Presence Of Psychiatric Disorders Research Articles

Epigenetics and suicidal behavior in adolescents: a critical review.

Suicide continues to be a significant public health issue globally, claiming over 700,000 lives annually. It is, therefore, important to assess the suicide risk properly and provide intervention in a timely fashion. While the heritability of suicidal behavior is around 50%, it does not explain the factors involved in causality. Recent evidence suggests that gene x environment interaction plays a vital role in suicidal behavior. In this paper, we critically evaluate the association between adolescent suicidal behavior and epigenetic modifications, including DNA methylation, histone modification, and non-coding RNAs, as well as epigenetic-based treatment options. It was noted that the prevalence of suicidal behavior in adolescents varied by age and sex and the presence of psychiatric disorders. Childhood adversity was closely associated with suicidal behavior. Studies show that alterations in epigenetic modifications may increase the risk of suicidal behavior independent of mental illnesses. Because epigenetic factors are reversible, environmental enrichment or the use of pharmacological agents that can target specific epigenetic modulation may be able to reduce suicidal behavior in this population.

Hospital Utilization in Sickle Cell Disease Patients: A One-Year Retrospective Study in Urban Underserved Communities

Introduction Sickle cell disease (SCD) is a common genetic disorder affecting approximately 100,000 people in the United States. It significantly reduces quality of life and leads to early death. Despite available FDA-approved medications that can reduce painful episodes, these treatments are often under prescribed due to healthcare access barriers, socioeconomic challenges, and psychosocial factors. This study examines how these factors impact healthcare use among SCD patients at NYCHHC/Lincoln Medical Center. Method We reviewed records of SCD patients admitted to Lincoln Medical Center between January 1 and December 31, 2022. We collected data on emergency department (ED) visits, hospital admissions, average length of stay (LOS), medication, and psychiatric disorders from electronic medical records. Data analysis was performed with SPSS. Results We identified 30 patients, and 2 who died within a year of their first 2022 admission were excluded. The remaining 28 patients accounted for 105 admissions during the study period. Of these patients, 21.4% were male (N=6) and 78.6% were female (N=22). The majority identified as Black (75%), while 25% identified as Hispanic. The average age was 20.3 years. Black patients, compared to Hispanic patients, had more ED visits (13.5 vs 4.6, p=0.101), more readmissions (4.2 vs 2.4, p=0.052), and longer LOS (5.3 vs 3.0 days, p=0.267). Regarding medication use, 78.6% of patients (N=24) were taking Hydroxyurea, 3.6% (N=1) were receiving Voxelotor, and 7.1% (N=2) were enrolled in the clinical trial (Etavopivat). Patients on FDA-approved SCD medications (Hydroxyurea and Voxelotor in our case) had fewer readmissions (2.17 vs 4.18, p=0.011) to compared to who were not. In terms of healthcare provider access, 21.4% of patients lacked a primary care provider (PCP), and 28.6% lacked a hematologist for SCD follow-up. Patients without hematologist follow up had more ED visits (24.75 vs 5.85, p<0.001), more readmissions (5.75 vs 2.95, p=0.013), and longer LOS (5.9 vs 4.3 days, p=0.045). Regarding insurance, 20 patients (71.3%) used Medicare or Medicaid as their primary payer, and 8 (28.6%) had private insurance. There was no statistically significant difference in ED visits, readmissions, or LOS between the insurance groups. Psychiatric disorders were diagnosed in 28.6% of patients (N=8). These patients had more readmissions (27.7 vs 5.8, p=0.015), more ED visits (9.29 vs 1.9, p=0.015), and longer LOS (8.2 vs 3.6 days, p<0.001) compared to those without psychiatric diagnoses. Discussion Our study highlights key insights into healthcare use among SCD patients in an urban underserved community. Black patients had more frequent ED visits, readmissions, and longer hospital stays than Hispanic patients, reflecting disparities in healthcare access, socioeconomic status, and potential treatment biases. Psychiatric disorders significantly influenced healthcare utilization, with conditions like depression, bipolar disorder, and anxiety leading to higher readmission rates, more ED visits, and longer hospital stays. This underscores the need for integrated mental health services within SCD management. Despite the high prescription rate of Hydroxyurea, the use of newer FDA-approved medications like Voxelotor and participation in clinical trials were minimal. Given that patients on FDA-approved treatments had fewer readmissions, optimizing pharmacological management is crucial. The study also highlights the importance of consistent follow-up care. Patients without regular hematologist follow-up experienced significantly higher ED visits, readmissions, and longer LOS, emphasizing the need for continuous care relationships with both primary care providers and specialists. Conclusion The study highlights the substantial hospital use burden among SCD patients, characterized by frequent ED visits and readmissions. Despite known benefits, usage of Hydroxyurea and newer FDA-approved medications was suboptimal. Lack of regular hematologist follow-up and presence of psychiatric disorders were associated with increased healthcare utilization. These findings emphasize the need for improved access to hematology follow-up and integrated psychiatric care, to enhance the quality of life for SCD patients.

