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Prospective evaluation of acute neurological events after paediatric cardiac surgery
- Olivia Frost, Deborah Ridout, Warren Rodrigues, Paul Wellman, Jane Cassidy, Victor T. Tsang, Dan Dorobantu, Serban C. Stoica, Aparna Hoskote, Katherine L. Brown
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- Cardiology in the Young , First View
- Published online by Cambridge University Press:
- 14 March 2024, pp. 1-9
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Objectives:
Children with CHD are at heightened risk of neurodevelopmental problems; however, the contribution of acute neurological events specifically linked to the perioperative period is unclear.
Aims:This secondary analysis aimed to quantify the incidence of acute neurological events in a UK paediatric cardiac surgery population, identify risk factors, and assess how acute neurological events impacted the early post-operative pathway.
Methods:Post-operative data were collected prospectively on 3090 consecutive cardiac surgeries between October 2015 and June 2017 in 5 centres. The primary outcome of analysis was acute neurological event, with secondary outcomes of 6-month survival and post-operative length of stay. Patient and procedure-related variables were described, and risk factors were statistically explored with logistic regression.
Results:Incidence of acute neurological events after paediatric cardiac surgery in our population occurred in 66 of 3090 (2.1%) consecutive cardiac operations. 52 events occurred with other morbidities including renal failure (21), re-operation (20), cardiac arrest (20), and extracorporeal life support (18). Independent risk factors for occurrence of acute neurological events were CHD complexity 1.9 (1.1–3.2), p = 0.025, longer operation times 2.7 (1.6–4.8), p < 0.0001, and urgent surgery 3.4 (1.8–6.3), p < 0.0001. Unadjusted comparison found that acute neurological event was linked to prolonged post-operative hospital stay (median 35 versus 9 days) and poorer 6-month survival (OR 13.0, 95% CI 7.2–23.8).
Conclusion:Ascertainment of acute neurological events relates to local measurement policies and was rare in our population. The occurrence of acute neurological events remains a suitable post-operative metric to follow for quality assurance purposes.
Profile of mood states-12: same validity, more usability
- A. T. Pereira, A. I. Araújo, C. Cabaços, M. J. Brito, M. Fernandes, A. Rodrigues, J. S. Silva, A. Macedo
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S553-S554
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Introduction
The Profile of Mood States is one of the most widely used instruments to assess mood states. It is a rapid and economic method of assessing transient affective states (McNair et al. 2003) and it has been translated and validated to several languages including Portuguese. In our country we have several versions, with different factorial structures and number of items. The scale presents a list of feelings and emotions (adjectives) that people commonly experience.
With university students, we have used a version composed of 36 items that evaluates three factors, with good validity and reliability: Depression, Anxiety/Hostility and Positive Affect (Amaral et al. 2013).
However, to be included in digital apps that in addition to ecological momentary assessment parameters require a weekly or even daily assessment of mood states, this version has little usability.
ObjectivesTo develop a shorter version of the POMS-36 based on Exploratory Factor Analysis and to analyse its construct validity using Confirmatory Factor Analysis in a sample of Portuguese college students.
Methods765 students (69.2% females; mean age=22.09±2.433; range: 17-26) fill in the POMS-36 and the Perceived Stress Scale (Amaral et al. 2014). The total sample was randomly divided in two sub-samples. Sample A (N=380) was used to EFA and sample B (N=385) was used to CFA.
ResultsThrough EFA (with varimax rotation and extracting three factors), the four items with the highest loadings in their respective factor were selected. Then, the CFA, carried out with the AMOS, revealed that this three-factor model, with two pairs of correlated errors, indicated a good fit (X2/df= 4.6010; CFI =.9561; GFI =.9406; TLI=.9559; RMSEA=.0687, p[rmsea=0.04]. The internal consistency analysis resulted in α (Cronbach alphas) <.75 for the three factors. Pearson correlations of the three factors - Depression, Anxiety/Hostility, Amability/Vigour – with Perceived stress were all significantly (p<.01) and moderate, respectively: .533, .614 and -.461.
ConclusionsAlthough much shorter, the new POMS-12 has good validity (construct and divergent-convergent) and reliability, being more suitable in studies that require frequent and rapid self-monitoring of affective states, such as ISABELA (“IoT Student Advisor and Best Lifestyle Analyser”), an app targeting student mental health and well-being in which we have been working.
Disclosure of InterestNone Declared
Mental Illness Stigma among professionals at a Portuguese Medical Center
- D. F. Rodrigues, C. Adão, A. S. Sequeira
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S353
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Introduction
Mental Illness Stigma is a barrier in access to healthcare. Stigma also influences population health outcomes by worsening, undermining adequate processes. The healthcare professionals show several stigmatising behavirous and cognitions, which may impair the adequate provision of care of this population with mental illness.
