Peak Age Of Onset Research Articles

Creative art therapies in the treatment of adolescents with eating disorders: An integrative review and thematic network analysis

Eating disorders, prevalent mental health conditions, affect between 0.1 % and 3.8 % of the general population and 1.1 % of adolescents in Europe. Evidence suggests that the peak age of onset is 15.5 years. The recent and ongoing integration of creative art therapies into clinical settings suggest mental health benefits, and their application has been extended to different disorders and populations including eating disorders. However, there is a paucity of research focusing specifically on adolescents. Therefore, the present integrative review identified and summarized research conducted with creative art therapies in the treatment of adolescents diagnosed with an eating disorder. Additionally, a thematic network analysis facilitated the identification and mapping of relevant clinical themes. A database search in English and German, conducted according to the PRISMA 2020 guidelines, resulted in the selection of ten articles. A thematic network analysis of both qualitative (n = 7) and quantitative (n = 3) studies, allowed the extraction of six global themes: identity, relationships, empowerment, hope, re-signify and defence. Themes were explored and described individually and intertwined. Results suggested consistency of creative art therapies interventions with other psychotherapeutic approaches for the treatment of eating disorders. Furthermore, their apparent developmental appropriateness for the adolescent population and the potential for strengthening the therapeutic process were highlighted.

Ruptured Peripheral Cerebral Aneurysms Associated With Moyamoya Disease: A Systematic Review.

A ruptured peripheral cerebral aneurysm (PPCA) associated with moyamoya disease (MMD) is a rare but potentially life-threatening condition with controversial management strategies. We aim to summarize the clinical characteristics, treatment strategies, and prognostic factors of PPCAs in MMD. We reviewed studies published in PubMed between 1980 and 2023 and used logistic regression analysis to identify the risk factors for adverse outcomes. Of 425 identified studies, 48 eligible studies involving 121 participants were included in the current study. The mean age at diagnosis was 40.8±15.1 years, with a peak age of onset between 41 and 50 years. Among the identified participants, 59.6% were female, and 55.9% presented with impaired consciousness. Aneurysms were present in the posterior (35.5%) or anterior (30.6%) choroidal arteries in 66.1% of the cases, and 71.1% of the patients presented with intraventricular hemorrhage (IVH) with or without intracerebral hematoma (ICH). The treatment strategies were embolization (28.9%), direct surgery (21.5%), revascularization (22.3%), and conservation (27.3%). Favorable outcomes were achieved in 86.8% of all cases, with 97.1% for embolization, 65.4% for direct surgery, 96.3% for revascularization, and 84.8% for conservative treatment. Aneurysm rebleeding occurred in 11 (26.8%) of 41 patients managed conservatively, leading to worse outcomes in 7 patients (63.6%). Impaired consciousness (odds ratio [OR], 8.61; 95% confidence interval [CI], 2.06-36.00) and aneurysm rebleeding (OR, 16.54; 95% CI, 3.08-88.90) independently predicted poor outcomes. PPCA should be considered in patients with hemorrhagic MMD, particularly those with IVH with or without ICH. Endovascular and bypass treatments are recommended as first-line options, with direct open surgery as an alternative in urgent hematoma evacuation cases. Detailed preoperative planning and intraoperative technical assistance are necessary to reduce procedure-related complications. Conservative management should be selected with caution because of the high risk of rebleeding and poor outcomes. Impaired consciousness and aneurysm rebleeding appeared to be independent risk factors for adverse prognoses. We emphasize that treatment selection should be personalized, and the potential benefits should be weighed against the associated risks.

