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Effect of depression treatment on health behaviors and cardiovascular risk factors in primary care patients with depression and elevated cardiovascular risk: data from the eIMPACT trial
- Matthew D. Schuiling, Aubrey L. Shell, Christopher M. Callahan, John I. Nurnberger, Jr., Krysha L. MacDonald, Robert V. Considine, Wei Wu, Adam T. Hirsh, Christopher A. Crawford, Michelle K. Williams, Timothy C. Lipuma, Samir K. Gupta, Richard J. Kovacs, Bruce L. Rollman, Jesse C. Stewart
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- Psychological Medicine , First View
- Published online by Cambridge University Press:
- 10 September 2024, pp. 1-14
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Background
Depression is an independent risk factor for cardiovascular disease (CVD), but it is unknown if successful depression treatment reduces CVD risk.
MethodsUsing eIMPACT trial data, we examined the effect of modernized collaborative care for depression on indicators of CVD risk. A total of 216 primary care patients with depression and elevated CVD risk were randomized to 12 months of the eIMPACT intervention (internet cognitive-behavioral therapy [CBT], telephonic CBT, and select antidepressant medications) or usual primary care. CVD-relevant health behaviors (self-reported CVD prevention medication adherence, sedentary behavior, and sleep quality) and traditional CVD risk factors (blood pressure and lipid fractions) were assessed over 12 months. Incident CVD events were tracked over four years using a statewide health information exchange.
ResultsThe intervention group exhibited greater improvement in depressive symptoms (p < 0.01) and sleep quality (p < 0.01) than the usual care group, but there was no intervention effect on systolic blood pressure (p = 0.36), low-density lipoprotein cholesterol (p = 0.38), high-density lipoprotein cholesterol (p = 0.79), triglycerides (p = 0.76), CVD prevention medication adherence (p = 0.64), or sedentary behavior (p = 0.57). There was an intervention effect on diastolic blood pressure that favored the usual care group (p = 0.02). The likelihood of an incident CVD event did not differ between the intervention (13/107, 12.1%) and usual care (9/109, 8.3%) groups (p = 0.39).
ConclusionsSuccessful depression treatment alone is not sufficient to lower the heightened CVD risk of people with depression. Alternative approaches are needed.
Trial Registration:ClinicalTrials.gov Identifier: NCT02458690
Australian Youth Self-Harm Atlas: spatial modelling and mapping of self-harm prevalence and related risk and protective factors to inform youth suicide prevention strategies
- E. Hielscher, K. Hay, I. Chang, M. McGrath, K. Poulton, E. Giebels, J. Blake, P. J. Batterham, J. G. Scott, D. Lawrence
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 33 / 2024
- Published online by Cambridge University Press:
- 09 September 2024, e34
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Aims
Suicide prevention strategies have shifted in many countries, from a national approach to one that is regionally tailored and responsive to local community needs. Previous Australian studies support this approach. However, most studies have focused on suicide deaths which may not fully capture a complete understanding of prevention needs, and few have focused on the priority population of youth. This was the first nationwide study to examine regional variability of self-harm prevalence and related factors in Australian young people.
MethodsA random sample of Australian adolescents (12–17-year-olds) were recruited as part of the Young Minds Matter (YMM) survey. Participants completed self-report questions on self-harm (i.e., non-suicidal self-harm and suicide attempts) in the previous 12 months. Using mixed effects regressions, an area-level model was built with YMM and Census data to produce out-of-sample small area predictions for self-harm prevalence. Spatial unit of analysis was Statistical Area Level 1 (average population 400 people), and all prevalence estimates were updated to 2019.
ResultsAcross Australia, there was large variability in youth self-harm prevalence estimates. Northern Territory, Western Australia, and South Australia had the highest estimated state prevalence. Psychological distress and depression were factors which best predicted self-harm at an individual level. At an area-level, the strongest predictor was a high percentage of single unemployed parents, while being in an area where ≥30% of parents were born overseas was associated with reduced odds of self-harm.
ConclusionsThis study identified characteristics of regions with lower and higher youth self-harm risk. These findings should assist governments and communities with developing and implementing regionally appropriate youth suicide prevention interventions and initiatives.
Personalization of therapy of psychopathological complications of cardiac surgery in artificial circulation conditions
- M. Markova, D. Mankovsky, T. Abdriakhimova
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S498-S499
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Introduction
The study of the clinical and phenomenological features of psychopathological complications of cardiac surgery (CS) in artificial circulation conditions (ACC), the development of modern approaches to early diagnosis and prognosis of psychopathology is an effective way to solve this problem has valid medical and social significance.
ObjectivesTo increase the effectiveness of prevention of psychopathological disorders in cardiosurgical interventions based on personalization of their correction.
MethodsThe examination included the use of socio-demographic, instrumental, biochemical, clinical-psychopathological, psychometric, and statistical methods.
ResultsThe study sample consisted of 700 patients who were treated by CS in ACC at the SI “Heart Institute of the MH of Ukraine”.
It was found out that the most common complication is postsurgeon cognitive dysfunction (PCD) (72.0% of patients), postsurgeon encephalopathy (PE) (31.0%) is less common, and cerebral infarction (CI) is the least common (12.2%).