ObjectivesWe aimed to measure mental health stigma in healthcare professionals at a portuguese hospital center.
MethodsA cross-sectional study of health profissionals was performed using a survey that included socio-economic and job related questions, personal and familiar questions regarding mental health, and Attribution Questionnaire 27 (AQ-27), a translated and validated stigma questionnaire with nine stigma sub-scales (Responsability, Pity, Anger, Dangerousness, Fear, Help, Coercion, Segregation and Avoidance).
ResultsThe sample included a total of 388 participants. The majority of the respondants were female (82,5%). The age ranged from 22 to 69 (mean = 40,05). According to the job place distribution, we found statistically significant differences in various stigma subscales among several healthcare settings within our center. The inpatient unit professionals showed lesser stigmatising attitudes in anger, coercion, segregation and avoidance domains; and higher stigmatising attitudes in pity and help domains. However, professionals who work at surgery room showed higher stigmatising attitudes in danger and fear, but lesser levels of help domains. We also found differences in five stigma subscales among various health professions. The study didn’t show differences in stigma domains regarding personal or professional contact with mental illness, neither academic studies in mental health.
ConclusionsOur findings suggest that workplace environment and profession may impact mental ilness stigma levels in healthcare professionals. We propose that future studies could be done to investigate methods to mitigate mental illness stigma, tailored to address different stigma domains in different workplace settings.
Disclosure of InterestNone Declared
Development of ethical competences in mental health and psychiatry: simulation with nursing students
- R. Lopes, I. Moreira, M. Neves, C. Brás, R. Rodrigues
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S878-S879
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Introduction
Simulation as a pedagogical strategy contributes to improving the acquisition, consolidation and retention of knowledge and is very attractive for students.
In simulation learning, students come into contact with real clinical practices, allowing them to develop personal, psychosocial, ethical and clinical skills, facilitating learning for decision-making.
The creation of different and complex simulation scenarios within the scope of Mental Health and Psychiatry (MHP) allows the empowerment of nursing students, through the anticipation and prevention of errors and the creation of training opportunities, which culminate in the development of critical thinking and reflective on the ethical dimension of caring for people experiencing mental illness.
ObjectivesTo analyze the simulation as a strategy to develop ethical competences in MHP; To reflect on respect for autonomy, capacity for self-determination and dignity of the person; To reflect on care practices that promote respect and dignity for people experiencing mental illness.
MethodsAfter the careful design of the situation simulation scenario in MHP, the steps are as follows:
Prebriefing - transmit generic information about the scenario to the participants/students; request the participation of some students to assume the role of actors in the context they will encounter and prepare to start the case; explain to observers what will happen and the goals of the scenario.
- Scenario development.
- Debriefing - ask observers to analyse and reflect on positive aspects of performance; lead participants to analyse and reflect on their actions; investigate the basis of gaps/errors.
- Reflection - facilitating students’ structured thinking (reflection-in-action and reflection-on-action); review learning.
- Assessment - focus group interview; observation and/or filming.
ResultsThe evaluation revealed that the use of a simulation scenario allows the connection between the theoretical contents of ethics (principles, dignity of the person, human rights, informed consent, …) with what they saw and experienced in the scenario; facilitates understanding of concepts, helps to internalize knowledge and retain information; favors reflection, development of critical thinking through discussion and argumentation; makes it easier to understand the relationship between the subject taught and reality; and the discussion of the situation helped to structure the thought.
The diversity of scenarios is interesting and useful, it allows understanding the different role of nurses in the hospital context and in the context of primary care.
ConclusionsIt is concluded that the use of a simulation scenario in MHP is of great interest and usefulness for the development of ethical competences, allowing reflection on care practices that promote respect and dignity of the person with experience of mental illness.
Disclosure of InterestNone Declared
Folie a deux / induced delusional disorder – case report and literature review
- A. Lourenço, A. L. Falcão, G. Soares, J. Petta, C. Rodrigues, M. Nascimento, C. Oliveira
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1038-S1039
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Introduction
Folie a deux, also known as shared psychotic disorder or induced delusional disorder, is a rare mental disorder that was first described in France in the late 19th century and was referred to delusions shared between two individuals in close relationship. The concept has evolved and according to ICD-10 the following criteria for the diagnosis is phenomenology-based only.
ObjectivesTo describe a clinical case and review the existing evidence on folie a deux.
MethodsClinical case and non-systematic review of the literature, from the last 15 years, on folie a deux. For this research, the keywords “folie a deux”, “shared psychotic disorder” and “induced delusional disorder” were used in the MEDLINE/PubMed database.
