Organic Disorders Research Articles

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

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

Clinical and psychopathological features of very late onset of schizophrenia-like psychosis

IntroductionVery late onset schizophrenia-like psychosis takes the 3rd place among late-life psychosis, after dementia and affective disorders associated psychosis. It’s still unknown the real place of this psychosis.Objectivesto investigate the clinical and psychopathological features and short-terms outcomes of late-onset schizophrenia and schizophrenia-like psychosisMethods45 patients, mean age 70,6 ±8,70 years, median age of manifestation psychosis - 68 [61; 75] years with late-onset schizophrenia (n=19, 42,2%), late-onset schizoaffective disorder (n=9, 20%), late-onset delusional disorder (n=7, 15,5%) and late-onset organic schizophrenia-like disorder (n=10, 22,3%) underwent clinical examination. Psychopathological, psychometric (PANSS, HAMD, CDSS, MoCA) and statistical methods were applied.Results3 clinical groups were allocated. The 1st group included 15 patients (33%) and was characterized with severe polymorphic psychotic symptoms, included catatonic and paraphrenic signs with mental disorganization. They had the highest score of PANSS (105,46±17,99, p=0,002) and the lowest score of MoCA (14,2±2,16, p=0,05) in compare with 2nd and 3rd groups. They also had symptoms of depression (CDSS 6,28±5,29), compared with the 3rd group (HAMD 21,00±5,92, p=0,05). In short-terms outcomes was formed negative symptoms and cognitive impairment with decreasing social and daily activity. The 2nd group (22 cases, 49%) included patients with prevalence of delusions of persecution, more rare auditory hallucinations and more often acoasms. They had medium score PANSS (90,22±16,79), with minimal cognitive declare (MoCA average score 20,33±4,27). The short-term outcomes were characterized with formation of residual positive and negative symptoms, that impact on daily and social activity. The 3rd group included 8 patients (8%) with prevalence of delusion symptoms, such as misidentification, persecutory and reference delusions, which were mood-congruent. They had medium PANSS score (89,75±18,90) with more severe depressive symptoms by HAMD scale in compare with 2nd group (22,00±10,00, p=0,07) and minimal cognitive declare (MoCA average score 25,00±1,00, p=0,05) in compare with 1st group. This group was characterized with high level of reduction of productive symptoms and restoration of premorbid social and daily activity in short-term outcomes.Conclusionsfeatures of clinical characteristics, including the nature and severity of cognitive impairment at the onset of disease, are significant for prognosis and outcomes of disease. The data obtained could be served for the development of personalized therapeutic approaches that take into account the syndromic features and course of late-onset psychosis.Disclosure of InterestNone Declared

Mental disorders in internally displaced persons: clinical features, therapy, prevention

IntroductionMilitary aggression significantly worsens the mental health of the population due to losses: human, economic-financial, social-psychological, ecological. One of the negative consequences of military aggression is migration, the movement of the population within the country and outside its borders, which disrupts adaptation and leads to the formation of a wide range of psychological and mental disorders.ObjectivesTo study the state of mental health of internally displaced persons (IDPs) and to develop, on this basis, a system of therapy and prevention of mental disorders.MethodsA combination of clinical-psychopathological and psychodiagnostics methods of studying were used to identify peculiarities of the mental state and various forms of mental pathology.Results270 IDPs were examined. It was established that the group of IDPs is heterogeneous and includes 3 categories: 1 group of IDPs who do not have signs of mental disorders (conditionally healthy) (34.81%), 2 group of IDPs who have separate symptoms of mental disorders (risk group) (25.19 %) and the 3 group of IDPs with established mental disorders (40.00 %). The assessment of the general condition of the IDPs of the 1 group shows that they have various somato-neurological disorders and the absence of mental disorders. The assessment of the emotional state of the IDPs of the 2 group indicates the presence of various emotional disorders that include asthenic syndrome (41.18 ± 5.97) %, agripnic syndrome (45.59 ± 6.04) %, somato-vegetative syndrom (30.88 ± 5.60) %, anxiety-depressive syndrome (20.59 ± 4.90) %). That separate syndromеs do not meet the criteria of ICD-10 and were subthreshold. The general features of mental disorders in group 3 IDPs are characterized by the predominance of disorders of the anxiety-depressive spectrum and includes adjustment disorders (F43.2) in 35,18%; post-traumatic stress disorder (F43.1) in 17.59%; a moderate depressive episode (F32.1) in 16, 67%; organic affective (depressive) disorder (F06.3) in 14.81%; organic anxiety disorder (F06.4) in 9.28%; recurrent depressive disorder (33.1) in 6.48%.ConclusionsA system of treatment of mental disorders in IDPs has been developed, which includes pharmacotherapy (the usage of antidepressants, anxiolytics and, if necessary, antipsychotics), cognitive-behavioral and family psychotherapy. For prevention mental disorders among IDPs of groups 1 and 2, a psychoeducational program was created, aimed at forming awareness of clinical manifestations of mental disorders, opportunities to prevent their formation, and necessary actions in conditions of exacerbation of the mental state. Evaluation of the effectiveness of the developed system of therapy and psychoeducation has testified to their effectiveness.Disclosure of InterestNone Declared

