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Traumatic stress symptoms among Spanish healthcare workers during the COVID-19 pandemic: a prospective study
- Ana Portillo-Van Diest, Gemma Vilagut, Itxaso Alayo, Montse Ferrer, Franco Amigo, Benedikt L. Amann, Andrés Aragón-Peña, Enric Aragonès, Ángel Asúnsolo Del Barco, Mireia Campos, Isabel Del Cura-González, Meritxell Espuga, Ana González-Pinto, Josep M. Haro, Amparo Larrauri, Nieves López-Fresneña, Alma Martínez de Salázar, Juan D. Molina, Rafael M. Ortí-Lucas, Mara Parellada, José M. Pelayo-Terán, Aurora Pérez-Zapata, José I. Pijoan, Nieves Plana, Teresa Puig, Cristina Rius, Carmen Rodríguez-Blázquez, Ferran Sanz, Consol Serra, Iratxe Urreta-Barallobre, Ronald C. Kessler, Ronny Bruffaerts, Eduard Vieta, Víctor Pérez-Solá, Jordi Alonso, Philippe Mortier, MINDCOVID Working Group
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 32 / 2023
- Published online by Cambridge University Press:
- 09 August 2023, e50
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Aim
To investigate the occurrence of traumatic stress symptoms (TSS) among healthcare workers active during the COVID-19 pandemic and to obtain insight as to which pandemic-related stressful experiences are associated with onset and persistence of traumatic stress.
MethodsThis is a multicenter prospective cohort study. Spanish healthcare workers (N = 4,809) participated at an initial assessment (i.e., just after the first wave of the Spain COVID-19 pandemic) and at a 4-month follow-up assessment using web-based surveys. Logistic regression investigated associations of 19 pandemic-related stressful experiences across four domains (infection-related, work-related, health-related and financial) with TSS prevalence, incidence and persistence, including simulations of population attributable risk proportions (PARP).
ResultsThirty-day TSS prevalence at T1 was 22.1%. Four-month incidence and persistence were 11.6% and 54.2%, respectively. Auxiliary nurses had highest rates of TSS prevalence (35.1%) and incidence (16.1%). All 19 pandemic-related stressful experiences under study were associated with TSS prevalence or incidence, especially experiences from the domains of health-related (PARP range 88.4–95.6%) and work-related stressful experiences (PARP range 76.8–86.5%). Nine stressful experiences were also associated with TSS persistence, of which having patient(s) in care who died from COVID-19 had the strongest association. This association remained significant after adjusting for co-occurring depression and anxiety.
ConclusionsTSSs among Spanish healthcare workers active during the COVID-19 pandemic are common and associated with various pandemic-related stressful experiences. Future research should investigate if these stressful experiences represent truly traumatic experiences and carry risk for the development of post-traumatic stress disorder.
LIVING IN A DOLL HOUSE: A CASE REPORT AND LITERATURE REVIEW OF REDUPLICATIVE PARAMNESIA
- J. M. Pinto, I. Faria, C. P. Gouveia, J. Andrade
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S934
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Introduction
Reduplicative paramnesia (RP) is a very rare content-specific delusional misidentification syndrome (DMS). RP entails the delusion that a place, an object, or an event has been duplicated or exists in two different places at the same time. RP is thought to result from an organic rather than psychiatric cause distinguishing it from other DMS. It has been suggested that damage to the right frontal and temporal lobe plays a crucial role, although other areas involved in visuospatial processing have also been reported.
ObjectivesThe aim of this study is to review the literature and report a clinical case of RP.
MethodsWe describe a case of an 81 year old woman admitted in a Neurology ward, with a 2 week clinical presentation of temporo-spatial disorientation, behavioural changes, persecutory delusions and reduplicative paramnesia phenomena concerning her house. She had previous history of a stroke 3 years prior to admission and, about one year before, the patient also started to present cognitive decline in the context of Parkinson’s dementia. One month before admission, treatment with Rotigotine was started and later suspended when the aforementioned clinical manifestations started. Upon admission it was diagnosed an urinary tract infection and treatment with antibiotics was started. Two days afterwards, the patient recovered orientation and her usual behaviour, but persecutory delusions and RP persisted. She then started treatment with low dose Olanzapine. Following 2 weeks of treatment the psychotic symptoms fully remitted, including RP.
ResultsWe underline CT-scan and EEG relevant findings upon admission. In the CT-scan sequelar lesions in left frontoparietal junction, right posterior frontal cortex, left inferior occipital cortex, bilateral cerebellar hemispheres, left caudate nucleae and thalamus were identified. The EEG showed a preserved posterior alpha rhythm associated with slow discontinuous right temporal and mainly left parieto-temporo-occipital activity, indicating dysfunction in these locations.
