Occurrence Of Mental Disorders Research Articles

Occupational Exposure to Pesticides and the Occurrence of Mental Disorders: A Systematic Review of the Literature

Occupational Exposure to Pesticides and the Occurrence of Mental Disorders: A Systematic Review of the Literature

The impact of excessive maternal weight on the risk of neuropsychiatric disorders in offspring-a narrative review of clinical studies.

The global prevalence of overweight and obesity is a significant public health concern that also largely affects women of childbearing age. Human epidemiological studies indicate that prenatal exposure to excessive maternal weight or excessive gestational weight gain is linked to various neurodevelopmental disorders in children, including attention deficit hyperactivity disorder, autism spectrum disorder, internalizing and externalizing problems, schizophrenia, and cognitive/intellectual impairment. Considering that inadequate maternal body mass can induce serious disorders in offspring, it is important to increase efforts to prevent such outcomes. In this paper, we review human studies linking excessive maternal weight and the occurrence of mental disorders in children.

A pilot study on AI-driven approaches for classification of mental health disorders.

The increasing prevalence of mental disorders among youth worldwide is one of society's most pressing issues. The proposed methodology introduces an artificial intelligence-based approach for comprehending and analyzing the prevalence of neurological disorders. This work draws upon the analysis of the Cities Health Initiative dataset. It employs advanced machine learning and deep learning techniques, integrated with data science, statistics, optimization, and mathematical modeling, to correlate various lifestyle and environmental factors with the incidence of these mental disorders. In this work, a variety of machine learning and deep learning models with hyper-parameter tuning are utilized to forecast trends in the occurrence of mental disorders about lifestyle choices such as smoking and alcohol consumption, as well as environmental factors like air and noise pollution. Among these models, the convolutional neural network (CNN) architecture, termed as DNN1 in this paper, accurately predicts mental health occurrences relative to the population mean with a maximum accuracy of 99.79%. Among the machine learning models, the XGBoost technique yields an accuracy of 95.30%, with an area under the ROC curve of 0.9985, indicating robust training. The research also involves extracting feature importance scores for the XGBoost classifier, with Stroop test performance results attaining the highest importance score of 0.135. Attributes related to addiction, namely smoking and alcohol consumption, hold importance scores of 0.0273 and 0.0212, respectively. Statistical tests on the training models reveal that XGBoost performs best on the mean squared error and R-squared tests, achieving scores of 0.013356 and 0.946481, respectively. These statistical evaluations bolster the models' credibility and affirm the best-fit models' accuracy. The proposed research in the domains of mental health, addiction, and pollution stands to aid healthcare professionals in diagnosing and treating neurological disorders in both youth and adults promptly through the use of predictive models. Furthermore, it aims to provide valuable insights for policymakers in formulating new regulations on pollution and addiction.

Genetically predicted processed meat, red meat intake, and risk of mental disorders: A multivariable Mendelian randomization analysis

BackgroundPrevious observational studies have highlighted potential links between the consumption of processed meat and red meat (such as pork, mutton, and beef intake) and the occurrence of mental disorders. However, it is unclear whether a causal association exists. Therefore, we employed the Mendelian randomization (MR) study to investigate the causal effects of genetically predicted processed meat and red meat on mood disorders (MD), anxiety disorders (AD), and major depressive disorder (MDD). MethodsGenetic instruments for processed and red meat were selected from the Genome-Wide Association Study (GWAS) of the UK Biobank Study. Their associations with MD (42,746 cases 254,976), AD (35,385 cases and 254,976 controls), and MDD (38,225 cases and 299,886 controls) were obtained from the FinnGen Consortium. The inverse variance weighted (IVW) method was the primary method for two-sample MR analysis. Additionally, we employed complementary analysis to assess the robustness of our MR findings (eg, MR Egger and weighted median). We also conducted multiple sensitivity analyses to investigate horizontal pleiotropy and heterogeneity. Moreover, we performed a univariate and multivariable MR (MVMR) study to evaluate these associations. ResultsIn our univariate MR analysis, we observed that genetically predicted beef intake was associated with a reduced risk of MD [odds ratio (OR) = 0.403, 95 % confidence interval (CI) = 0.246–0.659; PIVW = 4.428 × 10−5], AD (OR = 0.443, 95 % CI = 0.267–0.734; PIVW = 1.563 × 10−3), and MDD (OR = 0.373, 95 % CI = 0.216–0.643; PIVW = 3.878 × 10−4). After adjusting for processed meat, pork, and mutton intake in the MVMR analysis, the protective association of beef intake against MD and MDD remained. However, there was no substantial evidence indicating a significant causal relationship between processed meat, pork, and mutton intake and the occurrence of mental disorders. Furthermore, our sensitivity analysis revealed no significant evidence of horizontal pleiotropy. ConclusionThese findings support a causal relationship between genetically predicted beef intake and reducing the risk of MD and MDD.

