3294077 results
Electroconvulsive therapy: the perspective of the informal caregiver in the decision-making process
- P.-J. Geerts, S. Abihi, S. Verhaeghe
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S241
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Introduction
Despite the importance of electroconvulsive therapy (ECT) as treatment, it remains one of the most controversial and misunderstood treatments. Negative media representations, primitive practice in the past and fear for electricity results in fear that extends beyond other therapies. Research on the perspective and role of informal caregivers (IC) in the process of ECT is limited. Most research focuses on relatives’ attitude or knowledge of ECT measured with questionnaires. However, profound understanding of their perspective can facilitate the role of physicians (or psychiatrists) in guiding patients and their IC through the decision-making process of ECT.
ObjectivesThe aim of this study was to describe the perspective of informal caregivers in the decision-making process in ECT treatment.
MethodsA qualitative phenomenological study was set up. Semi-structured interviews were held with IC of patients who are treated with ECT. Purposive sampling was based on maximum variation. All interviews were fully transcribed and thematic analyses took place. Trustworthiness was guaranteed by e.g. researcher triangulation
ResultsIn nine interviews were held with partners, children and parents of patients. The interviews had a mean duration of 102 minutes and interviewing proceeded until saturation of the most important themes was reached. During the interviews it became clear that the decision-making process of ECT is strongly influenced by the illness-trajectory and context of living with the mental health problems of the patient. IC describe their life and that of the patient as ‘trying to survive’. The proposal of ECT is seen as a way out of this unendurable situation. The perceived responsibility of the IC in the informed consent process to ECT adds to this burden. The IC worry, feel uncertain and fear to do wrong. Nonetheless ECT seems to be a beacon of hope. Trust in the psychiatrist as a competent professional who wants the best for the patient seems more important than having an answer to all of their questions. After the ECT has been started, IC establish a framework to evaluate the side-effects and effectiveness of ECT. This framework is based on how they experience the patient in daily life and on what they define as ‘the patient becoming a bit more himself again’. IC weigh the effects and side-effects to support the continuation of ECT. However, if patients clearly express that they experience side-effects that are too hindering, IC follow the patient if he or she wants to stop ECT.
ConclusionsOur study gives an insight in the perspective of the IC of patients undergoing ECT. It could be helpful for IC if the psychiatric team repeats information stepwise and takes the burden of responsibility perceived by the IC into account. The framework used by IC to evaluate the effects of ECT could be a valuable addition to the clinical evaluation of the ECT treatment.
Disclosure of InterestNone Declared
The primary motor cortex of schizophrenia patients show neuronal and subcellular impairments in the right hemisphere – postmortem study
- P. Szocsics, P. Papp, L. Havas, J. Lőke, Z. Maglóczky
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S379
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Introduction
In mental disorders, very little is known about the cellular and subcellular mechanisms underlying the development of symptoms. Postmortem studies can contribute to understanding these. Our research group collects and studies cortical samples with short postmortem intervals from schizophrenia patients.
ObjectivesWe investigated primary motor cortical brain samples, to understand the background of motor symptoms in schizophrenia.
MethodsBoth hemispheres of primary motor cortices of eight control- and eight subjects with schizophrenia were analysed by immunohistochemistry. We labelled pyramidal cells with SMI32 antibody, which binds to neurofilaments, and parvalbumin (PV) antibody, which labels one type of inhibitory input on these cells, axo-axonic and axo-somatic interneurons, and a proportion of giant pyramidal neurons (Betz cells). We were interested in the size and density of layer 3 and 5 pyramidal cells and Betz cells, the distribution of PV-labelled terminals and the PV expression of Betz cells. Results of the subjects were compared both as a whole and separately per hemisphere.
ResultsMost changes were present in the primary motor cortices in the right hemisphere (presumably subdominant). Here, the density of Betz cells and their inhibitory inputs were also reduced. PV-expression of Betz cells was not dependent on the group studied, but we observed that it is decreasing with age. The other investigated characteristics show no significant differences.
ConclusionsOur results suggest that the primary motor cortex may be involved in schizophrenia. Neurodevelopmental, pharmacological and neurodegenerative causes could be involved in this process. Network dysconnectivity is likely to underlie the stronger involvement of the subdominant side, and literature data point also in this direction. We believe that our research method is suitable for the study of the background of other symptoms and may lead to a better understanding of schizophrenia, especially if we could combine our results with clinical research.
Disclosure of InterestNone Declared
Exploring predictors of Treatment Attendance in Patients with PTSD and Comorbid Personality Disorders: Secondary Analysis of a Randomized Controlled Trial
- A. van den End, A. Snoek, I. Aarts, N. Lommerse, J. Dekker, A. T. F. Beekman, K. Thomaes
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S43
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Introduction
Posttraumatic stress disorder (PTSD) and personality disorders (PD) often co-occur and treatment dropout remains a challenging problem for both disorders. The literature on predictors of treatment dropout is highly mixed and few reliable predictors have been identified for both PTSD and PD treatments separately, let alone for concurrent PTSD and PD treatment.
ObjectivesThe aim of the present study was to identify predictors of treatment attendance among a wide range of variables in patients with PTSD and comorbid PD who received trauma-focused treatment with and without concurrent PD treatment.