ConclusionsIn line with literature our patient had lesions in the right frontal and temporal lobe. She also presented lesions in other areas involved with visuospatial processing. Particularly the involvement of the left hemisphere reported in our case seems to be an exception. Other factors potentially played a role triggering this episode, namely the cognitive compromise due to dementia interposed with infectious disease, and the rotigotine treatment as well. Another aspect worth mentioning in our case was the remission of symptoms with the use of Olanzapine, even though only a few cases in literature have fully remitted with treatment with antipsychotics.
Disclosure of InterestNone Declared
The impact of self-stigma in people with diagnosis of severe mental illness: a cross-sectional pilot study from a community psychiatry unit in Porto, Portugal
- A. S. Pinto, M. Almada, I. Fonseca, A. Sousa, A. Lopes
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S866-S867
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Introduction
Self-stigma refers to the process in which a person internalizes negative stereotypes, beliefs, and prejudices about their mental illness, adopting a stigmatized view of themselves. Severe mental illness is one of the most socially exclusive stigmata and is associated with poor clinical and functional outcomes and social withdrawal.
ObjectivesIn Portugal, investigation regarding self-stigma is scarce. In this study, we aim to evaluate the impact of self-stigma among people with diagnosis of severe mental illness (SMI). For this goal we assess the prevalence of self-stigma of psychiatric patients with diagnosis SMI; and investigate the correlates of elevated self-stigma levels.
MethodsFifty-one outpatients with SMI, were recruited from a community psychiatry unit from Porto, Portugal. After informed consent, evaluations included sociodemographic data, illness characteristics, and self-reported standardized scales. Self-stigma (ISMI), self-esteem (RSES) and quality of life (WHO-QoL) were assessed. Data analyses were performed using the SPSS version 28.0 (IBM Corp., Armonk, NY). p-values<0.05 were considered significant.
ResultsFrom the study sample, 66.7% were male, with mean age of 44.8±11.0 and 56.9% were single. 33.3% reported living with their parents while 31.4% were living with a partner/spouse. The majority of participants had a diagnosis of schizophrenia (60.8%). Concerning the level of education, 58.8% completed basic education, but most patients were retired due to illness (62.7%). In this study, moderate to high self-stigma levels was found in 31.4% participants. Proportion of elevated self-stigma was significantly higher in unemployed/retired patients vs. those who were active (39.0% vs. 0%; P=0.021). No significant correlations were found with age, level of education, age at diagnosis, duration of illness, and number of hospitalizations. In the correlations analysis, a negative correlation between self-stigma and self-esteem (rho=-0.745; P<0.001), as well as self-stigma and quality of life (rho=-0.585; P<0.001) was found. A positive relationship between self-esteem and quality of life (rho=0.551; P<0.001) was found.
ConclusionsThis study investigates, for the first time, the prevalence of self-stigma among outpatients with SMI in a community psychiatric unit from Porto. Our findings suggest a high prevalence of elevated levels of self-stigma among these patients. A significant association with being unemployed/retired was also found. Our results support previous evidence that internalized stigma is strongly associated with diminished self-esteem and impaired quality of life, in particular those aspects related to physical and psychological complaints. Targeting internalized stigma and self-esteem among patient with SMI will likely improve their quality of life, besides improving their clinical and functional outcomes.
Disclosure of InterestNone Declared
Effectiveness and Tolerability of Intranasal Esketamine in Treatment-Resistant Depression: Report of Two Clinical Cases
- A. Mercado-Rodríguez, C. Martín Requena, A. Cano Baena, I. Zorrilla Martínez, A. González-Pinto Arrillaga, L. Mar-Barrutia
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S824
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Introduction
Major depressive disorder (MDD) is a mental health disorder characterised by persistently low mood; anhedonia; feelings of worthlessness and guilt; altered appetite, weight and sleep and suicidal ideation. About one-third of patients do not respond to available antidepressants (AD). Treatment-resistant depression (TRD) is a clinical term used to define a lack of response to two or more AD in patients with MDD that do not respond to other lines of treatment either. TRD is associated with an increased risk of relapse, hospitalisation and suicide. Esketamine is a non-competitive NMDAR antagonist that acts as an antidepressant by modulating glutamatergic neurotransmission, disturbed in MDD patients. It has recently been approved by the European Commission as a fast-acting nasal spray therapy for depression and suicidal ideation after showing effectiveness in TRD patients (Papakostas et al. JCP 2020; 81 4).
ObjectivesThe aim of this study is to determine the effectiveness, safety and tolerability of intranasal esketamine in two TRD-diagnosed patients and to assess their clinical evolution.
MethodsA prospective study was conducted describing the evolution of two TRD patients treated with intranasal esketamine. We used The Hamilton Depression Rating Scale (HDRS) to quantify the severity of their symptoms and assess their recovery over time, analyzing the score change from baseline to endpoint as a primary outcome of the study. We also applied the Addensbrooke Cognitive Examination (ACE-III) as a tool to establish their cognitive condition before therapy and its evolution. Changes in dosage during treatment, adverse effects, time required for onset of action, clinical outcomes and other variables were also measured.