ResultsThe clinical case presented refers to a 56-year-old female patient with no known psychiatric history. The patient stated that 5 years ago when his mother died, neighbors began to persecute her and her sister. She was medicated with a second-generation antipsychotic without total remission of symptoms. Generally, in folie a deux there is a close and prolonged relationship between the inducer and the receptor, as described in this case. We considered that the sister is the active subject. The delusion is persecutory, the most common in this disorder. The patient kept her job until she was hospitalized and as described in the literature patients with folie a deux maintain their functionality, which is responsible for the underdiagnosis of this disorder. The fact that the current evidence is based on case reports reflects the underdiagnosis and rarity of this disorder.
ConclusionsThis clinical case highlights the challenging diagnosis and difficulty in treating this condition. Patients can be diagnosed many years after the onset of symptoms, which may not resolve with treatment. Much information, as prevalence, natural history, and optimal treatment, is lacking on folie a deux, and the etiology remains unknown. As such, prospective studies should be carried out to help understand this disorder.
Disclosure of InterestNone Declared
Clozapine in First Episode Psychosis: The best is delayed
- J. B. Rodrigues, A. P. João, C. Adão, P. Trindade
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1061
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Introduction
Only two out of three patients diagnosed with First Episode Psychosis (FEP) achieve symptom remission after the administration of two different antipsychotics, illustrating the high prevalence of treatment-resistance in FEP. Of those, 84% are treatment-resistant since illness onset. Response to initial treatment is one of the main long-term illness course predictors. The only medication approved for treatment-resistant psychosis is clozapine and studies have demonstrated its superior antipsychotic effect among this drug class.
ObjectivesThe aims of this communication are to describe a clinical case of FEP with symptom remission achieved only with clozapine and to review the literature regarding the pattern of clozapine use in FEP, the main difficulties of implementing it and its impact on the prognosis of this patients.
MethodsRelevant data from the patient’s medical record were collected. Pubmed database was searched using the terms “clozapine” and “first episode psychosis”.
ResultsA 50 year old woman without previous contact with psychiatric services was taken to the emergency room following behavioural disorganisation and heteroagressive conduct. Poisoning and referential delusions, as well as alienation of personal action and elementary auditory hallucinations were found and the patient was admitted in the psychiatric unit. She began treatment with Aripiprazole without therapeutic benefit and a switch to Paliperidone was made, with the same result. Clozapine was then titrated to a dose of 100mg/day, with resolution of all the positive symptoms mentioned above and she acquired total insight to the disease and need for treatment, being discharged with a diagnosis of schizophrenia. 9 articles, all from 2017 onwards, were collected from the Pubmed database.
ConclusionsThere’s reluctance in prescribing clozapine in treatment-resistance FEP. This is evidenced by the mean number of antipsychotic prescribed before clozapine - 2.74 to 4.85 - as well as the delay on its prescription - 294 to 2447 days - and its prescription to only 16% in a cohort of patients with FEP. The main reasons for this hesitation are the serious, albeit rare, side-effects, such as agranulocytosis and myocarditis, as well as the difficulty in implementing it in community services, with mandatory weekly blood tests and very slow titration of the drug and treatment compliance issues, making it a very resource-consuming drug. However, in that same cohort, there was a significant reduction of the number of admissions, re-admissions and duration of hospitalisation, highlighting the need for earlier consideration in treatment-resistant FEP. The identification of treatment-resistance should then be proactive by the mental-health services, ensuring an earlier clozapine initiation with the goal of greatly improving the prognosis of these patients
Disclosure of InterestNone Declared
Lithium neurotoxicity – a case report and review of the literature
- C. Almeida Rodrigues, A. Carvalho, F. Martins Costa, V. Silva de Melo
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1006-S1007
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Introduction
Lithium, a mood stabilizer, is a commonly prescribed and effective treatment for bipolar affective disorder. It´s excreted almost exclusively by the kidneys with a half-life primarily determined by renal function. Chronic intoxication results from an insidious accumulation of lithium in a chronically medicated patient (due to a reduction in renal function secondary to volume depletion, a new medication, et cetera). Patients often present with neurologic findings, including tremor, ataxia, dysarthria, confusion and neuromuscular excitability.
ObjectivesThe objective of this report is to describe a clinical case of lithium neurotoxicity (myoclonus and encephalopathy), along with a review of the literature on the topic.
MethodsWe describe a case of lithium neurotoxicity, along with a brief non-systematic review of the literature on lithium toxicity. We conducted a PubMed bibliographic search using keywords such as “lithium intoxication”, “lithium neurotoxicity”, “lithium encephalopathy” and “lithium intoxication treatment”.