AB068. Psychiatric disorder in central nervous system tumor patients and its related factors.

Patients of central nervous system (CNS) tumors have a potential to develop psychiatric disorder. These may present resulting from tumor mass, edema, or patient's failure to adapt to their illness and treatment. The presence of psychiatric disorders may cause disability, decreased daily functioning, reduced quality of life, and even death. In order to provide adequate treatment to patients with CNS tumors, it's important to evaluate the type of psychiatric disorder in patients with spinal and brain tumors. This study aimed to investigate the prevalence of psychiatric disorder dan related factors that exist in patients with brain and spinal tumors. In a study conducted at Cipto Mangunkusumo General Hospital from January to December 2023, factors associated with psychiatric disorders in patients with CNS tumors were investigated. The analysis included a total of 161 subjects from inpatient settings. In depth interview was utilized to assess psychiatric disorder. Data analyses were carried out using the Chi-square and Fisher's exact test to assess the relationship between locations of tumor, neurological deficits, and psychiatric disorders. There were 161 subjects with mean age of 48.86±13.13 years, mostly women (59.0%). Patients with spinal tumor have more psychiatric disorders compared to their counterpart with intracranial tumor (79.1% and 76.3% respectively), while the most common psychiatric disorder was adjustment disorder. There is no significant relationship between tumor location and psychiatric disorder. In both patients with intracranial and spinal tumors, the most common neurological deficit was cancer pain (88.2%). However, bivariate analysis showed that among the neurological deficits found in the CNS tumor patients, dysphagia (P=0.02) and incontinence (P=0.02) have significant relationship with depression, while pain (P=0.02) and cognitive dysfunction (P=0.01) have significant relationship with adjustment disorder. It also showed that pain (P<0.001), cognitive dysfunction (P=0.002), and seizure (P=0.03) have significant relationship with organic mental disorder. Dysphagia, incontinence, pain, cognitive disfunction, and seizure were identified as risk factors for psychiatric disorders in intracranial and spinal tumor patients. The finding underscores the importance of screening and comprehensive psychiatric evaluations in patients with CNS tumors, as psychiatric symptoms may significantly impact their quality of life and treatment outcomes.

Seroprevalence of HIV, HCV, and HBV: The Associated Psychiatric Co-morbidities Among Injection Drug Users in Kashmir- A Hospital-Based Cross-sectional Study.

Injection drug use remains a significant public health concern globally, with injection drug users (IDUs) facing elevated risks of contracting blood-borne infections such as hepatitis C (HCV), hepatitis B (HBV), and acquired immune deficiency syndrome caused by the human immunodeficiency virus (HIV). This study delves into the seroprevalence of these disorders among IDUs in Kashmir and extends further to explore the relationship between injection drug use and psychiatric co-morbidities. A cross-sectional study was conducted among IDUs recruited from tertiary care drug addiction centers. Those who agreed to participate underwent serological testing for HCV, HBV, and HIV. The presence of psychiatric disorders was assessed using the Mini International Neuropsychiatric Interview, a standardized instrument for diagnosing mental health conditions. The results showed that the prevalence rate of HCV, HBV, and HIV was 73%, 12%, and 1%, respectively. Genotype 3a was the predominant genotype in 71 (51.5%) participants with detectable HCV-RNA. A total of 151 (50.3%) participants had a comorbid psychiatric illness with attention-deficit hyperactivity disorder and major depressive disorder in 63 (21%) and 36 (12%), respectively. Sharing of paraphernalia was the most common high-risk behavior in 234 (78%). Early initiation of opioid use, a history of sharing of paraphernalia, and the presence of comorbid psychiatric illness were found to be significantly associated with positive serology results, indicating a higher risk of contracting infection (χ2 = 24.55, p < .01; χ2 = 121.56, p < .01; and χ2 = 4.534, p <.01, respectively). IDUs have an elevated prevalence of HCV, substantial rates of infection with HBV and HIV, and a considerable burden of psychiatric morbidities. Considering the high seroprevalence of hepatitis infections and alarming rates of psychiatric morbidity in IDUs, this calls for a comprehensive and integrated approach to address the interconnected challenges faced by IDUs in Kashmir.

