Concomitant Mental Disorders Research Articles

Neurofunctional and microstructural features of the brain in patients with nutritional obesity according to special magnetic resonance imaging techniques (literature review)

Background. Obesity is a chronic disease characterized by excessive accumulation of adipose tissue in the body, manifested by an increase in body weight by 20 percent or more of the average values. Obesity is becoming an increasingly significant public health problem. Assessment of the functional pathology of the brain provides more information about the pathogenetic changes leading to metabolic disorders. Modern methods of neuroimaging make it possible to obtain information about the initial functional changes in the brain according to the data of intracerebral connectivity - functional connectivity between its individual structures.Objective. The study of modern literature data on functional disorders of brain connectivity in patients with obesity, including those with eating disorders.Materials and methods. A systematic review of studies published in foreign and domestic literature has been carried out. Articles were searched using the PubMed database and Elibrary.Results. The problem of functional and microstructural studies of the brain in obesity is covered in sufficient detail in Western English-language literature. Nevertheless, it must be stated that at the moment there are practically no articles on the subject under study in domestic scientific publications. However, it should be noted that in the foreign literature there are rare data on neuroimaging of the brain in the aspect of neural network connectivity, studies in obesity with concomitant somatic pathology, for example, in type II diabetes, and other disorders of the endocrine system. There are relatively few data where correlations would be made with the age and gender of patients, concomitant mental disorders, which emphasizes the relevance of the issue.At the subsequent stages of the joint development of endocrinology, psychiatry and radiation diagnostics, the use of modern MRI techniques will help with the choice of target structures for stereotaxic correction of the described pathology. The clinical application of functional MRI will help to reveal the pathogenesis of various types of obesity at the neurofunctional levels with further prediction and analysis of the development of the disease, while the inconsistency and inconsistency of the currently obtained results of studies of the pathogenesis of alimentary obesity in terms of the pathology of functional connectivity based on fMRI, the absence clinical application of special MRI techniques substantiate the need to continue scientific research in this direction

Alleviating depressive-like behavior in DSS-induced colitis mice: Exploring naringin and poncirin from Poncirus trifoliata extracts

Patients with inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), often have concomitant mental disorders such as depression and anxiety. Therefore, a bidirectional approach involving the gut and brain axes is necessary for the prevention and treatment thereof. In this study, we explored the potential of Poncirus trifoliata extract (PT), traditionally known for its neuroprotective effects against gastrointestinal diseases, as a natural treatment agent for IBD in a dextran sulfate sodium (DSS)-induced colitis model. Oral administration of PT ameliorated weight loss and inflammatory responses in mice with DSS-induced colitis. Furthermore, PT treatment effectively restored the colon length and ameliorated enterocyte death by inhibiting DSS-induced reactive oxygen species (ROS)-mediated necroptosis. The main bioactive components of PT, poncirin and naringin, confirmed using ultra-performance liquid chromatography-quadrupole time-of-flight (UPLC-qTOF), can be utilized to regulate necroptosis. The antidepressant-like effects of PT were confirmed using open field test (OFT) and tail suspension test (TST). PT treatment also restored vascular endothelial cell integrity in the hippocampus. In the Cornu Ammonis 1 (CA1) and dentate gyrus (DG) regions of the hippocampus, PT controlled the neuroinflammatory responses of proliferated microglia. In conclusion, PT, which contains high levels of poncirin and naringin, has potential as a bidirectional therapeutic agent that can simultaneously improve IBD-associated intestinal and mental disorders.

Plasma concentrations of IL-8, IFN-γ and IL-1β in schizophrenia patients with subgroup analysis of first episode drug naïve patients