Formation mechanisms of mental disorders in people living with HIV

The epidemic of Human Immunodeficiency Virus (HIV) infection affects all social groups of the population. Biopsychosocial stressors directly related to HIV infection, such as stigma, discrimination and shame, side effects of treatment, symptoms of HIV infection, and disclosure of the diagnosis influence the deterioration of mental health of people living with HIV. Stigma and discrimination can prevent the timely seeking of psychiatric help. Social stigmatization of HIV infection may affect their adherence to antiretroviral therapy. The purpose of our study was to study the formation mechanisms of mental disorders in people living with HIV. A comprehensive examination of 118 patients diagnosed with HIV infection between the ages of 22 and 61 was conducted at the Sumy Regional Clinical Medical Center for Socially Dangerous Diseases. During the examination of each patient, a psychiatric examination was carried out, anamnestic data were collected, and questionnaires were used: the Symptom Check List90-Revised psychopathological symptoms questionnaire, the Beck Depression Inventory, the State-Trait Anxiety Inventory (STAI). The examined patients were diagnosed with organic mood disorders, depressive disorders, anxiety disorders; disorders related to stress and trauma. The results of the questionnaires confirm the diversity and breadth of clinical symptoms found among those examined. 55.9% of patients had severe symptoms of psychological distress. 55.9% of the examined show symptoms of depression of varying severity. As a result of the study, the main parameters that influence the formation of mental disorders in people living with HIV were formed: socioeconomic factors, which are primarily represented by a low level of education and a fairly high level of unemployment, social isolation and the absence of family support, fear of stigmatization, the presence of harmful habits and stressful events and factors related to the detection of HIV infection. Keywords: antiretroviral therapy, depression, neuroinflammation, psychosocial factors.

Lymphocyte level and selected cognitive functions in patients with schizophrenia – preliminary results

IntroductionSchizophrenia is a mental disorder characterized by negative symptoms, such as cognitive impairment. Recent reports indicate the importance of the immune system in the pathophysiology of schizophrenia. The development of inflammation affects cognitive functioning.ObjectivesThe aim of the study was to analyze the association between the level of lymphocytes in venous blood and selected cognitive functions in patients with schizophrenia.MethodsLymphocyte levels were determined in the venous blood of patients suffering from schizophrenia and the control group. Additionally, a verbal fluency test (VFT) and a Stroop test were conducted on the same day. The VFT evaluates the ability to express words, and the Stroop test assesses verbal working memory. The inclusion criteria were age up to fifty years, and for the study group – diagnosis of schizophrenia and treatment with neuroleptics. Exclusion criteria included organic brain diseases, electroconvulsive therapy, and use of benzodiazepines within 48 hours before the study. Currently, six patients and six healthy people have been studied.Results Patients diagnosed with schizophrenia have an increased lymphocyte concentration in the blood compared to healthy individuals constituting the control group. There are discrepancies in the results of the phonemic fluency test, no significant differences were found between schizophrenics and the control group. Healthy men and women achieved higher results in the semantic fluency test compared to men and women with schizophrenia. Women constituting the control group achieved higher results in the Stroop test compared to women suffering from schizophrenia. Table 1 illustrates the concentration of lymphocytes in venous blood and the number of points in the phonemic fluency test, semantic fluency test, and in the Stroop test of the study and the control groups.Image:Conclusions Patients with schizophrenia are characterized by higher levels of immune system parameters and worse results in terms of semantic fluency. Men with schizophrenia showed no verbal working memory deficits. In turn, women with schizophrenia obtained worse results in the verbal working memory test. In conclusion, there is evidence of immune system activation in schizophrenia, which affects the cognitive functioning of patients.Disclosure of InterestNone Declared

