Disorders In People Research Articles

Development and Preliminary Evaluation of a Rapid Screening Tool for Detecting Borderline Personality Disorder in People Aged over 60 Years

ABSTRACT Objectives Screening and diagnostic instruments for Borderline Personality Disorder (BPD) are not validated in people aged over 60. We report a pilot study examining the sensitivity and specificity of a de-novo screening instrument in older adults. Methods The BPD-OA screening tool incorporates DSM 5 and literature describing the expression of BPD in older adults. This study was conducted using a case control design. The Diagnostic Interview for Borderlines–Revised (DIB-R) and the McLean Screening Instrument for BPD (MSI-BPD) were used as comparators. Comprehensive assessment by psychiatric teams determined participants to be (i) BPD-positive (n = 22) or (ii) BPD-negative (gender matched; n = 21). Results The BPD-OA was the most sensitive instrument for discriminating older adult BPD from non-BPD participants (sensitivity = 0.82). No significant relationship was found between the BPD-OA score and age in BPD-diagnosed participants (r = −0.181, n = 21, p = .432). Participant age explained 3.2% of the variance in BPD-OA scores. Of the 21 BPD-negative participants, eight false positives experienced prominent mood disorders (specificity = 0.62). Conclusions The BPD-OA screening tool is clearly superior to instruments validated for use in younger people. Further refinement and evaluation will enhance its sensitivity and specificity. Clinical Implications Detection of BPD in older adult care settings will improve outcomes for patients, families, and staff through better understanding and appropriate management and treatment strategies.

Mental health disorders in patients with end-stage renal failure

Renal failure is commonly accompanied by psychological distress compounding to mental health conditions such as anxiety and depression. Common risk factors towards the development of mental health disorders in people with renal failure include the need to attend regular hemodialysis session and the burden of related complications. A growing body of evidence has elucidated the biochemical and immunological underpinnings of mental health disorders in the context of renal failure. This knowledge calls for strengthening the existing mental health support frameworks and conducting research with the reported molecular pathways as potential therapeutic targets

Management of eating disorders for people with higher weight: clinical practice guideline

IntroductionThe prevalence of eating disorders is high in people with higher weight. However, despite this, eating disorders experienced by people with higher weight have been consistently under-recognised and under-treated, and there is little to guide clinicians in the management of eating disorders in this population.AimThe aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations.MethodsThe National Eating Disorders Collaboration Steering Committee auspiced a Development Group for a Clinical Practice Guideline for the treatment of eating disorders for people with higher weight. The Development Group followed the ‘Guidelines for Guidelines’ process outlined by the National Health and Medical Research Council and aim to meet their Standards to be: 1. relevant and useful for decision making; 2. transparent; 3. overseen by a guideline development group; 4. identifying and managing conflicts of interest; 5. focused on health and related outcomes; 6. evidence informed; 7. making actionable recommendations; 8. up-to-date; and, 9. accessible. The development group included people with clinical and/or academic expertise and/or lived experience. The guideline has undergone extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical academic and/or lived experience.RecommendationsTwenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence levels. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge-eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed.ConclusionsThis guideline will fill an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. This guideline acknowledges deficits in knowledge and consequently the reliance on consensus and lower levels of evidence for many recommendations, and the need for research particularly evaluating weight-neutral and other more recent approaches in this field.

Is epilepsy related to psychiatric disorders in people with intellectual disability? A systematic review.

The prevalence of psychiatric disorders in people with Intellectual Disability (ID) is statistically higher than in the general population. There is a lack of consensus on the role that epilepsy plays in psychiatric disorders in people with ID. We carried out a systematic review of articles published between 1960 and 2022, focusing on high-quality, case-control original research studies that only included adult populations. The primary outcome was the prevalence of psychiatric disorders in people with intellectual disability with and without epilepsy. Six articles were finally included. Results were varied; some reported a statistical increase, whereas others did not find any statistical difference. Due to the current controversy on the role of epilepsy in psychiatric disorders in people with ID and the small number of publications on the topic, we cannot affirm a relationship between epilepsy and psychiatric disorders in people with ID.

