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Intranasal esketamine efficacy as a treatment for treatment-resistant depression, case series
- C. Delgado Marmisa, I. Álvarez Correa, H. Vizcaíno Herrezuelo, L. Egüen Recuero, E. Garrido Dobrito, L. Gayubo Moreo, B. Sanz-Aranguez, L. Delgado Tellez, L. Caballero Martínez, R. De Arce Cordón, B. Jiménez-Fernández
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S692
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Introduction
Intranasal esketamine has been approved as a treatment for patients with treatment-resistant depression. We analyzed the results of its efficacy in 15 patients.
ObjectivesTo evaluate the efficacy of intranasal Esketamine as a treatment in patients with treatment-resistant depression
MethodsCase series
ResultsFor the last 8 months, since the treatment with intranasal esketamine was approved for resistant depression, we have treated 14 patients with this drug. Through this process, we followed a standardized method consisting in the following steps:
On the first esketamine session (DAY 1) the patient has to fill a CGI and a MADRS scale.
On the second esketamine session (DAY 7) the patient has to fill a CGI, a MADRS scale, a form about the level of satisfaction with the drug and a last form in which they can include the secondary effects.
On week 6 since the start of the treatment, the patient has to fill again a CGI, a MADRS scale, a form about the level of satisfaction with the drug and a last form in which they can include the secondary effects.
In the 6th month since the start of the treatment, the patient has to fill again a CGI, a MADRS scale, a form about the level of satisfaction with the drug and a last form in which they can include the secondary effects they have perceived.
We analyzed and compared all of the previous data and obtained the following results:
At day 7: 64% of the patients had a response in the form of improvement, of which 66% were feeling “slightly better” and 33% were feeling “better”.
At week 6: 71% of the patients had a response in the form of improvement, of which 50% were feeling “slightly better” and the other 50% were feeling “better”.
At month 6: only 28% of the patients completed the treatment; of which 100% had a response in the form of improvement: 50% were feeling “slightly better”, 25% were feeling “better” and 25% were feeling “far better”.
ConclusionsAlthough our data suggests that intranasal esketamine has been effective in short term depressive symptoms, we have yet no information about its medium and long-term efficacy or secondary effects. Nevertheless, other potential factors should be evaluated as they could affect the results in the long-term such as the difficulty in maintaining the treatment for more than 6 weeks.
In addition, the patients who experienced the most improvement according to our data were patients with a TAB diagnosis, so this could be an interesting research focus.
Disclosure of InterestNone Declared
The winners project: neuropsycological changes after a video game-based training program in pediatric cancer survivors. a case report
- C. Gonzalez-Perez, E. Moran, N. Malpica, J. Alvarez-Linera, H. Melero, M. Alonso, M. Esteban, A. Perez-Martinez, E. Fernández-Jiménez
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S649
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Introduction
Children who have undergone an oncological process and have received treatment with chemotherapy or radiotherapy on the central nervous system may have significant neurocognitive sequelae. Some video games have shown neurocognitive benefits in people with impairments in different areas, such as attention or memory.
ObjectivesThis work aims to demonstrate the benefit of a video game-based training program to improve the neurocognitive profile in a child survivor of cancer.
MethodsThe patient is a 9-year-old female who was diagnosed with acute lymphoblastic leukemia at the age of 4 years. She received routine treatment of this disease by chemotherapy, including high-dose chemotherapy (with blood-brain barrier crossing) and intrathecal chemotherapy. She is currently 3 years after the end of treatment.
The Continuous Performance Test 3 (CPT-3) (sustained attention/vigilance) was administered before and after a multifaceted training program consisting of playing 3 video games for 12 weeks, as follows: a brain-training game (4 days per week, 7-12 minutes per day), a skill-training game (2 days per week, 10 minutes per day) and an exergaming game (2 days per week, 10 minutes per day).
ResultsPrior to intervention, the patient had 3 atypical z-scores on the CPT-3 (z scores: mean = 0, S.D. = 1), with a pattern compatible with ADHD (omissions z = 1.2; hit reaction time z = 3.4; hit reaction time block change z = 1.2). After intervention, she had only an atypical z-score (hit reaction time z = 3.6), with a pattern compatible with slowing, without ADHD.
ConclusionsThe neuropsychological evaluation of this patient showed an improvement in his attentional pattern on the CPT-3 after the video game-based training.
Disclosure of InterestNone Declared
The study protocol of the winners project: a randomized and controlled trial using a videogame-based training program in pediatric cancer survivors
- C. Gonzalez-Perez, E. Moran, N. Malpica, J. Alvarez-Linera, H. Melero, M. Alonso, M. Esteban, E. Fernández-Jiménez, A. Perez-Martinez
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S648-S649
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Introduction
Childhood cancer survivors have neurocognitive sequelae that in most survivor follow-up programs are underdiagnosed and for which there is usually no treatment plan.
Video games have demonstrated various psychological and neurocognitive benefits in different subpopulations, such as patients with organic neurological deficits or children with ADHD. However, few studies have been carried out using video games-based interventions in the paediatric oncology population.
ObjectivesThe aim of this work is to present the WINNERS study protocol, the objectives of which are to diagnose the neurological and cognitive sequelae in child cancer survivors, and to demonstrate the benefit in these areas of a training program based on video games.
MethodsA randomized controlled and unblinded trial is presented. Fifty-six patients aged 8 to 17 years stratified into two age groups (8-12 and 13-17) who had received any of the following treatments 1 to 6 years before the enrolment will be selected: high-dose chemotherapy with blood-brain barrier crossing, intrathecal or intraventricular chemotherapy, CNS radiotherapy or hematopoietic stem cell transplantation.
A neuropsychological evaluation will be performed consisting of a battery of neuropsychological tests to assess parameters such as attention, memory, visuospatial ability or speed of response, as well as a neuroimaging evaluation by structural and functional magnetic resonance imaging. The evaluation will be repeated 3 months and 6 months after the enrolment. Patients will be randomized to a treatment group or to a recycled waiting group. Intervention will consist on a 12-week training at home using 3 video games: a brain training game, an exergaming game and a skill training game.