Impact of Bacille Calmette-Guérin vaccination on the therapeutic schedule of infantile epileptic spasms syndrome: A 25-year Japanese single-center survey

Adrenocorticotropic hormone (ACTH) therapy is effective for infantile epileptic spasms syndrome (IESS) but can induce immunosuppression. In Japan, Bacille Calmette-Guérin (BCG) vaccination, modified in 2013 to reduce osteitis/osteomyelitis risk, coincides with the peak onset age of IESS. This raises concerns about infection risks when administering ACTH therapy post-vaccination. To evaluate the impact of BCG vaccination timing on treatment decisions, we retrospectively reviewed the medical records of 86 IESS patients at our hospital (1996–2020). Infants who received ACTH therapy within eight weeks of BCG vaccination experienced no serious adverse events. Four patients deferred or opted out of ACTH therapy, with seizure remission taking 2–15 weeks. The overlap between IESS onset and BCG vaccination period presents clinical challenges in determining the appropriate timing for ACTH therapy. Further epidemiological and immunological research is needed to clarify the relationship between ACTH therapy and BCG-associated adverse events and to optimize treatment strategies and vaccination schedules.

Review of Generalized Pustular Psoriasis: Prevalence, Diagnosis, and Treatment Options

Background: Generalized pustular psoriasis (GPP) is a diagnostic challenge for clinicians and is relatively rare. Prevalence is currently reported to be higher in Asian countries and among female patients; peak age of onset is variable across studies. Objective: This article provides clinicians with an overview of the global prevalence of GPP, common clinical presentation and diagnostic criteria, pathogenesis, and evolving treatment options. Discussion: Clinical presentation is characterized by onset of generalized sterile pustules with erythema, and may include systemic inflammatory signs including fever and lab abnormalities. Diagnostic criteria vary globally. European Rare and Severe Psoriasis Expert Network (ERASPEN) criteria present a clinical diagnosis while Japanese criteria include a biopsy. Advancements in understanding of pathogenesis have uncovered the role of IL-36 as a driver of disease, and this is the target of new treatments including spesolimab, an anti-IL-36 receptor antibody.

Innovation in Breast Cancer Treatment and it's Potential in Pakistan.

Breast cancer is the second most common cancer globally, following lung cancer. It is a major health concern affecting both men and women, although it is more commonly diagnosed in women. Breast cancer is responsible for a significant number of cancer-related deaths worldwide, as it ranks fifth globally. Breast cancer surpasses all other types of cancer in its worldwide impact, and the occurrence of breast cancer is on the rise.1 Breast cancer can be divided into histological subtypes depending on the appearance of the cells under the microscope. The most common types include invasive ductal carcinoma, invasive lobular carcinoma, and ductal carcinoma in situ. A study conducted in 20222 highlighted the novel approach to inhibit PI3K/AKT pathway using a highly potent oral inhibitor Capivasertib. In preclinical trials it has shown promising outcomes by suppressing tumor growth and reducing the phosphorylation of biomarkers such as PRAS40, GSK3b, and S6. Furthermore, phase I/II trials that evaluated the used of capivasertib along with other antineoplastic agents such as paclitaxel, fulvestrant or Olaparib showed enhanced efficacy with manageable side effects as the toxicity profile was within the acceptable range. Another trial also demonstrated clinically significant activity of capivasertib in rare cancers such as AKT1 E17K-mutated tumor.3 Research conducted in Karachi indicates a notable increase in the prevalence of breast cancer across women of various age groups. Furthermore, the study anticipates a continued upward trend in the coming years.4 The study observed not only a rise in the age-specific incidence rate among Pakistani women but also forecasted a sustained elevation in the peak age of onset, particularly in post-menopausal women. A substantial concern for Pakistan is reflected in the fact that breast cancer constitutes 28.7% of newly diagnosed cancer cases in women, highlighting the gravity of this health issue.5 Researchers have made great strides in the treatment of many types of breast cancer, but the battle continues many fronts. However, the success of several biological drugs such as Capivasertib in treatment of people with a specific tumor promises the potential targeted treatments in the most vulnerable of regions such as Pakistan.