Depressive symptomology and cancer incidence in men and women: Longitudinal evidence from the HUNT study

BackgroundDepressive symptoms and mood disorders are associated with a host of physical conditions. However, it is inconclusive whether depressive symptoms are also associated with cancer onset. The aim of this study was to investigate whether depressive symptoms are associated with cancer incidence in a large population-based sample of men and women. MethodsThis study examined data from waves two (HUNT 2, 1995–97) and three (HUNT 3, 2006–08) of the Trøndelag Health Study (HUNT). Depressive symptoms were ascertained using the Hospital Anxiety and Depression Scale (HADS-D ≥ 8), cancer onset was identified via linkage with the Cancer Registry of Norway, death records by the national Cause of Death Register (CDR), and information on lifestyle and demographic factors was self-reported. Cox-proportional hazard regression models were used to test associations. Unadjusted, age-adjusted and multivariable best models accounting for smoking, education, marital status and current employment are presented. ResultsMen and women (n = 61,985; 46.0 % men) were followed from baseline over a period of 778,802 person-years. During the 20-year study period, there were 6856 (11.1 %) individuals with incident cancers and 12,480 (20.1 %) deaths (n = 2498 attributed to cancer). For men with depressive symptoms, 505 (15.3 %) developed incident cancer during the follow-up period, whereas among those without depressive symptoms, 3164 (12.5 %) developed incident cancer. Following adjustment for age, depressive symptomology was not significantly associated with risk of overall cancer onset, nor among prostate, colon or melanoma subtypes. Depressive symptoms were associated with an increased risk of bronchus and lung cancer both before (HR 1.90, 95 % CI 1.43–2.50, p ≤0.001) and after adjustment for age (HR 1.38, 95 % CI 1.04–1.80, p = 0.025). However, further adjustment for additional possible confounders explained this association. For women with depressive symptoms, 384 (11.2 %) developed incident cancer during the follow-up period, whereas among those with no depressive symptomology, 2803 (9.3 %) developed incident cancer. After accounting for age, depressive symptomology was not associated with risk of overall cancer onset, nor among breast, colon, lung and bronchus, or melanoma subtypes. Additional analyses evaluating relationship of depression symptom severity and cancer onset did not alter findings for men or women. LimitationsThis report is limited by the post-hoc study design and subsequent non-randomised nature. Future prospective studies are required. ConclusionThese results suggest that depressive symptoms are not associated with an increased risk of overall or site-specific cancer onset in these men and women. Given the increased co-occurrence of other medical conditions such as cardiovascular disease, diabetes, stroke and musculoskeletal disorders in people with depression, the role of clinically diagnosed depression and other psychiatric disorders in association with cancer onset necessitates further consideration.

Decoding the temporal dynamics of spoken word and nonword processing from EEG

The efficiency of spoken word recognition is essential for real-time communication. There is consensus that this efficiency relies on an implicit process of activating multiple word candidates that compete for recognition as the acoustic signal unfolds in real-time. However, few methods capture the neural basis of this dynamic competition on a msec-by-msec basis. This is crucial for understanding the neuroscience of language, and for understanding hearing, language and cognitive disorders in people for whom current behavioral methods are not suitable. We applied machine-learning techniques to standard EEG signals to decode which word was heard on each trial and analyzed the patterns of confusion over time. Results mirrored psycholinguistic findings: Early on, the decoder was equally likely to report the target (e.g., baggage) or a similar sounding competitor (badger), but by around 500 msec, competitors were suppressed. Follow up analyses show that this is robust across EEG systems (gel and saline), with fewer channels, and with fewer trials. Results are robust within individuals and show high reliability. This suggests a powerful and simple paradigm that can assess the neural dynamics of speech decoding, with potential applications for understanding lexical development in a variety of clinical disorders.

