History Of Psychiatric Disease Research Articles

Research of burnout, coronaphobia, hopelessness, and psychological resilience levels in healthcare workers during the COVID-19 pandemic

Healthcare workers (HCWs) who are at the forefront of combating the COVID-19 pandemic have faced significant psychosocial challenges. In this context, this study aimed to investigate burnout, hopelessness, coronaphobia, psychological resilience levels, and associated risk factors among HCWs during the COVID-19 pandemic. This study was designed as a cross-sectional study that was conducted from March 15 to August 15, 2021. A total of 432 HCWs were included in the study who are working in a tertiary central pandemic hospital. The rate of HCWs diagnosed with COVID-19 was 29.4%. It was found that HCWs experienced high levels of burnout, hopelessness, and coronaphobia. HCWs who have a history of psychiatric disease and who are doctors were at higher risk for burnout. It is noteworthy that more than one-third of HCWs (37.4%) reported moderate to severe levels of hopelessness. The levels of psychological resilience were higher in doctors and nurses. There was a significant positive correlation between burnout, hopelessness, and coronaphobia, and a significant negative correlation between psychological resilience and these variables. In conclusion, multidisciplinary approaches are needed to support the mental health of HCWs, providing psycho-educations, building psychological resilience, and providing the required institutional and psychosocial support.

Comparison of the Clinical Characteristics of Pediatric Poisoning Patients Who Visited Emergency Department Before and During the COVID-19 Pandemic.

We aimed to investigate changes in the clinical characteristics of pediatric poisoning patients who visited the emergency department (ED) before and during the coronavirus disease 2019 (COVID-19) pandemic. Poisoning cases below age 18 who visited the ED from January 2018 to December 2021 were retrospectively analysed. The study period was then divided into pre-COVID-19 and COVID-19 pandemic to compare poisoning patterns. During the study period, 86,153 visits to the pediatric ED had been recorded, with 625 patients being included the final analysis. During the COVID-19 period, the proportion of poisoned patients increased from 0.62% to 0.98%. The average age of the patients was higher in the COVID-19 period, with 53.4% of the cases being intentional (pre-COVID-19, 32.5%; P < 0.001). Moreover, 70.4% of poisoning cases during the COVID-19 period were caused by drugs (pre-COVID-19, 60.6%; P = 0.038). More patients underwent decontamination and laboratory investigation during the COVID-19 period than during the previous period (P = 0.007 and P < 0.001, respectively). The length of ED stay and the proportion of hospitalisation were significantly greater during the COVID-19 period. After analysing accidental poisoning cases, we found that antipyretics/nonsteroidal anti-inflammatory drugs and respiratory drugs were more common in the pre-COVID-19 group, whereas iron/vitamins, cardiovascular drugs and hormones were more common in the COVID-19 group. After analysing intentional poisoning cases, we found that 73.6% and 76.4% of the patients in the pre-COVID-19 and COVID-19 group had a history of psychiatric disease, respectively. Although no difference was observed in the frequency of previous first suicide attempts, 19.0% of the patients in the COVID-19 group attempted suicide more than three times. During the COVID-19 pandemic, intentional poisoning cases, especially in adolescence, increased and were treated more. Many of the patients with intentional poisoning had a history of mental illness or suicide in the past. Therefore, it seems that policy consideration for mentally vulnerable adolescents during this new pandemic period is necessary.

Neuropsychiatric Effects of Bilateral Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease: Results at the 12-Month Follow-up.

It is aimed to report the effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on motor symptoms, neuropsychiatric symptoms, and quality of life in Parkinson's Disease (PD) patients. The results of 22 patients with PD, who had undergone bilateral STN-DBS, were analyzed. The Unified Parkinson's Disease Rating Scale (UPDRS) was applied to assess the patients' clinical characteristics before surgery and 6-, and 12-month follow-up after surgery. The quality of life of the patients was evaluated with the Parkinson's Disease Questionnaire (PDQ-39). Neuropsychological tests including Minnesota Impulse Control Disorders Interview (MIDI), Beck Depression Inventory-II (BDI), Hospital Anxiety and Depression Scale (HADS), Lille Apathy Rating Scale (LARS), and Mini-Mental State Examination (MMSE) were also routinely performed at baseline and 6 months and 12 months after surgery. The mean age of patients was 57.3±8.8 years. Fourteen patients (63.6%) were male. Significant improvements were seen in UPDRS-part-II, UPDRS-part-III UPDRS-part-IV, and PDQ-39 in the follow-ups after the surgery. No significant change was observed in 6- and 12-month follow-up visits for BDI, HADS, MMSE, and LARS, compared to baseline. A depressive episode, requiring antidepressant treatment was recorded in four (18.1%) patients. Before DBS surgery, eight patients had at least one current impulse control behaviors (ICBs). Among these eight patients; ICBs disappeared in one patient, did not change in two patients, and worsened in five patients after STN-DBS treatment. In patients with a history of psychiatric disease, bilateral STN-DBS treatment may aggravate psychiatric symptoms such as depression, and ICBs.