MethodsData were used from the prediction and outcome study in comorbid PTSD and personality disorders (PROSPER), a study consisting of two randomized clinical trials (RCT) testing the effectiveness of trauma-focused treatment (eye movement desensitization and reprocessing or imagery rescripting) with versus without concurrent PD treatment (dialectical behavior therapy or group schema therapy). 256 patients with PTSD and comorbid personality disorder participated in the study. The potential predictors included demographic (e.g. work status), patient severity (e.g. PTSD severity), patient-therapist (e.g. working alliance) and therapist (e.g. therapist experience) variables. The ordinal outcome variable was treatment attendance (0, 1-7, 8-11, 12+ trauma-focused treatment sessions). Relevant predictors were identified by a series of ordinal regression analyses (threshold for inclusion p < .10). Relevant predictors were then entered together in a final ordinal regression model. Multiple imputation was used to handle missing data.
ResultsThe final model included ten predictor variables and provided a good fit for the data (pooled R2Nagelkerke = .29). Higher education level (OR = 1.22, p = .009), self-rated PTSD severity (OR = 1.04, p = .036) and working alliance (OR = 1.72, p = .047) were associated with a larger number of attended sessions. Higher levels of inadequate social support from a friend (OR = 0.90, p = .042) and being randomized in the concurrent treatment condition (OR = 0.52, p = .022) were associated with a smaller number of attended sessions.
ConclusionsIn terms of treatment attendance rates, the results suggest that trauma-focused treatment is preferred over concurrent trauma-focused and personality disorder treatment for patients presenting with PTSD and PD. Clinicians should further be aware of the risk of lower treatment attendance for patients with a lower educational background and those reporting inadequate social support. Enhancing working alliance may protect against early treatment termination. Finally, patients with higher levels of PTSD severity at baseline may need a larger number of treatment sessions.
Disclosure of InterestNone Declared
Skin picking disorder in the elderly- What is the available evidence?
- O. Vasiliu, A. G. Mangalagiu, B. M. Petrescu, C. A. Candea, C. Tudor, D. Ungureanu, M. Miclos, C. Florescu, A. I. Draghici, R. E. Bratu-Bizic, M. Dobre, A. F. Fainarea, M. C. Patrascu
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S632-S633
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Introduction
Excoriation disorder (ExD) is a pathology recognized by DSM-5, and it is considered a part of the obsessive-compulsive spectrum. ExD is associated with a high rate of psychiatric comorbidity (e.g., depression, ADHD, substance use disorders, etc.).
ObjectivesThe main objective of this review was to explore the available evidence to support the diagnosis and treatment of skin picking in elderly population.
MethodsA literature review of the available sources reporting on ExD in elderly patients, realized by searching three electronic databases (PubMed, Cochrane, Clarivate/Web of Science) but also the grey literature. All papers published between January 1990 and July 2023, including the terms “excoriation disorder”, “compulsive skin picking”, “dermatillomania” and “elderly” or “old-age patients” were reviewed.
ResultsThe information about ExD was extracted almost exclusively from reports on elderly patients with neurocognitive disorders. Tactile hallucinations, delusions of contamination, social isolation and focusing on own bodily sensations, and organic causes- dehydration, allergies, renal insufficiency, hepatic and pancreatic diseases, as well as toxic causes- e.g., adverse events of certain drugs should be investigated in elderly patients exhibiting signs of ExD. A differential diagnosis is very important in this population in order to find the most adequate treatment. Behavioral treatments, serotonergic antidepressants, and glutamatergic modulators have been explored in patients with ExD, although specific trials for elderly patients with this disorder are still lacking. However, case reports support the utility of several serotonergic antidepressants in the elderly.
ConclusionsExD is a less explored disorder in the elderly, where an extensive differential diagnosis and screening for somatic/psychiatric comorbidities are needed. Trials exploring the potential treatments for ExD in old-age patients are also required for evidence-based case management.
Disclosure of InterestNone Declared
The presence of personality traits of borderline personality disorder in anorexia nervosa and obesity
- F. Mustač, T. Galijašević, E. Podolski, M. Matovinović, D. Marčinko
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S560-S561
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Introduction
While in eating disorders such as anorexia nervosa, the comorbidity of pathological personality traits is very common, and accordingly the personality traits of borderline personality disorder is considered very frequent and coexisting. The treatment of anorexia nervosa is based primarily on the psychotherapy and work on pathological personality traits even more than the treatment of the syndrome and the consequences of malnutrition itself. That achieves a longer-term and more reliable solution than symptomatic treatment of anorexia nervosa which usually does not bring satisfactory results. On the other hand, in patients with obesity, pathological personality traits, especially those of borderline personality disorder, are still very rarely associated, since obesity is usually not even considered a disorder, but a variation in the population.
ObjectivesThe aim of this paper is to investigate the pathological personality traits of borderline personality disorder in people with obesity.
MethodsInvestigating relevant scientific and professional literature from the field of personality pathology and eating disorders.
ResultsWhen obesity is related to impulse control disorder in the sense of emotional eating under increased stress according to today’s relevant literature, it can definitely be related to personality traits of borderline personality disorder, i.e. the presence of elements of borderline personality organization and prementalization models. Such an inability to deal with negative emotions such as increased anxiety or rejection sensitivity, which results in overeating and the related feeling of shame that overwhelms the person, regardless of whether he/she/they has any of the certain forms of compulsive behaviour afterwards, can be related to impulsive behaviour and the “all or nothing” way of thoughts. This is also confirmed by cases when certain people have a history of both one and the other disorder. Thus, some people have, for example, malnutrition in adolescence as part of anorexia nervosa, only to have problems with obesity after some time with a healthy body mass.
ConclusionsSince pathological personality traits in people with anorexia nervosa and obesity give indications of common characteristics in the form of borderline personality disorder traits, i.e. borderline personality organization and prementalization models in both disorders, future research will certainly shed light on the connection between these eating disorders.