ResultsIntranasal esketamine was administered twice a week during the first 4-week induction phase and weekly during the following 6-month maintenance phase. Dosage of antidepressant was determined depending on each patient’s age and clinical evolution, being 56 mg the initial dose for case 1 (57 years old) and 28 mg for case 2 (71 years old). This antidepressant was effective in both patients in a fast-acting way, with the onset of action occuring within the first two weeks. During the course of treatment, the HDRS score significantly decreased, associated with improvement and remission of depressive symptoms. Cognitive performance got better in both cases. None of the patients discontinued treatment due to adverse effects or lack of efficacy.
ConclusionsOur data suggest that intranasal esketamine therapy is a good alternative in TRD patients, being effective, fast-acting and well-tolerated, with a manageable safety profile. Clinical stability was also observed in the medium-term follow-up after the end of treatment. This presents esketamine as a promising therapeutic and effective strategy in MDD patients who are either treatment-resistant or acutely suicidal.
Disclosure of InterestNone Declared
“It is Typical of Teenagers”: When Teachers Morally Disengage from Cyberbullying
- Nádia Salgado Pereira, Paula Da Costa Ferreira, Ana Margarida Veiga Simão, Andreia Cardoso, Alexandra Barros, Alexandra Marques-Pinto, Aristides I. Ferreira, Ana Cláudia Primor, Sara Carvalhal
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- Journal:
- The Spanish Journal of Psychology / Volume 25 / 2022
- Published online by Cambridge University Press:
- 01 December 2022, e30
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Teachers can contribute to preventing and solving cyberbullying situations. Therefore, it is relevant to investigate what may influence their involvement and actions concerning this phenomenon. A first study analyze teachers’ definitions of cyberbullying, how they would intervene and feel morally implicated with the phenomenon. A second study aimed to investigate the association between teachers’ being aware of cyberbullying and their perceived severity, moral disengagement with the phenomenon, perceived performance to solve such situations and their acquired knowledge about cyberbullying. Twenty semi-structured interviews were conducted in the first study with 25 to 65-year-old teachers. An online inventory was answered in study two by 541 middle and high school teachers (Mage = 50, SD = 7). A thematic analysis from the first study revealed that most teachers did not report repetition of behavior, power imbalance, intentionality to harm, and occurrence among peers as defining features of cyberbullying. Also, strategies they would use to intervene mainly focused on reporting the incident. Moreover, moral disengagement mechanisms were found in teachers’ discourse, which contribute to displacing responsibility for intervening and perceiving cyberbullying as less severe. In the second study, path analysis revealed that teachers’ awareness of cyberbullying among their students was positively associated with moral disengagement and acquired knowledge of the phenomenon. The mediating role of acquired knowledge of cyberbullying was significant between being aware of cyberbullying and teachers’ perceived severity of the situation, moral disengagement, and perceived performance to solve these situations. These findings highlight the relevance of developing cyberbullying training actions involving teachers.
Nitrous Oxide in Treatment Resistant Major Depression: Should We Laugh About It?
- B. Leal, D. Vila-Chã, S. Garcia, I. Pinto, R. Mateiro, M. Avelino, M. Martins, J. Salgado
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S716
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Introduction
Nitrous oxide (NO), also known as “laughing gas” is a colorless gas used as an anesthetic, a propellant in some foods, an engine performance enhancer and a recreational drug. When inhaled, it is known to provoke a rapid feeling of euphoria or excitement for a short period of time, dissociative phenomena and sometimes laughter. As its fellow anesthetic agent and NMDA-receptor antagonist, ketamine, NO is being studied for its possible therapeutic profile in treatment resistant major depression (TRMD).
ObjectivesTRMD is a serious illness, that urges for effective alternative treatments. In that regard, we explored the recent studies conducted in these patients, using NO in different dosages when compared to placebo.
MethodsThe authors revised the published literature about this topic, selecting relevant articles with the topic words: “Depression”, “Treatment Resistant Major Depression” and “Nitrous Oxide” in scientific data base.
ResultsSince 2018, at least two randomized clinical trials have demonstrated that NO has considerable antidepressant effects in TRMD, when compared to placebo. Investigators noted that these positive effects where maintained at least for two weeks after a single 1-hour inhalation. In a more recent study, scientists compared different NO concentrations (25% vs. 50%) concluding that the 25% concentration had similar efficacy with a lower risk of adverse effects.
ConclusionsThere appears to be encouraging results when treating patients with TRMD with NO in a 25% concentration. Nonetheless, there is need for further investigation, namely through studies that compare NO with other valid TRMD treatments and not only versus placebo.
DisclosureNo significant relationships.