ResultsA women aged 81 was brought to the emergency department by her daughter following 1 week of asthenia, diarrhoea, periods of confused speech and involuntary movements. In the previous week, the patient had been diagnosed with COVID-19. Her past medical history is significant for bipolar affective disorder, hypertension, diabetes mellitus, dyslipidemia and asthma. The patient has been treated with following drugs: lithium carbonate (no recent change of dose and previous serum levels around 1mmol/L), quetiapine, lisinopril, metformin, simvastatin, formoterol and budesonide. On the first examination, she had an exuberant multifocal myoclonus. Posteriorly, she became somnolent, with language impairment (verbal perseveration, echolalia) and dysarthria. Investigations revealed renal impairment (creatinine 1,5 mg/dL, blood urea nitrogen 42 mg/dL) and supratherapeutic lithium levels (lithium serum level 1,7 mmol/L). Computed tomography scan of the brain was negative for acute injuries. The electroencephalogram showed triphasic waves (1-1,5 Hz). Encephalopathy secondary to lithium intoxication was diagnosed (probably in the context of acute kidney injury precipitated by hypovolaemia – diarrhoea). Lithium was stopped and intravenous isotonic fluids were given. After 1 week, her myoclonus resolved and over the following week the other signs resolved as well. The patient was later discharged to her daughter’s home, with follow-up neurology and psychiatry visits.
ConclusionsBoth reversible and irreversible neurotoxicity related to lithium have been reported, specially occurring alongside chronic intoxication. If not addressed, impaired consciousness can lead to coma and death. A high clinical suspicion is needed for prompt diagnosis and treatment (intravenous fluids and sometimes haemodialysis are warranted).
Disclosure of InterestNone Declared
Difficult patients in mental health care–who are they?
- I. M. Figueiredo, G. Soares, C. Lopes, A. C. Rodrigues, A. L. Falcão, A. Lourenço, I. Cargaleiro, M. Nascimento, C. Oliveira
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S900
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Introduction
Difficult patients are not something new and we can find innumerous definitions for this concept. However, they form a very heterogenous group and we need a less abstract definition focused more on the clinical reality and the difficulties experienced by patients and mental health professionals.
ObjectivesOur goal was to find a more precise and clinical definition of the difficult patient based on quantitative measures using a statistical analysis of a series of hospitalizations.
MethodsA cluster analysis of our hospital’s in-patient treatment from the last 5 years was made concerning the duration of the stay and the number of previous hospitalizations.
ResultsA sample of 8576 inpatient treatment episodes was used. 52.4% were male and 47.6% female patients between the age of 15 and 103 years old. The length of the treatment varied from 0 to 1007 days and the number of previous hospitalizations from 0 to 109; excluding the outliers the means were, respectively, 21 days and 2 previous hospitalizations.
The cluster analysis excluded 85 episodes and it found the presence of 3 clusters, being the number 1 the wider one (n=5861 episodes) and the other quite similar.
The Cluster 1 was characterized by a smaller length of hospital stay and number of hospitalizations; the Cluster 2 was defined by the episodes with the highest number of previous hospitalizations (`x =8.77) and the Cluster C by the longest hospital stays (`x =58.09 days). With a Kruskal-Wallis test we found both variables statistically different between all clusters (p<0.001). In Cluster 2 and 3, respectively, we found that 40,24% and 34.61% was taking the medication before being hospitalized, 6.42% and 3.15% were compulsive hospitalizations, and 40.5% and 21.89% had LAI prescribed.
Concerning the diagnosis, Cluster 1 had more Depression, Neurotic and Somatoform disorders; Cluster 2 more Bipolar and Intellectual disability disorders and Cluster 3 more Dementia and Delusional disorders. Substance use disorders and Personality disorders were found more common in both Cluster 1 and 2, Schizophrenia in Cluster 2 and 3 and Psychosis non specified in Cluster 1 and 3.
ConclusionsWe can say Cluster 1 comprises the non-difficult patients and it’s not surprising that it includes more Depression and Neurotic and Somatoform disorders. The other diagnostic distributions among clusters were also expected and we can also theorize that Cluster 3 had higher percentages of social cases. Treatment with LAI is linked to a decrease in rehospitalizations and we found that in the majority of these episodes it wasn’t been applied. This research is important in order to identify the difficult patients and what challenges they can bring to the mental health services. Creating these patients’ profile will allow us to better understand their needs to create guidelines for a personalized inpatient treatment and to improve community services to prevent the rehospitalizations and prolonged hospital stays.