Disclosure of InterestNone Declared
Depression, Ulcers and Confusion – A Clinical Case of Behçet’s Disease with Psychiatric Presentation
- F. M. H. Agostinho, M. B. Resende, M. J. Amaral, R. Nogueira, V. P. Falcão, D. Cotovio
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S477
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Introduction
Behçet’s disease, a rare autoimmune disorder, can present a challenging diagnostic puzzle, particularly when neuropsychiatric symptoms take the forefront. In this case study, we delve into the diagnostic process of a 43-year-old patient without prior psychiatric history, who initially presented with depressive and catatonic symptoms. The trajectory from psychiatric admission to a final diagnosis of Behçet’s disease with neuropsychiatric involvement underscores the importance of interdisciplinary collaboration and the consideration of rare diseases in psychiatric assessment. Clinical remission was achieved with immunosuppressive therapy.
ObjectivesPresentation of a clinical case of Behçet’s disease with neuropsychiatric manifestations.
MethodsReview of the patient’s clinical data in SOARIAN platform and research on UptoDate and Pubmed using the terms “Catatonia,” “Behçet disease,” “Neuro-Behçet,” and “Psychiatry.”
ResultsWe present a clinical case of a 43-year-old patient, originally from India, not fluent in Portuguese or English, with no prior psychiatric history, who presented to the emergency department exhibiting mutism and was admitted to the psychiatry department with the diagnostic hypothesis of depressive episode with psychotic and catatonic symptoms. During hospitalization, severe vitamin deficiencies, gastrointestinal symptoms (vomiting, abdominal pain, and hematochezia), and gynecological symptoms (dyspareunia and vaginal discharge) were observed. From a psychiatric perspective, in addition to depressive and psychotic symptoms, atypical symptomatology incongruent with the initial diagnosis was identified, raising suspicion of an “organic” disease. There was an atypical fluctuation in symptoms, with periods of severe behavioral disorganization interspersed with periods of apathy and psychomotor retardation, significant alterations in attention and memory, and executive deficits. Additionally, there was a poor response to psychiatric medication and electroconvulsive therapy. A colonoscopy revealed ulcers at the ileocecal valve, and gynecological lesions suggestive of a vasculitic process were observed. Autoimmunity testing showed positivity for HLA B51/52. Given the neuropsychiatric, gastrointestinal, and gynecological manifestations, along with suggestive autoimmunity, the diagnosis of Behçet’s Disease with neurological involvement was established. Clinical remission was achieved only with immunosuppressive therapy. The case is enriched by the complex diagnostic journey, multiple complications encountered (including valproic acid-induced encephalopathy), and the challenges faced in treating neuropsychiatric manifestations.
ConclusionsThis clinical case exemplifies the challenges in diagnosing a systemic disease with primary psychiatric presentation, as well as the therapeutic success resulting from multidisciplinary collaboration in a public hospital.
Disclosure of InterestNone Declared
Psychiatry Trainees’ Perspectives on Psychotherapy Training in Residencies Worldwide
- R. M. Salgado, O. von Doellinger
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S796-S797
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Introduction
Incorporating psychotherapy into the curricula of psychiatry residency programs has been proven difficult, even in countries where psychotherapy training is a requirement for psychiatry residents to become psychiatrists. There is a risk that future psychiatrists lacking psychotherapy skills will be restricted in managing the wide scope of disorders and personalities they will face in clinical practice. It is important to assess what psychiatry trainees around the globe have to say about psychotherapy training as part of their residency curricula.
ObjectivesThe primary purpose of the article was to assess psychiatry trainees’ perspectives on psychotherapy training in residency programs worldwide.
MethodsThe authors performed a narrative review, resulting 19 original research studies, published between 2001 and 2021, evaluating psychiatry residents’ perspectives by the application of a questionnaire.
ResultsNineteen articles were included in this review. Most of the studies were developed across European countries (47.4%) and in the USA (36.8%). Psychiatry residents are interested in and value psychotherapy training, and some consider it should be an obligatory competency for psychiatrists, as it already occurs in some countries worldwide. Even though, most psychiatry trainees feel dissatisfaction with the existing training in residency curricula, pointing out concerns related to the quality of resources such as courses of psychotherapy and supervision of cases, time within the residency period, and financial constraints. In terms of personal psychotherapy, we found contrasting views of its importance in psychotherapy training for psychiatry residents. A crucial finding was that psychiatry residents tend to lose interest in psychotherapy during the years of the residency, and dissatisfaction with the quality of the psychotherapy curricula, lack of support, and low self-perceived competence in psychotherapy by trainees were factors associated with reduced interest in psychotherapy training.
ConclusionsAt a time when psychotherapy is increasingly becoming acknowledged to play a central role in the treatment of most psychiatric disorders, current training is failing to provide these competencies to psychiatry trainees. Serious reflection must be given to both the extent of the guidelines and the practical opportunities for psychotherapy training so future psychiatrists can be qualified to provide an accurate biopsychosocial model of psychiatric care. The authors postulate that maintaining residents’ interest in psychotherapy requires improvements in the residency curricula and departmental leadership must support trainees’ goals of becoming comprehensively trained psychiatrists.
Disclosure of InterestNone Declared
Factors associated with the quality of conflict management among anesthesia technicians
- A. Ghenim, M. Kahloul, I. Kacem, A. Aloui, A. Chouchane, M. Ajmi, W. Naija, M. Maoua, N. Mrizak
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S595-S596
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Introduction
A conflict arises when one or more individuals, groups or organizations disagree, creating internal or external tensions that can cause damage. This is particularly serious in operating theatres, where decisions involving life or death are common. Indeed, in this particular context, the multiplicity of stakeholders, the divergence of opinions and decisions related to patient care, the frequency of critical situations, stress and the limitation of resources are established causes of disagreement and tension.