Altered Executive Function in Suicide Attempts
- J. Fernández, S. Alberich, I. Zorrilla, I. González-Ortega, M.P. López, V. Pérez-Solà, E. Vieta, A.M. González-Pinto, P.A. Saiz
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S124
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Introduction
Executive function organizes and directs behaviour but alterations in this cognitive domain can lead to inaccurate perception, interpretation and response to environmental information, which could be a risk factor for suicide.
ObjectivesTo explore executive function performance of depressed recent suicide attempters in comparison to depressed past suicide attempters, depressed non-attempters and healthy controls.
Methods96 participants from the Psychiatry Department of the Araba University Hospital-Santiago were recruited as follows: 20 patients with a recent suicide attempt (<30days) diagnosed with a Major Depressive Disorder (MDD), 33 MDD patients with history of attempted suicide, 23 non-attempter MDD patients and 20 healthy controls. All participants underwent a clinical interview and neuropsychological assessment on executive function with the Wisconsin Sorting Card Test. Backward multiple regressions were performed adjusting for significant confounding variables. For group comparisons ANOVA test and Bonferroni post hoc test were performed with p<0.05 significance level.
ResultsPatient groups did not differ regarding severity of depression. All patient groups performed significantly worse than healthy controls on executive function. Adjusted comparisons between patient groups indicated that recent suicide attempters had a poorer performance in this cognitive domain in comparison to both depressed lifetime attempters and depressed non-attempters (B=0.296, p=0.019 and B=0.301, p=0.028 respectively).
ConclusionsExecutive function performance is altered in recent suicide attempts. As impaired executive function can be a risk factor for suicide, preventive interventions on suicide should focus on its assessment and rehabilitation.
DisclosureNo significant relationships.
Retinal Thickness as a biomarker of cognitive impairment in bipolar disorder
- E. García-Corres, S. Alberich, L. Rementeria, I. Pérez-Landaluce, A.M. González-Pinto
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S415-S416
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Introduction
Ocular Coherence Tomography (OCT) to measure retinal thickness is the current method to observe neurological impairment in neurodegenerative diseases [1] and in mental disorders [2] due to the composition of the retina itself as an anatomic extension of the brain.There can be found some factors to improve the resilience like the years of study.
ObjectivesOur aim is to evaluate cognitive and clinical impairment in Bipolar Disorder and see the correlation to the retinal thinning.
MethodsTwenty-seven patients diagnosed with Bipolar Disorder were assessed in the context of the FINEXT programme (3). Selective attention, executive functions and verbal memory were measured among other variables. Using the OCT technique, we measured the thickness of the ppRNFL, the RFNL, GCL and IPL layers in the macula in both eyes through several radial segments. Partial correlations were performed with Bonferroni correction (p≤0.006) adjusted for age and academic status except for the variable years of study which was adjusted for age.
ResultsSignificant direct correlations were observed between: - The study-years and the thickness of the retina in the NO and RFNL. -Selective attention and GCL and RFNL layers. -Executive function and the GCL and IPL.
ConclusionsWe can observe some preliminar results showing a significant correlation between some layers of the retina, upper segments more frequently, and the outcomes of the neurocognitive assessment. We can see a relationship as well between years of study and the thickness of the Retinal Nerve Fibre Layer in the retina and optic nerve head, the axons of the neurons in the eye.
DisclosureNo significant relationships.
Mental Health Refugees - Difficulties from the country of origin to the receiving country – A review
- D. Vila-Chã, B. Leal, I. Pinto, R. Mateiro, M. Avelino, J. Salgado
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S544-S545
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Introduction
The most recent global refugee figures are staggering, with over 82.4 million people forcibly displaced as a result of persecution, conflict, violence, human rights violations. However, little is known about their long-term mental health.
ObjectivesThis review aimed to assess prevalence of mental disorders and to identify the main factors associated with the development of mental disorders among refugees.
MethodsWe searched MEDLINE databases using the key terms “refugees” and “global mental health” without language or date restriction. Articles were considered for inclusion in the review if they comprised a population of refugees. Three studies were identified.
ResultsOur review showed a great heterogeneity in the prevalence of mental disorders that affect migrants showing an overall prevalence of 20% of these pathologies among them. War-related factors are more associated with Post Traumatic Stress Disorder and post-migration-related factors (acculturation, economic uncertainty and ethnic discrimination) are more associated with mood, anxiety and substance use disorders.
ConclusionsExisting evidence suggests that mental disorders tend to be highly prevalent in refugees many years after resettlement. The increased risk is not only caused by the past adversities in the country of origin but also by the post-migration-related factors. Thus, there is a need for more consistent and rigorous research from a methodological point of view on the mental health of refugees, allowing to find measures to protect and promote their mental health.
DisclosureNo significant relationships.
COVID-19 induced psychosis. Should we be concerned?