Psychotic experiences in university students: prevalence, correlates and association with non-specific psychological distress

Introduction Subclinical psychotic experiences (PEs) are far more prevalent than psychotic disorders, with an estimated prevalence of 7.2% (Linscott & Van Os. Psychol Med 2013;43(6) 1133-1149). PEs are particularly prevalent in late adolescence and young adulthood, when obtaining academic education is one of the main developmental tasks. University students are at the peak age of onset of mental disorders, and often experience high levels of social and academic stress that may contribute to the onset of psychopathology. Hence, estimating the prevalence and correlates of PEs among university students is particularly important.ObjectivesTo estimate the prevalence of PEs in a sample of Israeli students; assess whether rates of PEs differ by selected sociodemographic characteristics; and examine the association between PEs and non-specific psychological distress.Methods150 students from universities and colleges in Israel participated in a cross-sectional online survey. All students were over the age of 18 and were not diagnosed with psychotic disorders. Participants completed self-report questionnaires, including the Prodromal Questionnaire - Brief Version (PQ-B), Kessler Psychological Distress Scale (K10) and sociodemographic details. The PQ-B yields a score for the total number of items endorsed (range 0–21), and a total distress score (range 0–105). A cutoff of ≥8 distressing symptoms was used to identify participants at high-risk for psychosis.Results 21 participants (14.0%) reported 8 or more distressing PEs. PEs were more common in males and among those with a psychiatric illness (Table 1). PEs were not associated with marital status, religiosity, or immigrant status. While a greater number of PEs was positively associated with non-specific psychological distress (r=0.589, p<.001), there was no association between distress caused by PEs and non-specific psychological distress (r=0.145, NS). Table 1.Sociodemographic characteristics by groupPEs-PEs+X2, pSexM29.5%52.4%4.32, .038F70.5%47.6%Marital StatusMarried17.1%23.8%0.56, NSUnmarried82.9%76.2%ImmigrantNo89.9%85.7%0.34, NSYes10.1%14.3%ReligiositySecular74.4%57.1%2.67, NSOther25.6%42.9% PsychiatricillnessNo87.6%61.9%8.87, .003Yes12.4%38.1%ConclusionsThe findings confirm that self-reported PEs are much more prevalent than clinically diagnosed psychotic disorders, particularly among young adults. As PEs were found to be associated with non-specific psychological distress, and as they are known forerunners for severe mental disorders, it is important to address mental health issues in school settings and promote prevention and early intervention programs.Disclosure of InterestNone Declared

Diagnostic conversion to bipolar disorder among adolescents and young adults with major depressive disorder: a nationwide longitudinal study.

Although several studies have examined a diagnostic conversion from major depressive disorder (MDD) to bipolar disorder (BD), only a few studies specifically focused on adolescents and young adults who are at the peak ages of BD onset. Data from participants (N = 130,793) aged 10-29years who were diagnosed with MDD were extracted from the Taiwan National Health Insurance Research Database. We applied demographic analyses, survival analysis, Aalen Johansen curves, and Cox regression, investigating the diagnostic conversion rate and factors that were most or less predictive of conversion. Among the adolescents and young adults with MDD, the number of participant conversion subsample is 14,187 and the conversion rate was 13.80% (95% confidence interval: 13.54-14.06%) during the 11-year follow-up. The conversion rate was highest in the first year (4.50%; 4.39-4.61%) and decreased over time. The significant predictors were younger age of diagnosis with MDD (p < 0.001), moderate and high antidepressant resistance (p < 0.001), obesity (p < 0.001), psychiatric comorbidities (attention-deficit/hyperactivity disorder, substance use disorder, and cluster B and C personality disorder, all p < 0.001), a family history of mental disorders (schizophrenia and mood disorders, all p < 0.05), lower monthly income (p < 0.001), and more mental health visits to the clinic each year (p < 0.001). A composite of demographic characteristics, antidepressant resistance, physical and psychiatric comorbidities, and family history significantly predicted diagnostic conversion from MDD to BD (area under the curve = 0.795, p < 0.001). Compared to adult population, the adolescents and young adults had different factors that were most or less predictive of conversion, which warrants further investigation.