Preventive exercise attenuates IL-2-driven mood disorders in multiple sclerosis

BackgroundElevated levels of specific proinflammatory molecules in the cerebrospinal fluid (CSF) have been associated with disability progression, enhanced neurodegeneration and higher incidence of mood disorders in people with multiple sclerosis (MS). Studies in animal models of MS suggest that preventive exercise may play an immunomodulatory activity, with beneficial effects on both motor deficits and behavioral alterations. Here we explored the impact of lifestyle physical activity on clinical presentation and associated central inflammation in a large group of newly diagnosed patients with MS. Furthermore, we addressed the causal link between exercise-mediated immunomodulation and mood symptoms in the animal setting. MethodsA cross-sectional study was conducted on 235 relapsing-remitting MS patients at the time of the diagnosis. Patients were divided into 3 groups (“sedentary”, “lifestyle physical activity” and “exercise”) according to the level of physical activity in the six months preceding the evaluation. Patients underwent clinical, neuropsychological and psychiatric evaluation, magnetic resonance imaging and lumbar puncture for diagnostic purposes. The CSF levels of proinflammatory and anti-inflammatory cytokines were analyzed and compared with a group of 80 individuals with non-inflammatory and non-degenerative diseases. Behavioral and electrophysiological studies were carried out in control mice receiving intracerebral injection of IL-2 or vehicle. Behavior was also assessed in mice with experimental autoimmune encephalomyelitis (EAE), animal model of MS, reared in standard (sedentary group) or running wheel-equipped (exercise group) cages. ResultsIn exercising MS patients, depression and anxiety were reduced compared to sedentary patients. The CSF levels of the interleukin-2 and 6 (IL-2, IL-6) were increased in MS patients compared with control individuals. In MS subjects exercise was associated with normalized CSF levels of IL-2. In EAE mice exercise started before disease onset reduced both behavioral alterations and striatal IL-2 expression. Notably, a causal role of IL-2 in mood disorders was shown. IL-2 administration in control healthy mice induced anxious- and depressive-like behaviors and impaired type-1 cannabinoid (CB1) receptor-mediated neurotransmission at GABAergic synapses, mimicking EAE-induced synaptic dysfunction. ConclusionsOur results indicate an immunomodulatory effect of exercise in MS patients, associated with reduced CSF expression of IL-2, which might result in reduced mood disorders. These data suggest that exercise in the early stages may act as a disease-modifying therapy in MS although further longitudinal studies are needed to clarify this issue.

Bangladeshi Health Practitioner Knowledge, Confidence in Diagnosis, and Treatment of Mental Health Disorders in People with Intellectual Disabilities

ABSTRACT Background Intellectual disability and mental health disorders constitute a major health problem globally with higher economic burden in low- and middle-income countries such as Bangladesh. In 2017, the World Bank estimated that 85% of the global population lived in low-middle-income countries. Limited research has explored health practitioner knowledge and/or confidence in the diagnosis and treatment of mental health issues in persons with intellectual disabilities (IDs) in low-income countries such as Bangladesh. Method One hundred and ninety-seven Bangladeshi-based health practitioners were grouped into 7 main professional groups according the current Bangladeshi health hierarchy (psychiatrists; traditional healers and community workers; medical doctors; nurses; psychologists; allied health: speech therapists, occupational therapists, social workers; and others: teachers physiotherapists, administration staff). A 34-item online survey was completed, which included questions measuring symptoms of common mental health disorders with reference to the Psychiatric Assessment Schedule for Adults with Developmental Disabilities, and questions measuring confidence working with persons with IDs from the Therapy Confidence Scale-Intellectual Disabilities. Results Participants demonstrated low knowledge of symptomology but were “confident” working with people with IDs. Kruskal–Wallis H tests indicated a significant effect of professional group on both overall knowledge and confidence levels, respectively. Traditional healers and community health workers had significantly more knowledge of symptoms than all other practitioners for obsessive-compulsive disorder, depression, psychosis, and hypomania. Conclusion Participants demonstrated confidence, but low knowledge, in treating individuals with IDs. The development of training programs to address specific deficits in knowledge of mental health symptoms, and confidence in using assessment and assessment-based communication, is recommended.