ObjectivesTo identify factors associated with the alteration of conflict management quality among anesthesia and resuscitation technicians (ART).
MethodsThis is an observational, multicenter, cross-sectional and analytical study, enrolling all ART exercising at the two teaching hospitals of Sousse (Tunisia) over a two month period(March 1, 2022 to April 30, 2022). Conflict management was assessed using the Conflict Handling Style Scale.
ResultsOur study involved 50 participants, only eight of whom reported having had previous training in communication and conflict management. Conflicts in the hospital were rated frequent to very frequent by 58% of participants. Task conflicts were the most reported (74%). The main causes of conflict were lack of leadership (60%), unequal distribution of tasks (42%) and workload (28%). The main repercussions of the conflicts were the delay in patients care (60%), therapeutic errors (42%), and the cancellation or postponement of some acts (34%). The main factors associated with impaired conflict management abilities were age<40 years (p=0,03), tobacco consumption (p=0,001), and number of dependent children<2 p<10-3).
ConclusionsIn light of our results, it would be useful and urgent to develop the soft skills of our human resources, particularly in terms of communication and conflict management.
Disclosure of InterestNone Declared
The new paradigm of psychiatry precision medicine and its emerging clinical framework
- B. Abdelmoula, N. Bouayed Abdelmoula
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
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- 27 August 2024, pp. S668-S669
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Introduction
Precision medicine is a promising approach to improving the prevention, prediction and treatment of disease, based on individual characteristics and biomarkers/genetic variants shared by specific subgroups of patients.
ObjectivesThis study aims to address the new paradigm of precision medicine in psychiatry and to discuss, through the literature, its emerging clinical framework.
MethodsWe conducted an exhaustive review of the scientific literature using PubMed database and Google Scholar, with “Precision Medicine in Psychiatry” as keywords.
ResultsOur review revealed that while psychiatrists have long practiced a personalized therapeutic approach with, for example, treatment choices guided by individual criteria, the methods for achieving this objectively have until now been largely lacking. This dilemma has begun to be resolved with the implementation of data analysis methods such as machine learning and large-scale genomic analysis studies. The goals of precision psychiatry involved the delineation of genetic risk factors using GWAS, the redefinition of the functional domains involved in mental disorders and pharmacological repositioning. The highly polygenic nature of mental disorders and the failure of GWAS to confirm the role of candidate genes have suggested that a systems genetic approach that considers function at the network level would provide a better approach to the problem of linking heterogeneous genetic risk factors and brain mechanisms. In addition, the growing evidence that certain disorders such as psychotic disorders are syndromes rather than diseases in their own right suggests that many conditions currently recognized as such may have similar underlying patterns of cognitive dysfunction and neurobiological abnormalities that will need to be reclassified.
ConclusionsThe application of precision medicine in psychiatry is still in its infancy. Numerous research programs creating large multimodal databases with multiple data on brain imaging, genetics, etc. will soon support the clinical deployment of precision medicine in psychiatry.
Disclosure of InterestNone Declared
The DiSCoVeR trial – Mid-study look at post-training patient motivation for an innovative treatment approach
- L. Rubene, L. Konošonoka, A. Stūrmane, E. Dechantsreiter, F. Padberg, D. Bavelier, F. Hummel, O. Bonne, Y. Benjamini, M. Nahum, E. Rancāns
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
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- 27 August 2024, pp. S104-S105
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Introduction
The DiSCoVeR Project: ‘Examining the synergistic effects of a cognitive control videogame and a self-administered non-invasive brain stimulation on alleviating depression’ is a double-blind, sham controlled, randomized controlled trial investigating the feasibility and efficacy of an innovative, self-applied treatment approach for patients diagnosed with major depressive disorder. The trial is conducted at three clinical trial sites (Hadassah, Israel; Riga Stradiņš University, Latvia; Ludwig-Maximilian-University, Germany). The treatment approach combines prefrontal transcranial direct current stimulation with a videogame designed to enhance cognitive and emotional control. This treatment is self-applied at home and remotely monitored. At the beginning of the intervention the patients are randomized in an active group receiving both active stimulation and videogame and the other group receiving sham stimulation and visually similar but not active videogame.
ObjectivesThe present interims analysis after half of the patients included examines patients’ intrinsic motivation after completing the first five sessions (of 30) of the treatment. We also examine patients’ interest/enjoyment, perceived competence, effort, felt pressure/tension, and perceived choice following the first week of treatment. Intrinsic motivation has been associated with enhanced learning and performance, so it can be used as one of the predictors for patient compliance.
MethodsAt the end of the 5th session, the patients filled in the Intrinsic Motivation Inventory (IMI) including the following subscales: interest/enjoyment, perceived choice, perceived competence, effort/importance and felt pressure/tension (scored on a 7-point Likert scale, ranging from 1 “not at all true” to 7 “very true”).
ResultsThis report includes the first 55 patients randomized (27 patients in the active group and 28 patients in placebo group) for the DiSCoVeR trial. Patients rated their overall interest/enjoyment at 4.50 out of 7 (SD±0.17 95% CI 4.16 to 4.84), their perceived choice at 5.55 (SD±0.16; 95% CI 5.23 to 5.87), their perceived competence at 4.52 (SD±0.15; 95%CI 4.22 to 4.82), their effort/importance at 5.07 (SD±0.16; 95%CI 4.74 to 5.40) and their pressure/tension at 3.00 (SD±0.13; 95% CI 2.73 to 3.26).