Therapeutic Efficacy of Cold Pressed Virgin Coconut Oil an Adjuvant to Conventional Therapy in Recurrent Aphthous Stomatitis -A Comparative Clinical Study

Introduction Oral health correlates with systemic health and maintaining oral health is very important as oral cavity is considered a reflection of the general wellbeing of human body. Recurrent aphthous stomatitis (RAS) is one of the most common painful oral mucosal conditions seen among childhood or adolescence. There are various topical and systemic agents available for the symptomatic relief of RAS, which if used for a long duration might cause various adverse effects. To overcome these adverse effects there are numerous natural remedies available used as an alternative therapies to treat RAS, one such natural and alternative therapeutic agent is Virgin Coconut oil (VCO). Material and Methods A total of 52 subjects were recruited for the study who are clinically diagnosed as RAS based on the family history, peak age of onset, site, size, number and frequency of ulcer. All the subjects were randomly (lottery method) divided into two groups-Group A (26 patients) and Group B (26 patients). In Group A, Subjects was given 150 ml VCO, In Group B, subjects were given 5% Amlexanox paste. Results The mean and standard deviation values and P values achieved from unpaired t test which stated that group A and group B differ in terms of length at day1 and day 5, and in breadth day 3 and day 5, and the difference is statistically significant. Results of friednan test analysis infer that there is statistically significant difference in terms of VAS score in different time intervals in group A. Values of manwhitney U test infers that they exists a statistically significant difference between group A and Group B in terms of VAS score at day 3 ( P value 0.003) and at day 5 ( P value 0.000). Conclusion The study established a highly statistical significant difference within the groups in healing of ulcer and pain reduction (p=0.00) in both group A and B. When the outcomes were compared between the groups, reduction in ulcer size (p=0.068) and pain (p=0.003*) was observed on the 3rd day. However a significant reduction in pain was present on the 5th day (p=0.000*) in group A, with significant reduction in ulcer size (p=0.000*). This study suggests that VCO could be used as an effective and safe alternative drug in management of signs and symptoms of RAS. Key Words Amlexanox paste, RAS, VCO

The Diagnosis and Treatment of Anorexia Nervosa in Childhood and Adolescence.

Anorexia nervosa (AN) is a serious disease with a lifetime prevalence of up to 3.6% in women and 0.3% in men. Abnormally low weight and the associated starvation partly account for its somatic and mental manifestations. This review is based on publications retrieved by a selective search concerning AN in childhood and adolescence. The peak age of onset of AN is 15.5 years. The frequency of inpatient treatment for AN rose by 40% during the COVID pandemic, indicating the importance of environmental factors; the heritability of AN is estimated at 0.5. The ICD-11 sets the threshold for AN-associated underweight at the fifth percentile for age of the body mass index, as long as the remaining diagnostic criteria are met. The main goal of the multiprofessional treatment of AN is the return to normal body weight, which is a central prerequisite for regaining somatic and mental health. The mean duration of AN is 3.4 years, and approximately twothirds of patients recover from the disease over the long term. Marked weight loss in childhood and adolescence can trigger AN in the presence of a predisposition to this disease. Patients and their families should receive psychoeducation regarding the symptoms of starvation and their overlap with those of AN. Important objectives are to shorten the duration of the illness, minimize mortality and the risk of chronic illness, and to identify pharmacological approaches to treatment.

Evaluation of the Factors Associated with Post-Operative Outcome in Patients of Ulcerative Colitis Undergoing Ileal Pouchanal Anastomosis with Comparison of Functional Outcome between Stapler and Hand-Sewn Anastomosis