IntroductionIncreased plasma concentrations of proinflammatory cytokines are found in chronic schizophrenia patients, patients with first episode and in individuals with high risk for psychosis. The most replicated findings are increased concentrations of IL-6, TNF-α and IL-1β through different phases of the disorder while the results for two important proinflammatory cytokines IL8 and IFN-γ were not consistent.ObjectivesPrimary objective of this study was to assess differences in concentrations of IL-8, IFN-γ and IL-1β between schizophrenia patients and healthy controls, Secondary objective was to explore differences in first episode drug naïve patients.MethodsWe measured plasma concentrations of IL-8, IFN-γ and IL-1β in 64 healthy controls and 64 schizophrenia patients during acute exacerbation and remission phase. 25% were drug naive first episode schizophrenia patients. The patients were matched by age, sex and body mass index and exclusion criteria included obesity class 2 or higher, any concomitant organic mental or neurological disorder, acute or chronic inflammatory disease, and use of immunomodulatory drugs or psychoactive substances.Results Levels of IL-8 were significantly lower in patients with schizophrenia in acute phase and remission compared to healthy controls (p=0,009 for acute phase and p=0,020 for remission). There was no significant difference in the levels of INF-γ and IL-β between schizophrenia in acute phase and remission and healthy controls (p>0,05). In schizophrenia patients there was no difference in the levels of INF-γ, IL-β and IL-8 between acute phase, remission and healthy controls (p>0,05). There was no difference in plasma levels of IL-8, IFN-γ and IL-1β between first episode drug naïve and previously treated schizophrenia patients.Conclusions Our research did not find disturbance of plasma levels of IFN-γ and IL-1β in schizophrenia patients, although the increase of IL-1β was the most replicated finding up to date. Interestingly and contrary to expected the finding of significantly decreased levels of IL-8 in schizophrenia patients requires further research since IL-8 plays a vital role in the inflammatory pathway and may be implicated in cognitive dysfunction.Disclosure of InterestNone Declared

Mental disorders in children with rheumatic diseases

The prevalence of concomitant mental disorders in children with rheumatic diseases is notably higher than in the overall population. However, psychiatric comorbidity in pediatric rheumatology remains poorly understood, whereas approaches to mental disorders therapy in children with rheumatic diseases are not clearly defined. The review article considers currently available data on the mental disorders prevaling in patients with juvenile idiopathic arthritis, juvenile-onset systemic lupus erythematosus and juvenile primary fibromyalgia. The article provides data on the efficacy and safety studies of psychotherapy and psychopharmacotherapy. It also discusses application prospects of biological disease-modifying antirheumatic drugs for treatment of comorbid depression in children with rheumatic diseases.

Secondary school teachers' beliefs and needs about hikikomori and social withdrawn students

PurposeHikikomori is a multidimensional condition, characterized by voluntarily social withdrawal, impacting the relational dimension of life. The current study aims to examine secondary school teachers' beliefs, knowledge and needs on hikikomori and students' social withdrawal.Design/methodology/approachA qualitative method consisting of a semi-structured interview is adopted with 22 Italian secondary school teachers. The interview questions are focused on the beliefs, the profile, the conditions and the role of the school for adolescents socially retired.FindingsData are analysed using content analysis based on the grounded theory framework. Forty-nine codes emerged from the inductive analysis, which were sorted into the following categories: (1) Characteristics of hikikomori and social withdrawal; (2) Origin, causes and consequences; (3) Sources of information; (4) Socio-relational modalities; (5) Teachers' needs and role of the school. Teachers are aware of the educational issues and risks related to hikikomori and claim for more institutional support. Teachers reconsider the way of working in class for preventing the risk of self-isolation, supporting the development of social and emotional skills, and encouraging collaboration and positive exchanges among students. Participants mention a personalized student-centred method where families and external agencies support the school system.Originality/valueAlthough several clinical and psychological interventions have been developed for treating the hikikomori’s self-isolation and concomitant mental disorders, few plans have been implemented for reducing the risk of adolescents' social withdrawal. Preventing hikikomori is crucial as well as to investigate the role and the needs of school teachers, and the current study has tried to explore these.

Superior mesenteric artery syndrome (Wilkie’s syndrome) in children, as a late complication of neuropsychic diseases

Superior mesenteric artery syndrome (SMAS) in children is a rare cause of chronic duodenal obstruction (CDO), in which the inferior horizontal branch of the duodenum is compressed between the aorta and the acutely angled superior mesenteric artery. There are not many publications of clinical cases of SVBA in the literature, especially in the pediatric population. The main cause of the disease is weight loss due to various reasons, including anorexia nervosa, trauma, burns and other conditions. Currently, there is a frequent association of the syndrome with mental disorders. Literature data on the treatment of SVBA associated with various psychosomatic conditions vary; both conservative and surgical treatment methods are used. We present two clinical cases of SVBA in adolescent children, in which the cause of patient weight loss was concomitant mental disorders and previous surgical interventions. Both patients underwent laparoscopic side-to-side duodenojejunostomy with good long-term treatment results, confirmed during follow-up examination.