ConclusionsWe conclude that overall patients were quite interested in the treatment and had inherent pleasure while doing the sessions, felt that it was their choice to do them, felt that they performed the task quite effectively, were invested in doing the sessions and the experienced pressure and tension were low. The perceived choice and competence are positive predictors of intrinsic motivation. This aligns with the previous published data of a smaller patient subset (L. Konosonoka et al Medicina (Kaunas) 2022;58(Supplement 1):72) with the standard deviations being smaller in our larger patient sample.
Disclosure of InterestNone Declared
The Effect of the COVID-19 Pandemic on Suicide Attempts and Self-Harm in Teenagers and Young Adults: An Analysis of Regional Emergency Medical Center Data of a Metropolitan City in South Korea
- S. M. Bae, N. Ku
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S261-S262
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Introduction
The COVID-19 pandemic has had a wide-ranging impact on economic and social phenomena worldwide, particularly affecting mental health. However, these impacts have varied significantly across countries. Previous studies have shown that the groups more vulnerable to mental health problems also differ across countries and societies(Gunnel et al. Lancet Psy 2020; 7(6) 468-471, Pirkis et al. Lancet Psy 2021; 8(7) 579-588, Nomura et al. Psy Res 2021; 295 113622). Therefore, by examining changes in self-harm and suicide attempts, which constitute mental health emergencies, at the community level, we can explore the COVID-19 pandemic’s impact on the deterioration of mental health in various age groups within the region and identify the groups most vulnerable to mental health problems.
ObjectivesThe aim of this study is to examine the relationship between the COVID-19 pandemic and changes in the number of emergency room visits due to suicide attempts or self-harm in teenagers and young adults in Incheon, a metropolitan city in the capital area of South Korea.
MethodsWe conducted a retrospective data analysis on the medical records of patients who visited the regional emergency center of Incheon Medical Institution from January 2018 to December 2022 due to suicide attempts or self-harm. As our statistical method, we employed interrupted time series analysis to determine whether the COVID-19 pandemic has a statistically significant correlation with the trend changes in the number of emergency room visits related to suicide attempts or self-harm. This study was approved by the Institutional Review Board of Gil Medical Center, Gachon University of Korea(IRB approval number GFIRB2022-335).
ResultsThe data of 4,030 subjects(35.8% male; n=1,443) who visited the regional emergency center during the study period were analyzed. A total of 556 (13.79%) of the study participants were minors under the age of 19, and a total of 1,789 (44.39%) were young adults aged 20-39. The analysis revealed an increasing trend in the number of emergency room visits due to elevated suicidality in teenagers and young adults (20-39 years old) following the COVID-19 pandemic(figure 1 & figure 2).
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Image 2:
ConclusionsWhile suicide attempts and visits to the emergency room due to self-harm increased both before and after COVID-19, it is noteworthy that past suicide attempts are the most significant risk factor for future suicide attempts. Therefore, the data on vulnerable groups presented in this study can be instrumental for effective prevention and follow-up management of suicide attempts within the field of community psychiatry.
Disclosure of InterestNone Declared
Patterns of diversity in stream macroinvertebrate communities in a low-gradient agricultural stream (Sydenham River, Ontario, Canada) were driven by surficial geology and catchment position
- Andrea R. Bresolin, Roland A. Eveleens, Alyssa A. Frazao, Catherine M. Febria
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- The Canadian Entomologist / Volume 156 / 2024
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- 27 August 2024, e17
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Freshwater biodiversity is increasingly at risk wherever land uses such as agriculture exert multiple stressors that degrade habitat quality. Although stream macroinvertebrates act as bioindicators for monitoring these impacts, their responses are context-specific: examining drivers of community composition is therefore important to understand the results of monitoring efforts. In a primarily agricultural landscape, 15 sites across the Sydenham River watershed, Ontario, Canada, were assessed for in-stream habitat quality and stream macroinvertebrate diversity. We predicted that community assemblage would be driven by differences in surficial geology across branch (east branch versus north branch) and catchment position (main stem versus tributary). We found that the main stem of the east branch was characterised by significantly higher proportions (P = 0.053) and abundance (P = 0.038) of Ephemeroptera–Plecoptera–Trichoptera (EPT) taxa than north branch sites were, and sites in the east and north branch tributaries were characterised by significantly lower Hilsenhoff Biotic Index (HBI) scores (P = 0.088). Redundancy analysis found that substrate size was the main driver of community composition, generating a model that described these patterns across branch and catchment position. Our findings suggest that EPT abundance and HBI scores were the variables that were most effective at revealing differences in stream communities due to agricultural impacts and that sediment size is an important driver of these patterns.
Interrelations of phantom ringing related anxiety and personal self-esteem in undergraduate university students
- E. L. Nikolaev, M. Alhasan
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
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- 27 August 2024, p. S422
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Introduction
Manifestations of phantom ringing syndrome are widely seen in healthy population. Are there any interrelations between this phenomenon and personal psychological characteristics that are connected with the level of their mental health?
ObjectivesTo determine the specificity of interrelations of phantom ringing syndrome related anxiety and personal self-esteem in university students
MethodsThe anonymous survey covered 546 undergraduate university students. The questions were centered on the students’ patterns of their personal smartphone use.