Cardiac morbidity and mortality associated with the use oflamotrigine.

The US Food and Drug Administration recently issued a warning against the use of the antiseizure medication lamotrigine in people at risk of cardiac rhythm and conduction abnormalities. This study assessed the risk of cardiac morbidity and mortality in new users of lamotrigine. In a Danish population-based cohort study, we followed cohort members aged ≥15 years for the first 2 years after they initiated lamotrigine therapy. The main outcomes were cardiac conduction disorders in people without pre-existing cardiac morbidity and all-cause mortality in people with pre-existing cardiac morbidity. Cox proportional hazards models provided hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for comparison of the risk in current versus past users of lamotrigine. There were 91 949 (36 618 males [39.8%]) new users of lamotrigine (median age=45.7 years, interquartile range=32.0-60.2 years). Among users without pre-existing cardiac disease (n=86 769), 194 (.23%) developed a cardiac conduction disorder. Comparison of the risk in current and past lamotrigine treatment periods yielded an adjusted HR of new onset cardiac conduction disorder of 1.03 (95% CI = .76-1.40). Among users with pre-existing cardiac disease (n=5180), 1150 (22.2%) died. Comparison of the risk in current and past lamotrigine treatment periods yielded an adjusted HR for all cause-mortality of 1.05 (95% CI = .93-1.19). In this large population-based study, lamotrigine use was associated neither with a risk of cardiac conduction disorders in people without pre-existing cardiac morbidity nor with all-cause mortality in people with pre-existing cardiac morbidity.

Exploring bridge symptoms in HIV-positive people with comorbid depressive and anxiety disorders

BackgroundThe prevalence of comorbid depressive and anxiety disorders in people living with HIV (PLWH) is high. However, it is unclear which symptom is the bridge symptom between depression and anxiety in PLWH. This study aimed to develop symptom networks for depression and anxiety and explore the bridge symptoms and interconnectedness between these disorders in PLWH with comorbid depressive and anxiety disorders.MethodsA multisite, hospital-based cross-sectional study was conducted from March 2020 to November 2021. Depression and anxiety were measured with the Hospital Anxiety and Depression Scale. We visualized the symptom network using the qgraph package and computed the bridge expected influence of each node. The GLASSO layout was used to generate undirected association networks.ResultsA total of 2016 individuals were included in the analysis. In the anxiety cluster, “not feeling relaxed” had the highest bridge expected influence and strength (rbridge expected influence = 0.628, rstrength = 0.903). In the depression cluster, “not feeling cheerful” was identified as having a high bridge expected influence (rbridge expected influence = 0.385). “Not feeling cheerful” and “not feeling relaxed” were the strongest edges across the depression and anxiety clusters (r = 0.30 ± 0.02).ConclusionsHealthcare professionals should take note when PLWH report severe bridge symptoms. To enhance the levels of perceived cheerfulness and relaxation, positive psychology interventions could be implemented.

Evaluating the Effectiveness of Short-term Clinical Guideline to Treat Sexual Addiction Disorder in People With Sexual Addiction: A Clinical Trial