Clinical and psychopathological characteristics of patients with pulmonar y tuberculosis and anxiety-depressive disorders treated in a phthisiological hospital

The aim of the research was to study the clinical and psychopathological characteristics of patients with pulmonary tuberculosis in the active phase and identified anxiety and depressive disorders. The study included 145 patients with anxiety-depressive disorders: 85 patients with a diagnosis of pulmonary tuberculosis who were being treated in a phthisiological hospital (the main group) and 60 patients with anxiety-depressive disorders without a history of tuberculosis, who were under follow-up and treatment in a psychoneurological dispensary (comparison group). In addition, in the main clinical group, two subgroups were identified depending on the length of hospital stay: with hospital stays of up to 2 months (44 patients) and over 2 months (41 patients). The study assessed the level of anxiety-depressive disorders, asthenia, the nature and intensity of psychosomatic complaints, and signs of vegetative changes. The study showed the presence of more intense psychosomatic complaints, asthenic disorders, and signs of autonomic disorders among the patients with pulmonary tuberculosis compared to those without tuberculosis. Furthermore, in the main clinical group, there was an increase in anxiety-depressive symptoms, asthenic manifestations, and signs of vegetative changes during a longer stay in the phthisiological hospital. The obtained results are presented in the context of the concept of «psychosomatic proportion», implying the ratio of subjective and objective components of patients» psychosomatic status (intensity and structure of psychosomatic complaints and objectively detectable somatovegetative changes in the body). It is concluded that tuberculosis determines a more severe course of affective spectrum disorders and negatively affects the general psychosomatic state of patients, while a long stay in a phthisiological hospital contributes to the chronic course and aggravation of anxiety-depressive disorders, which indicates the need for timely detection and treatment of affective pathology, as well as taking into account predictors of its development in order to elaborate an integrated approach to the therapy of tuberculosis and concomitant mental disorders.

Alternative therapy for pregnant and breastfeeding women with gastro-intestinal pathology in psychiatric practice

Introduction. Drug treatment during pregnancy and breastfeeding period presents certain risks, especially in patients with concomitant mental disorders and somatic pathologies. The purpose of the research was to study the potential effects of medicinal plants and biological supplements during pregnancy and lactation in psychiatric patients with gastro-intestinal pathology. Materials and methods. We analyzed 504 herbs and active biological nutritional supplements including their alternative names: 299 in gastroenterology and 205 in psychiatry. From these, 40 alternative names of plants could be used in gastroenterology and psychiatry and 33 alternative names of plants and active biological nutritional supplements that could be used in psychiatry were selected. Results. Only one herb, damiana (Turnera diffusa), is described as having “no known side effects” during pregnancy and breastfeeding. According to other sources, this herb should not be used during pregnancy and breastfeeding due to the serious risks involved. Another plant Moringa oleifera is found to have multiple protective functions in mental health and gastro-intestinal diseases, being described as potentially safe during pregnancy and breastfeeding, but with specific indications. Conclusions. Prescribing herbs and active biological nutritional supplements during pregnancy and breastfeeding carries certain risks. The information is contradictory, requiring further research and informing patients about the risk-benefit ratio.

Trends in CV mortality among patients with known mental and behavioral disorders in the US between 1999 and 2020.

Patients with mental disorders are at increased risk of cardiovascular events. We aimed to assess the cardiovascular mortality trends over the last two decades among patients with mental and behavioral co-morbidities in the US. We performed a retrospective, observational study using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death dataset. We determined national trends in age-standardized mortality rates attributed to cardiovascular diseases in patients with and without mental and behavioral disorders, from 1999 to 2020, stratified by mental and behavioral disorders subtype [ICD10 codes F], age, gender, race, and place of residence. Among more than 18.7 million cardiovascular deaths in the United States (US), 13.5% [2.53 million] were patients with a concomitant mental and behavioral disorder. During the study period, among patients with mental and behavioral disorders, the age-adjusted mortality rate increased by 113.9% Vs a 44.8% decline in patients with no mental disorder (both p<0.05). In patients with mental and behavioral disorders, the age-adjusted mortality rate increased more significantly among patients whose mental and behavioral disorder was secondary to substance abuse (+532.6%, p<0.05) than among those with organic mental disorders, such as dementia or delirium (+6.2%, P- nonsignificant). Male patients (+163.6%) and residents of more rural areas (+128-162%) experienced a more prominent increase in age-adjusted cardiovascular mortality. While there was an overall reduction in cardiovascular mortality in the US in the past two decades, we demonstrated an overall increase in cardiovascular mortality among patients with mental disorders.