ResultsThe research showed that manifestations of phantom ringing syndrome is available in 189 students, or in every third student (34.6%), who use mobile phones. It is equally represented in males (49.7%) and females (50.2). Clinically, it is characterized by a higher level of anxiety, which reliably correlates (p<0.01) with the level of stress (r=.17), level of nervousness caused by absence of a mobile phone (r=.18), the frequency of headache (r=.15), the frequency of medication consumption related to chronic somatic disease (r=.15). We also established valid negative interrelations between the level of phantom ringing syndrome related anxiety and the personal self-esteem based on the parameters of religious belief (r=-.15), personal attractiveness (r=-.16), mind (r=-.17), happiness (r=-.24), liveliness (r=-.25) and well-being (r=-.15). We have not found any proof of valid interrelations with self-assessment of health.
ConclusionsThe received results prove that phantom ringing syndrome related anxiety is connected with the personal self-esteem, the level of the perceived stress and some other clinical manifestations
Disclosure of InterestNone Declared
Gut Microorganisms, Neuroinflammation and Behavioral Changes
- B. T. Adebisi
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
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- 27 August 2024, pp. S625-S626
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Introduction
Recent clinical and preclinical evidences suggested that neuroinflammation is a key factor which interacts with the neurobiological correlates of major depressive disorder, which are the (i) dysregulation of the hypothalamic-pituitary-adrenal axis, (ii) depletion of brain serotonin and (iii) alteration of neurogenesis in the dentate gyrus of the hippocampus.
The gut bacterial has major impact on the brain development, behaviour and host immune system through the microbiota-gut-brain axis.
ObjectivesThe objective of the research is to establish the role inflammation induced by gut dysbiosis plays in behavioural changes of patients suffering from major depressive disorders.
MethodsClinical data and preclinical experiments were used to elucidate the role gastrointestinal bacterial play in the development and functional physiology of the nervous system and because of the bidirectional communication between the enteric nervous system in the gut and the central nervous system, through the vagal plexus, blood circulation and endocrine system; it was discovered that the appropriate population of intestinal microbiota affect the immunological state of the brain.
ResultsThe intestinal microbiota has been able to maintain the attenuation and regulation of pro-inflammatory biomarkers in the brain and such had assisted in the healthy state of the brain; however, a disruption of gastrointestinal organisms in a condition called dysbiosis could result in breakdown of protective gastrointestinal mucosa barrier resulting in leaky gut and consequently, the permeability of the gut lining and migration of some bacteria, to the brain through the vagal networks and other channels.
These pathophysiological cascades appear to be triggered or sustained and reinforced by chronic inflammatory condition involving increased circulating markers of inflammation, which are able to cross the blood brain barrier to activate the microglia.
ConclusionsStudies in depression suggest that inflammatory biomarkers such as C-reactive protein can be used to enrich samples for anti-inflammatory clinical trials for depression that target inflammation-related symptoms such as anhedonia and anxiety.
Although, still at the developmental stages, imaging of neuroinflammation will help establish a target in the brain to further facilitate the testing of anti-inflammatory therapies for depression.
Disclosure of InterestNone Declared
Serotonin Syndrome Following Low-Dose Sertraline: A Case Report
- C. Y. Chan
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S565
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Introduction
Serotonin syndrome is a potentially life-threatening condition that is precipitated by the use of serotonergic medications, Selective Serotonin Reuptake Inhibitors (SSRIs) and Monoamine Oxidase Inhibitors (MAOIs). It usually occurs when high doses of serotonergic drugs are prescribed. It is a medical emergency that requires prompt recognition, cessation of offending drugs and supportive therapy.
ObjectivesWe present a case of serotonin syndrome that occurred in a patient who was prescribed a low dose of sertraline, and aim to highlight the importance of early detection of this severe condition.
MethodsDetails of the case were described. Information was gathered based on medical records.
ResultsPatient M was a 29-year-old Malay male with a history of major depressive disorder, who was previously trialed on fluvoxamine 100mg every night but subsequently switched to and maintained on sertraline 75mg every night in 2020. He then defaulted follow up appointments. In 2023, he presented to the emergency services for a suicide attempt and was diagnosed with major depressive disorder with psychotic features. He was restarted on sertraline 50mg every night and risperidone 0.5mg every night was newly started. Two days later, sertraline was increased to 100mg every night. Two days following this increase, he was noted to have altered mental state, fever of 39.3-degree celcius, tachycardia of 120 beats per minute, ocular clonus and generalized hyperreflexia. Sertraline and risperidone were immediately stopped. Blood tests including creatine kinase, lumbar puncture and magnetic resonance imaging (MRI) of the brain did not show any abnormalities. After stopping of the medications, the patient’s symptoms resolved within 24 hours. Based on clinical symptoms and a normal creatine kinase level, neuroleptic malignant syndrome (NMS) was ruled out. Subsequently, he was restarted on risperidone 0.5mg and mirtazapine 7.5mg every night. He developed symptoms of serotonin syndrome with a low dose of sertraline. Symptoms resolved after the discontinuation of the SSRI.
ConclusionsIn this case, differential diagnoses of serotonin syndrome were also considered, such as NMS, encephalitis, meningitis and thyroid storm. NMS was less likely due to the rapid onset of onset and resolution of symptoms. Encephalitis and meningitis were unlikely in view of normal MRI brain and lumbar puncture findings.
There have been case reports of serotonin syndrome developing with lower doses of an SSRI in the pediatric population. There is, however, a lack of literature describing serotonin syndrome with low doses of SSRI in the adult population. To avoid a missed diagnosis, clinicians should monitor closely for SSRI toxicity, including serotonin syndrome, even when low doses of serotonergic drugs are used.
