Preoperative monitoring of pro-inflammatory markers combined with regular surveillance may be helpful in the prediction and early detection of postoperative delirium in this patient group.

To probe the factors that contributes to the relapse of the major depression after being hospitalized for a period of three consecutive months in a psychiatric clinic.

22 patients (8 men) who were in the clinic were examined (average age 49.2, SD=7.2) suffering from major depression and who fully recovered between episodes. The criteria for their participation in the sample were according to DSM-IV®, and the >2 relapses/year.

By the stepwise multiple regression analysis it was found that by hierarchy the factors that cause the relapse are, the fact that the patient does not respond to the first antidepressant treatment (parameter estimate p< 0.002), child or teenage depression background (p< 0.002), the presence of stressful facts (diseases, financial problems, loss of 1st degree relatives, p< 0.004) and the co morbidity with character disorders in the II (p< 0.01) axis.

The importance of a negative outcome of the major depression should be co estimated with the danger of self-destruction as a result of the illness, the difficulties of the interpersonal relationships, the professional activities, the impact on the family, alcoholism, drug abuse etc. and mainly the empirical impact on the patient.

Of this project was to study the characteristics of stress and depression in mental health professionals and the degree at which they are affected by demographic factors.

The sample of the study includes 62 mental health professionals. An anonymous closed questionnaire by Bedford & Foulds was used. The data analysis was made with the use of SPSS 16.0.

Two factors were found statistically essential; the age[F(5,41)=0,52 p=0,004] and the marital statue [F(5,41)=0.49 p=0.008]. The married people seem to statistically develop higher anxiety (p=0,001), higher tension (p=0,002) and higher insomnia (p=0,001) in comparison to the singles, the divorced and the widows/widowers. The singles seem to keep more calm (p=0.014) in comparison to the married and the divorced (p=0.001).Working people aged 35-49 experience more intense sorrow than the other age groups (p=0,003), more intense feelings of panic (p=0,018) and tension (p=0,049). The age groups in stressful or depression situations diversify their needs as regards smoking, with the 35-49 age group being the heaviest smokers (p=0,029).

It is discovered that a different defense mechanism is used by mental health professionals as regards their marital statue and their age, developing sleeping disorders, increase in smoking and sadness elements indifference for the future, more often.

Depression is a dysfunction with great range of demonstrations and according to researches appears at person with diabetes mellitus two or three times more than in general population. The knowledge although about the reasons and the way that depression affects the management of diabetes are limited.

Of this study was the examination of existence of possible depression at patients with diabetes mellitus.

164 diabetics were studied (72 male and 92 female, medieval age 66,9 ± 11,53 years) at diabetic clinics. We used the self evaluation scale of Zung (ZDRS) and structured questionnaire about demographical and body measure data.

The statistic analysis was done with the statistic package SPSS 18.0.

57,3% of diabetics were overweight, and 30,5% obese, with high rates of central obesity (83,3% at males and 92,4% at females), while the big Index of Body Maze [r = 0,309, p = 0,001] and central obesity [t(162)=4,773, p = 0,001] were related significantly with depression. 50% of diabetics appeared depression symptoms at mild levels and 20% at medium levels, with the females [t(162)=3,26, p = 0,001] and elder to be related statistically significant with depression.

The majority of the sample appeared a level of mild or medium depression and correlation was observed between bad glycemic examinations. The daily and for many years effort of diabetes control can create the suitable situation for depressive symptomatology appearance. The examination and evaluation of the causative factors can help at the adaptation of diabetic and the solution of his problems.

Anxiety is considered to be a situation of agony, anguish and is being experienced as psychological pressure. At Mental Health Professionals’ work environment, a lot of factors may contribute to anxiety appearance and create the conditions of depression symptomatology development. The smoking habit is being connected with a great range of psychiatric diagnosis, including anxiety and depression.

Of this study was the examination of the relationship of smoking habit with the appearance of anxiety and depression at Mental Health Professionals.

317 mental health professionals were being examined (144 male, 173 female, with medieval age 38, 64 ± 7,945 years) and their smoking habits were recorded. For anxiety and depression examination the DSSI/Sad QUESTIONNAIRE was being used. The analysis of data was done by the use of statistical package SPSS 16.0.