ResultsAccording to the hypotheses of this study, it is expected that the proposed program of videogame-based interventions will improve neurocognitive and other wellbeing parameters in the intervention group.
ConclusionsThis study aims to improve the quality of care for patients who have survived a cancer disease by detecting sequelae that have so far been poorly attended, and by proposing a gamification-based intervention program that is effective and attractive for this population.
Disclosure of InterestNone Declared
Suicidality and social cognition: the association between hypomentalizing and suicide lethality
- J. Andreo-Jover, K. March, E. Fernández-Jiménez, J. Fernandez Fernandez, A. Garcia Fernandez, M. P. Lopez Peña, M. Ruiz Veguilla, B. Crespo Facorro, N. Garrido Torres, A. Cebria, I. Grande, N. Roberto, W. Ayad-Ahmed, A. Pemau Gurumeta, A. Garcia Ramos, M. Diaz-Marsa, M. F. Bravo-Ortiz, A. Palao-Tarrero, V. Perez-Sola
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S183
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Introduction
Suicide attempts (SA) leading to highly lethal consequences have been associated with heightened suicide planning (Barker et al., 2022), along with deficits in social cognition (Levi-Belz et al., 2022). Hypomentalizing, characterized by excessive uncertainty regarding mental states, may contribute to heightened social withdrawal and an increased risk of SA (Nestor & Sutherland, 2022). Although certain studies have identified a connection between hypomentalizing profiles and self-harm (Badoud et al., 2015), research into the lethality of SA remains limited.
ObjectivesThis study aimed to explore the association between hypomentalizing and SA lethality.
MethodsOur study encompassed a cohort of 1,371 patients who committed a SA. We conducted assessments of mentalizing using the RFQ-8 instrument, and evaluations of suicidal ideation and behavior employing the CSRSS questionnaire. Demographic and clinical characteristics were compared using the T-student and Chi-square tests. To investigate the relationship between hypomentalizing and the SA lethality, we employed logistic regression models.
ResultsDescriptive date are presented in Table 1. Our results show that hypomentalizing do not predict a higher SA lethality. Additionally, hypomentalizing increased the risk of SA planning (p≤0.001, B=-0.182), and SA planning predicted a higher SA lethality (see Table 2).
Table 1. Means Comparison for low and high lethality (N=1371)
Low lethality N=539 High lethality N=832 p value Effect size Age, mean (SD) 38.65 (15.65) 41.91 (15.37) ≤0.001 -0.209a Female sex, N (%) 392 (72.7) 571 (68.6) 0.116 0.044b Educational years, mean (SD) 12.45 (2.99) 12.43 (3.41) 0.890 0.0076a Employed, N (%) 220 (41.2) 332 (40) 0.692 0.012b Suicide Ideation, N (%) 475 (88.1) 742 (89.2) 0.541 0.016b Suicide Planning, N (%) 159 (39.2) 400 (58.1) ≤0.001 0.183b Number of attempts, mean (SD) 3.28 (5.48) 3.63 (5.74) 0.269 -0.169a RFQ, mean (SD) 4.68 (1.27) 4.56 (1.32) 0.087 0.095a Table 2. Logistic regression analyses for high SA lethality (N=1371).
Univariate analysis Multivariate analysis OR p value OR p value Age 1.014 (1.007-1.021) ≤0.001 1.014 (1.005-1.022) 0.001 Female sex 0.820 (0.646-1.042) 0.105 Educational years 0.998 (0.965-1.031) 0.890 Employed 0.952 (0.763-1.187) 0.660 Suicide ideation 1.111 (0.790-1.562) 0.545 Suicide planning 2.150 (1.674-2.761) ≤0.001 2.183 (1.697-2.808) ≤0.001 Number SA 1.012 (0.990-1.034) 0.277 RFQ 0.929 (0.854-1.011) 0.088 ConclusionsWhile the association between hypomentalizing and high SA lethality was not significant, a discernible trend toward such relationship can be noted. Further studies examining the moderating effects of planning in the association between hypomentalizing and SA lethality are required.
Disclosure of InterestNone Declared
Cognitive reserve in Older Adults with Bipolar Disorder and its relationship with cognitive performance and psychosocial functioning
- L. Montejo, C. Torrent, S. Martín, A. Ruiz, M. Bort, G. Fico, V. Oliva, M. De Prisco, J. Sanchez-Moreno, E. Jimenez, A. Martinez-Aran, E. Vieta, B. Sole
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S324-S325
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Introduction
Cognitive reserve (CR) refers to the ability of the brain to cope with damage or pathology. In bipolar disorder (BD), it has been seen that the effects of the disease may potentially reduce CR, thus compromising cognitive outcomes. This concept takes on special relevance in late life in BD, due to the increased risk of cognitive decline because of the accumulative effects of the disease and the potential effects of aging. Therefore, we believe that CR may be a protective factor against cognitive decline in older adults with bipolar disorder (OABD).
ObjectivesThe aim of this study was to study the CR in OABD compared with healthy controls (HC) and to analyze its association with psychosocial functioning and cognitive performance.
MethodsA sample of euthymic OABD, defined as patients over 50 years old, and HC were included. CR was assessed using the CRASH scale. Differences in demographic, clinical, and cognitive variables between patients and HC were analyzed by t-test or X2 as appropriated. Lineal simple and multiple regressions analyses were used to study the association of CR and several clinical variables with functional and cognitive performance.