Psychosomatic Rehabilitation for Post-COVID

Aim of the study Post-COVID is characterized by a large number of different symptoms. The indication for medical rehabilitation is based on the main symptom. Insured individuals who suffer from fatigue and have no relevant organic disorder are often rehabilitated in psychosomatic clinics. In the present study, the effectiveness of psychosomatic rehabilitation in patients with post-COVID will be investigated. Methods 91 patients with post-COVID are compared to 124 patients with mental disorders and 68 patients with cancer regarding the improvement of fatigue and depressiveness as well as satisfaction and socio-medical parameters. Results At admission, the level of fatigue did not differ in the three groups and was equally reduced. Patients with post-COVID and high depression scores at admission had clinically significant levels of fatigue at discharge. The proportion of patients with mental disorders who were discharged with a negative prognosis for employment was significantly increased. Discussion Although psychosomatic rehabilitation can reduce fatigue, the proportion of patients suffering from fatigue with post-COVID at discharge is still high. Conclusion The treatment concept for the rehabilitation of patients with post-COVID must take into account the often individual course of the disease. Psychosomatic rehabilitation can make an important contribution here.

Suspicion of autoimmune limbic encephalitis in post COVID-19 vaccine

Background: Empirical studies have so far demonstrated associations between COVID-19 and psychiatric manifestations. Research is still ongoing to know more about this novel virus responsible for the COVID-19 Infection. Several strains of the COVID-19 Vaccines were developed at the peak of the pandemic to combat this great challenge to human health and life with each vaccine having its own unique characteristics. It is established that autoimmune reactions could occur following vaccinations or viral infections. This case is presented to point attention toward the possibility of psychiatric symptoms arising as post-COVID-19 Vaccine autoimmune-related reactions. Case presentation: A Nigerian woman in her 50s with 1st episode of psychiatric disorder is reported here. She was mentally stable until day 2 of receiving the 2nd dose of the Astra Zeneca COVID-19 vaccine. She developed symptoms with a similar profile with a diagnosis of mania with psychotic symptoms, with a differential diagnosis of an organic psychotic disorder. All symptoms resolved within 2 weeks of commencement of treatment. In addition, there was a preceding history of a mild fever and cough following the second dose of the COVID-19 vaccine which spontaneously resolved giving way to the psychiatric symptoms manifestations. All these raise the index of suspicion that there could have been an autoimmune limbic encephalitis precipitated by the COVID-19 Vaccine administration. Important discussion points: The coincidence of 1st episode of Bipolar affective symptoms at the mid-life stage, preceded by 2 days of COVID-19 vaccine and genetic predisposition in the reported case calls for attention. Studies have shown that the COVID-19 vaccine may induce autoimmune conditions such as myocarditis, thrombotic thrombocytopenia, and IgA vasculitis. These reactions are commoner in middle-aged Females. Susceptibility to these reactions has a strong association with genetic predisposition and the limbic region of the brain that controls human emotions is a highly susceptible area. Thus, the COVID-19 vaccine autoimmune response may be an epiphenomenon in an individual with a likely risk of mental illness. Conclusion: This report could represent a rare occurrence. Also, the absence of needed investigative results caused by financial and logistic constraints could hamper making the obvious conclusions of a temporal relationship between the COVID-19 vaccine and post-vaccination affective disturbance. It is however worthy of note that this is an important study area to look into for future research work.

Steroid-induced mania in a patient with previously well-controlled organic bipolar 1-like affective disorder secondary to acquired brain injury: case report and literature review

Steroid-induced neuropsychiatric sequelae are common, and pose significant risks to people usually receiving glucocorticoids in the context of physical illness. Steroid-induced mania and hypomania are the most common of the acute complications, yet despite great progress in understandings in neurophysiology there are no recent studies which review the factors which might predict who will experience this severe complication, nor are there consensus guidelines on management. We report the unusual case of a woman in her 50s admitted to a psychiatric unit with steroid-induced mania despite compliance with two mood stabilisers, several days after the administration of a Dexamethasone and Docetaxel chemotherapy regime adjunctive to lumpectomy for breast cancer. She had previously been diagnosed with an organic affective disorder (with classical bipolar 1 pattern) following severe ventriculitis related to ventricular drain insertion for obstructive hydrocephalus secondary to a colloid cyst. She had no psychiatric illness before this brain injury, but has a maternal history of idiopathic bipolar 1 affective disorder. Her episode of steroid-induced mania resolved following use of sedative medications, continuation of her existing mood stabilisers, and reductions of the steroid dosing in collaboration with her oncology team, which also protected her from further manic relapses during continued chemotherapy. Established mental illness, a family history, and acquired brain injury may reflect risk factors for steroid-induced mania through currently unclear pathways. Future epidemiological studies could better confirm these observations, and basic neuroscience may look to further explore the role of extrinsic glucocorticoids in the pathophysiology of affective disorders.