It was revealed that the core psychopathological symptoms associated with CS are cognitive disorders (72.0% of the examined) and affective symptoms, represented by depressive (38.1%) and anxiety (33.9%) manifestations of mild and moderate expressiveness, and auxiliary constructs – dyssomnic (29.7%), asthenic (17.9%) and somatovegetative (9.0%) disorders. The highest prevalence of psychopathological symptoms was found in patients with CI, somewhat less in patients with PE, and the lowest in patients with PCD.
Signs of mild depressive disorder were found in patients who underwent CS in ACC, elevated levels of adynamic depression indicators, depression with fear and agitated depression, as well as increased levels of anxiety: the average level of anxiety, mental and somatic anxiety. The indicators of expressiveness of depression and anxiety in patients with CI turned out to be the highest, in patients with PE – lower, and in patients with PCD – the lowest.
We proposed a mathematical model for predicting the development of psychosocial maladjustment (PM) in patients who have undergone CS in ACC. It is based on a comprehensive assessment of three key vectors that can have a mutually potentiating pathogenetically related effect on the course of the formation of PM: surgical, neurological, and psychopathological. A complex of diagnostic, corrective and preventive measures for each of the risk groups has been developed.
ConclusionsVerification of the proposed model on a representative sample of patients confirmed its high predictive ability and reliability in use.
Disclosure of InterestNone Declared
Liquor for breakfast, fighting against alcohol consumption
- N. Navarro Barriga, P. Marqués Cabezas, M. B. Arribas Simón, B. Rodríguez Rodríguez, C. Alario Ruiz, G. Guerra Valera, A. Aparicio Parras, M. J. Mateos Sexmero, M. Fernández Lozano, P. Martínez Gimeno, M. A. Andreo Vidal, M. Calvo Valcárcel, M. P. Pando Fernández, M. D. L. A. Guillén Soto, T. Jimenez Aparicio, M. D. C. Vallecillo Adame, C. De Andrés Lobo
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S408-S409
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Introduction
The harmful consumption of alcohol is known for how tortuous its management can be in mental health, encouraging introspection of it as a serious problem is perhaps the main key to starting to battle against its damaging influence on the development of a functional and full life.
ObjectivesTo describe a clinical case showing an unpredictible complication in an alcohol detoxification process.
Methods54-year-old man, native of Cádiz, widowed for half a decade, without children. He resides with his parents in the family home. Currently unemployed for approximately a year. He has previously worked in the IT sector. As a notable somatic history, we found long-established arterial hypertension and a total hip replacement. He has been under irregular follow-up with a mental health team for anxiety-depressive symptoms in the context of grief. He goes to the emergency service brought by his family to begin the detoxification process in the hospital setting. He acknowledges ethanol consumption since he was widowed, which began when he awakes; quantities that ranged between one or up to three bottles of distilled liquor per day, generally consumption is in the home environment. A little less than a year ago, he began to isolate himself in his room and abandon his self-care, eating increasingly insufficient food intake, refusing to receive professional care to quit the habit, mainly because he did not recognize it as disruptive.
The patient was admitted to hospital with symptoms suggestive of withdrawal, making it extremely difficult to control blood pressure levels. On the third day of admission to the acute care unit, fever peaks, blood pressure levels well below normal parameters, and compromised level of consciousness began to be evident.
ResultsBlood tests were performed that, together with the clinical picture, suggested imminent septic shock, so critical care was contacted for transfer and stabilization. A germ of probable urinary etiology sensitive to a broad spectrum of antibiotics was isolated in blood cultures, and the medication of the detoxification process was progressively optimized. Once clinical stability was achieved at all levels, an inpatient cessation resource was managed, which the patient accepted and considered suitable for his complete recovery.
ConclusionsA holistic approach to the alcoholic patient is important, since serious problems of an organic nature often arise. This is why a multidisciplinary intervention is necessary, as well as a holistic approach to care, involving both classic pharmacology and assiduous long-term psychotherapeutic intervention.
Disclosure of InterestNone Declared
Bipolar Disorder due to Cushing’s Disease, with manic characteristics. Regarding a clinical case.
- M. D. C. Blasco Fresco, S. Ciria Villar, L. T. Durán Sandoval, A. Perez Poza, E. De La Fuente Ruiz
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S250
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Introduction
The increase in cortisol can be exogenous or endogenous. As etiologies of endogenous increase we find: Cushing’s disease, 68% of cases, generally due to an ACTH-producing pituitary tumor; Adrenal Cushing syndrome (17%); Ectopic Cushing syndrome (15%) due to lung tumor most frequently. It is relevant since among its symptoms one of the most notable are the psychiatric alterations it produces, among them mood disorders, depression being the most common, as well as psychotic symptoms, delirium and anxiety disorder.
ObjectivesTo carry out a correct differential diagnosis of the pathologies that could present with symptoms of a manic episode.
MethodsClinical case description of a 52-year-old woman, who presented with manic symptoms in 2020, requiring hospitalization. Upon discharge from the acute care unit, she consulted with the endocrinologist due to weight gain, revealing an increase in abdominal diameter, hyperpigmentation, a moon-like face, and a hump. Free cortisol was measured in 24-hour urine, with a high result, followed by brain MRI, and pituitary microadenoma was confirmed.
ResultsThe patient underwent surgical resection of the microadenoma, which was partially effective, so she maintained high cortisol levels, even despite oral retreatment. In 2023 she had a new manic episode, with a cortisol value of approximately 300 nmol/day.