An In Silico Investigation of the Molecular Interactions between Volatile Anesthetics and Actin.

Volatile anesthetics (VAs) are medicinal chemistry compounds commonly used to enable surgical procedures for patients who undergo painful treatments and can be partially or fully sedated, remaining in an unconscious state during the operation. The specific molecular mechanism of anesthesia is still an open issue, but scientific evidence supports the hypothesis of the involvement of both putative hydrophobic cavities in membrane receptors as binding pockets and interactions between anesthetics and cytoplasmic proteins. Previous studies demonstrated the binding of VAs to tubulin. Since actin is the other major component of the cytoskeleton, this study involves an investigation of its interactions with four major anesthetics: halothane, isoflurane, sevoflurane, and desflurane. Molecular docking was implemented using the Molecular Operating Environment (MOE) software (version 2022.02) and applied to a G-actin monomer, extrapolating the relative binding affinities and root-mean-square deviation (RMSD) values. A comparison with the F-actin was also made to assess if the generally accepted idea about the enhanced F-to-G-actin transformation during anesthesia is warranted. Overall, our results confirm the solvent-like behavior of anesthetics, as evidenced by Van der Waals interactions as well as the relevant hydrogen bonds formed in the case of isoflurane and sevoflurane. Also, a comparison of the interactions of anesthetics with tubulin was made. Finally, the short- and long-term effects of anesthetics are discussed for their possible impact on the occurrence of mental disorders.

Provision of E-Modules on Adolescent Mental Health Understanding


 
 
 
 Mental health frequently receives inadequate attention and is often disregarded by individuals who tend to prioritize physical health over mental well-being. The occurrence of mental disorders in adolescents (aged 15-24 years) is associated with a depression rate of 6.2%. Severe depression tends to lead to self-harm and suicide. Approximately 80-90% of suicide cases can be attributed to depression and anxiety.
 A comprehensive understanding of adolescent mental health is essential for determining appropriate actions to make adolescents aware that mental health is equally essential. Preventing mental health issues in adolescents is crucial for avoiding further mental disorders or psychological problems. Prevention can be effectively achieved through health education for adolescents, enabling them to comprehend the significance of their mental health.
 E-modules provide an ideal medium for reaching adolescents, as they adapt conventional modules by incorporating information technology, making them more engaging and interactive. This enhances their appeal as an engaging and interactive learning resource. Digital modules (e-modules) enriched with audiovisual technology are expected to apprehend students' interests and create a conducive learning environment.
 The research objective was to investigate the effect of E-modules on adolescents' understanding of mental health. The study adopted a quantitative approach, using a quasi-experimental research design with a pre-posttest without control, conducted through intervention with a single group. The study was conducted at SMP 8 Surakarta and data were collected before and after the intervention. Data analysis employed the Wilcoxon test was used to obtain a significant result with a p-value of 0.01 (p < 0.05). Based on these findings, E-modules affected adolescents' mental health acquaintances.
  
 
 
 

Calcification of the Pineal Gland and Psychopathology in Obsessive-Compulsive Disorder in Children and Adolescents: A Clinical Case Study

While it is generally believed that they result from the interaction of genetic and environmental factors, some cases of obsessive-compulsive disorder (OCD) can be attributed to specific neurological etiologies. Hence, the interest of this article, which discusses the case of a 13-year-old child, who has been experiencing sleep disturbances since early childhood and is seeking treatment for an obsessive syndrome with severe symptoms and a poor therapeutic response. An assessment revealed the presence of pineal gland calcification. Despite the patient being placed on a suitable treatment for obsessive-compulsive disorder, their symptoms only improved after the addition of melatonin, resulting in a significant enhancement in both their sleep and obsessive-compulsive symptoms on the Yale-Brown Scale. Thus, this article highlights the role of the pineal gland in melatonin secretion and also discusses the role of this hormone in the occurrence of mental disorders as well as its therapeutic attributes in psychiatry.

