Psychiatry

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Impulsivity is a multidimensional construct and has been previously associated with suicidal behaviour in borderline personality disorder (BPD). This study examined the associations between suicidal behaviour and impulsivity-related personality traits, as well as history of childhood sexual abuse, in 76 patients diagnosed with BPD using both the Structured Interview for Diagnostic and Statistical Manual of Mental Disorders III (DSM-III) Axis-II diagnoses and the self-personality questionnaire. Impulsivity-related traits were measured using the Barratt Impulsiveness Scale-11 (BIS-11), the Buss-Durkee Hostility Inventory (BDHI) and the Temperament and Character Inventory-Revised (TCI-R). We found that hostility and childhood sexual abuse, but not impulsivity or other temperament traits, significantly predicted the presence, number and severity of previous suicide attempts. Hostility traits and childhood sexual abuse showed an impact on suicide attempts in BPD. Our results support prev...

Introduction Schizophrenia is a psychiatric condition in which patient adherence is a key issue in its management. Objectives To estimate the prevalence and determine the factors associated with medication adherence in patients with schizophrenia. Methods This was a cross-sectional study conducted at the psychiatry department of the CHU IBN Rochd of Casablanca among schizophrenic patients followed from May 2019 to January 2020. The sample size was calculated apriori and the measurement of therapeutic compliance and Insight (patients' perception of the disorders related to their pathology) was made thanks to the Medication Adherence Rating Scale (MARS) and the Birchwood insight scale (BIS) respectively. Socio-demographic data and data on the management of schizophrenia were also collected. Statistical analyses were performed with RStudio software and the multivariate analysis method of logistic regression was used. The threshold of significance was set at 5%. Results A total of 3...

The objective was to elicit patient preferences for medicine administration method in the management of acute agitation episodes among patients diagnosed with bipolar disorder or schizophrenia. The patients' experiences of acute agitation episodes and their management of episodes were also explored. Data were collected via an anonymous, internet-based survey of residents in Denmark or Sweden with schizophrenia or bipolar disorder (October 2014 to December 2014). Inclusion criteria were having a diagnosis of schizophrenia or bipolar disorder, and being above 18 years of age. The questionnaire included questions about preferences for medication attributes, experiences with pharmacological treatment for agitation and involvement in treatment plans. A total of 237 diagnosed patients (61 with schizophrenia; 176 with bipolar disorder) completed the questionnaire. Agitation episodes were experienced by 90% of the respondents. In total, 83% of the respondents reported having received treatment with tablets. When patients were presented with the attributes of an inhalation method, respondents stated that the fast onset of action, low risk of adverse reactions and least invasive form of drug delivery were positive attributes of treatment with inhalation. Inhalation is a new delivery route for treatment of acute agitation in patients diagnosed with bipolar disorder or schizophrenia. Inhalation is the preferred treatment method for acute agitation among Danish and Swedish patients with bipolar disorder or schizophrenia.

Background: Agitation episodes are common among patients with schizophrenia or bipolar disorder. Oral and intramuscular administration methods are commonly used in pharmacological treatment of acute agitation. Recently, an innovative inhalation product with loxapine(Adasuve®)has become available for treatment of acute agitation episodes associated with bipolar disorder or schizophrenia. The objective for the present study was to investigate the impact of the pharmacological treatment's administration methods on the health-related quality of life (HRQoL) in patients with bipolar disorder or schizophrenia in Denmark and Sweden using a time trade-off (TTO) approach. Methods: The TTO methodology was used to examine the HRQoL impact of administration method of pharmacological treatment of acute agitation. Data were collected via an internet-based survey, using an existing panel of respondents with schizophrenia or bipolar disorder. Results: Respondents considered living with schizophrenia/ bipolar disorder, having one yearly agitation episode treated with inhaler better than living with the same conditions and receiving treatment with tablet or injection. The utility value was 0.762 for inhalable treatment, 0.707 for injection and 0.734 for tablet treatment. Conclusions: Patients' preference for treatment delivery options showed that inhalation was associated with a significant utility gain when compared to injection or tablets. Inhalable loxapine may be a new tool for control of agitation episodes for strengthening the patient provider alliance when taking patient's preference for delivery method into consideration.

En partant d'un corpus d'entretiens des acteurs de la geographie theorique et quantitative (1960-2010), cet article propose d'analyser les vies de laboratoire d'un cas particulier, dans une analyse historique et spatiale du developpement de l'equipe P.A.R.I.S. Elle a ete motrice dans le developpement de la geographie theorique et quantitative a partir des annees 1960-1970 et a en particulier renouvele l'approche des etudes urbaines en geographie. Cette equipe sera mise en regard d'un autre « laboratoire », le groupe Dupont. La focalisation sur une equipe, P.A.R.I.S., comparee a d'autres groupes, donne a voir des vies de laboratoires, en considerant les modalites de sa structuration d'un point de vue spatial, epistemologique mais aussi sociologique. D'un cote, P.A.R.I.S., un laboratoire parisien, feminise ; de l'autre, le groupe Dupont, un reseau informel et contestataire de chercheurs du Sud-Est de la France. Sur une periode allant des ann...