Disclosure of InterestNone Declared
Anti-amyloid-β Monoclonal Antibodies as Promising Disease-Modifying Therapies in Alzheimer’s Disease: A Focus on Aducanumab, Lecanemab, Crenezumab, Gantenerumab and Solanezumab
- V. S. D. Melo, C. A. Rodrigues, I. A. Silva
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S297
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Introduction
Alzheimer’s disease (AD) is the most prevalent form of age-related dementia in the world. The body of evidence suggesting that its main pathological features consist of amyloid-β (Aβ) plaque deposits and neurofibrillary tangles formed by hyperphosphorylated tau protein is robust. The drugs currently on the market have no effect on disease progression and provide only partial symptomatic relief, which creates a large unmet medical need. Anti-Aβ monoclonal antibodies (mAbs) have been shown to reduce amyloid plaques. Therefore, passive immunization is a major hope for treatment of AD.
ObjectivesThis review aims to summarize the up to date knowledge and experience with Anti-Aβ mAbs with positive clinical or biomarker effects in long-duration trials.
MethodsA narrative review was conducted based on a search in Google Scholar and Pubmed, using the following terms or combinations “anti-aβ protofibril antibody”; “early alzheimer’s disease”; “immunotherapy for Alzheimer’s disease”. Peer-reviewed literature published between 2016 and April 2022 was screened on full-text for this purpose.
ResultsAducanumab surpassed a successful Phase 1B trial demonstrating a dose and time dependency for Aß reduction with a beneficial impact on some clinical measures after 1 year of treatment. Two large Phase 3 clinical trials were initiated and already discontinued based on futility analysis done and not based on safety concerns. Further analyses including participants exposed for longer periods of time at higher doses indicated that aducanumab reduced brain amyloid and decreased the rate of decline.
Lecanemab (BAN2401) completed a Phase 2 trial (2018) with evidence of amyloid reduction and slowing of cognitive decline and has now entered Phase 3. Aducanumab and BAN2401 showed significant efficacy on both clinical and biomarker outcomes.
Crenezumab Phase 2 trial results suggested efficacy in mild AD; a Phase 3 program was recently halted due to futility. This mAb is currently being assessed in a prevention trial involving a Colombian kindred with autosomal dominant AD.
Gantenerumab showed significant biomarker effects, with no clinical efficacy reported to date and is being assessed in Phase 3 trials after a trial in prodromal disease stopped for futility suggested that higher doses might be efficacious. Gantenerumab and solanezumab showed no drug-placebo differences in clinical outcomes of specific studies included in this review.
ConclusionsTherapies with anti-Aβ mAbs have been developed successively and conducted in clinical trials signaling a promising new era for AD drug development and providing compelling evidence for the prominent role of neurotoxic soluble amyloid oligomers in the pathogenesis of AD and as therapeutic targets. Lessons learned from these studies may also be a bridge to more efficacious, safe drugs in AD.
Disclosure of InterestNone Declared
Changing trends of suicide mortality from 2011 to 2019: an analysis of 38 European Countries
- G. Fico, A. Gimenez-Palomo, R. Andra Bursan, C. R. Ionescu, F. Kraxner, P. Rolland, S. Gomes-Rodrigues, M. Batković, E. Metaj, S. Tanyeri Kayahan, A. Mamikonyan, P. Paribello, A. K. Sikora, C. M. Platsa, M. Spasic Stojakovic, A. H. Halt, M. Az, N. Ovelian, K. Melamud, M. Janusz, K. Hinkov, C. Gramaglia, J. Beezhold, J. L. Castroman, C. Hanon, D. Eraslan, E. Olie
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S85-S86
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Introduction
Suicide is a serious public health problem since it accounts for nearly 900,000 deaths each year worldwide. Globally in 2019, 10.7 persons out of 100,000 died by suicide. Psychiatric disorders are related to an overwhelming proportion of these cases. In the last years, several specific interventions and action plans for suicide prevention have been implemented in a number of European countries.
ObjectivesOur aim was to analyze recent epidemiologic trends of suicide mortality rates in Europe.
MethodsAnnual national statistics of suicide mortality rates derived from Eurostat public databases from 2011 to 2019 were analyzed for 38 European countries. The suicide mortality rate was estimated per year/100,000 population. Linear regression models were used to study temporal trends of suicidal mortality. Analyses were performed using RStudio.
ResultsAvailable data show a statistically significant reduction in suicide mortality rates from 2011 to 2019 in 15 European countries, and a significant increase for Turkey (ES=0.32, SD=0.06, p=0.037) (Fig 1). The greatest significant decrease was reported in Lithuania (ES=-1.42, SD=0.02, p=0.02), followed by Hungary (ES=-1.13, SD=0.11, p=0.0007), Latvia (ES=-0.76, SD=0.11, p=0.007), and Poland (ES=-0.73, SD=0.10, p=0.001). Italy reported the lowest significant reduction in suicide mortality rates (ES=-0.13, SD=0.018, p=0.003). The remaining 16 countries showed no significant changes in suicide mortality trends.