- P. Costa, I. Pinto, P. Branco
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S201-S202
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Introduction
Coronaviruses traditionally are considered to cause pulmonary diseases, often accompanied by gastrointestinal symptoms. Since the COVID-19 pandemic start in early 2020, there have been reports of a high prevalence of neuropsychiatric symptoms. Recent data show significant rates of neuropsychiatric diagnosis over the subsequent 6 months post-infection. Some of the data suggest the COVID-19 as a cause of new-onset psychotic symptoms in patients with no psychiatric history. Delusions, hallucinations, disorganized thoughts, and confusion were the most frequently reported psychotic features which low doses of antipsychotics seem to be helpful.
ObjectivesBrief literature review about the relationship between COVID-19 and new-onset psychotic symptomatology.
MethodsNon-systematic review through PubMed research using the terms “COVID-19”, “SARS-CoV-2”, “pandemics”, “psychotic symptoms” and “psychosis”.
ResultsThe severity of the infection, especially in those with the need for hospitalization/intensive care, seems to have a clear effect on the gravity of subsequent neuropsychiatric symptoms, namely psychosis. Viral invasion of the central neural system, hypercoagulable states, and neuroinflammation are potential associated mechanisms. It’s important to consider the effect of therapies that may have the potential to cause psychosis (eg steroids). According to recent literature, around 0.9-4% of people exposed to the COVID-19 virus develop psychotic episodes, which is much higher than the incidence in the general population.
ConclusionsPost-COVID-19 related psychosis has been reported in different nations. The pathophysiology is yet not clear, although the hyperinflammatory response has been suggested as the main mechanism for the neuropsychiatric manifestations. Given the high number of case reports with similar presentations, it’s important to proceed with more investigations.
DisclosureNo significant relationships.
Treating Patients with Aripiprazol: A Safe Gamble?
- B. Leal, D. Vila-Chã, S. Garcia, I. Pinto, R. Mateiro, M. Avelino, M. Martins, J. Salgado
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S713
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Introduction
Aripiprazole (ARI) is an atypical antipsychotic drug with D2 partial agonist properties, usually prescribed to treat mood disorders (major depression or bipolar disorder) and schizophrenic disorder (schizophrenia or schizoaffective disorder). Dopamine receptor agonists, as is ARI, have been implicated in some cases of impulse-control problems, such as gambling disorder (GD), increased spending, hypersexuality and compulsive eating.
ObjectivesCurrently, it is hypothesized that aripiprazole may cause impulse-control problems because it can produce a hyperdopaminergic state in the mesolimbic pathway (reward system) through its predominant action on dopamine D3 receptors. We intend to do a non-systematic review of the scientific information regarding this subject.
MethodsThe authors revised the published literature about this topic, selecting relevant articles, systematic reviews and case reports, with the topic words: “aripiprazol”, “gambling disorder” and “dopamine receptor” in scientific data base.
ResultsOverall, a few cases of ARI-induced pathological gambling as well as ARI-induced hypersexuality have been reported. In one study it was verified that comorbid psychiatric and substance use disorders were common among those who have experienced GD or worsened GD after beginning ARI treatment. In another study, it was verified that the group of patients who reported this alleged side-effect were mostly young (mean age, 33.6 years), mostly men (88.2%) and most lived alone.
ConclusionsAttributing to dopamine agonists the only factor that can explain the onset of GD is simplistic and dangerous. Many other potential risk factors, including individual vulnerability factors (temperament, genetics) as well as environmental factors, must be considered.
DisclosureNo significant relationships.
COVID-19 infection could be a risk factor for dementia?
- P. Costa, I. Pinto, P. Branco
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S519
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Introduction
Since the COVID-19 pandemic start in early 2020, there have been reports of a high prevalence of neuropsychiatric symptoms. Cognitive impairment is being increasingly recognized as an acute and possibly long-term sequel of the disease. According to recent data, limited evidence point to SARS-CoV-2 having a preferential neurotropism for the frontal lobes, as suggested by behavioral and dysexecutive symptoms, frontotemporal hypoperfusion on MRI, EEG slowing in frontal regions, and frontal hypometabolism on 18F-FDG-PET. Nevertheless, there isn’t a specific biomarker.
ObjectivesBrief literature review about the relationship between COVID-19, cognitive impairement onset and risk for dementia.
MethodsNon-systematic review through PubMed research using the terms “COVID-19”, “SARS-CoV-2”, “pandemics”, “cognitive impairement”, “dementia” and “risk factor”.
ResultsDirect neuronal infection via angiotensin-converting enzyme 2 receptor (ACE2R), hyperinflammation, brain ischemia related to respiratory failure or thromboembolic strokes, and severe psychological stress are the mechanisms more associated with a deleterious effect on cognition. The relation between SARS-CoV-2 infection and neurodegenerative diseases is still unclear. However, the high expression of the ACE2R in the brain, may explain the acute brain damage and could also be the basis for later neurodegenerative changes. The potentially long-term nature of the deficits makes it important to do an early identification, management, rehabilitation and follow-up of the patients exhibiting cognitive symptoms.