There has been a rapid increase in the use of artificial intelligence (AI) in our educational system. This descriptive, comparative, and correlational study investigated the use of AI-powered tools and examined 86 teachers' efficiency and 274 students' performance in a private Catholic school in Bacolod City, Philippines. The researcher developed a researcher-made questionnaire to gather the data. Major findings revealed that teachers used AI less frequently, often used it for tutoring, with ChatGPT being a popular choice. Students, on the other hand, reported using AI weekly, primarily for tutoring. While AI integration seemed to enhance teacher efficiency, male teachers perceived themselves as more efficient than females. Generally, the results show that AI contributes to an efficient teaching process with a mean score of 3.60, verbally interpreted as somewhat efficient. The results revealed that AI had a significant improvement on both male and female students. Interestingly, no significant differences were found in teacher efficiency and student performance when grouped according to sex using Mann-Whitney U-test. Using Spearman's rank correlation coefficient, the data revealed no correlation between the student performance in AI and the teachers' efficiency in AI. In light of these findings, the study recommends implementing programs and training to help teachers use AI more effectively and engage students. Additionally, it emphasizes the need to address any barriers educators may face in adopting AI, create supportive environments with equitable access to AI resources, and implement strategies to address potential gender biases in AI adoption.

Este estudo transversal quantitativo objetivou analisar a relação entre a percepção do adolescente sobre as atitudes parentais e sua tendência ao uso de substâncias psicoativas. Participaram 487 adolescentes brasileiros. Para análise estatística foi utilizado o Modelo Logístico Multinomial, sobre o qual se aplicou o método Stepwise para seleção de variáveis. O tabaco, o álcool e a maconha foram relacionados com as variáveis de maior influência no uso, abuso ou dependência. Verificou-se que um pai pouco afetivo, aumenta a chance de o filho ser dependente de tabaco (p = 0.001). A mãe sendo pouco afetiva tem maior possibilidade de ter um filho dependente do tabaco (p = 0.001). O controle do pai é um fator protetivo para a experimentação do tabaco (p = 0.023) e para a dependência da maconha (p = 0.042). A relação entre o uso de drogas na adolescência e a percepção que o jovem tem das atitudes de seus pais ficou evidenciada.

The article deals with the personal main features and mechanisms for psychological health development. Personal psychological health is regarded as a cumulative phenomenon and a part of two categoric concepts, such as Personality Psychology and Health Psychology. They are two fundamental notions viewed for the development prospects of Psychology as a scientific and practical subject. A student age is a shift in focus on addressing towards psychological health issues. It is taken into consideration that various factors influence student health. They are a way/standard of living, hereditary background, the environment (natural and social), health care quality provided, etc. The reality that a psychologist has to face at university is an adaptive health level of student psychological health. The characteristics of this level are individual features of social maladjustment. The authors define the main indicators of young people‟s psychological health via an anthropological approach. The...

Perfectionism constitutes a multidimensional personality trait. According to the diathesisstress model, perfectionism may predispose individuals to experience increased psychological distress during stressful periods. Since self-compassion is considered as a protective factor within the context of mental health difficulties, the primary objective of this study was to explore the mediating function of self-compassion in the relationship between positive (i.e., high standards and order) and negative (i.e., discrepancy) aspects of perfectionism and psychological distress among Greek emerging adults. The sample consisted of 410 university students (47.6% males and 52.4% females), with a mean age of 20.61 ± 1.88 years. The Almost Perfect Scale-Revised (APS-R), the Self-Compassion Scale (SCS), and the General Health Questionnaire-28 (GHQ-28) were used to assess perfectionism, selfcompassion, and psychological distress, respectively. The results indicated that self-compassion mediated the association between positive and negative aspects of perfectionism and different dimensions of psychological distress (i.e., somatic symptoms, anxiety/insomnia, social dysfunction, and severe depression). Specifically, discrepancy and increased levels of high standards were related to lower levels of self-compassion, thus leading to greater endorsement of psychological distress. In contrast, order was associated with higher levels of self-compassion, thus leading to lower levels of psychological distress. The findings of the present study highlight that self-compassion is an overall important area to examine in nonclinical populations. These findings have implications for the effectiveness of cognitive behavioral therapy (CBT) in enhancing individuals' self-acceptance and awareness of their perfectionistic tendencies, as well as compassion-focused therapy (CFT) in elevating self-compassion, mindfulness, and overall psychological well-being while reducing psychological distress.

Major depressive disorder (MDD) is a common, seriously impairing, and often recurrent mental disorder. Based on the predictions of the Circumplex Model of Marital and Family Systems and the Common-Sense Self-Regulation Model, the aim of the present prospective study is to examine the predictive value of clinical outcomes of a process model in which associations between perceived family functioning and patient’s clinical outcomes (i.e., symptom severity and suicide risk) are mediated by illness representations and coping strategies. A total of 113 patients with a clinical diagnosis of MDD (16.8% males and 83.2% females) aged 47.25 ± 13.98 years and recruited from the outpatient department and the mobile mental health unit of the Psychiatric Clinic of the University Hospital of Heraklion in Crete, Greece, and from a Greek online depression peer-support group participated in the study. Family functioning was assessed in terms of cohesion and flexibility (Family Adaptability and Cohesio...

Young adults are less likely to seek professional help even though they are most likely to experience mental health problems. The aim of the present study was to investigate young adults’ attitudes towards mental illness and self-stigma of help-seeking, identify possible determinants of attitudes and self-stigma, and examine the association between attitudes towards mental illness and self-stigma of help-seeking. The sample consisted of 485 Greek young adults (24.5% men, 75.5% women) aged 18–25 years (M = 19.54, SD = 1.83) who completed the Attitudes towards Severe Mental Illness (ASMI) and the Self-Stigma of Seeking Help Scale (SSOSH). The results indicated that Greek young adults hold mostly positive attitudes towards severe mental illness and help-seeking, while their unfavorable attitudes are mainly related to difficulties with viewing people with a severe mental disorder as similar to other people, and fear that by seeking professional help a person’s worth will be diminished. ...