Comparative study of perceived invalidating environment and stress coping strategies between patients with drug resistant epilepsy and functional dissociative seizures

Background and objectivesWe investigated perceived invalidating environment during childhood and stress-coping strategies in patients with; functional dissociative seizures (FDS, n=26), drug-resistant epilepsy patients with no psychiatric comorbidity (DREnc, n=23), and drug-resistant epilepsy patients with psychiatric comorbidity (DREpc, n=34). Design/MethodsWe performed a cross-sectional study. Patients underwent Video Electroencephalography to confirm the diagnosis and completed a psychiatric assessment supported by clinical instruments. Invalidating environment and stress coping were studied through the ICES and CAE questionaries, respectively. A series of multinomial logistic regression analyses were performed with the explored variables. ResultsThe maternal negative response model predicted a higher probability of FDS condition. A chaotic family type increased the likelihood of DREpc instead of FDS. DREpc and FDS patients displayed many different behaviors to cope with stress other than trying to solve the problem, the most used strategy in the DREnc group. Parental invalidation was higher in DREpc than in FDS. ConclusionsOur results deepen the data provided by previous studies indicating that multiple variables of biosocial origin have significant effects on these groups of patients. The presence of an invalidating environment may predict FDS but also the presence of psychiatric disorders among DRE. Psychotherapeutic strategies to enhance these variables might be necessary for this population.

Mental Disorders Among Healthcare Students Attending a Large University Hospital in Milan, Italy.

The high incidence rates, treatment difficulties, and tendency to become chronic, which subsequently affects personal and occupational functioning, make mental health disorders among the most important public health concerns. In this context, healthcare university students (HS) appear to be more vulnerable to psychological distress than others. Investigate the prevalence of diagnosed mental illness among different groups of HS to detect students who may be psychologically vulnerable and determine whether the implementation of support interventions is necessary. All HS who had a clinical examination performed by an occupational physician at our occupational health unit between 2021 and 2022 were included in our case series. Data were collected and analyzed as part of the occupational physicians' health surveillance program. out of 679 HS (507 females, 172 males, aged 22.2±3.9 mean±s.d) undergone clinical examination at our Occupational Health Unit, 36 (5.3%) reported a diagnosed psychiatric illness, and 20 were receiving pharmacological therapy at the time of the visit. A higher prevalence of psychological disorders has been highlighted in females (6.1% vs 2.9% in males) and students of the mental health sector (11.1%) when compared with others. A fit-to-work judgment with prescription was necessary for 16.7% of students with mental diseases. The presence of psychiatric disorders was associated with underweight (27.8%) and higher smoking habit (44.4%). These results underline the necessity of improving the current health surveillance protocols, which should also evaluate students' psychological fragility and implement effective intervention strategies to promote their health and wellbeing.

An Evaluation of Difficulty in Emotion Regulation, Impulsivity, and Emotional Eating in Children and Adolescents Diagnosed with Type 1 Diabetes Mellitus.

The aim of this study was to investigate difficulties in emotion regulation, emotional eating, and impulsivity in children diagnosed with type 1 diabetes mellitus (T1DM). The study included 53 children who were diagnosed with T1DM, and a control group of 50 subjects. The Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime Version, Difficulties in Emotion Regulation Scale- Short Form (DERS-16), Emotional Eating Scale-Child and Adolescent Form (EES-C), and the Barratt Impulsivity Scale 11-Short Form (BIS-11) were administered to the participants. In the T1DM group, the disease duration was a mean of 52.7 ± 40.62 months, and only 17% had good metabolic control. The rate of psychiatric disorder determined was significantly higher in the T1DM group (P = .001). No significant difference was determined between the 2 groups in respect of the DERS-16, EES-C, and BIS-11 total and subscale scores. However, in multivariate linear regression, the increase in BIS-11 total score was affected by increasing DERS impulse (β = 0.475), decreasing age (β = -0.209), and presence of T1DM (β = 0.211). An increase in the DERS-16 total score was associated with the presence of psychiatric disorder (β = -0.258) and an increase in BIS-11-A (the second scale assesses concentration problems) (β = 0.317) score. In the T1DM group, the glycated hemoglobin level was lower in the group with insulin treatment with the injection method (8.2 ± 2.1%) than in those with the pump method (9.1 ± 1.5%) (P = .069). It is important that mental health professionals take an active role in all processes of the disease in order to protect the mental health of children with T1DM. Cite this article as: Yıldız Miniksar D, Öz B, Kılıç M, et al. An evaluation of difficulty in emotion regulation, impulsivity, and emotional eating in children and adolescents diagnosed with type 1 diabetes mellitus. Turk Arch Pediatr. 2024;59(1):78-86.