ntroduction Ulcerative colitis defined as a non-granulomatous idiopathic inflammatory disease which mainly affects the colon and rectum. The disease may arise at any age but most commonly affects the adults between the age group of 30–40 years.1,2. The etiology of the disease is multifactorial, involving genetic predisposition, dysregulated immune responses, epithelial barrier defects and environmental factors. No sex predilection is seen in ulcerative colitis.3,5 The peak age of onset of disease is between 30 to 40 years.4,6 The environmental factors has also been found to play an important role in the etiopathogenesis of ulcerative colitis. Cigarette smoking is one of the major factor associated with ulcerative colitis, non-smokers have a milder disease course and active smokers are less likely to develop ulcerative colitis7 Appendectomy also confers a protective effect against ulcerative colitis, especially in young patients operated for acute appendicitis.8. Classic findings in endoscopy in patients with ulcerative colitis include loss of normal vascular pattern, erythema, erosions, granularity, friability, ulcerations and bleeding9 . The primary aim of medical management is to induce and maintain remission with the long-term goals of improving quality of life and prevent disability. Absolute indications for surgery include uncontrolled hemorrhage, perforation, and colorectal carcinoma or dysplastic lesions not amenable to endoscopic removal.10 Surgery is also indicated in refractory acute severe ulcerative colitis or medically refractory disease. The most commonly performed surgery for ulcerative colitis is restorative proctocolectomy with ileal pouchanal anastomosis (IPAA). An important aspect of the surgery is the use of either sutures or staplers for anastomosis. Two types of ileal pouch-anal anastomosis (IPAA) have been described: a mucosectomy of the rectal stump followed by a hand-sewn ileal pouch-anal anastomosis.11 The alternative technique is to retain the mucosa of the rectal stump and perform a stapled pouch-anal anastomosis.

Longitudinal and regional association between dietary factors and prevalence of Crohn's disease in Japan.

Although a Western diet has been identified as a risk factor for Crohn's disease (CD), there is still controversy surrounding the specific foods that may contribute to the development of the disease. In this study, we examined the association between food intake and the prevalence of CD in Japan, as Japanese patients with CD are known to have limited genetic involvement. We identified changes in food intake associated with an increase in the number of patients with CD by analyzing the per capita consumption of food types from 1981 to 2014. Additionally, we examined the association between CD prevalence and food intake in each prefecture. Finally, the relationship between food intake and estimated age at CD onset was also investigated. Between 1981 and 2014, we observed Increased consumption of meat, eggs, milk and dairy products, oil, and potatoes and decreased consumption of grains, beans, vegetables, fruit, fish, sugar, and seaweed. The annual incidence of CD increased by 1388% over the same period. We found that meat consumption was significantly associated with CD prevalence (β = 0.503, p = 0.0003), while a significant negative correlation was observed between CD prevalence and fruit and vegetable consumption (fruit, β = 0.464, p = 0.0012; vegetables, β = 0.404, p = 0.0023). Furthermore, we estimated that the peak consumption of more meat and less fruit and vegetables and the peak age of CD onset occurred within the age range of 20-24 years. Our study identified a clear correlation between the consumption of meat, fruits, and vegetables and the prevalence of CD in Japan. Additionally, we found an association between meat, fruit, and vegetable consumption and the age at CD onset.

Malignant arrhythmias and advanced heart failure in patients with RBM20 cardiomyopathy: a single center cohort study and review of the literature