The present study aimed to evaluate a path analytic model accounting for caregivers' psychological distress that takes into account perceived family cohesion and flexibility, expressed emotion and caregiver's burden associated with the presence of mental illness in the family. 50 first-episode and 50 chronic patients diagnosed with schizophrenia or bipolar disorder (most recent episode manic severe with psychotic features) recruited from the Inpatient Psychiatric Unit of the University Hospital of Heraklion, Crete, Greece, and their family caregivers participated in the study. Family functioning was assessed in terms of cohesion and flexibility (FACES-IV), expressed emotion (FQ), family burden (FBS) and caregivers' psychological distress (GHQ-28). Structural equation modelling was used to evaluate the direct and indirect effects of family dynamics on caregivers' psychological distress. The results showed that neither family cohesion nor family flexibility exerted sig...

The aim of the present study was to investigate whether dysfunctional family functioning contributes to relapse over a twoyear follow-up period in patients experiencing their first episode of psychosis (FEP) and chronic patients with psychosis. Methods: The sample consisted of 100 remitted patients (50 FEP and 50 chronic) diagnosed with schizophrenia (82%) or bipolar disorder with most recent episode manic severe with psychotic features (18%) recruited from the Inpatient Psychiatric Unit of the University Hospital of Heraklion, Crete, Greece, and their family caregivers. Family functioning was assessed in terms of cohesion and flexibility (FACES-IV), expressed emotion (FQ), family burden (FBS) and caregivers' psychological distress (GHQ-28). Relapse was defined as patient rehospitalisation due to acute psychotic exacerbation, while number, length, and type of hospitalisations were also evaluated. Results: Dysfunctional family functioning in terms of cohesion and flexibility was not found to be a significant risk factor for relapse in psychosis. High expressed emotion, as indexed primarily by increased levels of criticism rather than emotional over-involvement, was associated with increased risk of relapse and shorter time to relapse (HR = 0.48, 95% CI: 0.24, 0.98, p = 0.043). Similarly, high levels of family burden were related to shorter time to relapse (HR = 0.47, 95% CI: 0.23, 0.95, p = 0.037), whereas there was no significant difference in survival curves based on caregivers' psychological distress. No significant interaction effect of illness chronicity was observed in the aforementioned associations. Conclusion: These findings highlight caregivers' criticism and burden of care as long-term predictors of the course of psychosis from the early stages of the illness and later on. In contrast, unbalanced levels of cohesion and flexibility in the family, as well as caregivers' high emotional overinvolvement and psychological distress do not appear to be factors that contribute to patient relapse. Family psychoeducational interventions focusing at ameliorating caregivers' negativity toward the patient, and easing the burden of care should be considered as means in reducing relapse.

The present study aimed to investigate possible differences in family environment among patients experiencing their First Episode of Psychosis (FEP), chronic patients and controls. Family cohesion and flexibility (FACES-IV) and psychological distress (GHQ-28) were evaluated in families of 50 FEP and 50 chronic patients, as well as 50 controls, whereas expressed emotion (FQ) and family burden (FBS) were assessed in families of FEP and chronic patients. Multivariable linear regression analysis, adjusted for confounders, indicated impaired cohesion and flexibility for families of FEP patients compared to controls, and lower scores for families of chronic patients compared to those of FEP patients. Caregivers of chronic patients scored significantly higher in criticism, and reported higher burden and psychological distress than those of FEP patients. Our findings suggest that unbalanced levels of cohesion and flexibility, high criticism and burden appeared to be the outcome of psychosis...

Schizophrenia is a debilitating chronic disease that requires lifelong medical care and supervision. Even with treatment, the majority of patients relapse within 5 years, and suicide may occur in up to 10% of patients. Poor adherence to oral antipsychotics is the most common cause of relapse. The discontinuation rate for oral antipsychotics in schizophrenia ranges from 26% to 44%, and as many as two-thirds of patients are at least partially nonadherent, resulting in increased risk of hospitalization. A very helpful approach to improve adherence in schizophrenia is the use of long-acting injectable (LAI) antipsychotics, although only a minority of patients receive these. Reasons for underutilization may include negative attitudes, perceptions, and beliefs of both patients and health care professionals. Research shows, however, significant improvements in adherence with LAIs compared with oral drugs, and this is accompanied by lower rates of discontinuation, relapse, and hospitalization. In addition, LAIs are associated with better functioning, quality of life, and patient satisfaction. A need exists to encourage broader LAI use, especially among patients with a history of nonadherence with oral antipsychotics. This paper reviews the impact of nonadherence with antipsychotic drug therapy overall, as well as specific outcomes of the schizophrenia patient, and highlights the potential benefits of LAIs.

Achievement of viral load suppression among people living with HIV is one of the most important goals for effective HIV epidemic response. In Ukraine, people who inject drugs (PWID) experience the largest HIV burden. At the same time, this group disproportionally missed out in HIV treatment services. We performed a secondary data analysis of the national-wide cross-sectional bio-behavioral surveillance survey among PWID to assess the population-level prevalence of detectable HIV viremia and identify key characteristics that explain the outcome. Overall, 11.4% of PWID or 52.6% of HIV-positive PWID had a viral load level that exceeded the 1,000 copies/mL threshold. In the group of HIV-positive PWID, the detectable viremia was attributed to younger age, monthly income greater than minimum wage, lower education level, and non-usage of antiretroviral therapy (ART) and opioid agonistic therapy. Compared with HIV-negative PWID, the HIV-positive group with detectable viremia was more likely to be female, represented the middle age group (35-49 years old), had low education and monthly income levels, used opioid drugs, practiced risky injection behavior, and had previous incarceration history. Implementing the HIV case identification and ART linkage interventions focused on the most vulnerable PWID sub-groups might help closing the gaps in ART service coverage and increasing the proportion of HIVpositive PWID with viral load suppression.