Maternal Stress, Anxiety, Well-Being, and Sleep Quality in Pregnant Women throughout Gestation

Background: Maternal stress, anxiety, well-being, and sleep quality during pregnancy have been described as influencing factors during pregnancy. Aim: We aimed to describe maternal stress, anxiety, well-being, and sleep quality in pregnant women throughout gestation and their related factors. Methods: A prospective study including pregnant women attending BCNatal, in Barcelona, Spain (n = 630). Maternal stress and anxiety were assessed by the Perceived Stress Scale (PSS) and State-Trait Anxiety Inventory (STAI)-validated questionnaires. Maternal well-being was assessed using the World Health Organization Well-Being Index Questionnaire (WHO-5), and sleep quality was assessed using the Pittsburgh Sleep Quality Index Questionnaire (PSQI). All questionnaires were obtained twice during the second and third trimester of pregnancy. A multivariate analysis was conducted to assess factors related to higher maternal stress and anxiety and worse well-being and sleep quality. Results: High levels of maternal stress were reported in 23.1% of participants at the end of pregnancy, with maternal age &lt;40 years (OR 2.02; 95% CI 1.08–3.81, p = 0.03), non-white ethnicity (OR 2.09; 95% CI 1.19–4.02, p = 0.01), and non-university studies (OR 1.86; 95% CI 1.08–3.19, p = 0.02) being the parameters mostly associated with it. A total of 20.7% of women had high levels of anxiety in the third trimester and the presence of psychiatric disorders (OR 3.62; 95% CI 1.34–9.78, p = 0.01) and non-university studies (OR 1.70; 95% CI 1.11–2.59, p = 0.01) provided a significant contribution to high anxiety at multivariate analysis. Poor maternal well-being was observed in 26.5% of women and a significant contribution was provided by the presence of psychiatric disorders (OR 2.96; 95% CI 1.07–8.25, p = 0.04) and non-university studies (OR 1.74; 95% CI 1.10–2.74, p = 0.02). Finally, less sleep quality was observed at the end of pregnancy (p &lt; 0.001), with 81.1% of women reporting poor sleep quality. Conclusion: Maternal stress and anxiety, compromised maternal well-being, and sleep quality disturbances are prevalent throughout pregnancy. Anxiety and compromised sleep quality may increase over gestation. The screening of these conditions at different stages of pregnancy and awareness of the associated risk factors can help to identify women at potential risk.

The association between emotion malleability beliefs and severe psychological distress stratified by sex, age, and presence of any psychiatric disorders.

Recent studies have shown an association between psychological distress and emotion malleability beliefs, meaning mindsets about whether one's emotions are fixed or changeable. However, most studies have not examined the association between these beliefs and sociodemographic factors. A nationwide cross-sectional Internet survey of residents of Japan aged 15-79 years was conducted using sampling weights for national estimates to investigate the association between emotion malleability beliefs and sociodemographic factors and between fixed beliefs and severe psychological distress (SPD). SPD was defined as a Kessler 6 Scale score of ≥13. Adjusted odds ratios for SPD were calculated considering potential confounders. Further analyses were stratified by sex, age and presence of any psychiatric disorder. The analysis included 23,142 participants (female, 48.64%). Fixed beliefs were associated with female sex, age < 45 years, and presence of psychiatric disorders. These beliefs were associated with SPD, and additional analysis showed stronger associations with SPD among female respondents, respondents aged 45-59 years, and those aged ≥60 years. Results indicate that female sex, age < 45 years, and current mental disorders were associated with fixed emotion malleability beliefs. Associations between fixed emotion malleability beliefs and SPD were particularly strong among female respondents and people aged ≥45 years compared with the general population. Our study extends the association between emotion malleability beliefs and psychological health to the general population. Future studies should explore mechanisms underlying individual differences in emotion beliefs.