(115) Utility of Thermography as a Screening Tool for Erectile Disorder

Abstract Introduction Ultrasonography remains the gold standard for the evaluation of penile vasculature in men with erectile disorder. Despite its value, ultrasound assessment can be costly for patients, and requires an intracavernosal injection prior to imaging. With estimates of psychogenic ED being up to 40% or more in clinical populations, a less invasive method of quantifying penile vascular response would be beneficial in directing patients for further assessment and treatment. One such method that has potential is thermography as it requires no genital contact, can indirectly measure blood flow through temperature change, and has been validated in self-reported clinical non-clinical populations for the measurement of sexual response. Objective To determine whether thermography could be used to differentiate psychogenic from organic erectile disorder by comparing thermography to penile doppler ultrasound in men being assessed for erectile disorder. Methods 81 patients (m age = 43 years) recruited through a hospital Urology clinic completed penile vascular assessment across two different sessions: 1) thermographic measurement during a 15-minute baseline neutral and 15-minute sexually explicit film; 2) standard penile ultrasound assessment with an ICI of Prostaglandin E1. Demographic and sexual functioning questionnaires were completed, and urologist diagnosis following ultrasound assessment was used to classify patients as having psychogenic or organic ED. Results 45 patients had PSV values consistent with organic ED, while 36 patients were classified into the psychogenic ED group. Men with organic ED were significantly older than those in the psychogenic ED group (p < .05), and more likely to have concurrent health conditions (p < .05). A Repeated Measures ANOVA on temperature change measured through thermal imaging demonstrated that men with psychogenic ED had significantly greater penile temperature (m = 32.45°C, SD = 1.34) during sexual arousal than those with organic ED (m = 31.73°C, SD = 1.34; p <. 05), and also had a significantly (p < .01) stronger correlation between their self-reported and physical sexual response during thermographic assessment (psychogenic ED mean r =.49; organic ED mean r = .27). Furthermore, a hierarchical cluster analysis of thermography measures grouped patients into three distinct categories (high, medium and low temperature change), with significantly more of the psychogenic ED group being classified into the highest temperature cluster (82%). The medium and low temperature clusters were less sensitive at differentiating organic and psychogenic ED. Conclusions Thermography could provide a less costly and less invasive way to screen out patients presenting with ED who have a high degree of temperature change during sexual response. While thermography has been shown to differentiate between self-reported and clinical populations, this is the first evaluation of this instrument as a tool to differentiate within ED diagnostic groups. Although men with psychogenic ED were more likely to be classified in the highest temperature change cluster, thermography was less sensitive at differentiating organic and psychogenic ED in the middle and lower temperature groupings. Further research with larger samples would be beneficial in exploring potential clinical cutoffs for penile temperature change. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Dare Biosciences, Initiator Pharma.

The etiology, diagnostics, and treatment of the spasm of the near reflex - a narrative review.

Physiological adaptation of the eye to the visual perception of near objects consists of the "near triad": convergence, accommodation, and pupil miosis. Normally, these tend to revert when one stops fixating on a near object. Spasm of the near reflex (SNR) is a pathological phenomenon, which manifests itself by the persistence of the above-mentioned adjustments, which prevents the eye from returning to its relaxed state. In this narrative review, we aim to summarize the etiology, diagnostics, treatment, and prevention of SNR. The literature review was performed by searching online databases. The clinical presentation of SNR is diverse; it presents as isolated accommodative spasm more frequently than impairment of all three components of the near triad. Patients usually present with fluctuations in visual acuity, blurred vision, diplopia, and asthenopia. The etiology is not fully understood. Potential causes include neuroanatomic, organic, and psychogenic disorders. The diagnosis is clinical, based on the constellation of symptoms and assessment of the near triad. The diagnostic golden standard is a cycloplegic examination of refraction, preferably using cyclopentolate hydrochloride (1%, 0.5%, or 0.1% solution). The first-line treatment requires the administration of a cycloplegic drug in combination with plus lenses, flipper lenses, optical fogging, or miotics. For secondary cases, causal treatment should be implemented. Prevention of SNR should be based on eliminating modifiable risk factors. We propose including screening for SNR symptoms in every ophthalmic examination, especially among patients with psychogenic or neural disorders, after brain trauma, or young adults spending much time in front of computer screens.