ConclusionsThe importance lies in the correct diagnosis to provide appropriate treatment and avoid the chronicity of the disease and the patient psychiatrization. In this case and as in many other diseases, which present with psychiatric symptoms, it is important to differentiate whether it is a primary psychiatric disorder or are component symptoms of another disease that, upon receiving treatment, would resolve the psychiatric symptoms.
Disclosure of InterestNone Declared
Combating Gaming Disorder in 2024: A Survival Manual
- D. M. Ribeiro, D. Teixeira
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S401
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Introduction
Gaming Disorder (GD) has not been officially recognized as a diagnostic entity in the DSM-5, being listed in the “conditions for further study” section. However, it is described in the ICD-11, and clinically, it is observed that an increasing number of individuals, particularly the younger population with easier access to technology, are affected by this issue. Nefarious consequences include loss of performance at school/work and a potential for failing other responsibilities such as in the familiar and social spheres.
ObjectivesDespite its harm, psychiatrists are generally less familiar with this entity when compared to other psychiatric disorders. Thus, our main goal was to establish a comprehensive and hollistic review of its approach.
MethodsA bibliographical research on the topic was conducted from the available scientific literature on the topic, with the utmost priorization of evidence-based sources.
ResultsThe overall prevalence of Gaming Disorder is challenging to assess precisely, but it is estimated to be around 3%, making it comparable to obsessive-compulsive disorder and some substance use disorders. It is more common than pathological gambling. Clinically, GD is characterized by an excessive preoccupation with gaming that supersedes all aspects of life. It may also involve a compulsion to play and the presence of withdrawal symptoms from periods when there are no gaming activities. The behavior is driven by the ACE triad (anonymity, convenience, and escape). Often, individuals with GD do not seek treatment. Although there are no specific pharmacological agents, antidepressants, mood stabilizers, and naltrexone have shown some success. In psychotherapies, cognitive-behavioral therapy has the strongest evidence.
ConclusionsThere is a limited amount of information on GD, and when researching the topic, one primarily encounters information on other substance-related addictive disorders and, in the case of behavioral disorders, gambling. However, as young people are increasingly exposed to screens and video games with potential harmful effects on their development, and in adults, inhibiting them from taking on work and family responsibilities, it is essential to conduct more studies on the subject to prevent these deleterious consequences.
Disclosure of InterestNone Declared
The Zen Garden Virtual Reality App for eating disorders: description and preliminary results
- D. Gravina, S. Kirupakaran, M. Badr, A. Meaburn, M. Kresojevic, L. Dell’Osso, J. Treasure, H. Himmerich
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S107-S108
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Introduction
Virtual Reality (VR) represents an emerging and promising tool to enhance standard care for patients with eating disorders (EDs). Indeed, VR provides an immersive and interactive experience in a safe and controlled environment that can simulate real-life situations, showing encouraging findings on various components of psychological treatments such as exposure therapy, psychoeducation, and emotional regulation.
ObjectivesThis study aims to evaluate the Zen Garden VR App in patients with anorexia nervosa (AN) in order to obtain pilot data regarding changes in mood, relaxation, anger, anxiety, and weight and shape concerns. A secondary aim was to receive feedback from participants about the VR experience, its components, and its possible application for people with AN.
MethodsSelf-reported baseline and post-intervention data were collected from a sample of six female inpatients with AN recruited at the Eating Disorders Service at the Bethlem Royal Hospital of the South London and Maudsley NHS Foundation trust (SLaM). The technology used during the VR session consisted of an Oculus head-mounted display headset and two controllers which provided continuous rotational and positional tracking (Figures 1, 2 and 3).
ResultsFindings showed a global improvement after the VR Zen Garden App session, mainly in reducing levels of anxiety (Cohen’s d= 1.07) and promoting relaxation (Cohen’s d= 0.95), with possible applications especially before and after meals when food fears are at their highest. In addition, the music that was played during the intervention had a particularly positive effect.
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ConclusionsDespite limitations, such us the small sample size and the one time point measurement, positive clinical implications have been highlighted for the Zen Garden VR App in patients with AN, although further studies are needed to confirm these preliminary findings. It is possible that VR could usefully augment and personalize care for people with an EDs. A range of interventions might be used to target the most compromised symptoms such as designing interventions that can help with triggers to eating disorder psychopathology.
Disclosure of InterestNone Declared
Sex differences in diagnostic stability in first episode psychosis after 1-year follow-up
- B. Jiménez-Fernández, A. Toll-Privat, D. Bergé-Baquero, N. V. Motta-Rojas, M. Delgado-Marí, T. Legido-Gil, L. Martínez-Sarduní, T. Legido-Gil, J. Cuevas-Esteban, A. Mané-Santacana
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S470-S471
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Introduction
Diagnostic stability is a controversial issue in first episode psychosis (FEP) due to heterogenous symptoms and unclear affective symptoms. Differencing affective and non-affective psychoses is important as treatment strategies are different. Initial affective symptomatology has low specificity for predicting the subsequent diagnosis of affective psychosis. Sex has proven to be relevant for clinical and functional outcomes but it remains unclear how sex may contribute to diagnosis switch of FEP.
ObjectivesTo determine the role of sex in diagnostic stability in a sample of FEP after 1-year follow-up.