Decreased plasma concentrations of kynurenine and kynurenic acid in schizophrenia patients

IntroductionThe kynurenine pathway of tryptophan catabolism has come into the spotlight of schizophrenia research since its catabolites exert neuroactive effects. A strong body of evidence suggests that kynurenic acid, a catabolite of kynurenine pathway, acts as the only endogenous NMDA receptor antagonist leading to the weakening of circuits in layer III of dorsolateral prefrontal cortex of schizophrenia patients. Studies exploring the levels of kynurenic acid and other metabolites of tryptophan in peripheral blood did not yield any definite conclusions.ObjectivesPrimary objective of this study was to assess differences in concentrations of key constituents of kynurenic pathway in blood plasma – tryptophan (TRP), kynurenine (KYN) and kynurenic acid (KYNA) between schizophrenia patients (SCZ) and healthy controls (HC). Secondary objective was to explore correlations between these concentrations and clinical characteristics.MethodsIn our two-centre prospective case-control study we measured plasma concentrations of TRP, KYN and KYNA in 36 healthy controls (HC) and 38 schizophrenia (SCZ) patients during acute exacerbation and remission and explored the correlations with clinical parameters using PANSS scale. The patients were matched with HC by age, sex and body mass index and exclusion criteria included obesity class 2 or higher, any concomitant organic mental or neurological disorder, acute or chronic inflammatory disease, and use of immunomodulatory drugs or psychoactive substances.ResultsTRP concentrations were significantly higher in HC than in SCZ patients in acute phase (p&lt;0,001) and remission (p&lt;0,001), while SCZ patients in acute phase had significantly higher TRP levels than in remission (p&lt;0,01). Levels of KYNA and KYN were significantly lower in SCZ patients than in HC both in acute phase and remission, all with high statistical significance (p&lt;0,001). There was no statistically significant difference between acute phase and remission neither for KYN (p&gt;0,05), nor for KYNA (p&gt;0,05). There was no correlation of plasma levels of TRP, KYN and KYNA with total PANSS score, PANSS positive scale score, PANSS negative scale score and PANSS general psychopathology scores, both in acute phase and remission (p&gt;0,05). Also, there was no correlation between plasma levels of TRP, KYN and KYNA in SCZ patients in remission with improvements measured with PANSS scale (p&gt;0,05).ConclusionsAlthough there are concerns about the value of measurement of metabolites of kynurenine pathway in the peripheral blood, our data suggest that significantly decreased levels of KYN and KYNA could suggest that disrupted TRP degradation in SCZ patients may be reflected in the peripheral blood as well. Further studies of peripheral levels of kynurenine pathway metabolites on larger samples should also explore effects of antipsychotic therapy, but also their correlation with other clinical parameters such as neurocognition.Disclosure of InterestNone Declared

Disparities in the medical expenditures of patients with cancer and concomitant mental disorder: analyzing the effects of diagnosis sequence order

BackgroundCancer is the leading cause of death in Taiwan. Medical expenditures related to cancer accounted for 44.8% of all major illness insurance claims in Taiwan. Prior research has indicated that the dual presence of cancer and mental disorder in patients led to increased medical burden. Furthermore, patients with cancer and concomitant mental disorder could incur as much as 50% more annual costs than those without. Although previous studies have investigated the utilization of patients with both diseases, the effects of morbidity sequence order on patient costs are, however, uncertain. This study explored medical expenditures linked with the comorbidity of cancer and mental disorder, with a focus on the impact of diagnosis sequence order.MethodsThis population-based retrospective matched cohort study retrieved patients with cancer and mental disorder (aged ≥ 20 years) from the Ministry of Health and Welfare Data Science Center 2005–2015 database. 321,045 patients were divided based on having one or both diseases, as well as on the sequence of mental disorder and cancer diagnosis. Study subjects were paired with comparison counterparts free of both diseases using Propensity Score Matching at a 1:1 ratio. Annual Cost per Patient Linear Model (with a log-link function and gamma distribution) was used to assess the average annual cost, covarying for socio-demographic and clinical factors. Binomial Logistic Regression was used to evaluate factors associated with the risk of high-utilization.ResultsThe “Cancer only” group had higher adjusted mean annual costs (NT$126,198), more than 5-times that of the reference group (e^β: 5.45, p < 0.001). However, after exclusion of patients with non-cancer and inclusion of diagnosis sequence order for patients with cancer and concomitant mental disorder, the post-cancer mental disorder group had the highest expenditures at over 13% higher than those diagnosed with only cancer on per capita basis (e^β: 1.13, p < 0.001), whereas patients with cancer and any pre-existing mental disorder incurred lower expenditures than those with only cancer. The diagnosis of post-cancer mental disorder was significantly associated with high-utilization (OR = 1.24; 95% CI: 1.047–1.469). Other covariates associated with high-utilizer status included female sex, middle to old age, and late stage cancer.ConclusionPresence of mental disorder prior to cancer had a diminishing effect on medical utilization in patients, possibly indicating low medical compliance or adherence in patients with mental disorder on initial treatments after cancer diagnosis. Patients with post-cancer mental disorder had the highest average annual cost. Similar results were found in the odds of reaching high-utilizer status. The follow-up of cancer treatment for patients with pre-existing mental disorders warrants more emphasis in an attempt to effectively allocate medical resources.