Factors associated with involuntary mental healthcare in New South Wales, Australia.

There is uncertainty about factors associated with involuntary in-patient psychiatric care. Understanding these factors would help in reducing coercion in psychiatry. To explore variables associated with involuntary care in the largest database of involuntary admissions published. We identified 166 102 public mental health hospital admissions over 5 years in New South Wales, Australia. Demographic, clinical and episode-of-care variables were examined in an exploratory, multivariable logistic regression. A total of 54% of eligible admissions included involuntary care. The strongest associations with involuntary care were referral from the legal system (odds ratio 4.98, 95% CI 4.61-5.38), and psychosis (odds ratio 4.48, 95% CI 4.31-4.64) or organic mental disorder (odds ratio 4.40, 95% CI 3.85-5.03). There were moderately strong associations between involuntary treatment and substance use disorder (odds ratio 2.68, 95% CI 2.56-2.81) or affective disorder (odds ratio 2.06, 95% CI 1.99-2.14); comorbid cannabis and amphetamine use disorders (odds ratio 1.65, 95% CI 1.57-1.74); unmarried status (odds ratio 1.62, 95% CI 1.49-1.76) and being born in Asia (odds ratio 1.42, 95% CI 1.35-1.50), Africa or the Middle East (odds ratio 1.32, 95% CI 1.24-1.40). Involuntary care was less likely for people aged >75 years (odds ratio 0.68, 95% CI 0.62-0.74), with comorbid personality disorder (odds ratio 0.90, 95% CI 0.87-0.94) or with private health insurance (odds ratio 0.89, 95% CI 0.86-0.93). This research strengthens the evidence linking diagnostic, socioeconomic and cultural factors to involuntary treatment. Targeted interventions are needed to reduce involuntary admissions in disadvantaged groups.

Impact of non-participation bias due to psychiatric illness on mortality and cardiovascular event estimates: a Danish longitudinal population study

ObjectivesThe impact of non-participation due to psychiatric illness on study outcomes in general population studies is insufficiently investigated. Here, we investigate the mental health bias in a population study and...

Синдром функциональной абдоминальной боли: обзор литературы

ABSTRACT INTRODUCTION. About 40–60% of adult patients with complaints of abdominal pain suffer from functional gastrointestinal disorders. Currently, functional disorders of the gastrointestinal tract are associated with disturbances in the gut-brain interaction. Abdominal pain syndrome can be one of the leading manifestations of irritable bowel syndrome, functional dyspepsia syndrome and abdominal migraine. The exclusion of organic disorders of the gastrointestinal tract is an essential condition for the diagnosis of functional disorders. The basic principles of the treatment of functional abdominal pain syndrome should be aimed at correcting the psychological disorders involved in the formation of pain sensation. MATERIAL AND METHODS. A review of the literature on this topic was conducted in the following databases: PubMed, Research Gate, Elsevier. The following phrases were used to search for literature: “Functional abdominal pain syndrome”, “Disorders of the gastrointestinal tract”. DISCUSSION. Functional abdominal pain syndrome is a rather complex and ambiguous disease, which is based on complex cerebroabdominal connections (direct and reverse). This diagnosis is an exception, in other words, the diagnosis takes place when there are no obvious organic causes of the disease. The diagnosis of the functional abdominal pain syndrome is long and complex and includes various instrumental and laboratory methods of examination. Various methods are used in the treatment of the functional abdominal pain syndrome, ranging from non-drug methods (cognitive behavioral therapy, hypnotherapy) and ending with the use of medicines (antidepressants). It is important to keep in mind that the diagnosis and treatment of the functional abdominal pain syndrome requires the active participation of doctors of different specialties who are able to build a personalized diagnostic and therapeutic route using a biopsychosociocultural approach. CONCLUSION. Functional abdominal pain syndrome attracts special attention in the diagnostic and therapeutic aspect. Although the exclusion of organic diseases is an essential condition for the diagnosis of the functional abdominal pain syndrome, it is necessary to take into account the connection and involvement of mental factors in the phenomenon of abdominal pain. Taking into account the complexity of the mechanisms involved in the development of functional gastrointestinal diseases, the basic principles of functional abdominal pain syndrome treatment should be aimed at correcting psychological disorders involved in the formation of pain sensation. KEYWORDS: functional abdominal pain syndrome, disturbances in the gut-brain interaction, interaction

Drawing the abdominal pain: A powerful tool to distinguish between organic and functional abdominal pain.