Objectives Sex addiction is one type of behavioral addiction that is characterized by extreme fantasies and hard-to-control sexual behaviors. This disorder causes problems in the lives of affected people and their victims. The treatment is non-pharmacological and psychological, which are time-consuming and expensive. Short-term interventions are one of the ways to help these people. This study aims to evaluate the effectiveness of short-term clinical guidelines to treat sexual addiction disorder in affected individuals. Methods This was a randomized clinical trial study with pre-test-post-test and follow-up. The studied population in this research included all people with sexual addiction disorder who live in Isfahan City, Iran. The statistical population was those who had the chance to be included in the study. These were individuals who were referred to outpatient and residential drug abuse treatment centers, psychiatric treatment centers, and sexual disorders treatment clinics. Using the balance block randomization method, 30 male subjects who were diagnosed with sex addiction disorder based on the cut-off point of the hypersexual behavior inventory (HBI) with a score of 53 and above were randomly divided into 2 intervention and comparison groups. The intervention group received ten 120-min therapy sessions held weekly. Because of the coronavirus pandemic, the treatment sessions had to be held virtually (Skype). The comparison group was put on hold so that they could benefit from the treatment if the guide was effective. Both groups completed the HBI three times. The first time was immediately before the treatment, the second time immediately after the intervention, and the third time 3 months later in the follow-up phase. The results were analyzed via repeated measures analysis of variance (RM-ANOVA) in the SPSS software, v. 22. Results In the present study, there were 30 patients with a sexual addiction disorder, of which 15 were in the intervention group and 15 were in the comparison group (the Mean age of the participants was 26.4 years). The Mean scores of HBI in the intervention group in the pretest, post-test, and follow-up stages were 67, 49, and 57, respectively, while the mean scores of HBI in the comparison group were 64, 60, and 59 for the pretest, post-test, and the follow-up, respectively. Repeated measurement findings showed that this clinical guideline is effective in reducing participants’ sexual addiction symptoms (P‌<‌0.01). Conclusion Clinical guideline for short-term treatment of sexual addiction disorder is effective in reducing the symptoms of sexual addiction disorder. Using this method, which can be held online, and considering its short time and reduced cost of treatment, allows more people to benefit from it.

The Effect of Comprehensive Corrective Exercise on the Function of Lower Limb and Joint Position Sense in Female Karatekas With Flatfoot

Purpose: Karate is one of the most popular martial arts around the world, and flatfoot deformity is one of the most common disorders in people participating in this sport. This disorder can negatively affect the function and joint position sense (JPS). This study aimed to investigate the effect of 6 weeks of comprehensive corrective exercise training on the function of the lower limb and JPS in female karatekas with flatfoot. Methods: In this field trial study, 40 female karatekas with flexible flatfoot postures were recruited and randomly divided into two groups of exercise and control. The Staheli index test was performed for all subjects to assess the condition of the foot posture, as one of the inclusion criteria also, single leg 6-m timed hop test, single leg triple hop for distance test, and ankle joint JPS were used to evaluate the function of the lower limb. Then, the exercise group performed 6 weeks of corrective exercises, but the control group did not perform any specific exercises during this period. After 6 weeks, the tests were repeated. A covariance analysis test was used to evaluate the between-groups differences, and paired sample t-test was used to evaluate the within-group changes. Results: Corrective exercise group in the post-test had a better performance than the pre-test in the Staheli index test, JPS, the single leg 6-m timed hop test, and single leg triple hop for distance test (P=0.0001). However, in the control group, no significant difference was observed between the two stages of the test (P>0.05). Also, by comparing groups in the post-test via the Staheli index test, JPS, single leg 6-m timed hop test, and single leg triple hop for distance test. It was found that the experimental group achieved better results than the control group (P>0.05). Conclusion: Six weeks of comprehensive corrective training has significantly improved foot posture, JPS, and function of the lower limb in female karatekas with flatfoot. Thus, comprehensive corrective exercises can be used in this group to improve foot posture, JPS, and function of the lower limb.