Traitements pharmacologiques dans le trouble de stress post-traumatique : la nécessité d’une stratégie globale

International guidelines indicate that trauma-focused psychotherapeutic treatments are the recommended approach for first line treatment of post-traumatic stress disorder (PTSD). However, the guidelines concerning drug-focused treatment are less consistent and contradictory. Although trauma-focused therapy combined with cognitive-behavioral therapy is effective in treating PTSD, many patients do not respond adequately to this treatment, which stresses the need to develop effective adjuvant therapeutic treatments. In addition, most randomized controlled trials investigating psychological treatments for PTSD exclude patients with psychosis, addiction, bipolar disorder, and suicidal thoughts, and it is crucial to offer effective treatments for these patients. Off-label medication is frequently used in treating these populations, but there is a need to clarify these practices. We thus propose an evidence-based algorithm for the management of PTSD, based on current international literature and taking into consideration suicidal tendencies, the presence of psychiatric disorders (psychotic disorders, bipolar disorders, borderline personality disorders) or addictive disorders, the severity of PTSD, and resistance to treatment.

Serum levels of oxidative stress biomarkers is changed in pharmacoresistant mesial temporal lobe epilepsy patients with or without psychiatric disorders

The objective of the present study was to assess the levels of oxidative stress biomarkers (OSB) in patients with pharmacoresistant temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) in order to investigate a possible role of oxidative stress (OS) in the pathophysiology of such disease. Ninety-eight participants were included and distributed in three groups: group 1 (G1) - 25 patients with pharmacoresistant TLE-MTS, without comorbid PD; Group 2 (G2) - 21 patients with pharmacoresistant TLE-MTS with PD; Group 3 (G3) - 52 healthy control subjects. Serum levels of catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), reduced glutathione plus oxidated glutathione (total GSH), glucose-6-phosphate dehydrogenase (G6PD), Trolox-equivalent antioxidant capacity (TEAC), and thiobarbituric acid reactive substances (TBARS) were analyzed through spectrometry. The significance level was set at P<0.05. Sociodemographic data were similar in all groups (P>0.05). A family history of epilepsy was more frequent among G1 and G2 groups when compared to G3 (P = 0.0002). Compared to controls, G1 and G2 presented higher CAT (P<0.0001) and TBARS levels (P = 0.001), as well as lower GPx (P<0.0001), G6PD (P = 0.005) and total GSH levels (P = 0.04). The presence of psychiatric disorders (PD), analyzed both separately and together, was not associated with significant differences in OSB levels (P>0.05). The lower levels of GPx, G6PD, and total GSH, as well as the higher CAT and TBARS levels observed in pharmaco-resistant TLE-MTS patients can indicate an imbalance between oxidizing agent production and elimination, supporting the hypothesis of a possible role of OS in the pathogenesis of this condition.

How ambient temperature affects mood: an ecological momentary assessment study in Switzerland

BackgroundRecent research has suggested that an increase in temperature can negatively affect mental health and increase hospitalization for mental illness. It is not clear, however, what factors or mechanisms mediate this association. We aimed to (1) investigate the associations between ambient temperatures and bad daily mood, and (2) identify variables affecting the strength of these associations (modifiers) including the time, the day of the week and the year of the mood rating, socio-demographic characteristics, sleep quality, psychiatric disorders and the personality trait neuroticism in the community.MethodsData stemmed from the second follow-up evaluation of CoLaus|PsyCoLaus, a prospective cohort study conducted in the general population of Lausanne (Switzerland). The 906 participants rated their mood level four times a day during seven days using a cell phone app. Mixed-effects logistic regression was used to determine the association between daily maximum temperature and mood level. Participant ID was inserted as a random effect in the model, whereas the time of the day, the day of the week and the year were inserted as fixed effects. Models were controlled for several confounders (socio-demographic characteristics, sleep quality, weather parameters and air pollutants). Stratified analyses were conducted based on socio-demographic characteristics, sleep quality, presence of psychiatric disorders or a high neuroticism.ResultsOverall, the probability of having a bad mood for the entire day decreased by 7.0% (OR: 0.93: 95% CI 0.88, 0.99) for each 5 °C increase in maximum temperature. A smaller and less precise effect (-3%; OR: 0.97: 95% CI 0.91, 1.03) was found when controlling for sunshine duration. A higher association was found in participants with bipolar disorder (-23%; OR: 0.77: 95% CI 0.51, 1.17) and in participants with a high neuroticism (-13%; OR: 0.87 95% CI 0.80, 0.95), whereas the association was reversed for participants with anxiety (20%; OR: 1.20: 95% CI 0.90, 1.59), depression (18%; OR: 1.18 95% CI 0.94, 1.48) and schizophrenia (193%; OR: 2.93 95% CI 1.17, 7.73).ConclusionsAccording to our findings, rising temperatures may positively affect mood in the general population. However, individuals with certain psychiatric disorders, such as anxiety, depression, and schizophrenia, may exhibit altered responses to heat, which may explain their increased morbidity when exposed to high temperatures. This suggests that tailored public health policies are required to protect this vulnerable population.