Smokers have higher levels of depression (t(315) = 2,417, p = 0,016) as well as of anxiety (t(315) = 2,219, p = 0,027). However no one of the specific degrees was related with the number of cigarettes smoked by smokers (r = 0,022, p = 0,777 for depression, r = 0,133, p = 0,084 for anxiety)

The smoking habit appeared to be related with anxiety and depression, it cannot although be considered as the reason but as the result of emotional difficulty of the participants. Even though smoking decreases the privative symptoms, it does not decrease the anxiety and the depression or the confrontation of their deeper reasons. It is being seen the need of development and materialization of interventions of effective support for Mental Health Professional at their own work environment.

The presence of macro vascular diseases is common among patients with diabetes mellitus, with result the increase of danger for depression appearance.The attack of greater vessels (macro vascular disease) conducts to the appearance of coronary disease, vascular brain episodes(strokes) and peripheral vasculopathy.

of this study was the examination of the relation between depression and the existence of macro vascular diseases at patients with diabetes mellitus type II.

164 diabetics were examined (72 male and 92 female, medieval age 66,9 ± 11,53 years), at diabetological clinics. The tools that were used at this study was the scale of depression self evaluation of Zung and a structured questionnaire about the existence of macro vascular diseases. The analysis was done with the statistic package SPSS 18.0.

64,6% of diabetics reported hypertension and 61% dyslipidemia, 30,5% suffered from coronary disease and 26.2% of vascular brain episode (stroke), while 13,4% suffered from heart attack and 19,5% from other diseases. 50% of diabetics had depression at mild levels and another 20% at medium levels.

The majority of the sample appeared mild or medium degree depression and relation was observed between accompanying macro vascular diseases. The coronary disease, hypertension and dyslipidemia seemed to be independent prognostic factors of depression even after the abstraction of age effect and diseases duration effect, while the depressive effect of heart attack or stroke seemed to be effected mainly by age.

Stress and depression are among the most common complaints in primary healthcare settings.

To investigate stress and depression levels in chronic patients of a rural area.

118 chronic patients (53 males and 65 females, mean age 61 ± 4 years) that used primary healthcare services during the first three months of this study were interviewed. the Personal Disturbance Scale (DSSI/sAD), the Zung self-rating scale, and a structured demographic questionnaire were the tools used by the researchers. Statistical analysis was done with the SPSS 18.0 software.

The majority of our sample were living permanently in the area, 52% were married, and 73% had completed primary education. 76% complained of hypertension, 51% had dyslipidemia, and 28% suffered from stress and anxiety disorders under treatment. 61% had sleep problems, and 40% reported they had an undefined sense of unhappiness. Sexual dysfunction, eating disorders and pessimism about the future showed the worst Zung total scores. the analysis showed that coronary disease, hypertension and dyslipidemia seem to be independent prognostic factors for depression and anxiety disorders even after excluding age (r = 0,307, p = 0,001).

Early detection and management of mental disorders, as well as the identification of contributing factors to these disorders, seem to be key targets of primary health care.

Electroconvulsive therapy (ECT) is the most effective treatment for drug-resistant depression. However, long-term effects of such therapy on cognitive functions have not been adequately studied.

The aim of the study was to estimate short-term and long-term effects of ECT on cognitive functions in patients with drug-resistant depression.

Thirty seven patients were included (10 male, 27 female), aged 34-75 years. Cognitive assessments were performed before, immediately after completion of 6-12 sessions of the ECT, and 3 months thereafter, using Benton Visual Retention Test, Digit Span of the Wechsler Adult Intelligence Scale (WAIS), the Rey Auditory Verbal Learning Test (RAVLT), Color Reading Interference (Stroop test), Verbal fluency test, Trail Making Test (TMT) and the Rey-Osterrieth Complex Figure Test (ROCF).

Immediately after ECT, a significant worsening was noted in memory (most elements of RAVLT) and in verbal fluency. However, 3 months after ECT, the indices of both RAVLT and verbal fluency significantly improved compared to baseline, and also, these of Benton and ROCF were significantly better than before ECT. The results of Digit Span (WAIS), Stroop and TMT were not affected by the treatment.