ResultsA total of 83 participants (42 OABD and 41 HC) were included. Compared to HC, OABD exhibited poorer cognitive performance (p<0.001), psychosocial functioning (p<0.001) and lower CR (p<0.001). Within the patient’s group, the linear simple regression analysis revealed that CR was associated with psychosocial functioning (β=-2.16; p=0.037), attention (β= 3.03; p=0.005) and working memory (β = 2.98; p=0.005) while no clinical factors were associated. Age and CR were associated with processing speed and verbal memory, but after applying multiple regression model, only the effect of age remained significant (β =-2.26; p= 0.030, and β =-2.23; p= 0.032 respectively). CR, age, and number of episodes were related to visual memory, but the multiple regression showed that only age (β = -2.37; p= 0.023) and CR (β = 3.99; p<0.001) were associated. Regarding executive functions only the number of manic episodes were significant. CR and age at onset were associated with visuospatial ability, but multiple regression only showed association of CR (β =2.23; p=0.032). Other clinical factors such as number of depressive or hypomanic episodes, illness duration, admissions, type of BD, and psychotic symptoms were not associated.
ConclusionsTo the best of our knowledge, this is the first report that studies the CR in a sample of OABD. We demonstrated that OABD had lower CR than HC. Importantly, we observed that CR was associated with cognitive and psychosocial functioning in OABD, even more than disease-related factors. These results suggest the potential protector effect of CR against cognitive impairment, supporting that improving modifiable factors associated with the enhancement of CR can prevent cognitive decline.
Disclosure of InterestL. Montejo: None Declared, C. Torrent Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00344) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER), S. Martín: None Declared, A. Ruiz: None Declared, M. Bort: None Declared, G. Fico Grant / Research support from: Fellowship from “La Caixa” Foundation (ID 100010434 - fellowship code LCF/BQ/DR21/11880019), V. Oliva: None Declared, M. De Prisco: None Declared, J. Sanchez-Moreno Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER),, E. Jimenez Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060)integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER),, A. Martinez-Aran: None Declared, E. Vieta Grant / Research support from: Spanish Ministry of Science and Innovation (PI18/ 00805, PI21/00787) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIIISubdireccio ́n General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357; the European Union Horizon 2020 research and innovation program (EU.3.1.1. Understanding health, wellbeing and disease: Grant No 754907 and EU.3.1.3. Treating and managing disease: Grant No 945151)., B. Sole: None Declared
Sex differences in neurocognitive performance in older adults with bipolar disorder
- S. Martín-Parra, C. Torrent, A. Ruiz, M. Bort, G. Fico, V. Oliva, M. D. Prisco, J. Sanchez-Moreno, E. Jimenez, A. Martinez-Aran, E. Vieta, B. Sole, L. Montejo
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S440
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Introduction
In recent years, research has focused on the older adults with bipolar disorder (OABD), aged 50 years and over, a constantly growing population due to the increased of life expectancy. Actually, some authors suggest that these individuals constitute a distinct subtype with a specific and different needs such as seen in epidemiologic, clinical and cognitive features. Further research has revealed significant differences between females and males with BD in clinical and cognitive variables in middle-aged and young patients, but this topic among OABD population remains unclear.
ObjectivesThe aim of this study is to identify the distinctive profile in clinical, functional and neurocognitive variables between females and males in OABD.
MethodsA sample of OABD and Healthy Controls (HC) were included. Euthymic patients or in partial remission were included. Neurocognition was measured with a battery of tests that included premorbid intelligence quotient, working memory, verbal and visual memory, processing speed, language and executive functions. Independent t-test and Chi-squared test analysis were performed as appropriated.
ResultsAccording to the analysis, statistically significant differences were seen between females and males. A more impaired cognitive profile is observed in women. They performed worse in the subscales of Arithmetic (F= 6.728, p = <0.001), forward digits (F= 0.936, p= 0.019) and Total Digits (F= 1.208, p= 0.019) of the WAIS-III, in the Stroop Color Word Test, color reading (F= 0.130, p= < 0.001), in the Continuous Performance Test, block change measure (F= 2.059, p= 0.037), in the Rey-Osterrieth Complex Figure-copy (F= 0.005, p= 0.029) and in the Boston Naming Test (F= 0.011, p= 0.024). Nor significant differences were found in clinical neither in psychosocial functioning variables.
ConclusionsIn view of the following results, and since no differences were observed between women and men in terms of clinical and functional outcomes, it could be said that the differences observed in cognition cannot be explained by disease-related factors. Furthermore, these results highlight the need to develop a gender-specific cognitive interventions in OABD population. In this way, we could have an impact on the course of the illness to reach a better quality of life.
Disclosure of InterestS. Martín-Parra: None Declared, C. Torrent Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00344) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIIISubdireccion General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), A. Ruiz: None Declared, M. Bort: None Declared, G. Fico Grant / Research support from: Fellowship from “La Caixa” Foundation (ID 100010434 - fellowship code LCF/BQ/DR21/11880019), V. Oliva: None Declared, M. Prisco: None Declared, J. Sanchez-Moreno Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), E. Jimenez Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), A. Martinez-Aran: None Declared, E. Vieta Grant / Research support from: Spanish Ministry of Science and Innovation (PI18/ 00805, PI21/00787) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357; the European Union Horizon 2020 research and innovation program (EU.3.1.1. Understanding health, wellbeing and disease: Grant No 754907 and EU.3.1.3. Treating and managing disease: Grant No 945151), B. Sole: None Declared, L. Montejo: None Declared
Discrepancy between subjective perception and objective cognitive performance in attention assessment within the winners project for cancer survivors. a case report
- C. Gonzalez-Perez, E. Moran, N. Malpica, J. Alvarez-Linera, H. Melero, M. Alonso, M. Esteban, A. Perez-Martinez, E. Fernández-Jiménez
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S649
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Introduction
Paediatric cancer survivors have a risk for neuropsychological impairment due to the disease and the treatment received. These affections have been neglected in the follow-up of these patients. It is important to identify the most valid outcomes in the evaluation of neurocognitive sequelae in childhood cancer survivors.
ObjectivesThis work aims to compare the results obtained between subjective perception of caregivers and objective cognitive performance based on validated attention tests.