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ConclusionsIn the last years, Europe registered an overall reduction in reported suicide rates. However, more recent data (i.e., suicide rates after COVID-19 pandemic, age and sex-related effect on suicide rates) should be analyzed and used to implement future recommendations. Current and future suicide prevention strategies aim to contribute to a greater reduction of suicide rates in the different European countries.
Disclosure of InterestNone Declared
A Pragmatic Approach to define “DIFFICULT TO TREAT” patients
- M. Nascimento, A. Lourenço, A. L. Falcão, G. Soares, C. Rodrigues, J. Petta, C. Oliveira
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S542
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Introduction
Multiple definitions for “difficult to treat” patients (DTP) were given throughout the years. While most authors focus on diagnoses, others focus on clinical, social and demographic factors, which should be regarded as factors of bad prognosis and elevated costs for the healthcare systems.
ObjectivesTo identify and haracterize DTP patients admitted in acute ward, based on practical criteria.
MethodsThrough the hospital’s IT services, all acute inpatient episodes at Centro Hospitalar Psiquiátrico de Lisboa were collected, since 2017. Cluster analysis was performed, regarding number of previous admissions (PA) and days of admission. Descriptive and comparative statistics (with multiple comparisons) for the different clusters, regarding age, gender, diagnosis at discharge (according to ICD10), and, to the DTP, previous medical following, compliance to medication, and substance use at admission.
ResultsThree clusters were identified: (C1, n=5861) a larger, uncharacteristic one; (C2, n=1168) with a higher number of PA (average of 8, versus less than 2 on the others); and (C3, n=1462) with higher number of days of admissions (58 versus less than 16). Statistical significance was found regarding age (higher in C3), gender (more men in C2), nationality (C1 with more foreigners). Regarding diagnosis at discharge, statistical difference was found between the 3 groups: C1 has significantly less patients with Schizophrenia (11% versus 30% in the others), but more depressive (21% versus 6% in C2 and 12% in C3) and neurotic disorders. C2 presented less dementias (0,5% versus 3% in C1 and 10% in C3) and delusional disorders, but more bipolar disorders (24% versus 15% in C1 and C3); C3 represented less episodes due to substance abuse (alcohol or others) and personality disorders. In both C2 and C3, no psychiatric consultation happened in the 3 months prior admission to around 40% of episodes, and 50% had stopped medication. The majority had only oral medication. Almost 24% of C2 tested positive for cannabinoids, with no differences regarding other substances.
ConclusionsThese findings allow the definition of 2 kinds of DTP, which present unique characteristics but some common features (namely poor adherence to consultations and are in therapeutic compliance). An assertive multidisciplinary approach, focused on current treatment and relapse prevention (including social structures, more frequent clinical follow-up, and rehabilitation centers), will be the key to their treatment.
Disclosure of InterestNone Declared
Secular trends and social inequalities in child behavioural problems across three Brazilian cohort studies (1993, 2004 and 2015)
- Michelle Degli Esposti, Alicia Matijasevich, Stephan Collishaw, Thaís Martins-Silva, Iná S. Santos, Ana Maria Baptista Menezes, Marlos Rodrigues Domingues, Fernando C. Wehrmeister, Fernando Barros, Joseph Murray
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 32 / 2023
- Published online by Cambridge University Press:
- 17 April 2023, e23
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Aims
Previous epidemiological evidence identified a concerning increase in behavioural problems among young children from 1997 to 2008 in Brazil. However, it is unclear whether behavioural problems have continued to increase, if secular changes vary between sociodemographic groups and what might explain changes over time. We aimed to monitor changes in child behavioural problems over a 22-year period from 1997 to 2019, examine changing social inequalities and explore potential explanations for recent changes in behavioural problems between 2008 and 2019.
MethodsThe Child Behaviour Checklist was used to compare parent-reported behavioural problems in 4-year-old children across three Brazilian birth cohorts assessed in 1997 (1993 cohort, n = 633), 2008 (2004 cohort, n = 3750) and 2019 (2015 cohort, n = 577). Response rates across all three population-based cohorts were over 90%. Moderation analyses tested if cross-cohort changes differed by social inequalities (demographic and socioeconomic position), while explanatory models explored whether changes in hypothesized risk and protective factors in prenatal development (e.g., smoking during pregnancy) and family life (e.g., maternal depression and harsh parenting) accounted for changes in child behavioural problems from 2008 to 2019.