Stress levels, psychological symptoms, and C-reactive protein levels in COVID-19: A cross-sectional study

BackgroundAlthough many studies have pointed out a possible relationship between COVID-19 and the presence of psychiatric disorders, the majority of the studies have significant limitations. This study investigates the influence of COVID-19 infection on mental health. MethodsThis cross-sectional study included an age- and sex-matched sample of adult individuals positive (cases) or negative (controls) for COVID-19. We evaluated the presence of psychiatric conditions and C-reactive protein (CRP). ResultsFindings showed greater severity of depressive symptoms, higher levels of stress, and greater CRP in cases. The severity of depressive and insomnia symptoms, as well as the CRP were more remarkable in individuals with moderate/severe COVID-19. We found a positive correlation between stress and severity of anxiety, depression, and insomnia in individuals with or without COVID-19. There was a positive correlation between CRP levels and severity of depressive symptoms in cases and controls, and a positive correlation between CRP levels and the severity of anxiety symptoms and stress levels only in individuals with COVID-19. Individuals with COVID-19 and depression had greater CRP than those with COVID-19 without current major depressive disorder. LimitationsWe cannot infer causality because this is a cross-sectional study, and the majority of COVID-19 sample was asymptomatic or had mild symptoms, which may limit the generalizability of our findings for moderate/severe cases. ConclusionsIndividuals with COVID-19 showed greater severity of psychological symptoms, which may impact on the development of psychiatric disorders in the future. CPR seem to be a promising biomarker for earlier detection of post-COVID depression.

Chronic disease (CD) during transition from child to adult.Psychopathological consequences and coping strategies

IntroductionCD is characterized by at least three features: its duration is prolonged, it does not resolve spontaneously and it is rarely completely cured. Approximately 10-15% of young people have CD. Adolescents with CD often have emotional and behavioral problems.ObjectivesTo assess risk factors, derived psychiatric pathologies and coping strategies for a CD diagnosis in adolescence.MethodsAn extensive literature review was carried out on the subject in question, extracting information mainly from scientific articles, manuals and books.ResultsThe main risk factors are those related with the CD in question, physical sequelae, the need for long-term hospital admissions or the use of drugs whose side effects include affective or behavioral symptoms; those related to the personality traits of the affected child or adolescent. In addition, as far as the family is concerned, the presence of a low level of education, lack of support or communication, as well as the presence of psychiatric disorders or serious medical conditions in parents. Among the most frequent psychiatric disorders associated with CD are affective and anxiety disorders, adaptive disorders, somatoform disorders, eating disorders and behavioral disorders. Whatever the CD is, it generates high levels of stress and uncertainty in the patient and family, which must be dealt together from a flexible perspective, allowing child or adolescent to adapt to the changes, reorganize and facing them with adaptive patterns of behavior. For this, it will be essential to have adequate social and family support with relational style based on communication, trust and acceptance.ConclusionsIn general, both adolescents with CD and their families have an adequate capacity to adapt to the repercussions and effects derived from the disease. Nevertheless, in case of possible emotional difficulties that may appear, a comprehensive and individualized approach to these adolescents and their families is necessary to provide them resources and coping strategies in different areas and contexts in which the disease debuts.The comprehensive therapeutic approach will consist of interventions at the individual and family level. Among the main objectives of these interventions are to achieve acceptance and adaptation to CD provinding adequate psychosocial support to enable them to cope with CD in the best possible way and to detect and address the emotional implications, even coexisting psychopathology.Disclosure of InterestNone Declared

Self-injury and suicidal behavior in children and youth population: Learning from the pandemic

IntroductionSuicidal behaviour and self-harm are increasing in children and adolescents. Non-suicidal self-harm are a dysfunctional method of emotional regulation, and it must be distinguished from suicidal behaviours. MethodsNarrative review of the current situation on suicide and self-harm in Spain. Descriptive study of suicidal behaviours in paediatric emergencies. ResultsMental health consultations were analysed (March-2019 to March-2020 and March-2020 to March-2021) in a multicentric study of the SEUP (Spanish Society of Pediatric Emergencies), finding a 122 % increase of the diagnosis of "non-accidental drug intoxication” and 56 % of “suicide/suicide attempt/suicidal ideation”. In another prospective analysis, 281 attempts were recorded, with the patient profile being: female (90.1 %), 14.8 years old, 34.9 % without previous psychiatric diagnosis; 57.7% with previous suicidal behaviour. The presence of psychiatric disorders, especially depression, and previous attempts, are the best-known risk factors for suicidal behaviour, although other factors are involved (family, personal or social). Pediatricians should be trained to deal with questions about suicide and acquire the skills to conduct an interview with a supportive and empathetic attitude. In Spain, suicide prevention plans are heterogeneous among communities, and there is not a unified national suicide prevention plan. ConclusionsPrimary, hospital and mental health care resources for paediatric population should be strengthened to prevent suicidal behaviours. Specific training for school staff, and child and adolescent psychiatry training for paediatricians and nurses are crucial in the prevention of suicide in children and adolescent population.