Validation of the Iranian version of the Postpartum Specific Anxiety Scale 12-item research short-form for use during global crises (PSAS-IR-RSF-C)

BackgroundDue to its high pervasiveness and adversarial consequences, postpartum anxiety has been one of the most worrying public health concerns in the last decade. According to previous research, the occurrence of mental disorders among women in the postpartum period upsurges significantly in the course of universal disasters. The Postpartum Specific Anxiety Scale – Research Short Form – for use in global Crises [PSAS-IR-RSF-C] has not been used in Iran for postpartum women during a health system shock. Consequently, this study was conducted to determine the validity and reliability of the Persian version (PSAS-IR-RSF-C) during the COVID-19 pandemic.MethodsThis cross-sectional study was performed with 180 women who were between six weeks and six months after delivery, by random sampling method from December 2021 to June 2022. The validity of the PSAS-RSF-C in terms of face, content, was analyzed, and the construct validity was assessed using exploratory and confirmatory factor analyses. Internal consistency and test–retest reliability of the questionnaire were measured using (Cronbach’s alpha, McDonald’s ω) and intraclass correlation coefficient (ICC), respectively.ResultsThe content validity index and content validity ratio of the Persian version of the PSAS-IR-RSF-C were 0.96 and 0.98, respectively. A three-factor structure was extracted during the exploratory factor analysis process, and model validity was confirmed by the values of fit indices. Cronbach's alpha coefficient, McDonald’s ω and intra-cluster correlation coefficient (95% confidence interval) were 0.74, 0.92 (0.78 to 0.93) and 0.97 (0.93 to 0.98), respectively.ConclusionsFor the specific assessment of postpartum anxiety among Iranian women during crises, the Persian version of the PSAS-IR-RSF-C is a valid and reliable tool.

Sleep Deprivation Induces Dopamine System Maladaptation and Escalated Corticotrophin-Releasing Factor Signaling in Adolescent Mice.

Sleep disruption is highly associated with the pathogenesis and progression of a wild range of psychiatric disorders. Furthermore, appreciable evidence shows that experimental sleep deprivation (SD) on humans and rodents evokes anomalies in the dopaminergic (DA) signaling, which are also implicated in the development of psychiatric illnesses such as schizophrenia or substance abuse. Since adolescence is a vital period for the maturation of the DA system as well as the occurrence of mental disorders, the present studies aimed to investigate the impacts of SD on the DA system of adolescent mice. We found that 72h SD elicited a hyperdopaminergic status, with increased sensitivity to the novel environment and amphetamine (Amph) challenge. Also, altered neuronal activity and expression of striatal DA receptors were noticed in the SD mice. Moreover, 72h SD influenced the immune status in the striatum, with reduced microglial phagocytic capacity, primed microglial activation, and neuroinflammation. The abnormal neuronal and microglial activity were putatively provoked by the enhanced corticotrophin-releasing factor (CRF) signaling and sensitivity during the SD period. Together, our findings demonstrated the consequences of SD in adolescents including aberrant neuroendocrine, DA system, and inflammatory status. Sleep insufficiency is a risk factor for the aberration and neuropathology of psychiatric disorders.

Food insecurity and its socioeconomic and health determinants in pregnant women and mothers of children under 2 years of age, during the COVID-19 pandemic: A systematic review and meta-analysis.