ConclusionsGiven the reports of brain damage by SARS-CoV-2, there are concerns that this damage may substantially increase the incidence of neurodegenerative diseases and promote dementia. Further long-term studies may be required to identify the relationships between SARS-CoV-2 infection and risk for dementia.
DisclosureNo significant relationships.
The impact of SARS-CoV-2 pandemic on suicidal ideation admissions: a single adolescent and young adult psychiatry center experience
- D. Vila-Chã, B. Leal, I. Pinto, R. Mateiro, M. Avelino, J. Salgado
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S325
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Introduction
The COVID-19 pandemic and the lockdown brought about a sense of fear and anxiety around the globe. This phenomenon led to both short and long term psychosocial and mental health implications for children and adolescents.
ObjectivesTo evaluate the effect of COVID-19 pandemic on hospital admissions for suicidal ideation in a Portuguese adolescent and young adult psychiatry service.
MethodsWe conducted a single-center, retrospective study including adolescent and young adult patients (15-25 years old) admitted to our service with suicidal ideation within a year before and a year after the declaration date of SARS-CoV-2 disease as a pandemic. Patients were divided in two groups: Group A - patients admitted before the pandemic (March 11, 2019 and March 11, 2020) and Group B – patients admitted after the pandemic declaration (March 12, 2020 and March 12, 2021). The groups characteristics and outcomes were assessed and compared.
ResultsA total of 647 admissions were assessed (Group A, n= 372 and Group B, n=275). Demographic characteristics were similar between groups. 75 patients (vs 25 patients) were admitted with suicidal ideation in the year before the pandemic. There was a lower proportion of patients admitted with suicidal ideation during the year after the pandemic year - OR 0.374 (95% CI 0.228-0.614, P<0.001).
ConclusionsOur study showed a decrease in admissions for suicidal ideation in this service in the year after the pandemic. More studies are needed to understand the factors that may justify this decline and evaluate the longer effects of this pandemic in mental health.
DisclosureNo significant relationships.
Mental impact of Covid-19 among Spanish healthcare workers. A large longitudinal survey
- J. Alonso, G. Vilagut, I. Alayo, M. Ferrer, F. Amigo, A. Aragón-Peña, E. Aragonès, M. Campos, I. del Cura-González, I. Urreta, M. Espuga, A. González Pinto, J. M. Haro, N. López Fresneña, A. Martínez de Salázar, J. D. Molina, R. M. Ortí Lucas, M. Parellada, J. M. Pelayo-Terán, A. Pérez Zapata, J. I. Pijoan, N. Plana, M. T. Puig, C. Rius, C. Rodriguez-Blazquez, F. Sanz, C. Serra, R. C. Kessler, R. Bruffaerts, E. Vieta, V. Pérez-Solá, P. Mortier, MINDCOVID Working group
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 31 / 2022
- Published online by Cambridge University Press:
- 29 April 2022, e28
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Aims
Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors.
Methods8996 healthcare workers evaluated on 5 May–7 September 2020 (baseline) were invited to a second web-based survey (October–December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview.
Results4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar.
ConclusionsOur study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565
Suicidal behaviour and cognition: A systematic review with special focus on prefrontal deficits
- J. Fernández-Sevillano, A. González-Pinto, J. Rodríguez-Revuelta, S. Alberich-Mesa, L. González-Blanco, I. Zorrilla-Martínez, Á. Velasco, P. López-Pena, I. Abad-Acebedo, P.A. Saiz
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S584
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Introduction
Suicidal behaviour and cognition: A systematic review with special focus on prefrontal deficits Introduction: Suicide is a major health concern worldwide, thus, identifying risk factors would enable a more comprehensive understanding and prevention of this behaviour. Neuropsychological alterations could lead to difficulties in interpreting and managing life events resulting in a higher risk of suicide.
ObjectivesObjective: Bibliographic review about the influence of neuropsychological deficits on suicidal behaviour.
MethodsMethod: A systematic literature search from 2000 to 2020 was performed in Medline (Pubmed), Web of Science, SciELO Citation Index, PsycInfo, PsycArticles and Cochrane Library databases regarding studies comparing cognition of attempters versus non-attempters that share same psychiatric diagnosis. Results: 1.885 patients diagnosed with an Affective Disorder (n = 1512) and Schizophrenia/ Schizoaffective Disorder (n = 373) were included.
ResultsIn general comparison, attention was found to be clearly dysfunctional. Regarding diagnosis, patients with Schizophrenia and previous history of suicidal behaviour showed a poorer performance in executive function. Patients with current symptoms of an Affective Disorder and a previous history of suicidal attempt had poorer performance in attention and executive function. Similarly, euthymic affective patients with history of suicidal behaviour had worse decision-making, attention and executive function performance compared to euthymic non-attempters.