Background: Blast-explosion may cause traumatic brain injury (TBI), leading to post-concussion syndrome (PCS). In studies on military personnel, PCS symptoms are highly similar to those occurring in post-traumatic-stress-disorder (PTSD), questioning the overlap between these syndromes. In the current study we assessed PCS and PTSD in civilians following exposure to rocket attacks. We hypothesized that PCS symptomatology and brain connectivity will be associated with the objective physical exposure, while PTSD symptomatology will be associated with the subjective mental experience. Methods: 289 residents of explosion-sites have participated in the current study. Participants completed self-report of PCS and PTSD. The association between objective and subjective factors of blast and clinical outcomes was assessed using multivariate analysis. White-matter (WM) alterations and cognitive abilities were assessed in a sub-group of participants (n=46) and non-exposed controls (n=16). Non-pa...

 Self-reported, MMSE-defined, and autobiographical memory deficits are common following ECT.  Agreement between these memory deficits is poor, and their correlates are discrete.  Serum cortisol levels correlate significantly with self-reported memory complaints.  People receiving ECT need periodic assessments evaluating multiple cognitive domains.

Despite a range of long-standing historical, political, ideological, professional, structural, and practical barriers, there has been, and continues to be, a clear consensus that integration between mental health and addiction services is sorely needed and long overdue. This paper focuses on one dimension of the challenge of integration from among the several-the conceptual-and proposes the construct of recovery as an organizing principle for bridging the divide between the two domains. After reviewing briefly the parallel history of the two traditions and their shared need for transformation to a recovery orientation, the authors offer an integrated model of recovery for persons with co-occurring disorders. They then derive from this model the underlying values, guiding principles, key strategies, and essential ingredients of recovery-oriented systems of care which comprise a common approach across both addictions and mental illness, offering a strengths-based solution to achieving integration where pathology-focused approaches have failed. 1 "Treatment in parallel and separate mental health and substance abuse treatment systems . . . is remarkably ineffective" -Drake and colleagues 1, p. 361 This conclusion was drawn by Drake and colleagues from their recent review 1 of research on the care of individuals with co-occurring psychiatric and addictive disorders. While the conclusion itself is not surprising, it is striking that this conclusion continues to be just as salient today as it was when it was first reached over 25 years ago. Since that time, numerous reports, reviews, and research have documented well and extensively the uneasy relationship that exists between mental health services and services for persons with addictions. Consistent epidemiological and service utilization data collected during this same period have shown that mental illnesses and addictions co-occur within the same person as frequently as they exist independently of one another. These data further call into question the current bifurcation of the behavioral health field into two distinct and heavily bounded territories. While work such as the review by Drake and colleagues cited above has sought to overcome this split in the field by repeatedly highlighting the importance of providing integrated care for persons with co-occurring disorders, systemic efforts continue to lag behind and to encounter numerous obstacles. These obstacles range from historical, political, ideological, professional, and fiscal/structural issues at one end of the spectrum (e.g., separate funding streams, independent state agencies) to practical and logistical issues at the other end. And unfortunately, Ridgley, Goldman, and Willenbring's 14 discussion of these obstacles more than 15 years ago remains as relevant today as when first published. Despite these long-standing and formidable barriers, there has been, and continues to be, a clear consensus in the field that integration is both sorely needed and long overdue. This paper focuses on one dimension of this challenge from among those mentioned above: the conceptual dimension-and this for several reasons. First, previous efforts that have focused on the etiology or nature of mental illnesses and addictions, or on the types of treatments required by these conditions, have failed to establish a common ground adequate to provide a foundation for integration. Efforts aimed at resolving the political, fiscal, and structural issues that impede integration have had minimal impact thus far, perhaps in part due to their lack of a

Objective-Qualitative research methods were used to understand the experiences of families seeking treatment for young people with recent-onset psychosis; such knowledge can inform services design. The authors conducted open-ended interviews in 1999 through 2002 with family members of 13 patients with recent-onset nonaffective psychotic disorders in the New York metropolitan area, focusing on their experience in seeking treatment and engaging with mental health services. Results-Family members described early lack of clarity of diagnosis and obstacles to obtaining treatment. Entry into the mental health system frequently occurred in the context of crisis, with African-American families specifically reporting police involvement. Inpatient hospitalization was depicted as traumatic yet offering relief. Aftercare was described as fragmented, and issues with third-party payers were paramount. Families expressed a desire for more education, information, and support and described their struggles with stigma. These data from families are presented in the context of more recent literature as to the efficacy of specialized treatment programs for early stages of psychotic disorder and their involvement of families.

Several instruments have been developed by clinicians and academics to assess clinical recovery. Based on their life narratives, measurement tools have also been developed and validated through participatory research programs by persons living with mental health problems or illnesses to assess personal recovery. The main objective of this project is to explore possible correlations between clinical recovery, personal recovery, and citizenship by using patient-reported outcome measures. All study participants are currently being treated and monitored after having been diagnosed either with (a) psychotic disorders or (b) anxiety and mood disorders. They have completed questionnaires for clinical evaluation purposes (clinical recovery) will further complete the Recovery Assessment Scale and Citizenship Measure (personal-civic recovery composite index). Descriptive and statistical analyses will be performed to determine internal consistency for each of the subscales, and assess converge...