Disclosure of InterestNone Declared
The connection between professional burnout of medical workers and the specific working conditions during the COVID-19 pandemic in Russia
- E. V. Deshchenko, J. E. Koniukhovskaia, O. B. Stepanova, I. M. Shishkova, E. I. Pervichko, O. V. Mitina, E. A. Dorokhov
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S509-S510
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Introduction
The COVID-19 pandemic has certainly become a stressful event for medical workers, so the aim of this research was to study the pandemic-specific working conditions that may be associated with the professional burnout of medical workers in Russia.
ObjectivesTo study the pandemic-specific working conditions that may be associated with the professional burnout of medical workers in Russia.
MethodsThe Maslach Burnout Inventory (MBI) was used to measure the level of professional burnout. It was filled out by medical workers from January 2021 to November 2022.
The sample consisted of 314 medical workers (57 men and 255 women), whose average age was 36.97±11.93. According to the level of education, the sample included specialists with secondary general education (4.14%), with secondary special education (19.4%), with incomplete higher education (11.46%), with higher education (59.87%) and PhD (5.1%). 35 people (11%) of the surveyed medical workers worked in the red zone.
ResultsWorking in the red zone is significantly associated with Emotional Exhaustion (p=0.002) and Depersonalization (p=0.002), but not with a Reduction in Professionalism.
The working conditions of medical workers who were significantly associated simultaneously with Emotional Exhaustion, Depersonalization and Reduction of professionalism (respectively): (1) Lack of confidence in support from the health system and the state in case of illness (r=0.170, p=0.002; r=0.202, p=0.000; r=-0.171, 0. 002); (2) Inability to meet the usual personal needs (daily routine, nutrition, communication with loved ones) as employment increases at work (r=0.200, p=0.000; r=0.154, p=0.006; r=-0.186, 0. 001); (3) Lack of confidence in their own professional competence in the fight against COVID-19 due to lack of knowledge about COVID-19 (r=0.202, p=0.000; r=0.148, p=0.009; r=-0.211, 0. 000); (4) Lack of confidence in their own effectiveness in the fight against COVID-19 due to the increase in the volume of work and the expansion of the scope of professional responsibilities (r=0.234, p=0.000; r=0.152, p=0.007; r=-0.177, 0. 002); (5) Lack of access to up-to-date information about COVID-19 (r=0.190, p=0.001; r=0.158, p=0.005; r=-0.140, 0. 013).
The Emotional Exhaustion scale is also associated with the fear of getting infected and getting sick with COVID-19 (r=0.125; p=0.026), as well as the lack of quick access to testing when COVID-19 symptoms appear (r=0.169; p=0.003).
ConclusionsThus, not only work in the red zone, but also many specific working conditions during the COVID-19 pandemic can become a provocateur factor for the deterioration of the emotional state of medical workers.
Disclosure: Research is supported by the Russian Science Foundation, project No. 21-18-00624.
Disclosure of InterestNone Declared
Prevalence of Generalized Anxiety Disorder Among Five European Countries Before and During COVID
- D. Karlin, S. J. Suponcic, N. Chen, C. Steinhart, P. Duong
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S322-S323
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Introduction
Globally, there is a mental health crisis, and anxiety is the most prevalent mental health condition. However, the impact of the COVID-19 pandemic (COVID) on generalized anxiety disorder (GAD) prevalence has not been quantified across European countries, and such impact could establish a new baseline of GAD estimates in European countries.
ObjectivesTo assess GAD by severity level before and during COVID in 5 European countries, using the 7-Item GAD Questionnaire (GAD-7).
MethodsAdults (age 18+) in France, Germany, UK, Italy, and Spain completed a short survey in May 2020 to assess the impact of COVID on their mental health. All respondents had previously participated in the National Health and Wellness Survey, a nationally representative survey of the adult general population in each country, before COVID (December 2019–March 2020). In both surveys, respondents completed the GAD-7. GAD symptoms were defined by GAD-7 score as mild (5-9), moderate (10-14), and severe GAD (≥15). Positive screen was defined as GAD-7 score ≥10. Positive screen and GAD symptom severity prevalence were reported for the pooled European sample and by country, both before and during COVID. Chi-square and McNemar’s tests were used to evaluate the difference in GAD severity across countries and changes over baseline in GAD positive screen during COVID. P-values were reported for both tests.
ResultsIn total, 2401 adults were included in analysis (France, n=482; Germany, n=487; UK, n=487; Italy, n=474; Spain, n=471). Prior to COVID, 311 (13%) screened positive for GAD, with 208 (9%) moderate and 103 (4%) severe in the pooled European sample. During COVID, the distribution of GAD symptoms almost doubled, as 576 (24%) screened positive for GAD, and shifted towards greater severity with 337 (14%) moderate and 239 (10%) severe in the pooled European sample (Figure 1). Before COVID, the prevalence of positive screen ranged from 11% (France, Germany, Spain) to 16% (UK). Statistically significant increases in positive screen over baseline levels were observed across all countries (p<0.01), except Germany. Spain was the most impacted by COVID (increase: 16%), followed by Italy, France, and UK (increase: 14%, 12%, and 9%, respectively). Germany was the least affected, overall (increase: 4%) (Figure 2).
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ConclusionsDuring COVID, estimates of positive screen for GAD increased substantially to 24% across 5 European countries. Surges in positive screen and GAD symptom severity were observed in all 5 countries, with more profound impact in Spain, Italy, France, and UK. With new baseline GAD estimates, the country-specific data of COVID impact on GAD could help to inform appropriate allocation of mental health resources.
