The objective of this study was to compare the attitudes and beliefs of PCU physicians leaders in the United States versus Canada regarding the subcutaneous method in the administration of medications and hydration in order to gain a better understanding as to why variations in practice exist.

This survey trial took place from November 2022 to May 2023. The MD Anderson Cancer Center institutional review board in Houston, Texas, approved this study. The participants were the physician leaders of the acute palliative care units (PCUs) in the United States and Canada. The survey comprised questions formulated by the study investigators regarding the perceived comfort, efficiency, and preference of using the subcutaneous versus the intravenous method. The consent form and survey links were emailed to the participants.

Sixteen PCUs were identified in the United States and 15 PCUs in Canada. Nine US and 8 Canadian physicians completed the survey. Physicians in Canada were more likely to use the subcutaneous route for administering opioids, antiemetics, neuroleptics, and hydration. They preferred subcutaneous over intravenous or intramuscular routes (p = 0.017). Canadian physicians felt their nursing staff was more comfortable with subcutaneous administration (p = 0.022) and that it was easier to administer (p = 0.02). US physicians felt the intravenous route was more efficient (p = 0.013).

The study results suggest that exposure to the subcutaneous route influences a physician’s perception. Further research is needed to explore ways to incorporate its use to a greater degree in the US healthcare system.

According to the World Health Organization, addressing the mental health care gap for adolescents, especially in low-resource contexts, is a priority. Evidence-based assessment is crucial for selecting treatment strategies and for quality management.

To develop a digital platform for evidence-based assessments and implement it in different low-resource settings.

The project operates according to the principles of digital development (https://digitalprinciples.org/), including designing with the user, user testing, understanding the ecosystem, resusing software and being open source, think about sustainability and addressing privacy and security.

Different implementation contexts (in Tanzania, Kosovo and Chile) will be presented.

The learned lessons will be presented to the audience.

MHIRA is a promising tool that helps bridge the gap regarding adolescent mental health in low-resource settings. Challenges include the clinicans attitude towards evidence based assessment, sustainability of the project and integration with the existing information technology eco-system and regulations.

No significant relationships.

Despite significant advances, early detection and intervention regarding psychosis still face major obstacles. The Basel FePsy-study tries to contribute to optimising the methods for assessment of risk for psychosis, by describing individuals in an At Risk Mental State (ARMS) with and without later transition to psychosis as compared to healthy (HC) and depressive controls (DC) and by using a multidomain approach including not only psychopathology and clinical risk factors, but also neuropsychology, neurophysiology and neuroimaging.

60 ARMS subjects, 51 HC and 34 DC were investigated. 53 ARMS individuals could be followed up for up to 7 years.

21 ARMS individuals made the transition to psychosis (transition rate 34%). As compared to HC, they showed significant deficits in executive functions and working memory. Predictors of transition were certain attenuated psychotic and negative symptoms and certain cognitive deficits. In an integrated model for prediction of transition using these variables, the overall predictive accuracy was 80.9%, with a sensitivity of 83.3% and a specificity of 79.3%. Specificity of prediction could be further improved by EEG analysis. Furthermore, MRI showed specific differences between ARMS with and without later transition to psychosis.

Individuals at risk for psychosis do not only show psychopathological prodromes and social decline, but also neuropsychological impairments and EEG- as well as MRI-abnormalities. Hopefully in the near future, a clinical staging of individuals according to their risk for psychosis will be possible with corresponding stepwise early interventions.

There is growing evidence that major depressive disorder (MDD) might be overdiagnosed at the expense of bipolar disorders (BPD).

To identify a subgroup of subthreshold BPD among DSM-IV MDD, which is distinct from pure MDD regarding validators of bipolarity.

Data come from the ten-year prospective-longitudinal EDSP-Study, a community survey from Munich, and were assessed with the DSM-IV/M-CIDI. Subthreshold BPD was defined as fulfilling criteria for MDD plus presence of manic symptoms, but never having met criteria for hypomania.

Among 488 respondents with MDD, about 60% had pure MDD and 40% subthreshold BPD. Compared to pure MDD, the subthreshold BPD group was found to have

1. (a) an increased family history of mania,

2. (b) considerably higher rates of nicotine dependence and alcohol use disorders,

3. (c) twice as high rates of panic disorder, and

4. (d) a tendency towards higher rates of criminal acts.