MethodsIn a randomized controlled and unblinded trial to demonstrate the benefit of video games on different neurocognitive areas in cancer survivors, we studied attention functioning before and after the intervention program. The attention deficit subscale from the Behavior Assessment System for Children 3rd edition (BASC-3), self- and parent-reported versions, and the Continuous Performance Test, 3rd edition (CPT 3) will be used as outcomes (z scores: mean = 0, S.D. = 1).
ResultsWe observed an improvement in attention after intervention using the CPT-3 (omissions z = 1.2; hit reaction time z = 3.4; hit reaction time block change z = 1.2 versus hit reaction time z = 3.6 without other atipycal z scores after intervention), changing the attentional pattern from “ADHD” to “slowed”. However, in the parent-reported version of the BASC-3, a worsening in the attention subscale is observed (z = 0.3 pre-intervention vs z = 1.0 post-intervention) while the self-reported version of the patient didn’t show any significant changes (z = 1.4 pre-intervention vs z = 1.1 post-intervention).
ConclusionsIt is essential to use objective tests to measure neurocognitive sequelae in these patients. Subjective surveys can provide additional information, but not substitute the above.
Disclosure of InterestNone Declared
The Dilemma of Lithium Discontinuation in Bipolar Disorder During Pregnancy Planning: A Case Report and Literature Review
- B. Orgaz Álvarez, E. Jiménez Sola, M. Velasco Santos, P. Ibáñez Mendoza, Á. de Vicente Blanco, S. Cebolla Lorenzo
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S428-S429
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Introduction
Lithium is considered the gold standard mood stabiliser for bipolar disorder, yet its use during pregnancy remains controversial, demanding careful consideration of potential risks and benefits. Classically, it has been associated with an increased risk in congenital heart defects, however, recent studies point towards a much lower absolute risk than was previously believed. Furthermore, discontinuation of lithium before or during pregnancy poses a high risk of destabilisation and lithium has been shown to reduce the risk of relapse both in pregnancy and in the postpartum period. Hence, treatment planning is of the upmost importance in this patient group and individual risk stratification should be undertaken for patients to make informed decisions about their treatment.
ObjectivesTo describe the case of a patient with bipolar disorder who discontinued lithium treatment while attempting to conceive and subsequently presented with a manic episode and to expand the scientific knowledge on this topic.
MethodsCase report and brief literature review.
ResultsA 41-year-old patient with a diagnosis of bipolar disorder, previously on lithium 900mg/day, was admitted to the emergency department with symptoms suggestive of a manic episode. One month prior, the patient had discontinued treatment with lithium due to her desire to pursue pregnancy and interrupt treatment while trying to conceive. The patient had a history of postpartum psychosis followed by various depressive and manic episodes with psychotic symptoms, leading to a bipolar disorder diagnosis and commencing treatment with lithium. Her consultant psychiatrist had informed her of the individualised risks of interrupting treatment with lithium and had advised to continue treatment alongside frequent follow-up due to the high-risk of relapse. Despite her consultant’s recommendation, she decided to interrupt treatment and hence a personalised lithium tapering regime and advice to continue treatment with quetiapine 200mg/day was given.
During the ED stay, treatment with olanzapine was introduced which helped to stabilise her symptoms. Lithium levels were subtherapeutic (lithium serum level 0.11 mmol/L). Inpatient psychiatric admission was avoided due to rapid symptom improvement, strong social support in the community and her preference for ambulatory care. Lithium was gradually reintroduced and antipsychotic treatment was adjusted at follow up appointments, which ultimately led to the resolution of symptoms and stabilisation.
ConclusionsThis case highlights the significance of considering continuing lithium treatment in bipolar disorder during pregnancy planning. Decisions about medication in pregnancy are multifaceted, making appropriate risk stratification imperative in order to inform individualised care plans to minimise the risk of relapse in these patients.
Disclosure of InterestNone Declared
Association between loneliness in childhood and first-episode psychosis
- C. M. Díaz-Caneja, L. Donaire, V. Cavone, Á. Andreu-Bernabeu, J. González-Peñas, M. Díaz-Marsá, R. Rodríguez-Jiménez, Á. Ibáñez, E. Baca-García, J. C. Leza, M. F. Bravo-Ortiz, J. L. Ayuso-Mateos, C. Arango
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S88-S89
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Introduction
Evidence from observational and genetic studies suggests a bidirectional relationship between loneliness and psychosis. To our knowledge, no previous study has assessed the association between loneliness in childhood and first-episode psychosis (FEP).
ObjectivesWe aimed to assess the association between loneliness in childhood and the odds of FEP and clinical variables of interest (i.e., diagnosis and clinical and functional severity) in FEP and to explore gender differences in this association.
MethodsThis was an observational, case-control study, based on the AGES-CM cohort, a longitudinal prospective study including patients with FEP ages 7-40, their first-degree relatives, and an age- and sex-matched sample of controls in seven university hospitals in the region of Madrid. We assessed loneliness in childhood with the question “Have you ever felt lonely for more than 6 months before the age of 12” and objetive social isolation with the peer relationships item from the childhood subscale of the Premorbid Adjustment Scale. We conducted logistic and linear regression analyses to assess the association between childhood loneliness and i) the odds of presenting a FEP and ii) clinical variables of interest (diagnosis and scores on positive, negative, general, depressive, and manic symptoms and functioning), while adjusting for demographic variables.
ResultsThe study sample comprised 285 patients with FEP (32.6% female, age 24.50 ± 6.2 years) and 546 controls (48.7% female, age 25.93 ± 5.5 years). Loneliness in childhood was associated with increased odds of FEP (adjusted odds ratio; aOR: 2.17, 95% CI [1.40-3.51], p=.002). This association remained significant after controlling for objective social isolation in childhood (aOR:2.70, IC 95% [1.58-4.62], p<.001).
The effect of the association was stronger in females (aOR:4.74, 95% CI [2.23-10.05], p<.001) than in males (aOR:1.17, IC 95% [0.63-2.19], p=.623). In females with FEP, loneliness in childhood was significantly associated with increased odds of receiving a diagnosis of other psychosis (aOR:0.155, 95% CI [0.048-0.506], p=.002) relative to an SSD diagnosis. In the FEP sample, loneliness in childhood was associated with greater severity of positive and affective symptoms and worse functioning.