ConclusionsPatients who have attempted suicide have a poorer neuropsychological functioning than non-attempters with a similar psychiatric disorder in attention and executive function. These alterations increase vulnerability for suicide.
Conflict of interestJessica Fernández-Sevillano is beneficiary of the Pre-PhD Training Programme of the Basque Government. Dr. Gonzalez-Pinto has received grants and served as consultant, advisor or CME speaker for the following entities: Almirall, AstraZeneca, Bristol-Myers
Social cognition as a mediator between cognitive reserve and psychosocial functioning in patients with first episode psychosis
- I. González-Ortega, S. Alberich-Mesa, E. Echeburúa, M. Bernardo, B. Cabrera, S. Amoretti, A. Lobo, C. Arango, I. Corripio, E. Vieta, E. De La Serna, R. Rodriguez-Jimenez, R. Segarra, J.M. López-Ilundain, A. Sánchez-Torres, M. Cuesta, A. González-Pinto
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S163
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Introduction
Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear.
ObjectivesThe aim of the study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years.
MethodsThe sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis.
ResultsAt baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (−10.215 to −0.337) and (−4.731 to −0.605) respectively).
ConclusionsCognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.
DisclosureThis work was supported by the Carlos III Institute of Health and European Fund for Regional Development (PI08/1213, PI11/ 01977, PI14/01900, PI08/01026, PI11/02831, PI14/01621, PI08/1161, PI16/ 00359, PI16/01164, PI18/00805), the Basque Foundation for He
Angiostrongylus cantonensis in urban populations of terrestrial gastropods and rats in an impoverished region of Brazil
- Fábio N. Souza, Maísa Aguiar Santos, Daniele Almeida Alves, Leyva Cecília Vieira de Melo, Dan Jessé Gonçalves da Mota, Arsinoê Cristina Pertile, Ricardo Gava, Pedro Luiz Silva Pinto, Max T. Eyre, Caio Graco Zeppelini, Mitermayer G. Reis, Albert I. Ko, Mike Begon, Thiago C. Bahiense, Federico Costa, Ticiana Carvalho-Pereira
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- Journal:
- Parasitology / Volume 148 / Issue 8 / July 2021
- Published online by Cambridge University Press:
- 12 April 2021, pp. 994-1002
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The nematode Angiostrongylus cantonensis is the most common cause of neuroangiostrongyliasis (manifested as eosinophilic meningitis) in humans. Gastropod molluscs are used as intermediate hosts and rats of various species are definitive hosts of this parasite. In this study, we identified several environmental factors associated with the presence and abundance of terrestrial gastropods in an impoverished urban region in Brazil. We also found that body condition, age and presence of co-infection with other parasite species in urban Rattus norvegicus, as well as environmental factors were associated with the probability and intensity of A. cantonensis infection. The study area was also found to have a moderate prevalence of the nematode in rodents (33% of 168 individuals). Eight species of molluscs (577 individuals) were identified, four of which were positive for A. cantonensis. Our study indicates that the environmental conditions of poor urban areas (presence of running and standing water, sewage, humidity and accumulated rain and accumulation of construction materials) influenced both the distribution and abundance of terrestrial gastropods, as well as infected rats, contributing to the maintenance of the A. cantonensis transmission cycle in the area. Besides neuroangiostrongyliasis, the presence of these hosts may also contribute to susceptibility to other zoonoses.