Abdominal pain (AP) in children imposes a large economic burden on the healthcare system. Currently, there are no reliable diagnostic tools to differentiate between organic and functional disorders. We hypothesized from previous research that the analysis of patients' graphic expression of subjective symptoms as well as their interactional behavior adds new ways to differentiate between functional and organic AP. Conversation analyses of physician-patient-encounters and graphical expression of AP-based pain were performed. Twenty-twointeractions were recorded and analyzed. Fifteenchildren were diagnosed with organic AP and seven with functional AP. We found marked differences between children with organic and functional AP. For example, all 15 children with organic AP saw the task of drawing a picture of the pain during the interview as a duty, whereas the seven children with functional AP took this as an opportunity to provide detailed descriptions about the nature of the pain, the circumstances, and how the AP impaired their quality of life. Analysis of patients' interaction strategies in response to the painting task provides relevant clues as to whether AP is functional or requires further workup for organic causes.

Processus de maternité et fonctionnement limite : une approche longitudinale à l’aide du Rorschach

ObjectivesThis article aims to study the psychic changes during maternity in primiparous women without psychic and organic disorders and to put into perspective the reorganizations during the maternity process in patients with a borderline psychic functioning. MethodThis paper is based on longitudinal data collected with the Rorschach test. Two clinical cases revealing this processual dynamic will be analyzed and discussed. ResultsThe analysis of Rorschach protocols of two women with different psychic elaboration capacities reveals an experience of boundary invasions linked to the precariousness of psychic envelopes between the end of pregnancy and the beginning of postpartum, followed by a reinforcement of certain defensive mechanisms post-delivery in order to compensate for the state of disorganization linked to the processes of motherhood. DiscussionThe analysis of these data will allow us to observe modalities of psychic arrangements specific to the maternity process as well as reorganizations, close to a “symbolization catastrophe”. ConclusionThe psychic dispositions of women during maternity allow us to detect borderline arrangements of psychic functioning during this period.

Associations between COVID-19 vaccination and incident psychiatric disorders after breakthrough SARS-CoV-2 infection: The VENUS Study

BackgroundThe associations between COVID-19 vaccination and post-COVID psychiatric disorders are unclear. Furthermore, it is uncertain if these associations differ depending on the dominant SARS-CoV-2 variant at the time of infection. This retrospective cohort study aimed to clarify the associations between COVID-19 vaccination and incident psychiatric disorders after breakthrough infection according to the different variant periods in Japan. MethodsMedical claims data, COVID-19 case-related information, and vaccination records were collected from three Japanese municipalities. The study population comprised public insurance enrollees aged ≥65 years who developed COVID-19 between June 2021 and December 2022. The study exposure was each participant’s vaccination status 14 days before infection, and the outcomes were the occurrence of psychiatric disorders within three months of infection. Multivariable logistic regression analyses were performed to calculate the odds ratios (ORs) and 95 % confidence intervals (CIs) of vaccination for the occurrence of psychiatric disorders. Analyses were conducted for the Delta period (June to December 2021), Omicron BA.1/BA.2 period (January to June 2022), and Omicron BA.5 period (July to December 2022). ResultsWe analyzed 270 participants (vaccinated: 149) in the Delta period, 2,963 participants (vaccinated: 2,699) in the Omicron BA.1/BA.2 period, and 7,723 participants (vaccinated: 7,159) in the Omicron BA.5 period. During the Delta period, vaccinated participants had significantly lower odds for psychotic disorders (OR: 0.23, 95 % CI: 0.06–0.88, P = 0.032) than unvaccinated participants. During the Omicron BA.5 period, vaccinated participants had significantly lower odds for organic mental disorders (OR: 0.54, 95 % CI: 0.30–0.95, P = 0.033), psychotic disorders (OR: 0.31, 95 % CI: 0.19–0.53, P < 0.001), mood disorders (OR: 0.53, 95 % CI: 0.29–0.99, P = 0.046), and insomnia (OR: 0.48, 95 % CI: 0.32–0.72, P < 0.001) than unvaccinated participants. There were no significant differences in psychiatric disorders between the vaccinated and unvaccinated groups during the Omicron BA.1/BA.2 period. ConclusionsThis is the first study to demonstrate that the associations between COVID-19 vaccination and post-COVID psychiatric disorders vary among the different variant periods. Future studies on these associations should be conducted with consideration to the prevalent circulating variants.