Anti-NMDA Receptor Encephalitis Associated With an Ovarian Teratoma Presenting as First-episode Psychosis: A Case Report

We report an unusual case of a 27-year-old previously healthy female who presented with a 15-day history of psychotic, cognitive, and unspecified somatic symptoms. She was admitted to the psychiatric ward of an early intervention in psychosis team and medicated with aripiprazole. The young age of onset, the rapid onset, the absent history of psychiatric disease, and the persistence of a marked memory deficit after the psychotic symptoms remitted strongly suggested a nonpsychiatric etiology and led us to hypothesize autoimmune encephalitis as the most probable diagnosis. An investigation was carried out for anti-N-methyl-D-aspartate (anti-NMDA) receptor antibodies in the patient's serum and cerebrospinal fluid, and both tests were positive. The patient was transferred to the neurology ward, where an endovaginal ultrasound showed an ovarian teratoma in her right ovary. She underwent laparoscopic surgery without complications. She was initially treated with intravenous immunoglobulin and methylprednisolone for 5 days, which resulted in marked improvement of her memory and attention performance. Anti-NMDA receptor encephalitis, first described in 2007 by Dalmau and colleagues, is a form of auto-immune encephalitis with prominent neuropsychiatric manifestations, particularly psychotic symptoms. At symptom onset, distinguishing the disease from a primary psychiatric disorder is challenging. This case report highlights the importance of early psychosis treatment teams considering the diagnosis of anti-NMDA receptor encephalitis when evaluating new referrals with a potential diagnosis of first-episode psychosis, particularly when young patients with no relevant personal or familial psychiatric history present with neuropsychiatric symptoms and a distinctive pattern of symptom fluctuation over time.

Factors Associated with Prolonged Opioid Use after CMC Arthroplasty

Background Higher rates of prolonged opioid use have been reported in patients who undergo thumb carpometacarpal (CMC) arthroplasty compared with other hand procedures. Therefore, the aim of this study is to identify the risk factors associated with prolonged postoperative opioid use after CMC arthroplasty, along with reporting the number of patients who filled an opioid prescription more than 30 days postoperatively.Materials and Methods Retrospectively, 563 opioid-naïve patients who underwent CMC arthroplasty were included. A manual chart review was performed to collect patient characteristics, and opioid use was determined based on opioid prescription by a physician. Prolonged opioid use was defined as an opioid prescription at 90 to 180 days postoperatively. A multivariable analysis was performed to identify independent factors associated with an opioid prescription at 90 to 180 days postoperatively. Patients had a median age of 60.4 years (interquartile range [IQR]: 55.5–66.9) and had a median follow-up of 7.6 years (IQR: 4.3–12.0).Results The rates of postoperative opioid use ranged from 6.2% (53 out of 563 patients) at 30 to 59 days postoperatively to 3.9% (22 out of 563 patients) at 150 to 180 days postoperatively. In total, 17.1% (96 out of 563 patients) received a second opioid prescription more than 30 days following surgery, of which 10.8% (61 out of 563 patients) were between 90 and 180 days postoperatively. Older age, defined as a median of 63 years (IQR: 57.10–69.88) (p = 0.027, odds ratio [OR] = 1.04) and a history of psychiatric disease (p = 0.049, OR = 1.86) were independently associated with prolonged opioid use.Conclusion A prolonged opioid use rate of roughly 11% was found in opioid-naïve patients who underwent CMC arthroplasty. In patients at risk (older patients or psychiatric history) of prolonged opioid use, careful postoperative pain management is recommended.