Tıkınırcasına Yeme Bozukluğu ve Tip 2 Diabetes Mellitus

Tıkınırcasına yeme bozukluğu, telafi edici davranışlar olmaksızın, son 3 ay içerisinde en az haftada 1 kez tekrarlayan, bireyin kontrolünü kaybettiği tıkınırcasına yeme atakları ile karakterize olan bir yeme bozukluğudur. Zayıf benlik algısı, depresyon, belirli bir diyete uyma zorunluluğu, vücut ağırlığında artış gibi durumlar, Tip 2 Diabetes Mellitus ve tıkınırcasına yeme bozukluğu arasında çift yönlü bir ilişki oluşturmaktadır. İki rahatsızlığın birlikte seyretmesinin, diyabetli bireylerde metabolik kontrolünün sağlanmasını zorlaştırabileceği düşünülmektedir. Bu konuda literatürde çelişkili sonuçlar mevcut olsa da vücut ağırlığının, glisemik kontrol ve yeme bozukluğu arasındaki ilişkide düzenleyici olduğu düşüncesi yaygındır. Prevalansa yönelik yapılan çalışmalarda Tip 2 diyabetlilerin %0,1’i ile %25,6’sı arasında bir sıklıkta tıkınırcasına yeme bozukluğu olduğu saptanmıştır. Prevalanstaki bu geniş aralığın, çalışmalardaki katılımcılara ait özelliklerin ve kullanılan tarama araçlarının farklılığından kaynaklandığı düşünülmektedir. Tip 2 diyabetlilerde tıkınırcasına yeme bozukluğu tanısı için geliştirilmiş altın standart bir tarama testi bulunmamaktadır. Ancak bazı araştırmacılar, Yeme Bozukluğu İnceleme Anketi (Eating Disorder Examination-Questionnaire) ve Yeme ve Ağırlık Modelleri Anketi’nin (Questionnaire of Eating and Weight Patterns) taramada kullanmak için kullanışlı yöntemler olduğunu belirtmiştir. Bu derlemede, tıkınırcasına yeme bozukluğu ve Tip 2 Diabetes Mellitus arasındaki ilişki, görülme sıklığı, metabolik etkileri ve tanıda kullanılabilecek araçlar incelenmiştir.

Modified body - symbol of risk or resources?

Tattooing and body piercing are becoming more and more popular. The psychological approach to body modifications remains heterogeneous. The purpose of this replication was to assess the level of life satisfaction and self-esteem, as well as to reveal subjectively experienced symptoms of mental health disorders in people who reported having a tattoo and/or piercing during the coronavirus epidemic. Method. The research was conducted in the period from April to June 2020 in an on-line form. Participants (N = 557) were 15-68 years old. There were no significant differences in perceived life satisfaction, self-esteem and mental health assessment between people with and without body modifications. The revealed differences in the dimensions of self-esteem and the number of subjective depressive symptoms turned out to be accidental. All participants in the study (regardless of having body modification) were aware of having and the ability to use personal resources to deal with the COVID-19 pandemic. Body modifications should not be considered a risk factor. Especially among tattooed people, the self-assessment of psychological functioning increased with the increase in life satisfaction.

Prediction of binge-eating disorder based on symptoms of depression, emotion regulation, and psychological flexibility in women with type 2 diabetes

Introduction: Type 2 diabetes affects more than 90% of diabetic patients, which in addition to physical complications, is associated with psychological problems, such as binge-eating disorder. Diagnosing and treating binge-eating disorder can improve many comorbidities and type 2 diabetes. Therefore, this study aims to predict binge-eating disorder in women with type 2 diabetes based on symptoms of depression, emotion regulation, and psychological flexibility.
 Methods: The present descriptive-correlational study was conducted on 102 people with type 2 diabetes through the cooperation of centers related to diabetes and using social media in a targeted manner. Research tools included the Gormally et al. (1982) binge-eating, the Beck et al. (1996) depression, the Bond et al. (2011) acceptance and the practice, and Graz and Roemer (2004) difficulty in regulation of emotion questionnaires. The data were analyzed by SPSS software version 22 using Pearson correlation coefficient and multiple regression.
 Results: The results show that the symptoms of depression, emotion regulation, and psychological flexibility could significantly (p <0.001) predict binge-eating disorder. Among the predictor variables, depression symptoms with a prediction of 33% of the variance of binge-eating disorder, was the best predictor of the disorder in people with type 2 diabetes (p <0.001).
 Conclusion: It can be concluded that early detection and treatment of depression symptoms in people with type 2 diabetes, can reduce binge-eating disorder in these people.

Experiences Using a Multidisciplinary Model for Treating Injection Drug Use Associated Infections: A Qualitative Study.