Autolesiones y conducta suicida en niños y adolescentes. Lo que la pandemia nos ha desvelado

IntroductionSuicidal behavior and self-harm are increasing in children and adolescents. Non-suicidal self-harm are a dysfunctional method of emotional regulation, and it must be distinguished from suicidal behaviors. MethodsNarrative review of the current situation on suicide and self-harm in Spain. Descriptive study of suicidal behaviors in pediatric emergencies. ResultsMental health consultations were analyzed (March-2019 to March-2020 and March-2020 to March-2021) in a multicentric study of the Spanish Society of Pediatric Emergencies (SEUP), finding a 122% increase of the diagnosis of «non-accidental drug intoxication» and 56% of «suicide/suicide attempt/suicidal ideation». In another prospective analysis, 281 attempts were recorded, with the patient profile being: female (90.1%), 14.8 years old, 34.9% without previous psychiatric diagnosis; 57.7% with previous suicidal behavior. The presence of psychiatric disorders, especially depression, and previous attempts, are the best-known risk factors for suicidal behavior, although other factors are involved (family, personal or social). Pediatricians should be trained to deal with questions about suicide and acquire the skills to conduct an interview with a supportive and empathetic attitude. In Spain, suicide prevention plans are heterogeneous among communities, and there is not a unified national suicide prevention plan. ConclusionsPrimary, hospital and mental health care resources for pediatric population should be strengthened to prevent suicidal behaviors. Specific training for school staff, and child and adolescent psychiatry training for pediatricians and nurses are crucial in the prevention of suicide in children and adolescent population.

Development and Validation of a Deep Learning Model for Predicting Treatment Response in Patients With Newly Diagnosed Epilepsy

Selection of antiseizure medications (ASMs) for epilepsy remains largely a trial-and-error approach. Under this approach, many patients have to endure sequential trials of ineffective treatments until the "right drugs" are prescribed. To develop and validate a deep learning model using readily available clinical information to predict treatment success with the first ASM for individual patients. This cohort study developed and validated a prognostic model. Patients were treated between 1982 and 2020. All patients were followed up for a minimum of 1 year or until failure of the first ASM. A total of 2404 adults with epilepsy newly treated at specialist clinics in Scotland, Malaysia, Australia, and China between 1982 and 2020 were considered for inclusion, of whom 606 (25.2%) were excluded from the final cohort because of missing information in 1 or more variables. One of 7 antiseizure medications. With the use of the transformer model architecture on 16 clinical factors and ASM information, this cohort study first pooled all cohorts for model training and testing. The model was trained again using the largest cohort and externally validated on the other 4 cohorts. The area under the receiver operating characteristic curve (AUROC), weighted balanced accuracy, sensitivity, and specificity of the model were all assessed for predicting treatment success based on the optimal probability cutoff. Treatment success was defined as complete seizure freedom for the first year of treatment while taking the first ASM. Performance of the transformer model was compared with other machine learning models. The final pooled cohort included 1798 adults (54.5% female; median age, 34 years [IQR, 24-50 years]). The transformer model that was trained using the pooled cohort had an AUROC of 0.65 (95% CI, 0.63-0.67) and a weighted balanced accuracy of 0.62 (95% CI, 0.60-0.64) on the test set. The model that was trained using the largest cohort only had AUROCs ranging from 0.52 to 0.60 and a weighted balanced accuracy ranging from 0.51 to 0.62 in the external validation cohorts. Number of pretreatment seizures, presence of psychiatric disorders, electroencephalography, and brain imaging findings were the most important clinical variables for predicted outcomes in both models. The transformer model that was developed using the pooled cohort outperformed 2 of the 5 other models tested in terms of AUROC. In this cohort study, a deep learning model showed the feasibility of personalized prediction of response to ASMs based on clinical information. With improvement of performance, such as by incorporating genetic and imaging data, this model may potentially assist clinicians in selecting the right drug at the first trial.