September 28, 2016, marked the 50th anniversary of the Connecticut Mental Health Center, a state-owned and state-operated joint venture between the state and Yale University built and sustained with federal, state, and university funds. Collaboration across these entities has produced a wide array of clinical, educational, and research initiatives, a few of which are described in this column. The missions of clinical care, research, and education remain the foundation for an organization that serves 5,000 individuals each year who are poor and who experience serious mental illnesses and substance use disorders.

Qualitative research methods were used to understand the experiences of families seeking treatment for young people with recent-onset psychosis; such knowledge can inform services design. The authors conducted open-ended interviews in 1999 through 2002 with family members of 13 patients with recent-onset nonaffective psychotic disorders in the New York metropolitan area, focusing on their experience in seeking treatment and engaging with mental health services. Family members described early lack of clarity of diagnosis and obstacles to obtaining treatment. Entry into the mental health system frequently occurred in the context of crisis, with African-American families specifically reporting police involvement. Inpatient hospitalization was depicted as traumatic yet offering relief. Aftercare was described as fragmented, and issues with third-party payers were paramount. Families expressed a desire for more education, information, and support and described their struggles with stigma...

Schizophrenia and other psychotic disorders are a source of significant morbidity, both for patients and caregivers. The first 2-5 years after the onset of psychosis are a critical period wherein treatment might effect disproportionate improvements in long-term outcomes. Specialized services have been developed with the goal of providing early and effective treatment-however, engaging young patients in these services remains a challenge. In this study we sought to uncover possible reasons for this finding by collecting participants' narratives of their early treatment experience. We conducted in-depth, semi-structured interviews with 11 patients currently enrolled in a first episode psychosis program in Connecticut. Transcripts were analyzed using inductive thematic analysis. Participants reported that prior to them entering specialized treatment services, their initial contact with psychiatric care was brought about by abrupt behavioral changes that were noticed by others, and that this lead to treatment that was disconnected from their own concerns, which centered around more everyday challenges. This initial contact did not serve to engender trust or facilitate engagement in further treatment. Additional examples of disconnect were noted even after participants had entered specialized services, and these centered around the patients preference for conceptualizing their difficulties, treatment and recovery in multi-dimensional terms that emphasized social inclusion and vocational achievement. Participants in our study highlighted several areas of disconnect in the course of their early treatment. There is an opportunity to enhance early engagement by offering patients concrete evidence that their treatment priorities are understood and will be addressed.

Sleep disturbances occur in up to 60% of patients with chronic hepatitis C (CHC) and is often interrelated with comorbid psychiatric disorders. Moreover, neuropsychiatric complications of interferon-a during CHC treatment can manifest as sleep problems. Newly diagnosed sleep disturbance occurs in up to 60% and 30% of untreated CHC patients and patients undergoing interferon-a therapy, respectively. However, the presentation of insomnia in patients with CHC is influenced by significant psychiatric comorbidity, such as depression, and medical conditions, such as anemia and hypothyroidism. Therefore, prompt recognition using screening tools and exclusion of comorbid conditions contributing sleep pathology can enhance treatment outcomes. Owing to the paucity of studies, treatment recommendations for sleep disorders in CHC patients are derived from recommendations from general sleep disorder treatment guidelines. Further research is needed to elucidate the efficacy of pharmacological and nonpharmacological treatments of sleep disorders in CHC patients.

Psychiatric disorders are 1.5 to 2 times more prevalent in persons with inflammatory bowel disease (IBD) than in the general population, with pooled prevalence estimates of 21% for clinical anxiety and 15% for depression. Rates are even higher when considering mental health symptoms, as nearly one-third of persons with IBD experience elevated anxiety symptoms and one-quarter experience depression symptoms. Rates of these symptoms were much higher during periods of disease activity, more common in women than men, and more common in Crohn’s disease than ulcerative colitis. There is robust evidence of the detrimental effects of comorbid depression and anxiety on the subsequent course of IBD based on longitudinal studies tracking outcomes over time. However, psychiatric disorders and IBD have bidirectional effects, with each affecting risk of the other. Elevated mental health concerns have been consistently associated with greater healthcare utilization and costs related to IBD. There i...

Background. Mental and physical health conditions are frequently comorbid. Despite the widespread physiological and behavioral changes during pregnancy, the pattern of comorbidities among women in pregnancy is not well studied. This study aimed to systematically examine the associations between mental and somatic disorders before and during pregnancy. Method. The study used data from mothers of a nationally representative birth cohort of children born in Israel (1997Israel ( -2008)). We compared the risk of all major somatic disorders (International Classification of Diseases, Ninth Revision) in pregnant women with and without a mental disorder. All analyses were adjusted for maternal age, child's birth year, family socioeconomic status, and the total number of maternal encounters with health services around pregnancy period. Results. The analytical sample included 77,030 mother-child dyads, with 30,083 unique mothers. The mean age at child's birth was 29.8 years. Prevalence of diagnosis of mental disorder around pregnancy in our sample was 4.4%. Comorbidity between mental and somatic disorders was two times higher than the comorbidity between pairs of different somatic disorders. Of the 17 somatic disorder categories, seven were positively associated with mental health disorders. The highly prevalent comorbidities associated with mental disorders in pregnancy included e.g. musculoskeletal (OR = 1.30; 95% CI = 1.20-1.42) and digestive system diseases (OR = 1.23; 95% CI = 1.13-1.34). Conclusions. We observed that associations between maternal diagnoses and mental health stand out from the general pattern of comorbidity between nonmental health diseases. The study results confirm the need for screening for mental disorders during pregnancy and for potential comorbid conditions associated with mental disorders.