The COVID-19 pandemic has reduced access to adequate food in terms of quality and quantity, especially for the most vulnerable population groups. The objective of this study was to evaluate the prevalence of Food Insecurity and its main socioeconomic and health determinants in pregnant women and mothers of children under 2 years of age, during the COVID-19 pandemic. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021278033). The descriptors "Pregnant Woman", "Postpartum Women", "Breastfeeding Women", "COVID-19", "Food Insecurity", "Food Security" were combined in Scopus (Elsevier), Medline/PubMed (via National Library of Medicine), Embase (Elsevier), Web of Science and Science Direct independently by two researchers in September 2022. Original articles about Food Insecurity in households with pregnant women and mothers of children under 2 years of age during the COVID-19 pandemic were included. The meta-analysis of the prevalence of Food Insecurity was conducted using the RStudio software (4.0.4). The initial search resulted in 539 records, and 10 articles met the proposed criteria and were included in this review. The prevalence of Food Insecurity ranged from 11.5 to 80.3% and in the meta-analysis it was 51% (IC: 30-71) (I 2 = 100.0%). The main socioeconomic and health determinants were ethnicity, domain language, low education, low income, informal employment, unemployment, occurrence of mental disorders, domestic violence, in addition to the unavailability of food in markets and lack of transport. The inclusion of studies with data collection by telephone stands out as a limitation, due to the non-inclusion of vulnerable groups without access to this means of communication. It is necessary to implement and strengthen specific public policies for the maternal and child group with the objective of protecting and strengthening the rights of women to maintain the physical and mental integrity of this group and guarantee Food Security.

Comparison of depressive, anxiety, and somatic symptoms in patients with essential thrombocythemia, polycythemia vera, and myelofibrosis treated with interferon alpha

Introduction: The study aims to analyze the occurrence of depression, anxiety, and somatic symptoms in patients with chronic myeloproliferative neoplasms (essential thrombocythemia, polycythemia vera, and myelofibrosis) and to check whether individual side effects of interferon alpha treatment may contribute to the occurrence of depression, anxiety, and somatic symptoms. In addition, it was decided to check whether there were any relationships between age, gender, duration of treatment, and the intensity of anxiety, divided by the occurrence of individual side effects. Material and methods: The study involved 84 patients and was conducted at the Hematology Clinic of the University Hospital in Krakow and the Clinic of Hematology, Blood Cancer and Bone Marrow Transplantation in Wrocław. The following questionnaires were used: created by the author, David Goldberg General Health Questionnaire 28 (GHQ-28), and the Four-Dimensional Questionnaire (4DSQ). Results: The most frequently reported side effects of treatment were abdominal pain, fatigue, and bone and joint pain. Almost 40% of the respondents obtained a moderately and strongly increased result on the depression scale, less than 50% on the anxiety scale, and over 60% on the somatization scale. Somatic symptoms had the greatest impact on the occurrence of mental disorders, with anxiety symptoms being second in significance. There are differences in the severity of depressive, anxiety, and somatic symptoms depending on the side effects of interferon alpha treatment. Conclusions: The finding of the above study indicates the need for further research into the importance of detecting depressive, anxiety, and somatic disorders, and to addressing concomitant physical symptoms, both in patients with myeloproliferative neoplasms receiving interferon alpha and treated with other methods. In patients treated chronically, the occurrence of side effects of high intensity and lasting for a long time should alert medical personnel. The collected data on patients with myeloproliferative neoplasms who have to suffered from mental and physical symptoms of the disease or its treatment justifies the need for caring psychological, psychiatric, and educational care.

A Retrospective Study on Sexual Assault - Abuse Cases

Objective: In this study; it is aimed to analyze the sexual attack-abuse cases that occurred in Bolu province and were judged by the High Criminal Court. 
 Methods: A total of 148 cases of sexual assault - abuse decided by the Bolu High Criminal Court between 2007 and 2016 were analyzed retrospectively.
 Results: This study included 148 cases: 131 (88.5%) cases were female and 17 (11.5%) were male. The mean age was 18.6 ± 11.6 (min:4, max:83). The highest number of cases was in the 13-15 age group (n=52, 35.2%). Sexual abuse most frequently occurred through vaginal penetration (n=72: 48.6%). The most common psychiatric diagnosis was acute stress disorder (n:12, 10.8%) and post-traumatic stress disorder (n:12, 10.8%). Physical violence was found to be statistically effective (p = 0.008) in the occurrence of mental disorders after the event. The victim recognized 81.8% of the attacker.
 Conclusion: We think that more effective sexual attack-abuse prevention strategies can be developed at the national level by determining the risk factors of sexual assault-abuse in our country through wider research to be conducted across the country.