SARCOID MASQUERADING AS MALIGNANCY ON IMAGING

TOPIC: Imaging TYPE: Medical Student/Resident Case Reports INTRODUCTION: Sarcoidosis is a multi-system inflammatory disease that predominantly affects the lungs and histopathologically characterized by non-caseating granulomas. A comprehensive evaluation must be pursued to diagnose Sarcoidosis as some findings can overlap with other compatible conditions. CASE PRESENTATION: A-44-year-old woman presented with chronic fatigue, shortness of breath, left sided chest pain, and cough. CT chest revealed left hilar, anterior mediastinal, right paratracheal, and subcarinal lymphadenopathy. An 18-F-fluorodeoxyglucose (FDG) positron emission tomography (PET) CT showed extensive mediastinal and hilar PET avid adenopathy. Notable lymph nodes include a 25mm subcarinal node with a Standardized Uptake Value (SUV) of 32.6 and 11mm left hilar node with a SUV of 27.7. The PET CT findings were highly concerning for lymphoma. Patient subsequently underwent an Endobronchial Ultrasound-guided transbronchial needle aspiration of lymph nodes, and forceps biopsy of station 7. Pathology of the lymph nodes was significant for non-caseating granulomas. Ziehl–Neelsen and silver stains were negative for acid fast bacilli and fungi, respectively. Patient was diagnosed with Sarcoidosis and treatment with Methotrexate and folic acid was initiated. Steroids were avoided in the setting of morbid obesity (BMI >40), prediabetes and history of psychiatric disease. DISCUSSION: This case illustrates the potential for misdiagnosis based on high Standardized Uptake Values on FDG PET-CT scan and the value of a comprehensive evaluation involving tissue biopsy. A SUV of >2.5 is suggestive of malignancy however, false positives due to 18-FDG uptake by inflammatory cells in infectious and granulomatous diseases have been reported in a few case series. Sarcoidosis is characterized by non-caseating granulomas that are formed by the recruitment of multiple inflammatory cells such as activated macrophages and lymphocytes which can lead to increased radiotracer uptake. Other causes of granulomatous disease such as fungal and mycobacterial infections, foreign bodies, pneumoconiosis and vasculitis should be explored. Newer nuclear imaging modalities using alternate radio-tracers have been developed to improve specificity however, low accessibility has rendered a paucity of available data. CONCLUSIONS: FDG PET-CT can aid in the detection and monitoring of various pathologies including Sarcoid. Due to the lack of specificity of any one diagnostic evaluation currently, it is important to obtain pathological confirmation in addition to imaging, and rule out other causes of non-caseating granulomas, prior to starting treatment. REFERENCE #1: Anjali Shetty, M., and John D Carter, MD, Sarcoidosis mimicking lymphoma on FDG-PET imaging. Radiology Case Reports 2011. REFERENCE #2: Paul E. Kinahan, P.a.J.W.F., MD, PET/CT Standardized Uptake Values (SUVs) in Clinical Practice and Assessing Response to Therapy. Semin Ultrasound CT MR., 2010. REFERENCE #3: Miyakubo M, Oriuchi N, Tsushima Y, Higuchi T, Koyama K, Arai K, et al. Diagnosis of maxillofacial tumor with L-3-[F-18]-fluoro-alpha-methyltyrosine (FMT) PET: a comparative study with FDG-PET. Ann Nucl Med. 2007. DISCLOSURES: No relevant relationships by Hamna Ahmad, source=Web Response No relevant relationships by Sarah Dubin, source=Web Response No relevant relationships by Ashraf Gohar, source=Web Response No relevant relationships by Sindhuja Palle, source=Web Response

Brief psychotic disorder occurring after Covid-19 in a patient with no history of psychiatric diseases - a case report

Abstract Introduction: Although the typical symptoms of SARS-CoV-2 infection are respiratory symptoms, it has been shown that the virus can also attack the central nervous system (CNS) causing neurological and psychiatric symptoms. Aim: The aim of the study was to present a case of a 52-year-old woman, previously untreated for psychiatric diseases, who developed brief psychotic disorder occurring after Covid-19 infection. Case report: A patient in the biological treatment of asthma, came for a follow-up visit, during which the doctor diagnosed psychopathological symptoms in the form of delusions, never previously observed. The interview showed that the patient was discharged from the Isolation ward 10 days before, where she was hospitalized because of SARS-CoV-2 infection. Discussion: There are several theories regarding the mechanisms of pathogenesis of neuropsychiatric symptoms in the course of Covid-19 infection. Much space in the literature is devoted to pathological immune responses. One of the reasons for the development of delusions in the described patient could therefore be the acute phase of the inflammatory reaction in the course of SARS-CoV-2 infection.