ENGAGING PATIENTS IN INFLAMMATORY BOWEL DISEASE CARE — WHAT DETERMINES ACTIVE PARTICIPATION?

Abstract BACKGROUND Patient-provider co-production of care is integral to managing inflammatory bowel diseases (IBD), chronic and incurable conditions that affect patients’ quality of life. Patients in the IBD Qorus Learning Health System self-report symptoms and treatment goals prior to clinic visits via electronic surveys, which helps their providers develop patient-centered treatment plans. This study examines factors that predict patients’ active participation in the program to inform future strategies to promote programmatic engagement and continuity of care. METHODS A retrospective cohort study was performed using electronic health records and survey results from a private community gastrointestinal practice engaged with Qorus between 2016 and 2021. Patients with IBD who consented to participate in Qorus were followed for two years after they submitted the first pre-clinic visit survey. The primary outcome was the ratio of eligible surveys (submitted within two weeks prior to clinic visits) to the number of clinic visits, with a ratio &amp;lt;0.5 representing inactive participation and ≥0.5 representing active participation. The first survey and its associated clinic visit were excluded from participation score calculation because it does not reflect patients’ longitudinal involvement. Multivariable logistics regression was performed with patient demographics, mental health status, prior healthcare utilization, and disease severity as covariates. RESULTS Among 244 patients who met the inclusion criteria, 122 were inactive participants and 122 were active participants. Inactive participants completed a median of 0 (IQR 0-1) surveys and 3 (IQR 1-5) clinic visits, while active participants completed a median of 2 (IQR 1-3) surveys and 2 (IQR 2-4) clinic visits (Table 1). Multivariable logistics regression shows that older age, history of anxiety or depression, and higher number of clinic visits were associated with inactive participation. Compared to the age group 18-24 years old, patients ≥35 were less likely to participate actively: 35-44 (OR 0.32 [95% CI 0.11-0.90]), 45-54 (OR 0.24 [95% CI 0.07-0.72]), ≥55 (OR 0.34 [95% CI 0.12-0.94]). Patients with a history of anxiety or depression showed less active participation than those without (OR 0.44 [95% CI 0.25-0.77]). Higher number of clinic visits was also associated with less active participation (OR 0.88 [95% CI 0.78-0.99]) (Table 2). CONCLUSION Age ≥35, history of anxiety or depression, and frequent clinic visits were associated with less active participation in an IBD Learning Health System. Lack of familiarity with digital health resources, concomitant mental health disorders, or participation fatigue may potentially explain these findings. Further research is needed to investigate the causes of inactive participation to design interventions that address these causes.

High Rates of Symptoms of Major Depressive Disorder and Panic Disorder in a Canadian Sample of Adolescents With Juvenile Idiopathic Arthritis.

We aimed to evaluate the rate of depressive and/or anxiety symptoms in adolescents with juvenile idiopathic arthritis (JIA) and to explore the association with demographic and disease activity measures. Depressive and anxiety symptoms were assessed in adolescents with JIA aged 12 to 18 years at a Canadian tertiary care hospital, using the Revised Child Anxiety and Depression Scale (RCADS). The RCADS includes 6 subscales: separation anxiety, social phobia, generalized anxiety, panic disorder, obsessive-compulsive, and major depressive disorder. Scores above clinical threshold on the RCADS subscales indicate that an individual's responses reflect symptoms similar to those diagnosed with the corresponding mental health disorder. Fisher exact test and Mann-Whitney U test were used to compare demographic and disease-related variables between participants who scored above and below clinical threshold on each of the subscales. There were 32/80 (40%) of participants who scored above clinical threshold on at least 1 subscale. Scores above clinical threshold were most frequent for major depressive disorder (23.8%) and panic disorder (22.5%) subscales. Social phobia and separation anxiety followed with 16.3% and 13.8%, respectively. Females were more likely to have scores above clinical threshold on the panic disorder subscale. Participants with higher self-reported disease activity were more likely to have scores above clinical threshold for all anxiety subscales except separation anxiety. We report high rates of symptoms of depression and anxiety (panic in particular) in adolescents with JIA. This highlights the ongoing need for mental health screening protocols and services. The relationships between concomitant mental health disorders, disease activity, and patient-reported outcomes requires further research.