MethodsDiagnoses of FEP patients from Hospital del Mar of Barcelona were assessed at baseline and 1 year after. Univariate analyses was perfomed for all diagnoses and dichotomic variable (affective/non-affective). Logistic regression model was perfomed to know which variables predict diagnosis switch.
Results256 patients were enrolled. No differences were found at baseline between completers and non-completers (Table 1). No significant differences between men and women at baseline diagnosis were found, neither all diagnoses (p=0.274) nor the dichotomic variable affective/non-affective (p=0.829) (Table 2AB). Significant differences were found at 1-year follow-up between men and women, for all diagnoses (p=0.043) and the dichotomic variable (p=0.039). Sex was the only variable that predicted diagnosis switch (Figure 1), PANSS, CDSS, YMRS, GAF and cannabis did not.
Table 1. Baseline characteristics of participants
Completers (n=188) Non-completers (n=68) p Women (n, %) 71 (37.8) 30 (44.1) 0.111 Age (M, IQR) 24 (20-28) 22 (20-28) 0.899 Cannabis use (M, IQR) 5.5 (0-18) 7 (0-21) 0.231 DUP (M, IQR) 45 (12.5-130) 36 (11.25-115.75) 0.213 PANSS (m, sd) 44.55 (10.17) 40.93 (10.42) 0.761 CDSS (M, IQR) 2 (0-7) 3 (0-5.5) 0.199 YMRS (m, sd) 19 (9.64) 17.6 (9.15) 0.845 GAF (M, IQR) 30 (25-50) 30 (25-35) 0.114 TABLE 2A and 2B. Diagnosis comparison (n, %)
Baseline 1-year follow-up Men Women Total Men Women Total Psychosis NOS 69 (59) 39 (54.9) 108 (57.4) 28 (23.9) 10 (14.1) 38 (20.2) Schizophreniform disorder 22 (18.8) 16 (22.5) 38 (20.2) 14 (12 9 (12.7) 23 (12.2) Induced psychosis 4 (3.4) 0 (0) 4 (2.1) 15 (12.8) 4 (5.6) 19 (10.1) Affective psychosis 17 (14.5) 9 (12.7) 26 (13.8) 24 (20.5) 25 (35.2) 49 (26.1) Schizophrenia 0 (0) 0 (0) 1 (0.4) 30 (25.6) 14 (19.7) 44 (23.4) Brief psychotic disorder 5 (4.3) 7 (9.9) 12 (6.4) 6 (5.1) 8 (11.3) 14 (7.4) Baseline 1-year follow-up Men Women Total Men Women Total Affective psychosis 17 (14.5) 9 (12.7) 26 (13.8) 24 (20.5) 25 (35.2) 49 (26.1) Non-affective psychosis 100 (85.5) 62 (87.3) 162 (86.2) 93 (79.5) 46 (64.8) 139 (73.9) Image:
ConclusionsSex has proven to be the main predictor of switching initial diagnosis of FEP.
Disclosure of InterestNone Declared
The Delicate Balance: Aptitude of Physicians with Psychiatric diseases
- N. Khaterchi, G. Bahri, I. Youssef, M. Mersni, H. Ben Said, D. Brahim, N. Mechergui, M. Methni, C. Ben Said, N. Bram, N. Ladhari
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S825
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Introduction
The delicate balance between the need to ensure quality patient care and the reality of physicians dealing with psychiatric diseases poses a major challenge within the medical field. This issue raises fundamental ethical, legal, and medical questions, highlighting the complexity of decision-making regarding professional aptitude for practitioners affected by mental disorders.
ObjectivesTo examine the impact of psychiatric diseases on the medical aptitude of physicians.
MethodsThis was a retrospective descriptive study that focused on physicians with psychiatric diseases referred to the occupational pathology clinic at Charles Nicolle Hospital in Tunis for medical evaluations of their work aptitude between January 1, 2021, and September 15, 2023.
ResultsDuring the study period, we collected data from 20 patients. The mean age was 38 ± 11 years, with a sex-ratio (F/M)of 4.5. Five examined physicians had family histories of psychiatric disorders. Medical specialties were the most represented (N=17), including three general practitioners, two family medicine practitioners, and two anesthesiologists. The study population included 10 residents, eight hospital assistants, and two medical interns. The most common psychiatric diagnosis was depression (N=7), followed by bipolar disorder (N=5). The medical treatment prescribed was combinations of antidepressants and anxiolytics in seven cases, antipsychotics in five cases, and antidepressants in two cases. Medication adherence was noted in 10 physicians. Fourteen physicians had taken long-term sick leave, with an average duration of 203 days. Five physicians were declared fit to continue their regular professional activities, seven physicians were declared fit with restrictions on night work, and one physician was declared fit with workplace accommodations.
ConclusionsThis study highlights the challenges surrounding the medical aptitude of physicians with psychiatric diseases. However, it is imperative to promote mental health awareness and to implementsupport measures to ensure both compassion for physicians and patient safety.
Disclosure of InterestNone Declared
A multidisciplinary approach to the treatment of children and adolescents with Beckwith-Wiedemann syndrome
- M. Tripković, I. Bakija, D. Horvat, P. Lederer, I. Begovac
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S453
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Introduction
Beckwith-Wiedemann syndrome (BWS) is a rare and complex congenital disorder characterized by a spectrum of symptoms and somatic findings. The prevalence of classic BWS is 1:26,000 births in Europe, and is equal in both sexes. The causes of the disorder are complex and are related to alterations in the expression of one or more genes in the region of chromosome 11. The heterogeneity of the clinical picture results in a spectrum of clinical features, the most common of which include: excessive growth of one side or certain parts of the body, macroglossia, abdominal wall deficits such as umbilical hernia, hypoglycemia, enlarged abdominal organs and an increased risk of developing certain types of tumors in adulthood.