Abstract Background Sudden cardiac death (SCD), and death rate attributable to heart failure (HF) are common causes of death in the general population. Both are seen in cardiomyopathy patients. RBM20 mutations associated with a cardiomyopathy phenotype and a high risk of SCD and HF. Purpose The aim of this study is to investigate the genotype-phenotype correlations, and clinical outcomes of the RBM20 mutations. Methods Peripheral blood from patients was drawn as a routine diagnostic procedure and genomic DNA extracted according to standard protocols. Patients were tested for at least 45 cardiomyopathy-related genes included in the Dutch core panel. 23 patients with a likely pathogenic or pathogenic RBM20 mutation and a cardiomyopathy phenotype were retrospectively enrolled in a single-center cohort. Patient data on clinical characteristics, imaging and pathology were extracted retrospectively. Furthermore, a literature search was conducted for a literature review on RBM20 mutations in cardiomyopathies. Peer reviewed studies with patients aged 18 or older, a RBM20 mutation, and a cardiomyopathy were included. Results Whole genome sequencing found 5 different RBM20 protein altering mutations. The c.1900C&amp;gt;T mutation was the most frequently seen in 18 patients. Four RBM20 mutations were novel mutations; c.1912, c.2919, c.414 and c.1118_1119 (Table1). The 23 patients had a mean age of 52 ± 15 years, and 13 (59%) were male. The phenotype was predominantly dilated cardiomyopathy (DCM). This was seen in 18 (82%)patients compared to 2 (12%) noncompaction cardiomyopathy (NCCM) patients. Nine (41%) patients had experienced malignant ventricular arrhythmia (VA). The mean age of first VA was 49 ± 10 years. An implantable cardioverter-defibrillator (ICD) was implanted in 13 (57%) patients, and gave appropriate therapy in 5 (23%) patients compared to 1 (9%) patient receiving inappropriate therapy. Ten (46%) patients were diagnosed with heart failure (HF) at a mean age of 50 ± 11 years. One patient died of heart failure, while 5 (25%) patients underwent heart transplantation (HTx). Delayed enhancement (DE) was shown on MRI in 5 (50%) patients, of which 3 had DE located in the mid-myocardial and inferolateral segments. They all had c.1900C&amp;gt;T, but did not differ in clinical outcomes compared to patients without DE. The literature review included 32 studies with 394 total patients. Five studies reported on c.1900C&amp;gt;T, of which 4 case reports/series and 1 cohort study. The mean age at diagnosis was lower in 4 studies and varied between 26 and 52 years compared to 51 ± 15 years in our c.1900C&amp;gt;T group. The prevalence of VA was 66%-100% in the case reports/series, and 28% in the cohort study. In our cohort had 5 (42%) patients a VA. Conclusion This study found 4 novel RBM20 mutations. Moreover, the RBM20 mutation phenotype was predominantly DCM combined with a high prevalence of malignant VA and/or HF, which both had an peak age of early onset between 45-54 years.

Clinical characteristics of trichotillomania.

Trichotillomania is a common psychiatric disorder classified as an obsessive-compulsive and related condition in DSM-5. Despite being first described in the 1800s, little is known about its phenomenology and clinical presentation. Most information about trichotillomania is based on small samples. Clinical and demographic data were collected from 858 individuals with trichotillomania who participated in research studies that used in-person assessments with validated instruments. A total of 858 adolescents and adults (mean age 29.3; range 11 to 65; 89.9% female) were recruited. The peak age of symptom onset was 11 to 15, and most affected individuals (93.5%) had symptom onset before age 20. Individuals reported pulling from several body sites, and the most frequent triggers were stress and the feel of their hair. Comorbidities included major depressive disorder, generalized anxiety disorder, and skin picking disorder. Most individuals with trichotillomania (61.7%) previously had received treatment. Among those who had received treatment, more individuals had received medication (43.4%) than psychotherapy (33.0%). This study sheds new light on the clinical presentation and phenomenology of trichotillomania. Results highlight the need for further research into its clinical presentation, longitudinal course, and optimal treatment approaches.

Retroperitoneal Fibrosis

Retroperitoneal fibrosis (RPF) is a rare condition with an incidence of 1.3 per 100 000 population with a peak age of onset at 40 – 65 years old. The idiopathic form of RPF, also known as Ormond’s disease, is more common and makes up about 75% of the case. Here, we are presenting a case of a woman who was referred to our center due to worsening serum creatinine and was diagnosed with retroperitoneal fibrosis. This case has been taken up due to the rarity of the case and to discuss the radiological appearance specifically the CT appearance of retroperitoneal fibrosis. We have also discussed methods to differentiate between primary and secondary retroperitoneal fibrosis specifically based on CT findings. This is to provide guidance for the diagnosis and prompt management of cases, especially in district hospitals with no advanced diagnostic equipment such as MRI or the ability to biopsy.