ConclusionsLoneliness in childhood is associated with increased odds of FEP and clinical variables of interest. This suggests the potential role of this phenotype as an early risk marker for psychosis that could help guide targeted interventions.
Disclosure of InterestC. Díaz-Caneja Grant / Research support from: Instituto de Salud Carlos III (PI17/00481, PI20/00721, JR19/00024), European Union, Consultant of: Angelini, L. Donaire: None Declared, V. Cavone: None Declared, Á. Andreu-Bernabeu: None Declared, J. González-Peñas: None Declared, M. Díaz-Marsá: None Declared, R. Rodríguez-Jiménez: None Declared, Á. Ibáñez: None Declared, E. Baca-García: None Declared, J. C. Leza: None Declared, M. F. Bravo-Ortiz: None Declared, J. L. Ayuso-Mateos: None Declared, C. Arango Grant / Research support from: Madrid Regional Government (R&D activities in Biomedicine S2022/BMD-7216 AGES 3-CM), Instituto de Salud Carlos III, European Union, Consultant of: Acadia, Angelini, Biogen, Boehringer, Gedeon Richter, Janssen Cilag, Lundbeck, Medscape, Menarini, Minerva, Otsuka, Pfizer, Roche, Sage, Servier, Shire, Schering Plough, Sumitomo Dainippon Pharma, Sunovion and Takeda
Bridging the gap from medical to psychological safety assessment: consensus study in a digital mental health context
- Rayan Taher, Palak Bhanushali, Stephanie Allan, Mario Alvarez-Jimenez, Heather Bolton, Laura Dennison, Brian E. Wallace, Heather D. Hadjistavropoulos, Charlotte L. Hall, Amy Hardy, Alasdair L. Henry, Sam Lane, Tess Maguire, Adam Moreton, Talar R. Moukhtarian, Elvira Perez Vallejos, Sukhi Shergill, Daniel Stahl, Graham R. Thew, Ladislav Timulak, David van den Berg, Noemi Viganò, Ben Wensley Stock, Katherine S. Young, Jenny Yiend
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- Journal:
- BJPsych Open / Volume 10 / Issue 4 / July 2024
- Published online by Cambridge University Press:
- 03 June 2024, e126
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Background
Digital Mental Health Interventions (DMHIs) that meet the definition of a medical device are regulated by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK. The MHRA uses procedures that were originally developed for pharmaceuticals to assess the safety of DMHIs. There is recognition that this may not be ideal, as is evident by an ongoing consultation for reform led by the MHRA and the National Institute for Health and Care Excellence.
AimsThe aim of this study was to generate an experts’ consensus on how the medical regulatory method used for assessing safety could best be adapted for DMHIs.
MethodAn online Delphi study containing three rounds was conducted with an international panel of 20 experts with experience/knowledge in the field of UK digital mental health.
ResultsSixty-four items were generated, of which 41 achieved consensus (64%). Consensus emerged around ten recommendations, falling into five main themes: Enhancing the quality of adverse events data in DMHIs; Re-defining serious adverse events for DMHIs; Reassessing short-term symptom deterioration in psychological interventions as a therapeutic risk; Maximising the benefit of the Yellow Card Scheme; and Developing a harmonised approach for assessing the safety of psychological interventions in general.
ConclusionThe implementation of the recommendations provided by this consensus could improve the assessment of safety of DMHIs, making them more effective in detecting and mitigating risk.
TwinsMX: Exploring the Genetic and Environmental Influences on Health Traits in the Mexican Population
- Brisa García-Vilchis, Talia V. Román-López, Diego Ramírez-González, Xanat J. López-Camaño, Vanessa Murillo-Lechuga, Xóchitl Díaz-Téllez, C. Itzamná Sánchez-Moncada, Ian M. Espinosa-Méndez, Diego Zenteno-Morales, Zaida X. Espinosa-Valdes, Sofia Pradel-Jiménez, Andrea Tapia-Atilano, Ana V. Zanabria-Pérez, Federica Livas-Gangas, Oscar Aldana-Assad, Ulises Caballero-Sánchez, César A. Dominguez-Frausto, Miguel E. Rentería, Alejandra Medina-Rivera, Sarael Alcauter, Alejandra E. Ruiz-Contreras
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- Twin Research and Human Genetics / Volume 27 / Issue 2 / April 2024
- Published online by Cambridge University Press:
- 03 May 2024, pp. 85-96
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TwinsMX registry is a national research initiative in Mexico that aims to understand the complex interplay between genetics and environment in shaping physical and mental health traits among the country’s population. With a multidisciplinary approach, TwinsMX aims to advance our knowledge of the genetic and environmental mechanisms underlying ethnic variations in complex traits and diseases, including behavioral, psychometric, anthropometric, metabolic, cardiovascular and mental disorders. With information gathered from over 2800 twins, this article updates the prevalence of several complex traits; and describes the advances and novel ideas we have implemented such as magnetic resonance imaging. The future expansion of the TwinsMX registry will enhance our comprehension of the intricate interplay between genetics and environment in shaping health and disease in the Mexican population. Overall, this report describes the progress in the building of a solid database that will allow the study of complex traits in the Mexican population, valuable not only for our consortium, but also for the worldwide scientific community, by providing new insights of understudied genetically admixed populations.