ObjectivesThe aim of this article is to highlight the importance of an early multidisciplinary approach in the management of children and adolescents with BWS.
MethodsUsing clinical practice and a review of the existing limited literature, we examined the complexity of the disease and the importance of psychiatric, psychotherapeutic, and psychological interventions in the treatment of children and adolescents with rare diseases such as BWS.
ResultsAccording to our clinical practice, a number of uncertain physical symptoms and possible complications may in some children with BWS lead to psychomotor retardation and lack of self-confidence due to the often impaired physical appearance. Affected children and adolescents are more likely to be exposed to abuse at school, show more behavioral and learning difficulties, difficulties in social adjustment, and resultant emotional difficulties. After initial genetic and pediatric treatment and subsequent regular monitoring, it is necessary to pay additional attention to the development of psychological sequelae in order to involve them and their families in psychotherapeutic treatment, and intervene in a timely manner so that they can achieve or maintain psychological stability and functionality. Many adolescent patients with BWS do not have significant somatic difficulties that would require pediatric intervention, but often present with symptoms of mental illness.
ConclusionsPsychological stress in children and adolescents suffering from rare somatic diseases represents a negative experience of an emotional and social nature, which affects the course of the disease and interferes with the treatment. Due to a number of possible physical manifestations and outcomes of such diseases, extensive psychological support and care by child and adolescent psychiatrists and the entire medical team is required. A multidisciplinary approach is crucial in the treatment of these patients and results in improved functionality and quality of life.
Disclosure of InterestNone Declared
Impact of an Internet-Delivered Sound Healing Intervention on Chronic Non-Malignant Pain and Sleep Disturbances in Community Settings
- N. Sharma, D. Walker, B. S. Prasad, M. Patel
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S165-S166
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Introduction
Chronic pain patients often contend with insomnia symptoms, creating a reciprocal relationship that adds complexity to their condition. Evaluating interventions targeting insomnia in this population becomes paramount, given the intertwined nature of pain and sleep disturbances.
ObjectivesThis retrospective pretest design aimed to assess the efficacy of an Internet-delivered sound healing intervention in reducing insomnia severity and addressing sleep- and pain-related parameters among individuals with chronic pain.
MethodsConducted as a community-based project, Tuning for Health provided support to individuals grappling with long-term illnesses. The intervention involved the virtual delivery of a specially crafted sound track using tuning forks over a 6-week period, supervised by an experienced therapist and administered weekly for an hour. Participants were instructed to play the track daily at a time convenient for them. A total of 68 participants (mean age 59.3 years) completed the intervention. Outcome measures, including the Insomnia Severity Index (ISI), a sleep diary, and assessments for anxiety, depression, and pain-related parameters, were collected at the end of the 6-week intervention and repeated after a 6-month follow-up. Negative effects were monitored and reported.
ResultsSignificant immediate interaction effects (time by treatment) were observed for the pain severity, ISI and various sleep parameters, such as sleep efficiency, sleep onset latency, early morning awakenings, and wake time after sleep onset. A time effect for anxiety and depression was noted at the 6-month follow-up. The group exhibited highly significant improvements in pain-related parameters. At the 6-month follow-up, sustained enhancements in sleep parameters and mental health were reported, with no reported side effects.
ConclusionsThese unique results suggest the potential efficacy of sound healing in alleviating chronic pain and associated insomnia. Further research with a larger sample size is warranted to validate these findings. Combining sound healing with other treatments may offer enhanced outcomes for individuals dealing with both chronic pain and comorbid insomnia. This study lays the groundwork for future investigations into the promising intersection of sound healing, chronic pain management, and sleep improvement.
Disclosure of InterestNone Declared
The Portuguese version of the Screen for Disordered Eating: Validity and reliability in the perinatal period
- A. T. Pereira, R. Lima, J. M. Pinto, D. Pereira, A. Macedo, C. Marques, A. I. Araújo, B. Barbosa, C. Pinto Gouveia
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
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- 27 August 2024, pp. S308-S309
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Introduction
Despite the increased knowledge about the prevalence and consequences of eating disorders (ED), they continue to be underdiagnosed and undertreated. Being more common in women of childbearing age, the perinatal period may play a decisive role in the incidence and course of these pathologies. The Screen for Disordered Eating (SDE) was developed for the screen of ED in primary care.
ObjectivesOur aim was to analyze the psychometric properties of the Portuguese Version of SDE in women during the perinatal period.
MethodsParticipants were 346 women with a mean age of 31.68 of years old (± 4.061; range: 18-42). 160 were pregnant (second or third trimester) and 186 were in the post-partum (mean baby´s age=4.37 months (± 2.87; range: 1-12). They answered an online survey including the Portuguese version of the SDE and of the Eating Disorder Examination – Questionnaire (EDE-Q-7).