Validity, reliability and reproducibility of the VLS parameters form for the collection of videolaryngostroboscopic basic findings.

The videolaryngostroboscopy parameters form (VLSP form) is a diagnostic tool for the collection of videolaryngostroboscopic basic findings through the evaluation of 12 parameters. The aim of the present study is to preliminarily investigate intra- and inter-rater reliability, validity and responsiveness of the VLSP form. A study on a total amount of 160 forms for the evaluation of VLS basic findings was carried out. 80 forms were scored through the VLSP form and 80 with the Voice Vibratory Assessment with Laryngeal Imaging (VALI) form Stroboscopy (S) by four expert phoniatricians, that blindly scored the VLS recordings of 5 subjects without voice disorders and 5 patients with organic voice disorder before and after successful phonosurgery. Intra-rater and inter-rater analysis have been performed for both forms. The scores obtained through VLSP form and VALI form S have been compared to analyse concurrent validity, while VLSP scores before and after phonosurgery have been compared to analyse responsiveness. Finally, each rater annotated the "difficulty" in rating every parameter and its "importance" for the diagnosis. The VLSP form showed good inter- and intra-rater reliability. It showed a good accuracy for the documentation of changes of laryngeal anatomy and function after phonosurgery, similarly to the VALI form S. The 12 parameters of the VLSP form were judged "Slightly Important" in 28.3% of the samples, "Very Important" in 64.8% of the samples, "Not Difficult" in 73.1% of the samples. The results of the present study suggest that the VLSP form is comparable to the VALI form S for the evaluation of videolaryngostroboscopic parameters and is a valid, reliable and reproducible diagnostic tool. It can help voice clinicians in the evaluation of VLS examinations and it allows for a punctual assessment of modifications in laryngeal anatomy and function in pathological conditions and after phonosurgery.

Behavioral physical activity counselling to promote an active healthy lifestyle among adolescent psychiatric outpatients. The TRANSPAC-study

Introduction&#x0D; Mental health disorders are one of the main reasons for disability in adolescents worldwide (Dahl et al., 2018). Sleep disturbances are an important contributor to a vicious cycle of increased vulnerability during this developmental period. Interventions that improve sleep are suggested to improve psychosocial outcomes. One such intervention may be physical activity (PA), with a beneficial effect on both sleep and mental health. Yet, PA levels are declining during adolescent years, with even higher inactivity levels for individuals with psychiatric disorders. Guidance on how to address PA counselling (PAC) among psychiatric adolescents in routine clinical practice has the potential to improve clinical and psychosocial outcomes.&#x0D; Methods&#x0D; During this ongoing randomized waitlist controlled trial, 18 adolescent psychiatric outpatients have been recruited from local clinics and private practices. Those who met inclusion criteria were aged 12 to 18 years, suffered from sleep problems, and had at least one additional mental health diagnosis. Exclusion criteria included organic sleep and brain disorders and changes in medication. At baseline, participants completed questionnaires related to sleep and psychopathology. For the next seven days, participants wore an Actigraph to track PA and sleep patterns. Participants were serially randomized into two groups after baseline: PAC or Treatment as usual (TAU). At 3-month follow-up, all tests were repeated. Additionally, a semi structured interview was conducted with intervention participants. To assess intervention effects, mixed model ANOVAs were conducted for PA, psychopathology, and composite sleep health.&#x0D; The 6-session intervention builds on previous standardized and theory-based PAC programs (Gerber et al., 2019).&#x0D; Results&#x0D; By 2023, follow-up data were available from 12 participants (Mage 15.33 yrs; 75% females). Preliminary data show a significant trend for increased PA on school days, and composite sleep health (p = .07). Yet, compliance of Actigraph wear time was low. No changes were observed for psychopathology. The post-intervention interview revealed positive experiences.&#x0D; Discussion/Conclusion&#x0D; The preliminary data show the feasibility of the intervention. It is likely that improvements in PA and sleep patterns must first stabilize before they can have a meaningful impact on psychopathology. However, more data is needed to confirm the results. The interviews revealed that the content and mode of delivery were generally accepted. Considering the many other obligations adolescents face in their everyday lives, including homework and psychotherapy, the combination of online and face-to-face sessions was well received. Because of the low compliance rate of Actigraph wear time, alternative devices should be considered for this population.&#x0D; References&#x0D; Dahl, R. E., Allen, N. B., Wilbrecht, L., &amp; Suleiman, A. B. (2018). Importance of investing in adolescence from a developmental science perspective. Nature, 554(7693), 441–450. https://doi.org/10.1038/nature25770&#x0D; Gerber, M., Beck, J., Brand, S., Cody, R., Donath, L., Eckert, A., Faude, O., Fischer, X., Hatzinger, M., Holsboer-Trachsler, E., Imboden, C., Lang, U., Mans, S., Mikoteit, T., Oswald, A., Pühse, U., Rey, S., Schreiner, A. K., Schweinfurth, N., … Zahner, L. (2019). The impact of lifestyle physical activity counselling in IN-PATients with major depressive disorders on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers: Study protocol for a randomized controlled trial. Trials, 20(1), 1–21. https://doi.org/10.1186/s13063-019-3468-3