The results suggest that the negative effects of ECT on cognitive functions are transient. After three months, the indices of memory, verbal fluency as well as Benton and ROCF were significantly better than those before the treatment. Therefore, in addition to antidepressant effect in drug-resistant depression, electroconvulsive therapy, in a long-term perspective, may also exert a favorable influence on some cognitive functions.

Negative impact of long-term lithium treatment on kidney and thyroid functions makes the important problem of such therapy. While kidney functions deteriorate in time-dependent manner after ten years of lithium therapy it is unclear whether a significant association exists between thyroid dysfunction and duration of lithium administration.

The aim was to compare thyroid hormones and antibodies in bipolar patients receiving lithium for 10-19 years with those receiving for 20 years or more.

The cross-sectional study was performed on 66 patients (21 male, 45 female) with bipolar mood disorder, receiving lithium for 10-44 (20+9) years. Thyroid stimulating hormone (TSH), free thyroxine (fT3) and free triiodothyronine (fT4) as well as thyroid peroxidase (TPO), thyroglobulin (TG) and TSH receptor (TSH-R) antibodies were measured.

Features of hypothyroidism were found in 10 (22%) female patients but not in male patients. A significant percentage of patients had abnormally high anti-TPO, and anti-TG antibodies (45% and 65%, respectively). There were no differences in thyroid function between 38 patients receiving lithium for 10-19 years and 28 patients taking the drug for 20 years or more.

The results confirm greater susceptibility of female bipolar patients for lithium-induced hypothyroidism. High anti-TPO and anti-TG antibodies suggest a possibility of autoimmune disturbance in these subjects. However, in contrast to lithium effect on kidney function, our results do not show an association between duration of long-term lithium therapy and thyroid dysfunction.

The last decade the parents of autistic children have become objects of many controversial studies and theories. A lot of studies have revealed a positive relationship between father's age and the incidence of neurodevelopmental disorders.

In the present study, we investigated the association between paternal age and an increased risk of autism in offspring.

Samples consist of 88 autism cases from the Children's Health Center of Thessaly, Greece. Each case was matched with questionnaire on parental education, child's gender, dominant hand, presence of seizures. Six categories of paternal age were created. the relationship between the variables was investigated using Cramer's V correlation coefficient and chi-square tests to explore the relationship between categorical variables. Statistical Package for the Social Sciences v. 18.0 (SPSS) was used.

The data show a significant association between higher paternal ages and an increased risk of autism presented a strong, positive relation (Cramer's v = 0.468; p = 0.001< 0.05). An analysis of the combined effect of the incidence rates seizures (30%), offspring's gender (65.9%) male and (34.1%) female were found. in addition, the data shows the right hand is used (67%) more than the left (33%), furthermore the education also revealed that parents with higher education had an increased risk of having autistic children.

Our study provides evidence of the association of paternal age and risk of autism. However, the findings in our sample do not constitute a causal relationship but lay the foundations for thought and further research.

A morbidity and mortality (M&M) conference is a time-honored educational format in surgery and medicine to review bad patient outcomes and learn from mistakes made. However, despite the value of learning together as peers from difficult cases with unexpected outcomes, most psychiatric departments in the United States do not have an M&M conference. Several years ago, the department of psychiatry at Massachusetts's general hospital in Boston began a monthly M&M conference.

Describe our department's experience with the M&M format as an educational vehicle to teach patient safety and improve care in an increasingly complex care environment.

Introduce the M&M format that we have developed at our department and obstacles encountered.

We reviewed the content of our four years of M&M conferences; the feedback received from participants after each conference; and changes introduced to improve the conference.

Our department has successfully implemented and sustained a monthly psychiatric M&M conference that is well attended and valued. A critical decision was mandatory involvement of residents to prepare cases in conjunction with a dedicated faculty member. A structured presentation using a root cause analysis framework to guide the discussion in order to harness the wisdom of the group allows for a more comprehensive understanding of factors leading to bad outcomes, including systems-based problems.

A psychiatric M&M conference can teach individual clinicians about patient safety. Developing a departmental mechanism to apply lessons learned in the conference to improve hospital systems is the next task.

The authors have not supplied their declaration of competing interest.