ResultsConfirmatory Factor Analysis showed that the unidimensional model presented good fit indexes in pregnancy (), post-partum () and considering both – perinatal period (χ2/df=2.0335; RMSEA=.0547, p<.001; CFI=0.9976 TLI=0.9939, GFI=0.9906). The Cronbach’s alfa were ≥ 0.65. All the items contributed to the internal consistency and presented high internal validity. Pearson correlations between SDE and EDE-Q-7 total scores were significant (p<.001) positive and high in pregnancy (.639), postpartum (.583) and the perinatal period (.617).
ConclusionsThe Portuguese version of SDE has shown good validity (construct and concurrent) and internal consistency. As such, SDE might be a useful tool to screen ED in women during the perinatal period.
Disclosure of InterestNone Declared
Self-harm among Brazilian teenagers: scoping review
- J. L. Da Silva, J. E. D. L. sobrinho, M. V. Heimer, L. D. A. Oliveira, L. S. Malheiros
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S350-S351
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Introduction
Non-suicidal self-injury among adolescents has grown in recent years, becoming a significant public health issue. The high social and psychological impacts related to it are often characterized by substance abuse and the development of anxiety and depression. Furthermore, emotional dysregulation and heightened reactivity are associated psychological characteristics.
ObjectivesThe aim of this paper was to do a scoping review, mapping the existing literature on self-harming behaviors among Brazilian adolescents, considering their sociodemographic and clinical characteristics.
MethodsWe followed the adapted PRISMA checklist for scoping reviews. We searched eight databases: APA PsycNet, LILACS, MEDLINE, PubMed, Embase, Web of Science, The Cochrane Library, and Scopus. The selection of studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, where three independent researchers examined all titles and abstracts, applying the eligibility criteria. Accordingly, six studies were selected for descriptive analysis due to the variety of study types.
ResultsA total of 2,032 youngsters were studied in the age range of 10 to 19 years-old, among over 15,000 reported cases of self-harming behaviors. Females accounted for 51.3% of the cases and had higher scores of impulsivity and loneliness to self-harming behavior (P ≤ 0.05). Alcohol use was evident across both genders but showed higher measures for males in both age groups (10 to 14 and 15 to 19 years, p < 0.001).
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ConclusionsThe study pointed to a diversity of clinical and sociodemographic characteristics; however further research is needed on this topic on Brazilian adolescents. In addition, a broader standardization of data is necessary for more specific statistical analyses.
Disclosure of InterestNone Declared
Cyberaddiction in the medical setting: A study of 45 cases
- A. Ghenim, D. Brahim, I. Yaich, C. Ben Said, A. Belkahla, I. Youssef, M. Mersni, N. Mechergui, H. Ben Said, G. Bahri, M. Bani, N. Bram, N. Ladhari
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S403
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Introduction
Internet use can become uncontrollable, leading to physical and psychological suffering and what is known as cyberaddiction.
ObjectivesTo assess the frequency of cyberaddiction in a population of young doctors.
MethodsWe conducted a cross-sectional, descriptive study of a population of young doctors. We collected socio-professional and medical data using a Google Forms self-questionnaire. The Young scale was recommended for screening for cyberaddiction. A score ≥5 indicates Internet addiction. The Hospital Anxiety and Depression Scale (HAD) was adopted to reveal anxiety-depressive disorders.
ResultsA total of 45 physicians responded to our survey. The mean age was 29.93±4.8 years. The sex ratio (M/F) was 0.3. Participants were single in 69% of cases. Residents represented 64% of the population. Physicians were family medicine residents in 11% of cases. The mean Young’s score was 3.13±1.97/8. Cyberaddiction was noted in 24% of cases. A definite anxiety-depressive disorder was found in 6.7% and 13.3% of cases respectively. Internet addiction was significantly associated with female gender (p<0.05) and a positive HAD (A) score (p=0.03).
ConclusionsAccording to the results of our study, cyberaddiction is common among medical staff. A preventive strategy is needed to counter the harmful effects of this addiction.
Disclosure of InterestNone Declared
Risk factors and personality characteristics of nonsuicidal self-injurious behavior in clinical sample of female adolescents
- A. Osváth, C. Hankó, M. Csáki, E. Molnár, J. Pahocsa, S. Kocsor, K. Tóth, D. Fertői, K. A. Sándor-Bajusz, T. Dergez, G. Csábi
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S446-S447
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Introduction
Nonsuicidal self-injury (NSSI) is a self-damaging behavior with typical onset in early adolescence, and shows greater prevalence in females. NSSI is defined by recurrent episodes of intentional self-inflicted damage to body tissue, without suicidal intent. These recurring self-inflicted injuries are done by the indivuduel to relief oneself from negative feelings, to resolve interpersonal difficulties, or to induce positive feelings.
NSSI in DSM-5. has been included among the conditions in need of further study.
NSSI can be interpreted as a maladaptive coping mechanism that can be regarded as an emotional dysregulation. Adverse childhood experiences including physical abuse, neglect or sexual abuse are the strongest predictors of the NSSI. Research has repetitively found strong associations between NSSI and identity diffusion and/or distorted personality traits.
ObjectivesThe aim of our study was to assess the association between childhood traumatization, personality characteristics including stages of identity development, and self-injurious behavior among female adolescents that experience difficulties with emotional regulation.
MethodsWe compared our results to a Hungarian normative sample. The sample consisted of inpatients adolescents, age between 14 and 18, with a diagnosis consisting of „Emotional disorders with onset specific for childhood” or „Mixed disorders of conduct and emotions” with chronic nonsuicidal self-injurious behavior.