Reproductive system and mental health disorders are commonly comorbid in women. Although the causes of this overlap remain elusive, evidence suggests potential shared environmental and genetic factors associated with risk. To investigate the comorbidity between psychiatric and reproductive system disorders, both as broad diagnostic categories and among specific pairs of diagnoses. STUDY SELECTION Observational studies published between January 1980 and December 2019 assessing prevalence of psychiatric disorders in women with reproductive system disorders and prevalence of reproductive system disorders in women with psychiatric disorders were included. The study did not include psychiatric and reproductive disorders triggered by life events (eg, trauma, infection, surgery) to address potential confounding. A search yielded 1197 records, of which 50 met the inclusion criteria for the qualitative and 31 for the quantitative synthesis in our study. A random-effects model was used for data synthesis and Egger test and I 2 to assess study bias and heterogeneity. Data were analyzed from January to December 2022. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. RESULTS A total of 1197 records were identified, of which 50 met the inclusion criteria for qualitative and 31 for quantitative synthesis. Diagnosis of a reproductive system disorder was associated with a 2-to 3-fold increased odds of having a psychiatric disorder (lower bound odds ratio [OR], 2.00; 95% CI, 1.41-2.83; upper bound OR; 2.88; 95% CI, 2.21-3.76). The analysis focused on specific diagnoses described in the literature and found that polycystic ovary syndrome was associated with increased odds of depression (population-based studies OR, 1

ImportanceReproductive system and mental health disorders are commonly comorbid in women. Although the causes of this overlap remain elusive, evidence suggests potential shared environmental and genetic factors associated with risk.ObjectiveTo investigate the comorbidity between psychiatric and reproductive system disorders, both as broad diagnostic categories and among specific pairs of diagnoses.Data SourcePubMed.Study SelectionObservational studies published between January 1980 and December 2019 assessing prevalence of psychiatric disorders in women with reproductive system disorders and prevalence of reproductive system disorders in women with psychiatric disorders were included. The study did not include psychiatric and reproductive disorders triggered by life events (eg, trauma, infection, surgery) to address potential confounding.Data Extraction and SynthesisA search yielded 1197 records, of which 50 met the inclusion criteria for the qualitative and 31 for the quantitative ...

IMPORTANCE: Comorbidity between mental and physical health is a frequent problem, resulting in greater morbidity than the sum of the effects of individual diseases. Despite pervasive physiological and behavioral changes during pregnancy, the pattern of comorbidities among pregnant women is not wellunderstood. OBJECTIVE: Systematically examine the associations between mental and physical diagnoses around pregnancy. DESIGN, SETTING, PARTICIPANTS: Population-based sample, containing all children born between January 1st, 1997 and December 31 st , 2008 within a health maintenance organization (HMO) in Israel. Cohort children were linked to their mothers' health information, creating mother-child dyads. MAIN OUTCOMES AND MEASURES: The primary outcome was any ICD-9 mental health diagnosis within the pregnancy period or the preceding 12 months. The secondary outcomes were specific ICD-9 mental health diagnoses. Exposures were all ICD-9 physical (non-mental) health diagnoses received during the exposure period. We used logistic regression to test the risk of physical health diagnoses in pregnant women associated with mental health diagnoses. The covariates for this study included maternal age, birth year, socioeconomic status and total number of ICD-9 diagnoses during the exposure period. RESULTS: The analytical sample included 76,783 mother-child dyads, with 30,084 unique mothers. The mean age at birth was 29.8 years, with 4.4% of mothers diagnosed with a mental health disorder during the pregnancy period. Of the 18 major ICD-9 diagnostic categories, 10 were positively associated with mental health disorders, including ICD categories of e.g., symptoms, signs, and ill-defined conditions (OR=1.69; 95% CI=1.50, 1.89), musculoskeletal (OR=1.33; 95% CI=1.22,1.45) and digestive system diseases (OR=1.25; 95% CI=1. 15, 1.37). Comorbidity between mental and physical health diagnoses was higher than that observed between various physical health diagnoses. Associations between physical health diagnoses and specific mental health conditions were consistent with the results of the general mental health and physical health comorbidity. CONCLUSION AND RELEVANCE: We observed that associations between maternal diagnoses and mental health stand out from the general pattern of comorbidity between non-mental health diseases. The high co-occurrence of mental health and physical health diagnoses has implications for diagnoses and management of morbidity among pregnant women, with potential impact on pregnancy and child health outcomes.

Background Mental and physical health conditions are frequently comorbid. Despite the widespread physiological and behavioral changes during pregnancy, the pattern of comorbidities among women in pregnancy is not well studied. This study aimed to systematically examine the associations between mental and somatic disorders before and during pregnancy. Method The study used data from mothers of a nationally representative birth cohort of children born in Israel (1997–2008). We compared the risk of all major somatic disorders (International Classification of Diseases, Ninth Revision) in pregnant women with and without a mental disorder. All analyses were adjusted for maternal age, child’s birth year, family socioeconomic status, and the total number of maternal encounters with health services around pregnancy period. Results The analytical sample included 77,030 mother–child dyads, with 30,083 unique mothers. The mean age at child’s birth was 29.8 years. Prevalence of diagnosis of ment...

A personalized medicine approach seems to be particularly applicable to psychiatry. Indeed, considering mental illness as deregulation, unique to each patient, of molecular pathways, governing the development and functioning of the brain, seems to be the most justified way to understand and treat disorders of this medical category. In order to extract correct information about the implicated molecular pathways, data can be drawn from sampling phenotypic and genetic biomarkers and then analyzed by a machine learning algorithm. This review describes current difficulties in the field of personalized psychiatry and gives several examples of possibly actionable biomarkers of psychotic and other psychiatric disorders, including several examples of genetic studies relevant to personalized psychiatry. Most of these biomarkers are not yet ready to be introduced in clinical practice. In a next step, a perspective on the path personalized psychiatry may take in the future is given, paying particular attention to machine learning algorithms that can be used with the goal of handling multidimensional datasets.