Trend in CV mortality among patients with mental disorder in the US between 1999–2020

Abstract Background Patients with mental disorders are at increased risk of cardiovascular mortality. While the overall cardiovascular mortality rate in the western world is in decline, there is no up-to-date data on the cardiovascular mortality rates among patients with mental disorders. We aimed to assess the cardiovascular mortality trends over the last two decades among patients with mental co-morbidities in the US. Methods Using Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death data set, we determined national trends in age-standardized mortality rates attributed to cardiovascular diseases in patients with and without mental disorders, from 1999 to 2020, stratified by mental disorders subtype, age, gender, race, and place of residence. Results Among more than 18.7 million cardiovascular deaths in the United States, 13.5% were patients with a concomitant mental disorder. During the study period, among patients with mental disorders, the age-adjusted mortality rate increased by 113.9% (vs 44.8% decline in patients with no mental disorder). In patients with mental disorders, the age-adjusted mortality rate increased more significantly among patients whose mental disorder in secondary to substance abuse (+532.6%) than among with organic mental disorders, such as dementia or delirium (+6.2%), while among patients with mood disorders the age-adjusted CV mortality rate dropped by 23.5%. Men patients, minorities, and residents of more rural areas experienced a more prominent increase in the age-adjusted cardiovascular mortality compared to women, white, and residents of metro areas. Conclusions While there was an overall reduction in cardiovascular mortality in the US in the past two decades, we demonstrated an overall increase in cardiovascular mortality among patients with mental disorders. The increase was more significant among patients with substance abuse-related mental disorders, in men, minorities, and residents of rural areas. Funding Acknowledgement Type of funding sources: None.

S57 Opioid Use Patterns in Patients With Chronic Pancreatitis and Concomitant Mental Illness: A Propensity-Matched Cohort Analysis

Introduction: Chronic pancreatitis (CP) is commonly associated with pain that can be difficult to manage. This can result in high rates of healthcare utilization and chronic opioid use. Many patients with CP have concomitant mental health disorders (MHDs) which may be associated with greater disease burden. Genetic links between CP-associated pain and MHDs have been described. Given the current opioid epidemic trend, it is critical to assess whether concomitant MHDs affect opioid usage patterns in patients with CP. The aim of this study was to identify whether patients with coexisting CP and mental illness have higher opioid usage compared to their counterparts without any diagnosed mental illness. Methods: This was a large cohort study using TriNetX, which links anonymized inpatient and outpatient electronic health record data from more than 80,000,000 patients. We created two cohorts: patients with chronic pancreatitis from 2010-2020 with and without co-existing mental health disorders. The cohorts underwent 1:1 propensity matching based on age, sex, race, ethnicity, and alcohol and nicotine dependence. The primary outcome was a new diagnosis of opioid use disorder at 3 years after the first diagnosis of CP. Secondary outcomes at 3 years included any opioid use, long-term opioid use, opioid overdose, and all-cause mortality. Results: After matching, two cohorts of 48,960 patients remained for analysis. All covariates were well-matched. In the MHD cohort, 51.6% had mood /affective disorders (F30-39), 49.5% had anxiety (F40-48), and 5.9% had non-mood psychotic (F20-29). At 3 years, the MHD cohort had a near 5-fold increase in the rate of opioid use disorder (7.1% vs 1.6%, OR =4.8, 95% CI 4.4-5.2). The MHD cohort also had significantly higher rates of any opiate use,(OR 1.5, 95% CI 1.4-1.5), long-term opioid use (OR 2.2, 95% CI 2.1-2.3), opioid overdose (OR 4.2, 95% CI 3.7-4.6), and all-cause mortality (OR 1.3, 95% CI 1.2-1.3) (Table). Conclusion: In propensity-matched cohorts, patients with CP and concomitant MHDs had higher rates of opioid use disorder, long-term use, overdose, and all-cause mortality compared with those without MHDs. As CP-related pain has been shown to be augmented in patients with MHDs – specifically depression – identifying this opioid risk is critical in the management of these patients. Table 1. - Measures of Association. CP w/ MHD: chronic pancreatitis with mental health disorder cohort, CP w/o MHD: chronic pancreatitis without mental health disorder cohort Outcome Patients with outcome (% risk), CP w/ MHD Patients with outcome (% risk), CP w/o MHD Odds Ratio (OR) 95% Confidence Interval (CI) p-value Opioid use disorder (dependence or abuse) 3,467 (7.1%) 767 (1.6%) 4.8 4.4-5.2 < 0.0001 Opiate use (ever) 13,846 (28.3%) 10,310 (21.1%) 1.5 1.4-1.5 < 0.0001 Adverse opiate event 592 (1.2%) 158 (0.3%) 3.8 1.4-1.5 < 0.0001 Opiate overdose 1,809 (3.7%) 448 (0.9%) 4.2 3.7-4.6 < 0.0001 Long-term opiate analgesic use 9,896 (20.2%) 5,046 (10.3%) 2.2 2.1-2.3 < 0.0001 All-cause mortality 6,958 (14.4%) 5,702 (11.8%) 1.3 1.2-1.3 < 0.0001