Childhood traumatization was measured with the short version of Childhood Trauma Questionnaire (H-CTQ-SF). Identity development and identity diffusion were measured with the Assessment of Identity Development in Adolescence Questionnaire (AIDA). Temperament and character factors were measured with the Junior Temperament and Character Inventory (JTCI).
ResultsAdolescent patients with NSSI reported severe and multiplex childhood traumatization. These patients scored higher on novelty seeking and harm avoidance and scored lower on the persistence, self-directedness, and cooperativeness factors in the JTCI. These results were compared with the Hungarien normative sample. Adolescents scored higher on the Discontinuity and Incoherence scales of the AIDA.
ConclusionsOur preliminary results suggest that childhood traumatization predicts self-injurious behavior in adolescent females. Additionally, we have found associations between signs indicative of personality disorder, including lower level of self-cohesion, self-integration and self-directedness.
Disclosure of InterestNone Declared
Mental Health in Medicine: A novel stepped care model in medical psychiatry and the implementation of measurement-based care
- D. Wiercigroch, S. Wright, N. Bangloy, S. Bush, A. Wai, D. Koshy, L. Thomson, N. Abdel Gawad, S. Abbey, M. Kaye, M. Kelsey, A. Tan, J. Delwo, K. Sheehan
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S157
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Introduction
Individuals with co-occurring mental and physical health issues have worse health outcomes in both domains. Integration improves outcomes and aligns with patient preference, but health services tend to be siloed. The Mental Health in Medicine Clinic (MHiM) supports patients receiving inpatient or outpatient medical or surgical care at a tertiary academic hospital in Toronto, Canada. The predominantly virtual clinic has an interdisciplinary team offering services via stepped care, matching patient need with service intensity. Measurement-based care (MBC), the systematic evaluation of patient reported outcomes, was not initially used routinely in the clinic, but its implementation may improve treatment decision-making and may be useful in allocating patients within a stepped care model.
Objectives1) To describe the stepped care model, referral patterns, diagnoses, and level of care provided since implementation of stepped care. 2) To conduct a quality improvement initiative to implement MBC in the clinic, with a goal of 50% of patients completing at the time of first assessment and prior to discharge from the clinic.
MethodsWe reviewed the electronic medical record for referral source, diagnoses, and level of stepped care within the clinic. We conducted semi-structured interviews with stakeholders (clinicians, administrative staff, patients) to explore barriers to implementation of MBC. Interviews were analyzed for themes around barriers and facilitators to MBC. Plan, Do, Study, Act cycles were carried out around change concepts informed by stakeholder interviews and relevant literature.
ResultsThe MHiM clinic began operations in August 2020. The clinic operated on a physician-only model until March 2022 and then shifted to a stepped care model with an interdisciplinary team. The most frequent referral sources were internal medicine, COVID19 clinics, consultation-liaison psychiatry, red blood cell disorders clinic and cardiology. Since the implementation of stepped care, 250 referrals were assessed. 58% of new referrals were assessed by the psychiatrist, 42% were managed by the NP, and 25% consulted with the social worker. Referrals consisted of trauma and stress-related disorders (32%), depression (21%) or anxiety disorders (20%). Personality, substance use, and psychotic disorders accounted for less than 10% of referrals combined. Some patients did not have any diagnosis (6%). Results from the quality improvement initiative to implement MBC will also be presented.
ConclusionsThe MHiM clinic provides an integrated care pathway addressing comorbid mental and physical health conditions. We describe a novel stepped care model and the implementation of MBC. Future directions include ongoing quality improvement of MBC and its integration within the clinic to assess and re-assess service intensity.
Disclosure of InterestNone Declared
Health Outcomes and Health Services Utilization Evaluation Protocol: Assessing the Impact of the Nova Scotia Rapid Access and Stabilization Program
- M. K. Adu, R. D. L. Dias, G. Obuobi-Donkor, N. Ezeanozie, S. Sridharan, J. Morrison, P. Simon, B. Taylor, M. MacKinnon, S. Gossen, B. Agyapong, L. Wozney, V. I. Agyapong
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S320-S321
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Introduction
Emergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative, the Rapid Access, and Stabilization Program (RASP).
ObjectivesThis study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners’ (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population.
MethodsThis is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and examine health care partners’ impressions.
ResultsThe results for the primary, secondary, and qualitative outcome measures to be available within 6 months of study completion. We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days. In addition, we anticipate that patients, healthcare providers, and healthcare partners would express high levels of satisfaction with the new service.
ConclusionsThis study will demonstrate the results of the Mental Health and Addictions Program (MHAP) efforts to provide stepped-care, particularly community-based support, to individuals with mental illnesses. Results will provide new insights into a novel community-based approach to mental health service delivery and contribute to knowledge on how to implement mental health programs across varying contexts.
Disclosure of InterestNone Declared
Prevalence, sociodemographic factors and psychological distress related to compulsive buying online
- M. Mnif, F. Guermazi, D. Mnif, W. Abid, I. Feki, I. Baati, J. Masmoudi
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S406-S407
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Introduction
Since that the online commerce provides an important shopping environment, it has been argued that traditional buying-shopping disorder may migrate into the online market.
ObjectivesThe aims of the current study were to investigate the prevalence of online buying-shopping disorder, and to determine sociodemographic and psychological factors related to this addictive behavior.