Comorbid psychiatric disorders in children and adolescents with attention deficit hyperactivity disorder: A descriptive analytic study

Background. Psychiatric studies are influenced by geographical conditions and research methods. Among them, the use of diagnostic tools may cause controversy over the results of studies on psychiatric disorders as such ADHD. The aim of this study was to investigate comorbid psychiatric disorders in children and adolescents with attention deficit hyperactivity disorder. Methods. In this study, 400 children and adolescents with ADHD were selected from the clients of Razi and Sharif Hospital Psychiatric Clinic. For sample selection, a demographic questionnaire and semi-structured diagnostic interview (K-SADS-PL) were utilized to evaluate the presence of psychiatric disorders. The duration of the project was 4 months. Results. The mean age of the patients was 9.16±2.46 years and the highest frequency was in the age group of 6 to 9 years (63%). Of the 400 patients studied, 73.3% were boys. The highest frequency of education was related to preschool (61.5%). A history of ADHD was positive in 10.8% in the father, 2.3% in the mother and 3.8% in both parents. Also, 9.5% of patients had a history of ADHD in their brother and 4% had a positive history of ADHD in their sister. The most common psychiatric disorder in the present study was oppositional defiant disorder (92%). One comorbid disorder was identifiable in more than 54% of participants. Conclusion. The most common psychiatric disorder in children with ADHD includes oppositional defiant disorder, which is more common in boys, although no significant differences was founded in terms of sex and age. Practical Implications. Findings of this study suggest that the clinicians, child psychologists and psychiatrists ought to take into consideration the probability of comorbid disorders with ADHD, since failing to consider them might directly influence the quality and quantity of treatments utilized.

Chronic Pelvic Pain in Women with Endometriosis is Associated with Psychiatric Disorder and Quality of Life Deterioration

BackgroundEndometriosis is a condition associated with pelvic pain, infertility, and possibly with decreased quality of life as well as psychiatric disorder. The purpose of our study was to evaluate the association between pain characteristic, psychiatric disorder, and quality of life in women with endometriosis.MethodsA cross-sectional study was done involving 160 women with medical diagnosis of endometriosis. Pain intensity was evaluated using Visual Analog Scale (VAS), Quality of Life with Endometriosis Health Profile (EHP-30), and psychologic condition with Mini International Neuropsychiatric Interview International Classification of Diseases (Mini-ICD).ResultsVAS and psychiatric disorder were associated with higher EHP-30 score (β = 9.3 (95% CI: 7.15–11.45; p < 0.001 and β = 28.51 (95% CI: 20.06–36.05; p < 0.001), respectively) and hence, lower quality of life. The strongest correlation between VAS and EHP-30 was in pain (r=0.586; p<0.001) and ‘control and powerlessness’ (r = 0.583; p < 0.001). VAS was also higher in subjects with depression (49.5 (25.4–77.8) vs 34.4 (6.1–74.6); p < 0.001).ConclusionWe conclude that severe endometriosis-related pain and the presence of psychiatric disorder were associated with lower quality of life. Comprehensive management of endometriosis is crucial to improve patients’ quality of life.

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INTRODUCTION :Chronic obstructive pulmonary disease (COPD) is a progressive, partially reversible, preventable, and treatable lung disease which is characterized by long-term breathing problems which typically worsens over time. Acute exacerbations and frequent comorbidities contribute to the overall severity in individual patients and eventually everyday activities, such as walking or getting dressed, become difficult. Psychiatric illnesses are increasingly common in patients with chronic illnesses like COPD. Despite this, psychiatric co-morbidities among patients with COPD are less studied in comparison with general medical conditions.AIM :To study the psychiatric morbidity in individuals with COPD.METHODOLOGY :60 patients including inpatients and outpatients in the Department of Pulmonology, NRI Academy OF Medical Sciences, Guntur, diagnosed with COPD consenting for the study were included. Diagnosis of COPD was made using HRCT chest and pulmonary function tests(PFT).A descriptive study was done and psychiatric disorders were diagnosed using the Mini International Neuropsychiatric Interview Questionnaire (MINI).RESULTS :Among the 60 patients two-third patients had psychiatric comorbidity.Anxiety and Depression were the most frequently diagnosed psychiatric disorders in the study and more than 50 % of the patients had history of smoking.There was a significant correlation between severity of COPD and psychiatric disorders.CONCLUSION :This study showed increased psychiatric morbidity in patients suffering from COPD. The presence of psychiatric disorders in COPD leads to increased morbidity. However, these have not been screened for routinely. Early detection and treatment of psychiatric comorbidity in COPD will help in reducing the morbidity and increase in the level of functioning.