PL02: Double Sequential External Defibrillation for Refractory Ventricular Fibrillation: the DOSE VF pilot randomized controlled trial
- S. Cheskes, P. Dorian, M. Feldman, S. McLeod, D. Scales, R. Pinto, L. Turner, L. Morrison, I. Drennan, P. Verbeek
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, p. S5
- Print publication:
- May 2020
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Introduction: Despite recent advances in resuscitation, some patients remain in ventricular fibrillation (VF) after multiple defibrillation attempts during out-of-hospital cardiac arrest (OHCA). Vector change defibrillation (VC) and double sequential external defibrillation (DSED) have been proposed as alternate therapeutic strategies for OHCA patients with refractory VF. The primary objective was to determine the feasibility, safety and sample size required for a future cluster randomized controlled trial (RCT) with crossover comparing VC or DSED to standard defibrillation for patients experiencing refractory VF. Secondary objectives were to evaluate the intervention effect on VF termination and return of spontaneous circulation (ROSC). Methods: We conducted a pilot cluster RCT with crossover in four Canadian paramedic services and included all treated adult OHCA patients who presented in VF and received a minimum of three defibrillation attempts. In addition to standard cardiac arrest care, each EMS service was randomly assigned to provide continued standard defibrillation (control), VC or DSED. Services crossed over to an alternate defibrillation strategy after six months. Prior to the launch of the trial, 2,500 paramedics received in-person training for VC and DSED defibrillation using a combination of didactic, video and simulated scenarios. Results: Between March 2018 and September 2019, 152 patients were enrolled. Monthly enrollment varied from 1.4 to 6.1 cases per service. With respect to feasibility, 89.5% of cases received the defibrillation strategy they were randomly allocated to, and 93.1% of cases received a VC or DSED shock prior to the sixth defibrillation attempt. There were no reported cases of defibrillator malfunction, skin burns, difficulty with pad placement or concerns expressed by paramedics, patients, families, or ED staff about the trial. In the standard defibrillation group, 66.6% of cases resulted in VF termination, compared to 82.0% in VC and 76.3% of cases in the DSED group. ROSC was achieved in 25.0%, 39.3% and 40.0% of standard, VC and DSED groups, respectively. Conclusion: Findings from our pilot RCT suggest the DOSE VF protocol is feasible and safe. VF termination and ROSC were higher with VC and DSED compared to standard defibrillation. The results of this pilot trial will allow us to inform a multicenter cluster RCT with crossover to determine if alternate defibrillation strategies for refractory VF may impact patient-centered, clinical outcomes
PW01-35 - A Prospective Study of Mixed Bipolar Patients: Ten Years of Follow Up
- A. Ugarte, J. García, S. Ruiz de Azúa, I. González, M. Sáenz, M. Gutierrez, C. Valcarcel, E. Zuhaitz, I. de la Rosa, R. Alonso, A. González-Pinto
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- Journal:
- European Psychiatry / Volume 25 / Issue S1 / 2010
- Published online by Cambridge University Press:
- 17 April 2020, 25-E1437
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Introduction
Mixed Bipolar patients are those who have co-existing depressive symptoms during mania. These patients are supposed to have a worse evolution.
ObjectiveThe objective of this study was to compare the long-term outcomes of patients who had at least one mixed episode with those who experienced only pure manic episodes.
Methods169 outpatients diagnosed of Bipolar I disorder and treated at least during two years were included. 120 patients (71%) complited the follow-up over 10 years. Baseline demographic and clinical variables were included.
ResultsThe patients with mixed episodes (37%) had a significantly younger mean age at onset comparing with those with manic episodes (25.3 years vs. 30.8 years; p=0.025) they also had more previous mood- incongruent psychotic symptoms χ2= 6.77, p=0.034), more number of hospitalizations (OR= 1.36, 95% CI = 1.14; -1.63; p< 0.001), and more number of episodes (OR= 1.21, 95% CI = 1.10-1.31; p< 0.001). There were no significant differences relating to depressive episodes, alcohol use, drug abuse, suicidal behaviour and suicide attempts.
DiscussionAge at onset differed significantly between the mixed episode and pure mania groups, with mixed episode patients having a younger age of onset. This is interesting as one of the major results of the study we have found that age at onset mediates some of the factors classically related to outcome in mixed episodes like alcohol abuse and suicide attempts. However, independently of age at onset, these patients represent a especially severe type of bipolar disorder.
PW01-214 - Long-Term Outcomes In Patients With First Psychotic Episode And Cannabis Use
- S. Alberich, S. Barbeito, M. Fernández, M. Karim Haidar, S. Ron, A. Villamor, A. Jimeno, I. Zorrilla, L. Celaya, M.A. Alecha, A. González-Pinto
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- Journal:
- European Psychiatry / Volume 25 / Issue S1 / 2010
- Published online by Cambridge University Press:
- 17 April 2020, 25-E1621
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Objectives
To evaluate the influence of cannabis in the long-term follow-up in patients with a first psychotic episode, comparing those who have never used cannabis with (a) those who used cannabis before the first psychotic episode but stopped it during the follow-up, and (b) those who used cannabis both before and after the first psychotic episode.
MethodPatients were followed from the first psychotic admission. They were assessed at 1, 3 and 5 years obtaining information about functional outcome, positive and negative symptoms. At 8th year functional outcome was evaluated. Patients were classified in 3 groups: 40 that never used cannabis (NU), 27 that used cannabis and stopped during follow-up (CUS), and 25 that had continued use during follow-up (CU).
ResultsAt baseline, there were differences neither in functional outcome nor in negative symptoms. The CUS group improved the functional outcome during the follow-up (p< 0.001), while CU and NU groups did not show any significant results (p= 0.466 and p= 0.370 respectively). CUS group had also a significant decreasing trend in negative symptoms (p= 0.012), whereas for the other two groups no significant results were observed (p= 0.069 and p= 0.226 respectively). All groups improved in positive symptoms during follow-up.
ConclusionsAlthough cannabis use has deleterious effect, to stop it after the first psychotic episode produces a clearly improvement in the long-term follow-up.