MethodsA cross-sectional, descriptive and analytical study was conducted among subjects who had already made at least one online shopping. Data was collected using a self-questionnaire published by GOOGLE FORMS. Assessment included the short version of the Internet Addiction Test modified for online shopping sites (s-IATshop). The Hospital Anxiety and Depression Scale (HADS) has been used to assess anxiety and depression.
ResultsA total of 137 participants aged 34.62 ± 9.82 years completed the online questionnaire.
Only 4 (2.9%) participants had a probable compulsive buying shopping on line.
The HADS-A score ranged from 0 to 14, with a mean of 6.85 +/- 3.49 and almost half of the participants (44.5%; N=61) had anxiety symptoms.
A high s-IAT shopping score was correlated with secondary or university education (p=0.046). We also found that women, who were younger and had higher incomes, had the highest scores on the s-IAT-shopping scale, without however confirming statistical significance.
ConclusionsOur study has shown the potential vulnerability factors for compulsive online shopping disorder. Thus, this behaviour deserves to be taken into account in behavioural addictions.
Disclosure of InterestNone Declared
Between Delusions and Borders: Diagnosing Delusional Disorder in Migratory Contexts
- L. M. Carrasqueira, M. D. Pereira, I. Marques, M. Silva, C. Laureano
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S613
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Introduction
The mental health of immigrants is a significant, yet often overlooked, aspect of public health. This case study highlights the intersection of migration and mental health, focusing on a patient with delusional disorder. It is particularly relevant for psychiatrists due to the unique challenges in diagnosing and treating mental health conditions in migrant populations, who often face cultural, linguistic, and systemic barriers in accessing care.
ObjectivesThe primary objective of this case study is to elucidate the diagnostic and clinical challenges encountered in managing delusional disorder in a migrant patient. The case study presented aims to provide insights into how delusional beliefs can precipitate and perpetuate the process of migration.
MethodsThe case study was developed through comprehensive psychiatric interviews during the patient’s stay in a Psychiatric Inpatient Unit, supplemented by a targeted literature review on PubMed using “delusion disorder” and “immigration” as keywords.
ResultsThe patient, a 44-year-old Indian male, was a functional young adult until 2007 when he began exhibiting symptoms of delusional disorder. His delusions progressively evolved from local scenarios to national and eventually to a global scale. The initial delusions were focused on personal and professional conspiracies within his home country, leading to his first internal migration. As the condition worsened, his delusions expanded, fueling a belief in a widespread conspiracy that transcended national borders. This escalation of delusional beliefs became the primary motivation for the patient’s international migration. He changed countries four times, each move driven by an attempt to escape the perceived threats and conspiracies associated with his delusional disorder. The patient’s journey through various countries was a direct result of the intensifying nature of his condition.
ConclusionsThis case study accentuates the profound impact that a delusional disorder can have as a driver and catalyst of international migration, influencing the individual’s decision-making process and shaping the migratory experiences. It emphasizes the necessity for psychiatrists to consider the unique socio-cultural contexts of migrant patients in diagnosis and treatment. The case study advocates for a comprehensive treatment approach, integrating psychiatric care with a nuanced understanding of the migrant’s experiences and challenges. This multifaceted approach is crucial in addressing the complex needs of patients with delusional disorder in migrant populations.
Disclosure of InterestNone Declared
Achieving functional remission in schizophrenia: a pilot study
- D. Bošnjak Kuharić, A. Jambrošić Sakoman, Z. Lovrić Makarić, A. Savić, A. Papić, M. Herceg
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S727-S728
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Introduction
Many patients with schizophrenia are unable to achieve adequate levels of psychosocial functioning and quality of life despite of the remission of illness symptoms. According to previous reports, only one-third of patients with symptomatic remission reach functional remission. While current pharmacotherapy options seem to be relatively effective for different symptoms of schizophrenia (e.g. positive symptoms), more specific psychosocial interventions that could enable functional remission are yet to be developed.
ObjectivesOur objective is to investigate differences in psychopathology, quality of life, functioning, and achieving functional remission before and after specific group treatments developed in our clinic.
MethodsWe will conduct a prospective study including a consecutive cohort of female patients older than 18 years of age, which fulfilled the criteria for schizophrenia and schizoaffective disorder according to the International Classification of Disorders, 10th revision. Exclusion criteria are intellectual disabilities, mental disorders due to known physiological or neurological conditions, lactation or pregnancy, treatment with medications that can provoke psychosis, alcoholism, and other addictions. Patients will be recruited after finished hospital treatment or during individual outpatient controls. The Recovery Helm will be used at the beginning of the treatment, to make individual treatment plan and include patients in specific programs including day hospital treatment and/or outpatient group programs: psychoeducation, relaxation, metacognitive training, and social skills training. Besides collecting sociodemographic data, pre- and post-treatment assessment will include the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF), the Quality of Life Scale (QLS), and the “Functional Remission of General Schizophrenia” (FROGS) scale.
ResultsWe will analyze the changes in psychopathology levels, quality of life, functioning, and achieving functional remission between the two assessment points, taking into account different treatment possibilities.
ConclusionsEvaluation of current available programs can help with recognition of specific needs of patients with schizophrenia and provide guidelines for further development of treatment programs that could be helpful in achieving functional remission.
Disclosure of InterestNone Declared
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