5. (e) In prospective analyses, subthreshold BPD converted more often into BPD during follow-up with the criterion D (symptoms are observable by others) being of critical predictive relevance.

Data suggest that MDD is a heterogeneous concept including a large group of subthreshold BPD, which is clinically significant and shares similarities with BPD. Findings might support the need for a broader concept and a more comprehensive screening of bipolarity.

This study assessed the underexplored factors associated with significant improvement in mothers’ mental health during postpartum inpatient psychiatric care.

This study analyzed clinical improvement in a prospective cohort of 869 women jointly admitted with their infant to 13 psychiatric Mother-Baby Units (MBUs) in France between 2001 and 2007. Predictive variables tested were: maternal mental illness (ICD-10), sociodemographic characteristics, mental illness and childhood abuse history, acute or chronic disorder, pregnancy and birth data, characteristics and mental health of the mother's partner, and MBU characteristics.

Two thirds of the women improved significantly by discharge. Admission for 25% was for a first acute episode very early after childbirth. Independent factors associated with marked improvement at discharge were bipolar or depressive disorder, a first acute episode or relapse of such an episode. Schizophrenia, a personality disorder, and poor social integration (as measured by occupational status) were all related to poor clinical outcomes.

Most women improved significantly while under care in MBUs. Our results emphasize the importance of the type of disease but also its chronicity and the social integration when providing postpartum psychiatric care.

In light of the ongoing debate whether agoraphobia [AG] should be viewed as a severe phobic disorder similar to specific phobia [SPE] or as a complication of panic disorder [PD] we aim to study the vulnerability structure of PD, AG and SPE.

3021 14-24 year-olds from the general population were followed-up over 10 years. DSM-IV syndromes were assessed via computerized M-CIDI interview and vulnerability factors via questionnaires. Associations were assessed with odds ratios from logistic regression. Latent class analysis (LCA) regressed on vulnerability factors was used to derive classes that underlie panic and phobic syndromes and to assess their associations with vulnerability factors.

1. 1. Vulnerability patterns were largely similar between PD, AG and SPE.

2. 2. The LCA resulted in a best fitting model with 4 classes: a healthy class, a class with moderate frequency of phobias without PD, a class characterized by PD and AG and moderate frequency of SPE (PDAG class) and one class characterized by high frequency of AG and SPE situational type and lower frequency of PD (AGSIT class).

3. 3. All classes showed different associations with multiple vulnerability measures. Subjects in the PDAG class reported less SPE in parents (OR=0.2; 95% CI=0.0-0.6) and older onset-age of any psychopathology (OR=2.0; 95% CI=1.07-3.6) than the AGSIT class.

We found indications for separate latent classes underlying PD and phobias that were characterized by different vulnerability factors. We interprete the different classes as different vulnerability clusters and evidence of multiple pathways leading to panic and phobias.

Affective disorders are associated with an increased risk of cardiovascular disease, which, at least partly, appears to be independent of psychopharmacological treatments used to manage these disorders. Reduced heart rate variability (SDNN) and a low Omega-3 Index have been shown to be associated with increased risk for death after myocardial infarction. Therefore, we set out to investigate heart rate variability and the Omega-3 Index in euthymic patients with bipolar disorders.

We assessed heart rate variability (SDNN) and the Omega-3 Index in 90 euthymic, mostly medicated patients with bipolar disorders (Bipolar-I, Bipolar-II) on stable psychotropic medication, free of significant medical comorbidity and in 62 healthy controls. Heart rate variability was measured from electrocardiography under a standardized 30 minutes resting state condition. Age, sex, BMI, smoking, alcohol consumption and caffeine consumption as potential confounders were also assessed.

Heart rate variability (SDNN) was significantly lower in patients with bipolar disorders compared to healthy controls (35.4 msec versus 60.7 msec; P < 0.0001), whereas the Omega-3 Index did not differ significantly between the groups (5.2% versus 5.3%). In a linear regression model, only group membership (patients with bipolar disorders versus healthy controls) and age significantly predicted heart rate variability (SDNN).

Heart rate variability (SDNN) may provide a useful tool to study the impact of interventions aimed at reducing the increased risk of cardiovascular disease in euthymic patients with bipolar disorders. The difference in SDNN between cases and controls cannot be explained by a difference in the Omega-3 Index.