P-46 EPIDEMIOLOGICAL PROFILE AND CLINICAL OUTCOMES OF PATIENTS INTOXICATED WITH ACETAMINOPHEN FOR SUICIDAL PURPOSES AT HOSPITAL SAN VICENTE FUNDACIÓN RIONEGRO: A CASE SERIES

Acetaminophen is the most widely used analgesic in the world and its overdose is a major cause of hepatic failure in developed countries. This study aims to describe patients with overdose intake of acetaminophen between 2019 and 2020 at a reference center for liver transplantation in Rionegro-Colombia. Case-series study derived from a secondary analysis of the clinical records between January 1st of 2019 to December 31st of 2020. Inclusion criteria were individuals with voluntary acute ingestion of toxic doses of acetaminophen (>4 g/day). 63 cases, 68% women, 67% <18-year-old, and 54% students. 60% had a personal history of psychiatric illness and 35% reported at least one previous suicide attempt. The median dose of acetaminophen was 15g (IQR:11.5g; Max:50g), 46% referred to co-ingestion with other substances and 13% were under the effect of any psychoactive substance. 57% had a clear intention of suicide. 81% vomited before the arrival to the emergency room, 22% received decontamination intervention with gastric lavage or activated charcoal, and 10% did not receive any dose of N-Acetylcysteine. 15 individuals developed an acute liver injury, 9 with severity criteria, and 1 developed acute kidney injury. The population was predominantly young, the personal history of psychiatric disease was highly prevalent, and most of the cases referred to a vital event that explains the impulsive behavior in acetaminophen consumption. No one developed criteria for liver transplantation and this could be explained by the young age of the individuals, the episodes of early vomiting, and the absence of chronic liver disease or hepatotoxic substance consumption.

Postictal Psychosis in Epilepsy: A Clinicogenetic Study.

ObjectivePsychoses affecting people with epilepsy increase disease burden and diminish quality of life. We characterized postictal psychosis, which comprises about one quarter of epilepsy‐related psychoses, and has unknown causation.MethodsWe conducted a case–control cohort study including patients diagnosed with postictal psychosis, confirmed by psychiatric assessment, with available data regarding epilepsy, treatment, psychiatric history, psychosis profile, and outcomes. After screening 3,288 epilepsy patients, we identified 83 with psychosis; 49 had postictal psychosis. Controls were 98 adults, matched by age and epilepsy type, with no history of psychosis. Logistic regression was used to investigate clinical factors associated with postictal psychosis; univariate associations with a p value < 0.20 were used to build a multivariate model. Polygenic risk scores for schizophrenia were calculated.ResultsCases were more likely to have seizure clustering (odds ratio [OR] = 7.59, p < 0.001), seizures with a recollected aura (OR = 2.49, p = 0.013), and a family history of psychiatric disease (OR = 5.17, p = 0.022). Cases showed predominance of right temporal epileptiform discharges (OR = 4.87, p = 0.007). There was no difference in epilepsy duration, neuroimaging findings, or antiseizure treatment between cases and controls. Polygenic risk scores for schizophrenia in an extended cohort of postictal psychosis cases (n = 58) were significantly higher than in 1,366 epilepsy controls (R 2 = 3%, p = 6 × 10−3), but not significantly different from 945 independent patients with schizophrenia (R 2 = 0.1%, p = 0.775).InterpretationPostictal psychosis occurs under particular circumstances in people with epilepsy with a heightened genetic predisposition to schizophrenia, illustrating how disease biology (seizures) and trait susceptibility (schizophrenia) may interact to produce particular outcomes (postictal psychosis) in a common disease. ANN NEUROL 2021;90:464–476

Effect of COVID-19 Pandemic on Mental Health in Patients with Kidney Transplantation

Severe acute respiratory syndrome coronavirus-2 is the cause of coronavirus disease 2019 (COVID-19). The most effective method in controlling the disease is maintaining the distance between people and, if necessary, quarantine. Recent evidence suggests that people kept in isolation and quarantine experience significant anxiety, confusion, and stress levels. This study aims to investigate the effects of COVID-19 on mental health in kidney transplant recipients. In this cross-sectional study, all renal transplant patients who followed up in our transplantation clinic were evaluated to be included in the study. The Turkish version of the fear of COVID-19 scale, depression anxiety stress scale (DASS-21), and satisfaction with life scale (SWLS) were administered to the patients. Patients were interviewed face-to-face by the same physician. A total of 68 patients were included in the study: 29 (42.6 percent) women and 39 (57.4 percent) men. In the present study, we detected that DASS-21 anxiety, depression, stress, and total scores were higher in patients with a family history of psychiatric disease than without (p&lt;0.05). We did not find any statistical differences between patients’ demographic characteristics and fear of COVID-19 scale, DASS-21 anxiety, depression, stress, and total scores except for family history of psychiatric disease. More extensive and multi-center studies are needed to determine these patients' anxiety and depression states in the future.