Disclosure of InterestD. Karlin Employee of: MindMed, S. Suponcic Shareolder of: Eli Lilly, Stryker, Abbott, Amgen, Consultant of: MindMed, Becton Dickinson Company, CSL Behring, N. Chen Consultant of: MindMed, C. Steinhart Employee of: MindMed, P. Duong Employee of: MindMed
Comorbidity costs for the healthcare of mental patients
- P. Dr. Fadgyas-Freyler
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S313
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Introduction
Most patients with mental disorders exhibit multiple comorbidities. Without doubt the presence of multiple co-occurring somatic and mental disorders is associated with a higher insurance spending for the psychiatric patients. The details of this association need to be elucidated.
ObjectivesThe aim of current study was 1) to delineate the typical nonmental comorbidities that occur among mental patients, and 2) to investigate social health insurance spending on comorbidities compared to the direct mental care costs of the same population. The analysis offers unique insight into the health care spending, since it focuses not only the costs of psychiatric care but reflects the whole range of treatments delivered to this group.
MethodsA database with the claim records of the Hungarian NHIF was created including direct healthcare costs for mental diagnosis. Patients were recorded either in primary or in specialist care with at least one mental health diagnosis in the last pre-pandemic year (2019). Adopting a case-control design, spending and comorbidities were compared to the control group, which comprised patients who did not have any mental diagnosis. Cases and controls were matched on demographic characteristics like age, gender, place of residence with deprivation index and marital status..
ResultsMental problems affected in 2019 more than 1,5 million persons in Hungary. Half of them did not access specialist care but were only seen with the mental diagnosis by a GP. Direct insurance spending for mental care is around 156 million EUR/year with 4% of the total direct health spending. Besides these costs another 665 million EUR (+17% of all health spending) were reimbursed for the same patient group for the treatment of other diseases. With regards to affected patient numbers, the three most important comorbidities were cardio-vascular conditions (34% of mental patients with 14% of all spending of the group); diseases of the digestive system (29% vs 14%); and musco-sceletal conditions (28% / 9% ) In terms of spending three other disease groups also have to be considered as of high significance: carcinomas (4% patients vs 13% of spending); neurological disorders (13% /vs 7%); and diseases of the endocrine, nutritional and metabolic system (24% vs 6%).
ConclusionsThe analysis aims to raise awareness for the complex issues of comorbidities of mental patients. We see that this patient group suffers heavily from other conditions the costs of which is much higher than the direct mental care costs. A better understanding of the coexistence of somatic and mental disorders and a holistic approach of treatment (care integration, reimbursement across different types of care, etc.) would be desirable.
Disclosure of InterestNone Declared
Spiritual awakening. Substance abuse, dual pathology
- M. J. Gordillo Montaño, L. Rodriguez Rodriguez, C. Pérez Aparicio, S. V. Boned Torres
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S488
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Introduction
Kambó is considered an “ancestral medicine” by the indigenous tribes of the western region of the Amazon.
ObjectivesThrough this clinical case, the aim is to present the particularities of the symptoms and management of patients with consumption of not so common substances, such as Kambo or salvia divinorum, as well as the evolution that will occur in a patient with a previous diagnosis of a Depressive Episode.
MethodsWe present the case of a 23-year-old male, Gestalt therapy student. History of tobacco, THC, and recent use of salvia divinorum and Kambo. He began follow-up by psychiatry in a private setting three years ago due to a severe depressive episode, having required treatment with antidepressants, antipsychotics and benzodiazepines, and having been triggered by a serious assault. The episode is resolved and follow-up is discontinued. Family history of depressive syndrome and suicide.
He resumed contact through the Emergency Department, requiring hospital admission due to symptoms compatible with a manic episode with psychotic symptoms. It begins with behavioral alterations and global insomnia that are related to the consumption of some substance, initially unknown to them, making the skin lesions they presented suspect the consumption of kambo.
ResultsWe assess the risk of consuming these substances, which are sometimes used as alternative therapies, and especially in this type of patient, who is more vulnerable and perhaps seeks a way out of the problems they present.
ConclusionsIn our case, it triggered a manic episode with psychotic symptoms, which consisted of delusional ideation of mystical content accompanied by auditory hallucinations. The episode took about a month to subside, despite treatment. Subsequently, there have been more episodes with similar characteristics, and they have not been associated with the consumption of kambó, but have been linked to the consumption of “natural medicinal substances.”
Disclosure of InterestNone Declared
GADTs are not (Even partial) functors
- Pierre Cagne, Enrico Ghiorzi, Patricia Johann
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- Mathematical Structures in Computer Science , First View
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- 27 August 2024, pp. 1-24
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Generalized Algebraic Data Types (GADTs) are a syntactic generalization of the usual algebraic data types (ADTs), such as lists, trees, etc. ADTs’ standard initial algebra semantics (IAS) in the category $\mathit{Set}$ of sets justify critical syntactic constructs – such as recursion, pattern matching, and fold – for programming with them. In this paper, we show that semantics for GADTs that specialize to the IAS for ADTs are necessarily unsatisfactory. First, we show that the functorial nature of such semantics for GADTs in $\mathit{Set}$ introduces ghost elements, i.e., elements not writable in syntax. Next, we show how such ghost elements break parametricity. We observe that the situation for GADTs contrasts dramatically with that for ADTs, whose IAS coincides with the parametric model constructed via their Church encodings in System F. Our analysis reveals that the fundamental obstacle to giving a functorial IAS for GADTs is the inherently partial nature of their map functions. We show that this obstacle cannot be overcome by replacing $\mathit{Set}$ with other categories that account for this partiality.