Chronic stress-induced depression requires the recruitment of peripheral Th17 cells into the brain

BackgroundDepression is a recurrent and devastating mental disease that is highly prevalent worldwide. Prolonged exposure to stressful events or a stressful environment is detrimental to mental health. In recent years, an inflammatory hypothesis has been implicated in the pathogenesis of stress-induced depression. However, less attention has been given to the initial phases, when a series of stress reactions and immune responses are initiated. Peripheral CD4+ T cells have been reported as the major contributors to the occurrence of mental disorders. Chronic stress exposure-evoked release of cytokines can promote the differentiation of peripheral CD4+ cells into various phenotypes. Among them, Th17 cells have attracted much attention due to their high pathogenic potential in central nervous system (CNS) diseases. Thus, we intended to determine the crucial role of CD4+ Th17 cells in the development of specific subtypes of depression and unravel the underpinnings of their pathogenetic effect.MethodsIn the present research, a daily 6-h restraint stress paradigm was employed in rats for 28 successive days to mimic the repeated mild and predictable, but inevitable environmental stress in our daily lives. Then, depressive-like symptoms, brain–blood barrier (BBB) permeability, neuroinflammation, and the differentiation and functional changes of CD4+ cells were investigated.ResultsWe noticed that restrained rats showed significant depressive-like symptoms, concomitant BBB disruption and neuroinflammation in the dorsal striatum (DS). We further observed a time-dependent increase in thymus- and spleen-derived naïve CD4+ T cells, as well as the aggregation of inflammatory Th17 cells in the DS during the period of chronic restraint stress (CRS) exposure. Moreover, increased Th17-derived cytokines in the brain can further impair the BBB integrity, thus allowing more immune cells and cytokines to gain easy access to the CNS. Our findings suggested that, through a complex cascade of events, peripheral immune responses were propagated to the CNS, and gradually exacerbated depressive-like symptoms. Furthermore, inhibiting the differentiation and function of CD4+ T cells with SR1001 in the early stages of CRS exposure ameliorated CRS-induced depressive-like behaviour and the inflammatory response.ConclusionsOur data demonstrated that inflammatory Th17 cells were pivotal in accelerating the onset and exacerbation of depressive symptoms in CRS-exposed rats. This subtype of CD4+ T cells may be a promising therapeutic target for the early treatment of stress-induced depression.

Association between Psychiatric disorders & Substance use disorder in rehabilitation center of Islamabad: A cross-sectional study

IntroductionThe prevalence of substance use disorder has rapidly increased recently. It is believed that the occurrence of mental disorders is strongly associated with substance use.ObjectivesTo identify prevelance of different psychiatric mobidity & symptomatology as Comorbidity amon the diagnosed patients of Substance Use DisorderMethodsThis study was conducted from June till December 2021. A total of 486 PDUs were recruited for this study. A self-administered questionnaire was distributed among PDUs admitted at the Rehabilitation Centre during the period of the study. The questionnaire inquired about the demographic details of the PDUs, their substance history and the occurrence of any MDs.ResultsThe mean age of the PDUs was 25.9 + 6.0 years. A total of (95%) men and (5%) women reported their gender. There were single (74.7%), married (23.1%), divorced (1.4%) and separated (0.7%) PDUs. A large majority of the PDUs (n = 159, 55.6%) had been using different drugs for more than three years. The various MDs reported among the PDUs were delusion (n = 100, 35.2%); paranoia (n = 51, 17.8%); mania (n = 36, 12.6%); depression (n = 156, 54.5%); (n = 100, 35.2%); auditory hallucinations (n = 73, 25.7%); visual hallucinations (n = 106, 37.3%) and anxiety (n = 46, 16.2%). Among 164 cannabis users, hallucinations (n = 35, 21.3%; p = 0.04) was the only significant MD.ConclusionsDelusion and paranoia were amongst the most highly prevalent MDs reported. The occurrence of auditory hallucinations, mania and paranoia were significantly associated with cannabis, heroin and cocaine use, respectively.DisclosureNo significant relationships.