ResultsInitial increases in child behavioural problems from 1997 to 2008 were followed by declines in conduct problems (mean change = −2.75; 95% confidence interval [CI]: −3.56, −1.94; P < 0.001), aggression (mean change = −1.84; 95% CI: −2.51, −1.17; P < 0.001) and rule-breaking behaviour (mean change = −0.91; 95% CI: −1.13, −0.69 P < 0.001) from 2008 to 2019. Sex differences in rule-breaking behaviour diminished during this 22-year period, whereas socioeconomic inequalities in behavioural problems emerged in 2008 and then remained relatively stable. Consequently, children from poorer and less educated families had higher behavioural problems, compared to more socially advantaged children, in the two more recent cohorts. Changes in measured risk and protective factors partly explained the reduction in behavioural problems from 2008 to 2019.
ConclusionsFollowing a rise in child behavioural problems, there was a subsequent reduction in behavioural problems from 2008 to 2019. However, social inequalities increased and remained high. Continued monitoring of behavioural problems by subgroups is critical for closing the gap between socially advantaged and disadvantaged children and achieving health equity for the next generation.
Nicotine exposure during breastfeeding alters the expression of endocannabinoid system biomarkers in female but not in male offspring at adulthood
- Rosiane Aparecida Miranda, Vanessa Silva Tavares Rodrigues, Thamara Cherem Peixoto, Alex C. Manhães, Egberto Gaspar de Moura, Patricia Cristina Lisboa
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- Journal:
- Journal of Developmental Origins of Health and Disease / Volume 14 / Issue 3 / June 2023
- Published online by Cambridge University Press:
- 23 February 2023, pp. 415-425
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Early nicotine exposure compromises offspring’s phenotype at long-term in both sexes. We hypothesize that offspring exposed to nicotine during breastfeeding show deregulated central and peripheral endocannabinoid system (ECS), compromising several aspects of their metabolism. Lactating rats received nicotine (NIC, 6 mg/Kg/day) or saline from postnatal day (PND) 2 to 16 through implanted osmotic minipumps. Offspring were analyzed at PND180. We evaluated protein expression of N-acylphosphatidylethanolamide-phospholipase D (NAPE-PLD), fatty acid amide hydrolase (FAAH), diacylglycerol lipase (DAGL), monoacylglycerol lipase (MAGL) and cannabinoid receptors (CB1 and/or CB2) in lateral hypothalamus, paraventricular nucleus of the hypothalamus, liver, visceral adipose tissue (VAT), adrenal and thyroid. NIC offspring from both sexes did not show differences in hypothalamic ECS markers. Peripheral ECS markers showed no alterations in NIC males. In contrast, NIC females had lower liver DAGL and CB1, higher VAT DAGL, higher adrenal NAPE-PLD and higher thyroid FAAH. Endocannabinoids biosynthesis was affected by nicotine exposure during breastfeeding only in females; alterations in peripheral tissues suggest lower action in liver and higher action in VAT, adrenal and thyroid. Effects of nicotine exposure during lactation on ECS markers are sex- and tissue-dependent. This characterization helps understanding the phenotype of the adult offspring in this model and may contribute to the development of new pharmacological targets for the treatment of several metabolic diseases that originate during development.
Introduction
- John C. Rodrigue
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- Book:
- Freedom's Crescent
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- 19 January 2023
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- 26 January 2023, pp 1-21
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Summary
The Civil War in the lower Mississippi valley demonstrates the complexities of abolishing slavery. Focusing mostly on the Emancipation Proclamation, historians fail to explain how military emancipation was translated into abolition, viewing the Thirteenth Amendment as a stand-alone measure that gave constitutional sanction to the proclamation and that followed inevitably from it. However, abolition must be understood in conjunction with restoring the seceded states to the Union, since Americans generally believed that only states could abolish slavery. After the proclamation, Unionists in Louisiana and Tennessee split into free-state and proslavery – or “conservative” – factions, with both attempting to organize loyal governments. Taking proslavery Unionism seriously, Republicans insisted that the rebellious states abolish slavery in their state constitutions as a condition for readmission. The Thirteenth Amendment was thus originally envisioned to complement state action. Federal military success in the lower Mississippi valley first elucidated the problem of conjoining abolition and state restoration, and the region served as the crucible for transforming military emancipation into constitutional abolition.
4 - “The Unsatisfactory Prospect Before Them”
- from Part I - From War for Union to Military Emancipation, 1860–1862
- John C. Rodrigue
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- Freedom's Crescent
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- 19 January 2023
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- 26 January 2023, pp 100-112
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Summary
With Lincoln having issued preliminary Emancipation Proclamation, Unionists in Tennessee and southern Louisiana undertake to organize congressional elections so as to gain exclusion from the Emancipation Proclamation on January 1, 1863. Lincoln encourages southern Unionists – and provides them military assistance – in their efforts. Lincoln’s Annual Message in December 1862 puts forward compensated abolition plan, providing for abolition in the rebellious states. Lincoln issues Emancipation Proclamation, but exclusion of Tennessee and southern Louisiana do not comport with specifications in the preliminary version. Exclusions will provide opportunity for proslavery Unionists to salvage slavery, but proclamation also raises issue of how fate of slavery will factor into restoring rebellious states to the Union.