BackgroundOver the past two decades, the United States has experienced a dramatic increase in the rate of injection drug use, injection associated infections, and overdose mortality. A hospital-based program for treating opioid use disorder in people who inject drugs presenting with invasive infections was initiated at an academic tertiary care center in 2020. The goal of this program was to improve care outcomes, enhance patient experiences, and facilitate transition from the hospital to longer term addiction care. The purpose of this study was to interview two cohorts of patients, those admitted before vs. after initiation of this program, to understand the program's impact on care from the patient's perspective and explore ways in which the program could be improved.MethodsThirty patients admitted to the hospital with infectious complications of injection drug use were interviewed using a semi-structured format. Interviews were transcribed and coded. Emergent themes were reported. Limited descriptive statistics were reported based on chart review.ResultsThirty interviews were completed; 16 participants were part of the program (admitted after program implementation) while 14 were not participants (admitted prior to implementation). Common themes associated with hospitalization included inadequate pain control, access to medications for opioid use disorder (MOUD), loss of freedom, stigma from healthcare personnel, and benefits of having an interprofessional team. Participants in the program were more likely to report adequate pain control and access to MOUD and many cited benefits from receiving care from an interprofessional team.ConclusionsPatients with opioid use disorder admitted with injection related infections reported improved experiences when receiving care from an interprofessional team focused on their addiction. However, perceived stigma from healthcare personnel and loss of freedom related to hospitalization were continued barriers to care before and after implementation of this program.

The Need for a Diagnostic Instrument to Assess Post-Traumatic Stress Disorder in People with Dementia: Findings from a Delphi Study.

Cognitive and behavioral aspects may mask posttraumatic stress disorder (PTSD) in people with dementia. PTSD severely lowers quality of life in people with dementia. Proper recognition of PTSD is essential to ensure adequate treatment. However, a valid diagnostic tool for PTSD in dementia is lacking. A Delphi study was conducted among 20 Dutch and 6 international experts in the field of PTSD and dementia care or research. The aim was to reach consensus in 3 rounds on the added value, form, content, and application for developing such an instrument. The first round confirmed the need for a new diagnostic tool for research and clinical practice. Consensus was reached on 23 statements regarding the support base and 19 related to content of the instrument. In the third round, opinions on several conceptual problems were gathered. Based on the experts' opinions, a draft version of an instrument, the TRAuma and DEmentia-interview (TRADE-interview), was developed. Clinical and research implications of this new measure are discussed.

Sleep problems in patients with diabetes mellitus during the pandemic COVID-19

Introduction The COVID-19 pandemic have a negative impact on sleep in people with diabetes mellitus, which can lead to other health problems. The aimed of this study is to synthesize the available evidence regarding sleep problems in people with diabetes mellitus during the COVID-19 epidemic. Methods: We performed a systematic search of five databases: Science Direct, EBSCO, Scopus, Sage, and ProQuest, to identify previous studies. Studies that enrolled adults with diabetes mellitus, sleep problems, and COVID-19 were published between 2019 and 2021, and used English or Indonesian were included. Results: We identified 819 articles, and fourteen studies met the review's inclusion criteria. The prevalence of sleep disorders ranged from 19.2% to 74.2%. Sleep disturbances have been shown in the majority of studies to have an effect on glycemic control in people with diabetes during COVID-19 pandemic. Conclusions: Sleep disorders in people with diabetes during the COVID-19 pandemic were caused by physiological factors and had a negative impact on glycaemic control. In summary, during the COVID-19 pandemic, sleep disturbances were extremely common in people with diabetes. To address sleep disturbances, specific health strategies should be implemented.