Specific Comorbidities Are Associated with Poor Outcomes in Adolescents and Young Adults Undergoing Allogeneic Stem Cell Transplantation

Introduction:Given the significant morbidity and mortality of allogeneic hematopoietic stem cell transplantation (HCT), a hematopoietic stem cell transplantation - comorbidity index (HCT-CI) was previously developed in adults to help risk-stratify patients prior to transplant. Adolescent and young adult (AYA) patients typically have less comorbidities than older adults, yet they still have significant rates of non-relapse mortality (NRM) following allogeneic HCT. We sought to demonstrate that poor outcomes among AYA patients that had undergone allogeneic HCT were likely associated with specific comorbidities that are seen more commonly in this population.Methods: This was a retrospective study of 241 patients aged 15-39 years who underwent allogeneic HCT from January 2005 - December 2015 at UCLA. Patients were excluded if they had a prior allogeneic HCT. Data was collected on the fifteen comorbidities from the original HCT-CI study, as well as other possible risk factors in the AYA population including a practical and psychosocial variable and history of congenital heart disease. The primary endpoints for the analysis were the cumulative incidence of NRM and overall survival (OS) after allogeneic HCT.Results: Demographic data for patients with allogeneic HCT was demonstrated to be diverse, as 63% of patients were described as non-White. OS for this population at 1, 3, and 5 years was 62%, 52%, and 46%, respectively, with a median overall survival of 4 years. NRM at 1, 3, and 5 years was 26%, 31%, and 32%, respectively. Most deaths (62%) were not attributed to relapse. Of the comorbidities that are included in the HCT-CI, pulmonary, hepatic, infectious, cardiac, obesity, and psychiatric were the only pre-transplant risk factors to have greater than 10% prevalence in the patients studied. The pulmonary comorbidity had the highest prevalence rate (55%). A practical and psychosocial component was the second most common comorbidity in this population (35%). Financial concerns were the most frequent reason (23%) for patients to be considered positive for this risk factor. History of a psychiatric disorder was significantly associated with a greater rate of NRM (HR = 1.74; 95% CI: 1.02-2.97, p=0.041) as was presence of severe lung disease (HR = 2.49; 95% CI 1.35-4.59, p=0.003).Discussion: We have shown that AYAs that received allogeneic HCT had poor outcomes and most deaths were attributed to treatment-related causes. In addition, among several previously described comorbidities and a novel practical and psychosocial component, a history of psychiatric disease and severe lung disease were associated with higher rates of NRM in this younger patient population prior to allogeneic HCT. This further supports the notion that AYA patients have unique needs and we believe that a simpler and more efficient HCT-CI should be developed to better assess these patients prior to transplant. Further, our preliminary results suggest that interventions aimed at targeting modifiable risk factors may improve outcomes for AYA patients undergoing allogeneic HCT. Future research is needed to validate our findings in a larger prospective study. DisclosuresNo relevant conflicts of interest to declare.

Psychogenic non-epileptic seizure-status in patients admitted to the intensive care unit.

Psychogenic non-epileptic seizure-status (PNES-status), defined by psychogenic non-epileptic seizures (PNES) over 30min, are often misdiagnosed as status epilepticus. We aimed to describe the features of patients who experienced PNES-status, admitted to an intensive care unit (ICU). We screened the patients hospitalized in our epilepsy unit during a 4-year period, with a diagnosis of PNES-status and ICU admission. Among 171 patients with PNES, we identified 25 patients (15%) who presented 39 episodes of PNES-status leading to ICU admission. Some 76% of the patients were women. The median age at the time of the PNES-status episode was 35years. Half (48%) alleged a history of epilepsy, but epilepsy was confirmed in only 12%. A history of psychiatric disease was found in 68%. PNES were present in 85% of patients before PNES-status, and semiology of PNES and PNES-status was similar for 79% of the patients, including hyperkinetic movements in 95% of the episodes and suspected loss of consciousness in 87%. Benzodiazepines were administrated in 77% of the episodes, antiepileptic drugs in 87%, and antibiotherapy for a ICU-related infection in 15% of the episodes. Oral intubation was performed in 41% of the episodes. Blood tests showed normal levels of creatine phosphokinase and leucocytes in 90% and 95% of the episodes, respectively. No epileptic activity was found during per-event electroencephalography but interictal epileptic activity was found in 10% of the episodes. Hyperkinetic PNES-status should always be considered as a differential diagnosis of status epilepticus, with a high risk of iatrogenic consequences.