Conceptualisation and psychometric evaluation of positive psychological outcome measures used in adolescents and young adults living with HIV: a mixed scoping and systematic review protocol

IntroductionSub-Saharan Africa bears the greatest burden of HIV. Concomitant mental disorders are common, necessitating the integration of mental healthcare into routine HIV care. Consequently, it is necessary to holistically evaluate...

The aggressive tendencies in HIV-positive persons with concomitant mental disorders

Hostility and aggressiveness can be a marker of individual psychological vulnerability to stressors leading to reduced social adjustment and the risk of mental disorder manifestation. The aggressive tendencies prevalence is believed to be high among people living with HIV. With an increase in the incidence of HIV infection, the number of HIV-positive patients with concomitant mental disorders is increasing.Aim: to evaluate the intensity and the structure of aggressive tendencies in HIV-infected persons with concomitant mental disorders. Material and Methods. 78 HIV-positive persons and 24 HIV-negative psychiatric patients. The Bass-Darkie Aggressive Level Questionnaire (BDHI) and Short Psychiatric Assessment Scale (BPRS) were used. Nonparametric statistics, dispersion analysis was performed with p≤0.05, Cohen’s d calculated (effect size).Results. We examined 102 people, 51 (50.0%) men, 51 (50.0%) women, the average age — 35.5 ± 9.7 years. 58 (74.4%) HIV-infected respondents had mental disorders. HIV-positive persons with schizophrenia had higher values of most aggressive tendencies (p&lt;0.05) in the group of HIV-infected subjects. In comparison with HIV-negative patients, HIV-positive persons with schizophrenia had higher mean values of «Physical aggression» (p&lt;0.001, Cohen’s d=1.0), «Verbal aggression» (p &lt;0.001, Cohen’s d = 1, 0), and «Aggressiveness» (p=0.004, Cohen’s d=0.86). 4B clinical stage of HIV infection was associated with higher scores of «Physical aggression», «Indirect aggression», «Verbal aggression», «Negativism», «Aggressiveness» (p&lt;0,05).Conclusion. The study findings contribute to the understanding of the features of aggressive tendencies in HIV-positive persons and call for further research to improving the quality and personalization of medical care for patients with concomitant mental disorders.

Reduced Healthcare Resource Utilization in Patients with Opioid Use Disorder in the 12Months After Initiation of a Prescription Digital Therapeutic.

Background and AimsreSET-O, an FDA-authorized prescription digital therapeutic (PDT) delivering cognitive behavioral therapy and contingency management to patients with opioid u®se disorder (OUD), may help improve clinical outcomes. One-year differences in healthcare resource utilization (HCRU) and costs post-PDT initiation were evaluated.MethodsRetrospective analysis of healthcare claims data compared all-cause HCRU (across hospital facility encounters [sum of inpatient stays, treat-and-release emergency department [ED] visits, partial hospitalizations, and hospital outpatient department visits] and clinician services [procedure categories]) after PDT initiation (index) between reSET-O patients and controls. Overall and Medicaid-specific differences in HCRU, costs, and buprenorphine adherence were evaluated.FindingsCohorts included 901 reSET-O patients (median age 36 years, 62.4% female, 73.9% Medicaid) and 978 controls (median age 38 years, 51.1% female, 65.4% Medicaid). Compared to the control group, the reSET-O group experienced 12% fewer total unique hospital encounters (non-significant), driven by 28% fewer inpatient stays (IRR 0.72; 95% CI 0.55–0.96; P = 0.02), 56% fewer hospital readmissions [IRR 0.44; 95% CI 0.20–0.93; P = 0.033]), and 7% fewer ED visits (IRR 0.93; 95% CI 0.79–1.09; P = 0.386). Total clinician services increased by 1391 events versus controls. Differences were greater among the Medicaid patients. Adjustment for concomitant baseline substance use and mental health disorders resulted in similar HCRU incidence rate ratios. Changes in all-cause HCRU drove per-patient per-year cost differences of − $2791 versus controls (− $3832 versus Medicaid controls). Adjusted mean medication possession ratio was 0.848 (SE 0.0118) at 12 months for reSET-O patients, which was significantly higher than controls (0.761 [SE 0.0108]; P < 0.001).ConclusionsUse of reSET-O is associated with significant and durable real-world reductions in ED and inpatient (including readmissions) utilization, reduced net costs, and increased clinician services and buprenorphine adherence. Differences in costs versus controls were greatest among Medicaid patients.Infographic Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02217-y.