Inequality on the frontline: A multi-country study on gender differences in mental health among healthcare workers during the COVID-19 pandemic
- Diana Czepiel, Clare McCormack, Andréa T.C. da Silva, Dominika Seblova, Maria F. Moro, Alexandra Restrepo-Henao, Adriana M. Martínez, Oyeyemi Afolabi, Lubna Alnasser, Rubén Alvarado, Hiroki Asaoka, Olatunde Ayinde, Arin Balalian, Dinarte Ballester, Josleen A.l. Barathie, Armando Basagoitia, Djordje Basic, María S. Burrone, Mauro G. Carta, Sol Durand-Arias, Mehmet Eskin, Eduardo Fernández-Jiménez, Marcela I. F. Frey, Oye Gureje, Anna Isahakyan, Rodrigo Jaldo, Elie G. Karam, Dorra Khattech, Jutta Lindert, Gonzalo Martínez-Alés, Franco Mascayano, Roberto Mediavilla, Javier A. Narvaez Gonzalez, Aimee Nasser-Karam, Daisuke Nishi, Olusegun Olaopa, Uta Ouali, Victor Puac-Polanco, Dorian E. Ramírez, Jorge Ramírez, Eliut Rivera-Segarra, Bart P.F. Rutten, Julian Santaella-Tenorio, Jaime C. Sapag, Jana Šeblová, María T. S. Soto, Maria Tavares-Cavalcanti, Linda Valeri, Marit Sijbrandij, Ezra S. Susser, Hans W. Hoek, Els van der Ven
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- Cambridge Prisms: Global Mental Health / Volume 11 / 2024
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- 04 March 2024, e34
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Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women’s well-being and ensure healthcare system preparedness during future public health crises.
Effect of calcium soaps from garlic (Allium sativum) and willow (Salix babylonica) extracts on nematode loads, nutrient intake and digestibility, nitrogen balance and rumen fermentation kinetics in dairy goats
- Einar Vargas-Bello-Pérez, Navid Ghavipanje, Teresa Torres-Gonzalez, Juan Carlos Angeles-Hernandez, Valente Velázquez-Ordoñez, Octavio Alonso Castelán-Ortega, Lizbeth E. Robles Jimenez, Sergio Daniel Roskopf, Manuel Gonzalez-Ronquillo
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- Journal of Dairy Research / Volume 91 / Issue 1 / February 2024
- Published online by Cambridge University Press:
- 17 May 2024, pp. 19-24
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- February 2024
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The objective of this study was to determine the effect of dietary calcium soaps from garlic (Allium sativum) and willow (Salix babylonica) extracts on nematode loads, nutrient intake and digestibility, nitrogen balance and rumen fermentation kinetics in dairy goats. Nine adult non-lactating Saanen goats were grouped into a complete randomized block design with 3 treatments (n = 3) over a period of 28 d. Animals were fed a diet based on alfalfa hay and a concentrate that was supplemented (65 g/kg DM) with calcium soaps of safflower (control), garlic or willow. Intake of dry matter (DM), organic matter (OM) and neutral detergent fiber (NDF) were not affected by dietary calcium soaps. However, the highest digestibility of DM and OM were observed in willow supplemented goats. In vitro gas kinetics and fermentation profile were not affected by diets. Results from fecal egg count indicated a reduction in total count, Haemonchus spp. and Trychostrongylus spp. for both garlic and willow compared to control. Our results suggest that calcium soaps of garlic or willow extracts can be used to reduce gastrointestinal parasites in goats without compromising productive traits or rumen function.
58 Right Anterior Temporal Lobe Atrophy is Associated with Informant-Reported Socioemotional Dysfunction in Patients with Frontotemporal and Early Onset Alzheimer's Dementia
- Kelsey A. Holiday, Youssef I. Khattab, Diana Chavez, Alexander Sheppard, Imaad Nasir, Elvira E. Jimenez, Rebecca J. Melrose, Mario F. Mendez
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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, pp. 263-264
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Objective:
Abnormalities in social and emotional behavior are the major diagnostic criteria for behavioral variant frontotemporal dementia (bvFTD). Investigators have attributed their behavioral disturbances to disease in mesial prefrontal and related networks, such as the salience network. This study examined the main neural correlates of informant-reported socioemotional dysfunction among patients with bvFTD compared to those with early-onset (before age 65) Alzheimer's Disease (EOAD).
Participants and Methods:Participants included 13 patients with bvFTD and their caregivers and 18 patients with EOAD and their caregivers. The caregivers consisted of a spouse, family member, or other informant who resided with the patient. They completed the informant-based Socioemotional Dysfunction Scale (SDS), a 40-item scale which rates common disturbances in social and emotional behavior on a five-point Likert scale (1-5). The patients underwent magnetic resonance imaging (MRI) with tensor-based morphometry (TBM) analysis of the 3D T1-weighted MRI scans. Computations of mean Jacobian values within select regions of interest (ROIs) in frontal and temporal lobes generated numerical summaries of regional volumes, and voxel-wise regressions created 3D statistical maps of the association between tissue volume and SDS total scores. Statistical analyses included independent samples t-tests group differences in ROIs and SDS scores, Pearson correlations between SDS scores and brain volumes, and multiple regression of ROIs with SDS scores and group as predictor variables.
Results:Compared to the EOAD group, the bvFTD group had significantly higher SDS scores (p < .001; d = 2.24), smaller frontal lobe volumes (specifically dorsolateral-prefrontal cortex, p = .003; d = 1.24), and larger temporal lobe volumes (specifically hippocampus, p = .014; d = 0.979). Within the bvFTD group, higher SDS scores were associated with a smaller right anterior temporal lobe (ATL; p = .005; r = -.729), especially the lateral ATLs (p = .002; r = -.776), and a smaller bilateral orbitofrontal cortex (OFC; p = .016; r = -.650). In contrast, within the EOAD group, higher SDS scores were associated with a smaller right parietal cortex (p = .030; r = .542). In the entire sample (both bvFTD and EOAD), higher SDS scores was associated with a smaller lateral ATL volumes (p = .019; r = -.431). Regression analyses confirmed that SDS score predicted lateral ATL volume (p = .041; b = -.262) after controlling for diagnosis (p < .001; b = -.692).