14 - “No Longer Slaves but Freedmen”
- from Part III - Abolition: State and Federal, 1864
- John C. Rodrigue
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- Book:
- Freedom's Crescent
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- 19 January 2023
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- 26 January 2023, pp 282-296
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Summary
The Federal Red River campaign of spring 1864 is a military and political disaster, casting a pall over Louisiana’s constitutional convention and the inauguration of Arkansas’s Unionist government. Federal forces ostensibly control most of Arkansas, but such control tenuous in places, and the Arkansas government encounters much resistance to its authority. The Louisiana constitutional convention crafts a free-state constitution, but conservative Unionists contest it relentlessly, and the large majority of free-state delegates oppose black political and legal equality. The organization of a free-state government and constitution in Tennessee remains on hold, although Andrew Johnson nominated as Lincoln’s running-mate in the 1864 election. Confederate atrocities against black Union troops at Poison Spring and Marks’ Mill, Arkansas, and at Fort Pillow in Tennessee underscore the determination to preserve slavery.
5 - “The Return of the Seceded States to This Union as Slave States”
- from Part II - From Military Emancipation to State Abolition, 1863
- John C. Rodrigue
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- Book:
- Freedom's Crescent
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- 19 January 2023
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- 26 January 2023, pp 115-131
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Summary
Emancipation Proclamation also provides for black military enlistment, and a significant percentage of black Union troops eventually come from the lower Mississippi valley. Proclamation also raises issue of how emancipation will factor into restoring rebellious states, and debate begins in Congress and northern society over securing free-state restoration. Unionist movements in Louisiana and Tennessee begin to divide into “free-state” and “conservative” factions. Free-state Unionists are committed to restoring rebellious states without slavery, though opposing black political and legal equality. Conservative Unionists develop argument for restoring states to the Union while maintaining slavery. Republicans formulate Reconstruction policy around the Constitution’s “republican form of government” in requiring the rebellious states to abolish slavery.
16 - “Freedom, Full, Broad and Unconditional”
- from Part III - Abolition: State and Federal, 1864
- John C. Rodrigue
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- Freedom's Crescent
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- 19 January 2023
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- 26 January 2023, pp 318-336
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Summary
The Union capture of Atlanta in early September 1864 reframes the presidential election and the war. Louisiana’s free-state constitution wins voter approval and becomes operative, formally abolishing slavery in Louisiana, although military–civilian conflict continues to hamper the Unionist government. Free-state radicals and black leaders call for political and legal equality, but the Louisiana government takes no action in defining black freedom. The Arkansas Unionist government faces difficulties in asserting its authority, and it receives limited assistance from Federal military officials. In Tennessee, free-state and conservative Unionists offer competing plans for the state to conduct a presidential election, and black Tennesseans in Nashville hold their own election, but Tennessee’s electoral votes ultimately not counted. Andrew Johnson delivers “Moses of the Colored Man” speech during the campaign, affirming commitment to abolition. Republican support for the Thirteenth Amendment muted during the campaign, but Lincoln wins reelection.
Epigraph
- John C. Rodrigue
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- Freedom's Crescent
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- 19 January 2023
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- 26 January 2023, pp viii-viii
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19 - “This Cup of Liberty”
- from Part IV - The Destruction of Slavery, 1865
- John C. Rodrigue
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- Freedom's Crescent
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- 19 January 2023
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- 26 January 2023, pp 377-395
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During winter and spring of 1865, Tennessee amendments gain voter approval, abolishing slavery in the state, and loyalist government elected and inaugurated. Legislatures of Louisiana, Arkansas, and Tennessee approve Thirteenth Amendment. Lincoln and congressional Republicans fail to reach accord on Reconstruction legislation before Congress adjourns in early March, and Congress refuses to seat Louisiana and Arkansas claimants but creates Freedmen’s Bureau. Lincoln’s Second Inaugural Address promises reconciliation for former Confederates and justice for freedpeople. Following Lee’s surrender, Lincoln’s “last” address defends his Reconstruction policy and the Louisiana government, although Lincoln also for the first time publicly endorses black suffrage and acknowledges black role in Reconstruction. Confederate surrender in western theater takes several more weeks. Andrew Johnson announces Reconstruction policy in late May 1865, recognizing governments of Tennessee, Arkansas, and Louisiana but rejecting calls for black role in Reconstruction.