Medical Comorbidities Associated With Outcomes in Patients With Traumatic Epidural Hematomas.

BackgroundTraumatic brain injury (TBI) is a frequently encountered neurosurgical pathology with significant morbidity and mortality. One such subtype is the epidural hematoma. Literature regarding the effects of comorbidities in TBI and epidural hematomas is limited.MethodologyThis was a single-center retrospective review of 50 consecutive patients admitted to a level two trauma center with epidural hematomas. Patients were identified using an internal trauma database. Patients were included if they were 18 years of age with a diagnosed epidural hematoma. Outcome variables of Glasgow coma scale (GCS), length of stay in the intensive care unit (ICU) and hospital, and requirement of a neurosurgical procedure were analyzed. Identification of the presence of diagnosed comorbidities was performed including common comorbidities such as obesity, diabetes, hypertension, hyperlipidemia, drug use, tobacco use, cancer, psychiatric disease, and renal disease. Correlations were evaluated using two-sided bivariate analysis (p < 0.05).ResultsA total of 50 patients were included for analysis. Significant correlations with a p-value less of than 0.05 were noted in initial GCS and cancer (r = -0.357, p = 0.011), requirements of an intracranial procedure with a history of gastrointestinal disease (r = 0.377, p = 0.007), and younger age (r = -0.306, p = 0.031). Increased ICU length of stay was related to a history of cancer (r = 0.494, p < 0.001), a history of respiratory disease (r = 0.427, p = 0.002), and a history of psychiatric disease (r = 0.297, p = 0.036). Increased hospital length of stay was related to psychiatric disorders (r = 0.285, p = 0.045). Discharge GCS was negatively associated with a history of hypertension (r = -0.374, p = 0.008), tobacco use (r = -0.417, p = 0.003), drug use (r = -0.294, p = 0.037), and history of cancer (r = -0.303, p = 0.032).Discussion and ConclusionsIn our 50 consecutive patient subset, selected comorbidities demonstrated significant relationships with outcome measures of GCS, need for a procedure, and lengths of stay in the hospital and ICU. Obtaining comorbidity information when available from families can better allow the clinician to optimize treatment and educate loved ones about the potential effects of these comorbidities on the overall health of the patient. Understanding these correlations may allow for a better understanding of the systemic effects of the pathophysiology of injury in epidural hematomas.

Perinatal Depression and Anxiety in Women With Multiple Sclerosis: A Population-Based Cohort Study.

ObjectiveTo assess the occurrence of perinatal depression and anxiety in women before and after diagnosis of multiple sclerosis (MS).MethodsA total of 114,629 pregnant women were included in the Norwegian Mother, Father and Child Cohort study (1999–2008). We assessed depression and anxiety by questionnaires during and after pregnancy. Women with MS were identified from national health registries and hospital records and grouped into (1) MS diagnosed before pregnancy (n = 140) or MS diagnosed after pregnancy with (2) symptom onset before pregnancy (n = 98) or (3) symptom onset after pregnancy (n = 308). Thirty-five women were diagnosed with MS in the postpartum period. The reference group (n = 111,627) consisted of women without MS.ResultsWomen with MS diagnosed before pregnancy had an adjusted odds ratio of 2.0 (95% confidence interval, 1.2–3.1) for depression in the third trimester. Risk factors were adverse socioeconomic factors and history of psychiatric disease and physical/sexual abuse. The risk of anxiety was not increased. Women diagnosed with MS in the postpartum period had especially high risk of postpartum depression. Women with MS symptom onset within 5 years after pregnancy had increased risk of both depression and anxiety during pregnancy, whereas women with more than 5 years until symptom onset did not.ConclusionWomen diagnosed with MS have increased risk of perinatal depression. Women with MS symptom onset within 5 years after pregnancy have increased risk of both depression and anxiety during pregnancy.