44-LB: Evaluating the Effectiveness of a Novel Form of Online Cognitive Behavioural Therapy for Patients with Type 2 Diabetes and Comorbid Anxiety or Depression

Mental health disorders like depression and anxiety are highly prevalent in people with diabetes and are associated with poorer outcomes. The current study investigated the effect of a novel online cognitive behavioural therapy (CBT) based intervention derived from Acceptance and Commitment Therapy (ACT) for people with type 2 diabetes. A total of 102 patients with type 2 diabetes and a concomitant mental health disorder completed a course of the novel CBT-based intervention, delivered one-to-one over the internet, using text, by therapists who were specially trained in diabetes. Patients showed pre-treatment scores indicative of moderate to severe depression and anxiety and clinically significant diabetes distress. The treatment paradigm caused statistically significant and clinically meaningful decreases in depression, anxiety and diabetes distress scores. Changes in patient activation further illustrated the degree of improvement seen, with the proportion of patients at the lowest level of activation decreasing from 44.1% to 23.5%, pre- to post-treatment, and half of patients increasing by at least one level of activation. Comparisons between the study group and different synthetic control groups, derived from real-world data obtained using the same online platform as used for the trial, underlined the marked improvements achieved - recovery rates of 76% in the study group compared to 56% and 68% in the synthetic control arms. This study demonstrates that this novel CBT-based treatment, delivered by therapists who have specialism in the disease, provides an integrated therapy which can deliver substantial clinical benefit to patients with diabetes and comorbid mental health problems. Moreover, because it is delivered online, it can be given at a time and place that is convenient to both patients and therapists. Disclosure A. G. Hayes: Consultant; Ieso Digital Health Ltd. A. Catarino: Employee; ieso. S. Mehew: None. A. Blackwell: Employee; IESO. Funding Roche Diabetes Care Limited

Sexual dysfunctions among men with paroxysmal or persistent atrial fibrillation - a two-center study in the Polish population

IntroductionThere are no comprehensive studies on sexual dysfunctions among people with paroxysmal and persistent atrial fibrillation after excluding concomitant somatic and mental disorders, even though their presence has a significant impact on observed changes in sexual activity and behaviour. Most of the available studies among males are focused on erectile dysfunction due to well established relationship of it with the occurrence of cardiovascular disorders in the future.ObjectivesThe aim of the study was to assess the prevalence of sexual disorders among male patients treated for paroxysmal and persistent atrial fibrillation.MethodsThe study group included 54 men diagnosed with paroxysmal and persistent atrial fibrillation, qualified for electrical cardioversion and/or ablation of circumferential pulmonary vein, not burdened with additional somatic diseases. The control group consisted of 55 men matched in terms of sex, age and health condition. The study used standard CSFQ-14 sexuality assessment questionnaires, and the WHOQoL-BREF quality of life survey. Mental status examination was performed to exclude those with mental disorders, currently or in the past receiving psychiatric and/or addiction treatment.ResultsThe analysis of the survey studies showed that among the surveyed men with paroxysmal and persistent atrial fibrillation, the prevalence of sexual problems is high (61.1% study group vs 47.3% control group). There were significant differences between the study group with lower sexual function scores in pleasure, desire/interest, arousal/erection, orgasm/ejaculation, and in the overall CSFQ-14’s score. The desire/frequency ratio did not differ between the groups.ConclusionsComprehensive care requires the assessment of sexual satisfaction and the presence of possible dysfunctions using standardized tools.DisclosureNo significant relationships.