People living with chronic kidney disease (CKD) frequently suffer from mild cognitive impairment and/or other neurocognitive disorders. This review in two parts will focus on adverse drug reactions resulting in cognitive impairment as a potentially modifiable risk factor in CKD patients. Many patients with CKD have a substantial burden of comorbidities leading to polypharmacy. A recent study found that patients seen by nephrologists were the most complex to treat because of their high number of comorbidities and medications. Due to polypharmacy, these patients may experience a wide range of adverse drug reactions. Along with CKD progression, the accumulation of uremic toxins may lead to blood–brain barrier (BBB) disruption and pharmacokinetic alterations, increasing the risk of adverse reactions affecting the central nervous system (CNS). In patients on dialysis, the excretion of drugs that depend on kidney function is severely reduced such that adverse and toxic levels of a drug or...

Primary care plays a key role in the detection and management of depression and anxiety. At present it is not clear if the prevalence of depression and anxiety in primary care differs between migrants and ethnic minorities (MI) and natives and ethnic majorities (MA). A systematic review and a meta-analysis of studies comparing the prevalence of depression and anxiety in MI and MA in primary care were performed. Studies were identified by searching MEDLINE, PsychINFO, EMBASE and through hand-search. We included 25 studies, most of which had a relatively small sample size. Significant variations were found in the prevalence of anxiety and depression across studies. Pooled analyses were carried out for 23 studies, based on randomeffects models. Pooled RR of depression and anxiety in MI were 1.21 (95% CI 1.04-1.40, p = 0.012) and 1.01 (95% CI 0.76-1.32, p = 0.971), with high heterogeneity (I² = 87.2% and I² = 73%). Differences in prevalence rates among studies can be accounted for by inclusion criteria, sampling methods, diagnostic instruments and study design. Further research on larger samples and with culturally adapted instruments is needed to estimate the prevalence of depression and anxiety in MI seeking help for these disorders.

It has been suggested that a cardinal symptom of mania is over-activity and exaggerated goaldirected behavior. Nevertheless, few attempts have been made to quantify this behavior objectively in a laboratory environment. Having a methodology to assess over-activity reliably might be useful in distinguishing manic bipolar disorder (BD) from schizophrenia (SCZ) during highly activated states. In the current study, quantifiable measures of object-interaction were assessed using a multivariate approach. Additionally, symptom correlates of over-activity were assessed. Patients admitted to an acute care psychiatric hospital for either BD with mania or SCZ (paranoid and non-paranoid subtypes) as well as non-patient comparison (NC) participants were assessed in an open field setting referred to as the human Behavioral Pattern Monitor (hBPM). Activity and interactions with novel and engaging objects were recorded for 15 minutes via a concealed video camera and rated for exploratory behavior. Both BD and SCZ patients spent more time near the objects and exhibited more overall walking compared to NC. In contrast, BD patients exhibited greater physical contact with objects (number of object interactions and time spent with objects) relative to SCZ patients or NC participants, as well as more perseverative and socially disinhibited behaviors, indicating a unique pattern of over-activity and goal-directed behavior. Further analyses revealed a distinction between SCZ patients according to their subtype. The current study extends our methodology for quantifying exploration and over-activity in a controlled laboratory setting and aids in assessing the overlap and distinguishing characteristics of BD and SCZ.

São apresentados sete casos de saúde mental, dentre os 150 atendidos nos Centros de Referência em Saúde do Trabalhador de Santo Amaro e André Gabois, no período de 1994 a 1997. Com base na análise das anamneses e prontuários, buscou-se caracterizar as situações de trabalho, discutir o estabelecimento do diagnóstico e do nexo causal com o trabalho. As situações de trabalho caracterizaram-se por: condições de trabalho nocivas, problemas relacionados à organização do trabalho, gestão inadequada de pessoal e violência. Os quadros clínicos mostraram a existência de medo, ansiedade, depressão, nervosismo, tensão, fadiga, mal-estar, perda de apetite, distúrbios de sono, distúrbios psicossomáticos (gastrite, crises hipertensivas), além disso, ocorreu contaminação involuntária do tempo de lazer, ou seja, os trabalhadores sonhavam com o trabalho, não conseguiam "desligar-se". Os diagnósticos foram variados. Em três casos tivemos síndromes pós-traumáticas ligadas a assaltos. Dois cas...

Background Older adults with serious mental illness (SMI) often have multiple comorbidities and complex medication schedules. Shortages of behavioral health specialists (BHSs), especially in rural areas, frequently make primary care providers (PCPs) the only clinician managing this complex population. The aim of this study was to describe rural/urban psychiatric medication prescribing in older adults with SMI by PCPs and BHSs, and by clinician type. Methods This retrospective descriptive analysis used 2018 Medicare data to identify individuals with a bipolar, major depression, schizophrenia, or psychosis diagnosis and examined medication claims for antianxiety, antidepressants, antipsychotics, hypnotics, and anticonvulsants. Descriptive statistics summarized percentage of medications provided by PCPs and BHSs stratified by rural and urban areas and by drug class. Additional analyses compared psychiatric prescribing patterns by physicians, advanced practice registered nurses (APRNs),...