To assess iodine status among pregnant women in rural Zinder, Niger and to compare their status with the iodine status of school-aged children from the same households.

Seventy-three villages in the catchment area of sixteen health centres were randomly selected to participate in the cross-sectional survey.

Salt iodization is mandatory in Niger, requiring 20–60 ppm iodine at the retail level.

A spot urine sample was collected from randomly selected pregnant women (n 662) and one school-aged child from the same household (n 373). Urinary iodine concentration (UIC) was assessed as an indicator of iodine status in both groups. Dried blood spots (DBS) were collected from venous blood samples of pregnant women and thyroglobulin (Tg), thyroid-stimulating hormone and total thyroxine were measured. Iodine content of household salt samples (n 108) was assessed by titration.

Median iodine content of salt samples was 5·5 ppm (range 0–41 ppm), 98 % had an iodine content <20 ppm. Median (interquartile range) UIC of pregnant women and school-aged children was 69·0 (38·1–114·3) and 100·9 (61·2–163·2) µg/l, respectively. Although nearly all pregnant women were euthyroid, their median (interquartile range) DBS-Tg was 34·6 (23·9–49·7) µg/l and 38·4 % had DBS-Tg>40 µg/l.

In this region of Niger, most salt is inadequately iodized. UIC in pregnant women indicated iodine deficiency, whereas UIC of school-aged children indicated marginally adequate iodine status. Thus, estimating population iodine status based solely on monitoring of UIC among school-aged children may underestimate the risk of iodine deficiency in pregnant women.

Among adolescents and young adults with DSM-IV alcohol use disorders (AUDs), there are inter-individual differences in the speed of transition from initial alcohol use (AU) to AUD. AUDs are highly co-morbid with other mental disorders. The factors associated with rapid transition from first AU to AUD remain unknown and the role of mental disorders in rapid transitions is unclear. Given this background we examined (1) whether prior anxiety, mood, externalizing and non-alcohol substance use disorders are related to the risk and speed of transition from first AU to DSM-IV alcohol abuse (AA) and alcohol dependence (AD) and (2) whether early age of onset of prior mental disorders (PMDs) is a promoter of rapid transition.

A total of 3021 community subjects (97.7% lifetime AU) aged 14–24 years at baseline were followed up prospectively for up to 10 years. AU and mental disorders were assessed with the DSM-IV/M-CIDI.

Among subjects with lifetime AU, several PMDs, such as specific phobia, bipolar disorder and nicotine dependence, were associated with an increased risk of AUD independent of externalizing disorders. Associations of PMDs with the speed of transition to AUDs were mostly weak and inconsistent. Only social phobia and externalizing disorders were associated with faster transitions to AD even after adjustment for other PMDs. Earlier age of onset of PMD was not associated with rapid transition.

Mental disorders are associated with the risk of AUD. With the possible exception of social phobia and externalizing disorders, they do not promote rapid transition, even if they occur particularly early. Future research needs to identify factors relevant to rapid transition to AUD.

Body image distortion is a key symptom of anorexia nervosa. In behavioral research two components of body image have been defined: attitudes towards the body and body size experience. Neuroimaging studies concerning own body image distortions in anorexia nervosa have revealed an inconsistent pattern of results and are constrained by the fact that no direct distinction between the different parts of body image has been made.

The present study therefore set out to investigate the neural correlates of two parts of the own body image using functional magnetic resonance imaging (fMRI): satisfaction rating and size estimation for distorted own body photographs in patients with anorexia nervosa and controls.

Anorectic patients were less satisfied with their current body shape than controls. Patients further demonstrated stronger activation of the insula and lateral prefrontal cortex during the satisfaction rating of thin self-images. This indicates a stronger emotional involvement when patients are presented with distorted images close to their own ideal body size. Patients also overestimated their own body size. We were able to show complex differential modulations in activation of the precuneus during body size estimation in control and anorectic subjects. It could be speculated that a deficit in the retrieval of a multimodal coded body schema in precuneus/posterior parietal cortex is related to body size overestimation.

We were able to find specific behavioral responses and neural activation patterns for two parts of body image in anorexia nervosa and healthy controls. Thus, the present results underline the importance of developing research and therapeutic strategies that target the two different aspects of body image separately.