Conclusions:These findings are consistent with greater socioemotional dysfunction, smaller frontal, and larger mesial temporal regions in bvFTD, when compared to EOAD. The findings, however, suggest that positively disturbed socioemotional behavior in bvFTD, as reported by caregivers, results from involvement of the right temporal lobe and the lateral temporal region, with further contribution from disease in OFC. The association of SDS scores and ATL volume across diagnostic groups suggests that this region is instrumental in socioemotional functioning and that the SDS may have diagnostic value in distinguishing the "right-temporal variant" of bvFTD.
Estimating the Genetic Contribution to Astigmatism and Myopia in the Mexican Population
- Talía V. Román-López, Brisa García-Vilchis, Vanessa Murillo-Lechuga, Enrique Chiu-Han, Xanat López-Camaño, Oscar Aldana-Assad, Santiago Diaz-Torres, Ulises Caballero-Sánchez, Ivett Ortega-Mora, Diego Ramírez-González, Diego Zenteno, Zaida Espinosa-Valdés, Andrea Tapia-Atilano, Sofía Pradel-Jiménez, Miguel E. Rentería, Alejandra Medina-Rivera, Alejandra E. Ruiz-Contreras, Sarael Alcauter
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- Twin Research and Human Genetics / Volume 26 / Issue 4-5 / August 2023
- Published online by Cambridge University Press:
- 16 October 2023, pp. 290-298
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Astigmatism and myopia are two common ocular refractive errors that can impact daily life, including learning and productivity. Current knowledge suggests that the etiology of these conditions is the result of a complex interplay between genetic and environmental factors. Studies in populations of European ancestry have demonstrated a higher concordance of refractive errors in monozygotic (MZ) twins compared to dizygotic (DZ) twins. However, there is a lack of studies on genetically informative samples of multi-ethnic ancestry. This study aimed to estimate the genetic contribution to astigmatism and myopia in the Mexican population. A sample of 1399 families, including 243 twin pairs and 1156 single twins, completed a medical questionnaire about their own and their co-twin’s diagnosis of astigmatism and myopia. Concordance rates for astigmatism and myopia were estimated, and heritability and genetic correlations were determined using a bivariate ACE Cholesky decomposition method, decomposed into A (additive genetic), C (shared environmental) and E (unique environmental) components. The results showed a higher concordance rate for astigmatism and myopia for MZ twins (.74 and .74, respectively) than for DZ twins (.50 and .55). The AE model, instead of the ACE model, best fitted the data. Based on this, heritability estimates were .81 for astigmatism and .81 for myopia, with a cross-trait genetic correlation of rA = .80, nonshared environmental correlation rE = .89, and a phenotypic correlation of rP = .80. These results are consistent with previous findings in other populations, providing evidence for a similar genetic architecture of these conditions in the multi-ethnic Mexican population.
Interventions to prevent obesity in Latinx children birth to 6 years globally: a systematic review
- Rachel Bleiweiss-Sande, Kara Skelton, Daniel Zaltz, Montserrat Bacardí-Gascón, Arturo Jiménez-Cruz, Sara E Benjamin-Neelon
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- Public Health Nutrition / Volume 26 / Issue 11 / November 2023
- Published online by Cambridge University Press:
- 25 August 2023, pp. 2498-2513
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Objective:
To conduct a systematic review of obesity prevention interventions in Latinx children ages birth to 6 years published in any language from 2010–2020.
Design:We used PubMed, ERIC, PsycINFO, Scopus, Scientific Electronic Library Online (SciELO) and Google Scholar databases to conduct a search on May 1 2020, January 1 2021 and November 1 2022. We included randomised controlled trials, quasi-experimental studies and non-randomised interventions with a control or comparison group that reported measures of adiposity.
Setting:Interventions taking place in the United States, Latin America or the Caribbean.
Participants:Latinx children ages birth to 6 years.
Results:Of 8601 unique records identified, forty manuscripts about thirty-nine unique studies describing thirty distinct interventions in the United States and nine interventions in Latin America and the Caribbean met our inclusion criteria. Interventions were primarily based in early care and education centres (n 13) or combined home settings, for example home and community (n 7). Randomised interventions taking place in community or home settings were more likely to report significant reductions in adiposity or weight-related outcomes compared to other settings. Using the Cochrane risk of bias tools for randomised and non-randomised studies, we judged thirty-eight randomised trials and nine non-randomised interventions to have a high or unclear risk of bias.
Conclusions:The results highlight a need for more rigorous designs and more effective intervention strategies in Latinx children at risk for having overweight and obesity. Registered with the PROSPERO database for systematic reviews under registration number CRD42020161339.
Preeclampsia and risk of maternal pulmonary hypertension at high altitude in Bolivia
- C. E. Salinas, O. V. Patey, C. Murillo, M. Gonzales, V. Espinoza, S. Mendoza, R. Ruiz, R. Vargas, Y. Perez, J. Montaño, L. Toledo-Jaldin, A. Badner, J. Jimenez, J. Peñaranda, C. Romero, M. Aguilar, L. Riveros, I. Arana, D. A. Giussani
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- Journal of Developmental Origins of Health and Disease / Volume 14 / Issue 4 / August 2023
- Published online by Cambridge University Press:
- 27 July 2023, pp. 523-531
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Women with a history of preeclampsia (PE) have a greater risk of pulmonary arterial hypertension (PAH). In turn, pregnancy at high altitude is a risk factor for PE. However, whether women who develop PE during highland pregnancy are at risk of PAH before and after birth has not been investigated. We tested the hypothesis that during highland pregnancy, women who develop PE are at greater risk of PAH compared to women undergoing healthy highland pregnancies. The study was on 140 women in La Paz, Bolivia (3640m). Women undergoing healthy highland pregnancy were controls (C, n = 70; 29 ± 3.3 years old, mean±SD). Women diagnosed with PE were the experimental group (PE, n = 70, 31 ± 2 years old). Conventional (B- and M-mode, PW Doppler) and modern (pulsed wave tissue Doppler imaging) ultrasound were applied for cardiovascular íííassessment. Spirometry determined maternal lung function. Assessments occurred at 35 ± 4 weeks of pregnancy and 6 ± 0.3 weeks after birth. Relative to highland controls, highland PE women had enlarged right ventricular (RV) and right atrial chamber sizes, greater pulmonary artery dimensions and increased estimated RV contractility, pulmonary artery pressure and pulmonary vascular resistance. Highland PE women had lower values for peripheral oxygen saturation, forced expiratory flow and the bronchial permeability index. Differences remained 6 weeks after birth. Therefore, women who develop PE at high altitude are at greater risk of PAH before and long after birth. Hence, women with a history of PE at high altitude have an increased cardiovascular risk that transcends the systemic circulation to include the pulmonary vascular bed.