Pharmacists' mental health during the SARS-CoV-2 pandemic in Italy.

The year 2020 was characterized by the outbreak of a new pandemic caused by a novel coronavirus named SARS-CoV-2. To face the pandemic, many countries worldwide imposed general lockdowns, closing all non-essential businesses. As primary care services, pharmacies had to remain open, thus putting pharmacy staff at significant risk of viral infection and overwork. This study aimed to assess the mental health of Italian Pharmacists, considering demographic and occupational characteristics, lifestyle, and habits, during the SARS-CoV-2 outbreak and the subsequent lockdown period (March-May 2020). A web-based survey was created using Google® Forms to collect data from March 30, 2020, to June 1, 2020. The questionnaire consisted of three sections investigating: (1) demographic and occupational variables, (2) lifestyle and habits variables, (3) psychological distress and perceived well-being. A total of 401 participants completed the questionnaire. Older workers and those with more work experience reported more psychological stress. Older and female workers, who felt lonely at home and reported psychological stress, perceived poor well-being. Our findings demonstrate that the Sars-CoV-2 outbreak and subsequent lockdown rules affected pharmacists' mental health and that it is important to put in place preventive measures against the occurrence of mental disorders among them.

Stressor-Specific Microbiota Intervention.

To date, mental disorders are diagnosed and treated by the subjective judgment of psychiatrists based on diagnostic criteria and treatment guidelines, respectively. Mental disorders are heterogeneous illnesses with a substantial treatment-refractory rate. Thus, there is a great need for novel treatment approaches. This article proposes a treatment approach centered on the concept of the gut–brain axis. There is mounting evidence indicating an association between stressors, microbiota, microglia, and mental disorders. Stressors might facilitate dysbiosis, inflammation, and the occurrence of mental disorders. This novel treatment approach is based on the idea that stressor types instead of the heterogeneous psychiatric diagnosis might be closer to the neurobiological underpinnings of mental disorders. First of all, patients with treatment-resistant mental disorders will be asked to describe their major stressors. Then, clinicians will calculate the total threat score and the total deprivation score. Subsequently, treatment tailored to the major stressor type will be administered to restore a healthy gut microbiome. Presumably, treatment will be aimed at increasing microbiota diversity in those who mainly have deprivation stressors and boosting Actinobacteria in those who have mainly threat stressors. Large-scale clinical trials are warranted to test this hypothetical approach.

Predictors of Mental health in Pregnant Women: Application of the theory of planned behavior

Aim. The purpose of this study was to predictors of mental health in pregnant women based on theory of planned behavior referred to Iran health centers during the COVID-19 in 2021.
 Materials and methods. This study was cross-sectional study thatwas conducted on 250 pregnant women. Pregnant women completed General Health Questionnaire (GHQ) and theory of planned behavior questionnaire. The data were analyzed with SPSS software version 20 (SPSS Inc., Chicago, IL, USA) through running Pearson Correlation statistical tests, descriptive statistics methods including frequency, percentage, mean, standard deviation scores. The Kruskal-Wallis test was used for normally distributed variable. The significance level of the tests was considered to be 0.05.
 Results. There was a significant correlation between mental health disorders and some personal and socioeconomic factors. The findings showed that all structures attitude (r=0.69, p0.001), subjective norms (r=0.58, p0.001) and perceived behavioral control (r=0.56, p0.001) and intention (r=0.51, p0.001) had significant correlations with mental health. Among the variables entered into the regression model, attitude, subjective norms and perceived behavioral control were able to predict 65 percent of variance of mental health among the participants (F=60.75, R=0.66, R2=0.65).
 Conclusion. It is necessary to plan for appropriate care in order to prevent the occurrence of mental disorders among this vulnerable group.