483-P: Predictors of Major Adverse Lower Limb Events for Chronic Arterial Trophic Disorders

Background: Peripheral arterial disease (PAD) affects more than 200 million people with an ever-increasing prevalence. Faced with this public health issue, it seems crucial to take an interest in PAD management. In this study, we evaluated the predictors of major adverse lower limb events (MALEs) and wound healing following revascularization for chronic arterial trophic disorders in people with and without diabetes. Methods: This retrospective study included all patients with Rutherford-Becker stage 5 or 6 who required a minor amputation in combination with a revascularization procedure in our vascular surgery department at Bordeaux University Hospital, from January 2016 to December 2018. The primary endpoint was MALEs. The secondary endpoints were wound healing at 6 months and 2 years, in-hospital and all-cause mortality. Results: We included 241 patients, 180 with diabetes (74,7%) , with an average age of 74 years, 79,7% men. According to the Wound, Ischemia and foot Infection classification, 95,9% were ranked clinical stage 4, and to the TransAtlantic Inter-Society Consensus for the management of PAD (TASC) below-the-knee classification, 50,7% were stage C/D. Among patients with diabetes, 63,3% had post-operative uncontrolled diabetes. One-hundred seven MALEs occurred during 2-year follow-up (estimated rate of patients free of MALEs 48,7%, 95% CI: 41,7-55,4) , 78 MALEs in patients with diabetes. Revascularization failure predicted the occurrence of MALEs in multivariate analysis, while the lack of revascularization option predicted major amputation. Wound healing was adversely affected by haemodialysis, TASC C/D below-the-knee lesions, the number of bacteria, and reocclusion of the target artery. The in-hospital mortality rate was 5,4% and the overall 2-year mortality rate was 22,8%. Conclusion: This study highlights the necessity to provide optimal revascularization associated with comprehensive medical care using multidisciplinary approaches to those patients affected by PAD. Disclosure V.Vosgin-dinclaux: None. K.Mohammedi: Board Member; Lilly, Novo Nordisk, Sanofi, Research Support; Cyclerion Therapeutics, Inc., Speaker's Bureau; Abbott, AstraZeneca. C.Caradu: None.

Sex-specific fat mass ratio cutoff value identifies a high prevalence of cardio-metabolic disorders in people living with HIV

Background and aimsHIV-associated lipodystrophy syndrome (HALS) contributes to the increased cardiovascular risk connoting people living with HIV (PLHIV). HALS recognition, based on clinical ground, may be inaccurate urging an objective instrumental diagnosis. The aim of this study is to search for the DXA-derived fat mass ratio (FMR) threshold, among those suggested for the diagnosis of HALS, able to identify PLHIV at high cardiovascular risk. Methods and resultsIn a cross-sectional analysis of 101 PLHIV (age 53 ± 11 years, men 55%) and 101 age- and sex-matched uninfected controls, DXA-derived FMR and anthropometric as well as cardio-metabolic parameters were assessed. PLHIV showed a higher FMR (1.15 ± 0.42 vs 0.95 ± 0.18, p < 0.01) together with a greater cardio-metabolic derangement than controls, in spite of lower BMI (24.3 ± 4.3 vs 26.9 ± 4.0 kg/m2, p < 0.01) and fat mass index (FMI, 6.6 ± 3.0 vs 9.2 ± 3.1 kg/m2, p < 0.01). Particularly, PLHIV with HALS (n = 28), defined as those with a FMR above 1.260 and 1.329 for men and women, respectively, had a greater prevalence of type 2 diabetes mellitus (18% vs 1%), insulin resistance (68% vs 27%), hypertriglyceridemia (50% vs 29%), hypertension (61% vs 30%) and metabolic syndrome (32% vs 10%) than those without HALS (p < 0.05 for all comparisons) and controls. At multivariate analyses, FMR in PLHIV was significantly associated (p < 0.05) with fasting glucose (β [95%CI] = 0.5, [0.1–0.9]), insulin (44.6, [14.9–74.2]), HOMA-IR (1.6, [0.5–2.7]), triglycerides (1.0, [ 0.2–1.8]) and HDL-cholesterol (−2.1, [-3.9/-0.4]) levels. ConclusionSex-specific FMR thresholds, proposed for diagnosis of HALS, could represent new indices of cardio-metabolic derangement in PLHIV.