CLINICAL FEATURES OF CROHN'S DISEASE AND ULCERATIVE COLITIS

The retrospective study was conducted in the Department of Gastroenterology, THQ Hospital, from March 2020 to March 2021 to assess CD and UC's clinical characteristics and demographic features in a relatively diverse group of patients. The study included patients diagnosed with IBD. The questionnaire was used to gather data regarding clinical and demographic features, disease duration, and family history of IBD, surgical interventions, extra-intestinal manifestations, and clinical and socio-economic variables relevant to CD and UC patients. 500 patients were included in the study, of which 135 (28%) had CD and 365 (73%) had UC. UC patients predominantly had bloody diarrhea and/or hematochezia, while CD patients had abdominal pain. 50% of CD patients required surgical intervention, compared to only 9.8% of UC patients. Evaluation of chemotherapy showed that 66.6% of CD patients and 37.8% of UC patients received steroid therapy. 22 (6%) UC patients and 7 (5.1%) CD patients had a family history of IBD (P=.819). The most frequent extra-intestinal complication in UC patients was PSC; it was acute arthropathy in CD patients. It is concluded that the peak age of disease onset in UC and CD patients is similar to other Asian countries. There was non-significant male predominance for UC and CD. Diagnosis of CD is delayed compared to UC, which may be due to negligence towards disease symptoms.

Insomnia and distress as mediators on the relationship from cyber-victimization to self-reported psychotic experiences: a binational study from Tunisia and Lebanon

BackgroundWhile expansive research has accumulated concerning the association between traditional, face-to-face peer victimization and psychosis, a paucity of empirical research has been undertaken so far to investigate these associations with experiences of new and evolving ways of victimization through the digital world. Exploring these associations is highly relevant and timely, given that emerging adults are heavy users of digital technologies, highly exposed to online risks, and are at the peak age of onset of psychosis. This study aimed to test the hypothesis that psychological distress and insomnia symptoms have a significant indirect mediating effect on the association between cyber-victimization and self-reported positive psychotic experiences (SRPEs) in a binational sample of Tunisian and Lebanese community adults.MethodThe total sample was composed of 3766 participants; 3103 were from Lebanon (Mean age: 21.73 ± 3.80 years, 63.6% females) and 663 from Tunisia (Mean age: 26.32 ± 4.86 years, 59.9% females). Online anonymous self-report questionnaires were administered to all participants.ResultsHigher SRPEs were found in Lebanese participants compared to Tunisians, in single participants compared to married ones, in those with a university level of education compared to secondary or less, in those who live in rural areas compared to urban, in those who do not smoke, do not drink alcohol and do not use marijuana or any other illegal drug. Furthermore, more cyber-victimization, a higher insomnia severity and psychological distress were significantly associated with higher SRPEs. After adjusting for potential confounders, mediation analysis demonstrated that higher cyber-victimization was significantly associated with more insomnia severity/psychological distress; which were, in turn, significantly associated with greater SRPEs. Finally, more cyber-victimization was significantly and directly associated with more positive dimension.ConclusionIdentifying insomnia and distress as mediators could provide novel insight for psychosis prevention efforts and intervention targets for cyber-victimized individuals prone to experience subclinical psychotic symptoms.

Drug induced psychosis

Psychosis describes a set of psychological symptoms that reflect a loss of contact with reality; it arises from a variety of causes. Approximately 2% of people will have an episode of psychosis in their lifetime; however, around half of these will not have further episodes. The peak age of onset in men is in late adolescence or early 20s, and for women between late 20s and early 30s. Detailed assessment is needed to establish the cause. This article will focus on psychotic episodes associated with drug use and include presentation, diagnosis and management. Drug induced psychosis is challenging to manage, with a high incidence of relapse, self-harm and suicide.

The time is now to start evaluating biomarkers in the clinic.

The time is now to start evaluating biomarkers in the clinic.