Dual guidance structure for evaluation of patients with unclear diagnosis in centers for rare diseases (ZSE-DUO): study protocol for a controlled multi-center cohort study

BackgroundIn individuals suffering from a rare disease the diagnostic process and the confirmation of a final diagnosis often extends over many years. Factors contributing to delayed diagnosis include health care professionals' limited knowledge of rare diseases and frequent (co-)occurrence of mental disorders that may complicate and delay the diagnostic process. The ZSE-DUO study aims to assess the benefits of a combination of a physician focusing on somatic aspects with a mental health expert working side by side as a tandem in the diagnostic process.Study designThis multi-center, prospective controlled study has a two-phase cohort design.MethodsTwo cohorts of 682 patients each are sequentially recruited from 11 university-based German Centers for Rare Diseases (CRD): the standard care cohort (control, somatic expertise only) and the innovative care cohort (experimental, combined somatic and mental health expertise). Individuals aged 12 years and older presenting with symptoms and signs which are not explained by current diagnoses will be included. Data will be collected prior to the first visit to the CRD’s outpatient clinic (T0), at the first visit (T1) and 12 months thereafter (T2).OutcomesPrimary outcome is the percentage of patients with one or more confirmed diagnoses covering the symptomatic spectrum presented. Sample size is calculated to detect a 10 percent increase from 30% in standard care to 40% in the innovative dual expert cohort. Secondary outcomes are (a) time to diagnosis/diagnoses explaining the symptomatology; (b) proportion of patients successfully referred from CRD to standard care; (c) costs of diagnosis including incremental cost effectiveness ratios; (d) predictive value of screening instruments administered at T0 to identify patients with mental disorders; (e) patients’ quality of life and evaluation of care; and f) physicians’ satisfaction with the innovative care approach.ConclusionsThis is the first multi-center study to investigate the effects of a mental health specialist working in tandem with a somatic expert physician in CRDs. If this innovative approach proves successful, it will be made available on a larger scale nationally and promoted internationally. In the best case, ZSE-DUO can significantly shorten the time to diagnosis for a suspected rare disease.Trial registration ClinicalTrials.gov; Identifier: NCT03563677; First posted: June 20, 2018, https://clinicaltrials.gov/ct2/show/NCT03563677.

Association between intensive care unit admission of a patient and mental disorders in the spouse: a retrospective matched-pair cohort study

BackgroundPrevious prospective studies have suggested that spouses of patients who are admitted to the intensive care unit (ICU) have a high prevalence of mental disorders, termed post-intensive care syndrome-family (PICS-F). However, it remains unclear whether the patient’s ICU admission is associated with the occurrence of mental disorders in the spouse outside of the prospective study setting. We therefore investigated the proportion of ICU patients’ spouses who visited medical facilities for mental disorders and the association between ICU admission of a patient and mental disorders in the spouse using real-world data.MethodsThis was a retrospective matched-pair cohort study using commercially available, routinely collected administrative claims data. As the study population, we identified all married couples (both wife and husband) who were registered in the database from 1 April 2012 to 31 August 2018 using family identification codes. We identified spouses of patients who were admitted to the ICU for more than 2 days as the exposure group and defined the date of admission to the ICU as the index date. We randomly matched four individuals in the non-exposure group with one individual in the exposure group. The primary outcome was any PICS-F–related mental disorder in the spouses within 6 months from the index date. As a sensitivity analysis, we also investigated the proportion and association of individuals (excluding spouses) with a history of mental disorders.ResultsAmong 1,082,208 married couples, we identified 8490 spouses of ICU patients, and they were matched with 33,946 individuals. The proportion of any PICS-F–related mental disorder within 6 months from the index date was 12.8% in ICU patients’ spouses and 11.3% in the matched individuals (adjusted odds ratio, 1.29; 95% confidence interval, 1.03–1.42). The sensitivity analysis showed significant associations between ICU admission and spouses’ mental disorders.ConclusionsSpouses of patients who were admitted to the ICU had a slightly higher risk of mental disorders within 6 months than spouses of patients who were not admitted to the ICU.

Features of bipolar depression in the postpartum period: a clinical case

The postpartum period is quite often complicated by the occurrence of mental disorders of various origins. One of the most common complications is postpartum depression (PPD). At the same time, the presence of a history of endogenous mental illness in women significantly increases the risk of developing postpartum depression. The closest relationship is found between PPD and bipolar affective disorder (BAD). According to the literature, postpartum depression in the context of bipolar disorder almost always proceeds in a milder form with a predominance of atypical and anxiety symptoms. The paper presents an analysis of a clinical case of severe postpartum depression in a patient with bipolar affective disorder.