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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- Journal:
- 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
“Asking for help, quite a challenge”. Time from onset of symptoms to consultation with a psychiatrist
- T. Jiménez Aparicio, M. Fernández Lozano, M. Merizalde Torres, E. Domínguez Guerra, A. Rodríguez Campos
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S469-S470
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Introduction
One of the biggest challenges for primary care professionals is to know when it is appropriate to request a consultation with a psychiatrist. A complete medical history should be performed to detect anxious-depressive symptoms, as well as to determine the intensity, the trigger, time of evolution, and the functional repercussion (1). It is also important that the patient is able to express his or her symptoms and ask for help. The concept of “Alexitimia” refers to the difficulty of expressing feelings verbally, and is a frequent symptom in depressive patients (2).
In mild cases and with little repercussion, the physician himself can initiate treatment and follow up (3). However, on other occasions, it will be advisable to request a consultation with psychiatry.
ObjectivesThe main objective is to observe the time that elapses from the onset of symptoms until consultation with the Mental Health team is finally requested. Some preliminary results can already be obtained from this data collection.
MethodsWe have decided to carry out a descriptive study, collecting different variables from patients attending a first Psychiatry consultation.
ResultsIn a total sample of 208 patients, the majority (67%) were between 31 and 60 years old. Following the DSM-V criteria (4), patients were classified into groups according to their disorder: Adaptive, depressive, or other. These data were cross-referenced (Figure 1).
Subsequently, the time elapsed from the onset of symptoms (referred by the patients) was collected, until the referral to Psychiatry was processed. In order to make a comparison, average time (in days) was calculated for the different groups according to their age and diagnosis.
Those patients under 30 years were referred to psychiatry later. A downward trend was seen as the age range increased. In the “younger than 30” and “between 31 and 60” groups, patients who met criteria for Depressive Disorder took longer to be referred, which was striking considering that they are usually considered as more severe patients (Figure 2). This can be attributed to a greater difficulty in expressing their emotions (alexithymia), as another depressive symptom. Disaggregating these data by gender, the patients who clearly took the longest to be referred were men under 30 years old with a final diagnosis of Depressive Disorder (Figure 3). This gender difference is consistent with the social impact of alexithymia according to some articles (5).
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ConclusionsIt is important that primary care physicians know how to take a complete history in those patients with symptoms of anxiety and depression.
In many cases, patients themselves have difficulties expressing their emotions and feelings (alexithymia), which may be another symptom of their discomfort.
This may lead to a delay in the time until referral to a psychiatry is requested, and therefore a worsening of symptoms.
Disclosure of InterestNone Declared
Association between adverse childhood experiences and the number of suicide attempts in lifetime
- J. Andreo-Jover, E. Fernandez-Jimenez, J. Curto-Ramos, N. Angarita-Osorio, N. Roberto, A. De la Torre-Luque, A. Cebria, M. Diaz-Marsa, M. Ruiz-Veguillla, J. B. Bobes Garcia, M. Fe Bravo Ortiz, V. Perez Solá
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S561-S562
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Introduction
Adverse childhood experiences (ACEs), defined as abuse, neglect, or a dysfunctional household in childhood, have been associated with suicidality (Fjeldsted et al., 2020). Every type of ACE has a direct impact on suicide ideation, self-harm and/or suicide attempt (Angelakis et al., 2019).
ObjectivesWe aim to quantify the association between types of ACEs (including emotional, physical, sexual abuse, and emotional and physical neglect) and the number of suicide attempts in lifetime.
MethodsWe included 748 patients who attempted suicide at least once. They were asked to complete the Columbia-Suicide Severity Rating Scale (CSSRS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Logistic regression models were run to assess the association between each ACE type and the number of suicide attempts.
ResultsPoisson univariate regression analyses show a linear trend in the relationship between having a higher number of suicide attempts and having suffered every ACE type in childhood (p<0.05). Our results show a lower percentage of previous suicide attempts among participants without ACEs, and an increasing tendency among patients with various types of ACEs. The rate of ACEs types is significantly higher in the group with previous suicide attempts than in the first-attempt group (p=0.000).
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ConclusionsThis study contributes to clarify the role of childhood trauma in the number of suicide attempts in lifetime. This has important implications for reducing suicide rates, and preventing future re-attempts. Further studies analysing every construct of childhood trauma may contribute to the detection of suicidal behaviour.
FundingsThis work was supported by the Instituto de Salud Carlos III (grant number: PI19/00941 SURVIVE) and co-funded by the European Union (grant numbers: COV20/00988, PI17/00768), the European Union’s Horizon 2020 research and innovation programme Societal Challenges (grant number: 101016127), and the Fundación Española de Psiquiatría y Salud Mental
AcknowledgementsSURVIVE project (PI19/00941)
KeywordsSuicide attempt, Adverse Childhood Experiences
ReferencesAngelakis, I., Gillespie, E. L., & Panagioti, M. (2019). Childhood maltreatment and adult suicidality: A comprehensive systematic review with meta-analysis. Psychological Medicine, 49(7), 1057-1078. https://doi.org/10.1017/S0033291718003823
Fjeldsted, R., Teasdale, T. W., & Bach, B. (2020). Childhood trauma, stressful life events, and suicidality in Danish psychiatric outpatients. Nordic Journal of Psychiatry, 74(4), 280-286. https://doi.org/10.1080/08039488.2019.1702096
Disclosure of InterestNone Declared