Feasibility of a breath robot intervention to reduce sleep problems in posttraumatic stress disorder: protocol for a randomized controlled study

BackgroundMany patients with posttraumatic stress disorder (PTSD) suffer from sleep problems. Robot-based interventions might be an innovative approach to reduce sleep problems and hyperarousal in PTSD. However, the feasibility and effectiveness of a breath robot in patients with PTSD have never been empirically tested. The aim of this study is to investigate the feasibility of a breath robot to reduce sleep problems and hyperarousal in patients with PTSD.MethodsThis randomized controlled feasibility study will include N = 30 adult patients with at least subsyndromal PTSD (PTSD Symptom Scale – Interview-5 (PSSI-5)) according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and impaired sleep quality (Pittsburgh Sleep Quality Index (PSQI) > 5). Patients with organic sleep disorders or currently in psychotherapeutic treatment are excluded. Study participants are randomized to receive either a 4-week Somnox 2 robot intervention including simulation of human breath or a 4-week Somnox 2 robot intervention without human breath simulation. The primary outcome will be the proportion of randomized participants providing outcome data at post-treatment. We consider a proportion of > 50% to indicate feasibility. Additional feasibility outcomes include eligibility rate, recruitment speed, uptake, retention, treatment adherence, and dropout. Potential outcomes of effectiveness (sleep quality, PSQI; severity of PTSD symptoms, PSSI-5) will be assessed at two time points, before (T0) and after (T1) the intervention. Sleep characteristics (Consensus Sleep Diary (CSD)) are measured daily.DiscussionThis study is the first to investigate the feasibility of a novel breath robot intervention for reducing sleep problems and hyperarousal in PTSD patients, with effectiveness considered as a secondary outcome. If feasible and effective, the use of a breath robot could be a nonintrusive and flexible intervention to supplement psychotherapy or to bridge treatment gaps.Trial registrationDRKS, DRKS00031063. Registered on 10/012023.

Worldwide population prevalence and impact of sub-diagnostic gastrointestinal symptoms.

The Rome Foundation Global Epidemiology Study (RFGES) found that 40.3% of adults in 26 internet-surveyed countries met Rome IV criteria for disorders of gut-brain interaction (DGBI). However, additional people not meeting DGBI criteria may also be burdened by frequent gastrointestinal symptoms. To explore the prevalence and demographic distribution of sub-diagnostic gastrointestinal symptoms, and the hypothesised associated effects on quality of life (QoL), life functioning and healthcare needs. We analysed data from the RFGES survey, which included the Rome IV diagnostic questionnaire and QoL, psychological, work productivity and healthcare questions. Of the 50,033 people without a history of organic gastrointestinal disorders, 25.3% classified in the sub-diagnostic group (no DGBI but one or more frequent gastrointestinal symptoms), 41.4% had DGBI and 33.4% had no frequent gastrointestinal symptoms (non-GI group). Sub-diagnostic prevalence in different world regions ranged from 22.2% (North America) to 30.5% (Middle East), was slightly higher among males than females and decreased with age. The sub-diagnostic group was intermediate between the non-GI and DGBI groups, and significantly different from both of them on QoL, anxiety, depression, somatisation, healthcare utilisation and life and work impairment. One in four adults without organic gastrointestinal disorders or DGBI report frequent gastrointestinal symptoms. This sub-diagnostic group has reduced QoL, greater psychological and non-GI bodily symptoms, impaired work productivity and life activities and greater healthcare use compared to non-GI individuals. This suggests that many in this sub-diagnostic group might benefit from healthcare services or symptom self-management advice.