Abstract #1413664: A Case of Familial Isolated Pituitary Adenoma Emphasizing an Often-Overlooked Aspect of Medical History

Familial Isolated pituitary adenoma (FIPA) is a rare cause of pituitary adenoma and underscores the importance of family history and the knowledge of screening guidelines in these patients. A 26-year-old female presented with secondary amenorrhea, galactorrhea, headaches and dizziness. Labs showed Prolactin 501 ng/ml (3.3-26.7 ng/mL) and IGF 391 ng/ml (96-301 ng/mL). MRI of the brain showed a 12 x 14 x 15 mm pituitary mass. Acromegaly was confirmed with glucose suppression test with growth hormone (GH) lowering to 1.08 ng/ml (< 0.8 ng/ml). Further history revealed a paternal cousin with gigantism diagnosed at the age of 17. She underwent transsphenoidal resection of the adenoma which stained positive for GH and prolactin. Post operative labs show improved levels: Prolactin 31 ng/mL (3.3-26.7 ng/mL) and IGF 317 ng/mL (96-301 ng/mL). Genetic evaluation showed a pathogenic mutation in AIP (aryl hydrocarbon receptor-interacting protein). Labs 4 months later- Prolactin 36.1 ng/mL (3.3-26.7 ng/mL), IGF 209 ng/mL (96-301 ng/mL), and GH 0.1 ng/mL (0.05-8.00 ng/mL). She was amenorrheic post surgery and with hormone replacement therapy, regular menstrual cycles ensued. Surveillance showed consistently normal IGF but prolactin levels were trending upwards. Prolactin: 80 ng/mL (3.3-26.7 ng/mL). A repeat MRI brain did not show any adenoma. She was started on Cabergoline and that helped with normalization of prolactin levels. FIPA is a rare hereditary disorder responsible for less than 2% of pituitary adenomas. Mutation of AIP is seen in 20% cases and associated with worse outcomes. The peak age of onset is between 10-30 years of age. Affected patients tend to have larger tumors than non-FIPA which increases the risk of pituitary apoplexy. GH secretion is the most common; followed by prolactin, GH-Prolactin co-secretion, non-functional and rarely TSH secreting. It has an autosomal dominant transmission but with incomplete penetrance often skipping generations making the diagnosis even more challenging. Obtaining detailed family history in any patient with pituitary adenoma is essential in uncovering the inheritance pattern of this disease. Screening for FIPA and AIP is recommended if patients are noted to have- 1. GH secreting adenoma diagnosed before the age of 18 2. Pituitary macroadenoma (>10 mm) diagnosed before the age of 30 3. Any pituitary adenoma with a family history of pituitary adenoma in more than one member First degree family members of patients with FIPA and AIP need to be tested for the mutation. Patients with positive mutation are recommended to undergo screening evaluation as follows- 1. Growth assessment and evaluation for signs and symptoms of pituitary adenoma with pituitary function tests a. Age 4-30 years: annually b. Age 30-50 years: every 5 years 2. Pituitary MRI a. Age 10-30 years: every 5 years Prospective observational data shows genetic testing followed by clinical screening leads to early detection of pituitary disease which results in early interventions and better outcomes. This highlights the importance of recognition of FIPA in patients presenting with any kind of pituitary adenomas.

The phenotype of type 1 diabetes in sub-Saharan Africa.

The phenotype of type 1 diabetes in Africa, especially sub-Saharan Africa, is poorly understood. Most previously conducted studies have suggested that type 1 diabetes may have a different phenotype from the classical form of the disease described in western literature. Making an accurate diagnosis of type 1 diabetes in Africa is challenging, given the predominance of atypical diabetes forms and limited resources. The peak age of onset of type 1 diabetes in sub-Saharan Africa seems to occur after 18-20 years. Multiple studies have reported lower rates of islet autoantibodies ranging from 20 to 60% amongst people with type 1 diabetes in African populations, lower than that reported in other populations. Some studies have reported much higher levels of retained endogenous insulin secretion than in type 1 diabetes elsewhere, with lower rates of type 1 diabetes genetic susceptibility and HLA haplotypes. The HLA DR3 appears to be the most predominant HLA haplotype amongst people with type 1 diabetes in sub-Saharan Africa than the HLA DR4 haplotype. Some type 1 diabetes studies in sub-Saharan Africa have been limited by small sample sizes and diverse methods employed. Robust studies close to diabetes onset are sparse. Large prospective studies with well-standardized methodologies in people at or close to diabetes diagnosis in different population groups will be paramount to provide further insight into the phenotype of type 1 diabetes in sub-Saharan Africa.