History of Psychiatric Disease Inversely Correlates with Age of Onset in Alzheimer’s Disease. (2474)

History of Psychiatric Disease Inversely Correlates with Age of Onset in Alzheimer’s Disease. (2474)

Zoanthropy in confinement

IntroductionZoanthropy is a mental disorder in which a patient believes to be an animal. These patients believe they have morphed into another species and began to act like such. Several types of zoanthropy have been described. Mental disorders can be triggered by stressful life events in patients with certain vulnerability. Hearing impairment as a risk factor for psychosis has been suggested in Psychiatry research. The potential mechanisms underlying this association included loneliness, diminished theory of mind, disturbances of source monitoring and top-down processing and deafferentiation.ObjectivesThis case presents a patient, with no history of psychiatric diseases, who developed the delirious of being a dog during Codiv-19 quarantine.MethodsPreviously healthy, sixty-year-old woman, with poor hearing, was taken to the Hospital for altered behavior after the confinement was stated. A low back pain started which derived on walking difficulties. The transformation begun and she started walking on four legs, barked and even pooped like a dog. Physical examination was normal. Mental exam revealed presence of delusion. Blood tests and brain imaging revealed no abnormalities. A treatment based on long-acting injectable aripiprazole was started.ResultsWithin 4 months of treatment, her mental state improved by attenuation of psychotic symptoms.ConclusionsSensory impairment and social isolation, have been associated with late-onset psychosis, but appear to exert a nonspecific influence on vulnerability. Early assessment and treatment of hearing impairment in patients with high risk of psychosis may be essential in psychosis treatment and prevention.DisclosureNo significant relationships.

Vagus nerve stimulation in treatment-resistant depression. Long-term clinical outcomes

IntroductionVagus nerve stimulation (VNS) is a neuromodulation technique approved for Treatment-Resistant Depression (TRD). Evidence regarding its long-term efficacy and safety is still scarce.ObjectivesTo descriptively report a case series of 3 patients undergoing adjunctive VNS for TRD with an over 10-year follow-up.MethodsWe investigated outcomes of clinical interest in patients with ongoing VNS for at least 10 years after the device implantation. They had participated in a larger single-arm interventional study conducted at the University Hospital of Padua. They were diagnosed with chronic unipolar (1), recurrent unipolar (1), and bipolar (1) TRD.ResultsOur 3 cases had an average 14-year history of psychiatric disease before surgery. Afterward, all subjects achieved clinical remission within two years. 2 patients experienced relapses within the first 4 years of treatment (respectively, 1 and 2 episodes). The other case showed a recurrent trend of brief relapses every two years. Only 1 individual needed to be admitted to the psychiatric unit once. None of them committed suicidal attempts. Prescription of antidepressants remained almost unchanged after the first two years. 2 individuals improved and 1 maintained their working position. Common adverse events were voice alteration (3/3), neck pain (2/3), and cough (2/3).ConclusionsVery few cases of 10-year VNS for TRD have been reported so far. For our subjects, VNS was most likely to have a major impact on the clinical course of the disease. This treatment can be a safe and effective adjunctive intervention in a subgroup of patients with TRD.

Clinical characteristics and sociodemographic features of psychotic major depression

BackgroundPsychotic major depression (PMD) is a subtype of depression with a poor prognosis. Previous studies have failed to find many differences between patients with PMD and those with non-psychotic major depression (NMD) or schizophrenia (SZ). We compared sociodemographic factors (including season of conception) and clinical characteristics between patients with PMD, NMD, and schizophrenia. Our aim was to provide data to help inform clinical diagnoses and future etiology research.MethodsThis study used data of all patients admitted to Shandong Mental Health Center from June 1, 2016 to December 31, 2017. We analyzed cases who had experienced an episode of PMD (International Classification of Diseases, Tenth Revision codes F32.3, F33.3), NMD (F32.0–2/9, F33.0–2/9), and SZ (F20–20.9). Data on sex, main discharge diagnosis, date of birth, ethnicity, family history of psychiatric diseases, marital status, age at first onset, education, allergy history, and presence of trigger events were collected. Odds ratios (OR) were calculated using logistic regression analyses. Missing values were filled using the k-nearest neighbor method.ResultsPMD patients were more likely to have a family history of psychiatric diseases in their first-, second-, and third-degree relatives ([OR] 1.701, 95% confidence interval [CI] 1.019–2.804) and to have obtained a higher level of education (OR 1.451, 95% CI 1.168–1.808) compared with depression patients without psychotic features. Compared to PMD patients, schizophrenia patients had lower education (OR 0.604, 95% CI 0.492–0.741), were more often divorced (OR 3.087, 95% CI 1.168–10.096), had a younger age of onset (OR 0.934, 95% CI 0.914–0.954), less likely to have a history of allergies (OR 0.604, 95% CI 0.492–0.741), and less likely to have experienced a trigger event 1 year before first onset (OR 0.420, 95% CI 0.267–0.661). Season of conception, ethnicity, and sex did not differ significantly between PMD and NMD or schizophrenia and PMD.ConclusionsPMD patients have more similarities with NMD patients than SZ patients in terms of demographic and clinical characteristics. The differences found between PMD and SZ, and PMD and NMD correlated with specificity of the diseases. Furthermore, allergy history should be considered in future epidemiological studies of psychotic disorders.