Depression is common in patients presenting to cognitive clinics, but prevalence estimates are varied. While there are many self-report screening tools for depression, there is no clear consensus on the best instruments for this patient population. Methods: Data were prospectively collected as part of a larger cohort called the Neurological Disease and Depression Study (NEEDS). Participants were recruited from the cognitive neurology outpatient clinics at the University of Calgary from March 2014 to June 2017. All patients had to have a confirmed diagnosis of subjective cognitive decline, mild cognitive impairment (MCI), or mild or moderate dementia. Patient reported depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9), Hospital Anxiety and Depression Scale (HADS), and Center for Epidemiologic Studies Depression Scale (CES-D). The reference standard was the Structured Clinical Interview for the DSM-IV (SCID). Results: 202 participants completed both the questionnaire and SCID. The point prevalence of major depression in our cohort using the SCID as the gold standard was 12.4% (n¼25). The prevalence of depression according to the PHQ-9, HADS-D, and CES-D was 29.8%, 28.4% and 43.3% respectively at traditional cut-points for the general population. The mean MMSE score was 25.5 (n¼192) and 13.0 for the MOCA (n¼197). At traditional cut-points, all 3 scales performed well in the ROC analysis with all AUC > 80% (Figure ). The PHQ-9 and HADS performed better at lower cut-point in this population than at the traditional cut-points. The CES-D maintained 100.0% sensitivity from cut-points 13-21, but the cut-points that maintained the best overall accuracy was 18-21. The optimal cut-point of the CES-D in this population is higher than the recommended cut-point in the general population. Conclusions: Depression in common in patients presenting to memory clinics, and self-report measures can be useful to detect depression as defined by DSM criteria. Local

Perceptions of mental health conditions influence how individuals with psychiatric diagnoses are treated within the community, in the legal system, and at different institutions. We examined perceptions of mental health conditions among lay judges ( N = 643), working at district and appellate courts throughout Sweden. Participants read a web-based survey including a crime vignette in which the person charged with a crime was described as having schizophrenia ( n = 186), antisocial personality disorder (ASPD) with psychopathic traits ( n = 219), or intellectual disability ( n = 238). Participants’ perceptions of schizophrenia were largely in line with Swedish legislation regarding the medicolegal concept of severe mental disturbance (SMD). Findings were more varied for the other two conditions, however. Perceptions of individuals with ASPD with psychopathic traits were not consistent with the Swedish SMD legislation. The results highlight the complexity of legislation addressing ment...

Background Epilepsy's psychological effects are variable, some may experience a few mental health issues while some may experience serious problems such as anxiety, depression, attention deficit hyperkinetic disorder (ADHD), and mood disorders. Hence, there is a need to screen these problems at an early age for timely intervention. So, our study was conducted to determine the prevalence of emotional and behavioral problems in children with epilepsy. Methods This was a prospective observational study on 111 children, 6 to 14 years of age. The overall prevalence of emotional and behavioral problems in childhood was determined by calculating the percentage of children with child behavior checklist score indicative of specific emotional and behavioral problems. The prevalence for specific morbidities was also calculated and reported separately for each condition. Results were presented in the form of tables, charts, graphs, and narratives. Results The overall prevalence of emotional...

Anxiety sensitivity (AS) has been linked to both pathological anxiety and substance use problems. We evaluated relations between AS and substance use situations among individuals with substance use disorders (SUDs) and concurrent DSM-IV anxiety disorders. We predicted that AS would be most strongly associated with substance use in situations involving negative emotions and interpersonal conflict in substance abusers with anxiety disorders. This group was compared to substance abusers with concurrent mood disorders and substance abusers without other disorders (N = 88). AS was positively related to negative emotion situations substance use for substance abusers with anxiety disorders and for substance abusers without other disorders. Contrary to predictions, significant differences between these groups were not found. The relationship between AS and negative emotion situations substance use remained after controlling trait anxiety in a combined group (anxiety disorders and substance abuse only groups). AS did not predict substance use for participants with concurrent mood disorders. Identification of factors that place anxious patients at risk for substance use problems will have implications for treatment and for the prevention of this form of maladaptive coping.

Objectifs. -Les symptômes de la schizophrénie ne se manifestent pas généralement avant la fin de l'adolescence ou au début de l'âge adulte. Plusieurs symptômes de différents types peuvent être présents à l'adolescence et peut-être même à l'enfance. La présente étude a pour objectif principal d'étudier le comportement de nos patients schizophrènes durant leur enfance et leur adolescence. Méthodes. -Il s'agit d'une étude rétrospective menue au service universitaire de psychiatrie de Fès à propos de 100 patients atteints de la schizophrénie. Pour étudier le comportement de nos patients durant leur enfance et leur adolescence, nous avons utilisé la version pour adolescents de la (Child Behavior Cheklist 4-18 [CBCL]). Résultats. -100 patients atteints d'une schizophrénie et leurs parents ont participé à notre étude. L'âge moyen de nos patients était de 25,36 ± -3,54 ans, avec des extrémités d'âge de 18 et de 30 ans. Nous avions une prédominance masculine avec seulement vingt femmes. La moyenne d'ancienneté du trouble était de 4,10 ± -2,74 ans. Le score moyen de CBCL était de 41,69 ± 26,397 avec quarante-sept patients qui avaient un score supérieur au seuil. Plusieurs facteurs étaient significativement liés à un score CBCL élevé : le genre, l'âge précoce de début de la maladie, et la présence d'un événement traumatique à l'enfance. Conclusion. -L'enfance et l'adolescence des schizophrènes sont caractérisées par la présence d'une multitude de symptômes et de troubles de comportement. Même si ces symptômes sont peu spécifiques, leur présence doit alerter le clinicien sur la probabilité non négligeable de développer une schizophrénie.