Investigating of fear of COVID-19 after pregnancy and association with breastfeeding

Background: COVID-19 pandemic has certainly become the most important global problem. Deficient information may increase the fear of COVID-19, affect pregnant women's psychology, and even affect breastfeeding during the postpartum period. This study aimed to assess the fear of the COVID-19 pandemic after pregnancy and its association with breastfeeding.&#x0D; Methods: A cross-sectional study designed to survey all pregnant women who gave birth at ≥36 weeks between March 10 and June 10, 2020, at the Private Nisa Hospital, Istanbul, Turkey. Participants respond to questions related to sociodemographic, genealogical, pregnancy, birth information, postpartum baby care, and breastfeeding status, in addition to the 7-item Fear of COVID-19 Scale (fcv-19s) via phone. Descriptive, bivariate, and linear regression analysis was performed to predict fcv-19s. SPSS version 22.0 was used to analyze the data.&#x0D; Results: A total of 906 (response rate 78.8%) respondents with a mean age of 29.59 (±4.74years) were included in the study. Most of them were highly educated (75.2%), housewives(86.1%), and living in nuclear families (96.1%). The majority of women (92.9%) gave birth at 38 weeks via cesarean section (71.7%) and breastfeeding (94.2%). Although the mean score of (fcv-19s) was high in non-breastfeeding mothers, no significant correlation was seen in bivariate analysis. In the linear regression analysis, the highly educated, good income status, having at least once follow-up a month, having a history of psychiatric disease, cesarean section delivery, competence in baby care, breastfeeding, and milk adequacy significantly predicted the (fcv-19s) (R = 0.67, R2 = 0.46, F = 42.10, p &lt; 0.001).&#x0D; Conclusions: During pandemics, including COVID-19, the psychological state of society is negatively affected, and therefore special attention must be given to the most affected groups, especially pregnant and postpartum women.

Rapid Support for Older Adults during the Initial Stages of the COVID-19 Pandemic: Results from a Geriatric Psychiatry Helpline.

Background. The COVID-19 pandemic and governmental lockdown measures disproportionally impact older adults. This study presents the results from a psychiatric helpline for older adults in Mannheim, Germany, during the lockdown, set up to provide information and psychosocial support. We aim to elucidate the needs of older adults, their reported changes, and the psychological impact during the initial stages of the health crisis. Methods: A total of 55 older adults called the psychiatric helpline between April and June 2020. Information on demographics, medical and psychiatric history. as well as changes in daily life due to the pandemic was collected anonymously. Mental health status was assessed using the 7-Item Hamilton Depression Rating Scale (HAMD-7) and the Hamilton Anxiety Rating Scale (HAM-A). Results: Most callers were women, older adults (M = 74.69 years), single, and retired. In total, 69% of callers reported new or an increase in psychiatric symptoms, with anxiety and depressive symptoms being the most common ones. Age was significantly negatively correlated to higher levels of anxiety and depression symptoms. Individuals with a previous diagnosis of a psychiatric disease reported significantly higher levels of depressive and anxiety symptoms than those without a diagnosis. Conclusion: In older adults, the perceived psychological impact of the COVID-19 crisis appears to ameliorate with age. Individuals with a history of psychiatric disease are most vulnerable to negative mental health outcomes. Rapid response in the form of a geriatric helpline is a useful initiative to support the psychosocial needs of older adults during a health crisis.