Previous Psychiatric History Research Articles

7025 Acute Psychosis and the Diagnosis of Cushing’s Syndrome: Lessons Learned from a Patient with a Long History of Obesity

Abstract Disclosure: S. Modi: None. L. Belalcazar: None. Background: Although the association of hypercortisolism and psychosis is well established, acute psychosis remains a very rare manifestation of Cushing’s syndrome, especially in the absence of previous psychiatric history. We present lessons learned from a patient in whom the diagnosis of Cushing’s syndrome was missed until the onset of acute psychosis helped identify his underlying endocrine disorder. Clinical Case: A 31-year-old male presented to the Emergency Department after being found down on the street. The patient had superficial lacerations that were suspected to be self-inflicted due to a suicide attempt, but later found to be the result of auditory hallucinations. He had no previous psychiatric history and no history of suicidal ideation. His medical history was positive for obesity since adolescence and a recent diagnosis of hypertension. His family noted that for the past several months he had been experiencing headache, fatigue, muscle weakness and, more recently, insomnia, restlessness, and confusion. Weight gain was noted, but of unknown magnitude. On admission, he was agitated and hallucinating. He was initially sedated with dexmedetomidine and started on quetiapine. Physical examination revealed Cushingoid features with truncal obesity (body mass index of 35 kg/m2), facial plethora, and dorsocervical fat pad; no abdominal striae were present. Labs showed mild hypokalemia. His AM cortisol was markedly elevated at > 123 ug/dL (normal 4.5-23.0 ug/dL) with an ACTH level at 144 pg/mL (normal 7.2-63.3 pg/mL). MRI Brain showed a 1.9 cm pituitary macroadenoma with small suprasellar extension. With a diagnosis of Cushing’s disease, later confirmed by pathology, he underwent transsphenoidal resection. AM cortisol on post-operative day 3 was 3.2 ug/dL (normal 4.5-23.0 ug/dL). Maintenance-dose steroids were started due to evidence of post-surgical corticotroph suppression. Notably, there was marked improvement in his anxiety, paranoia, and confusion post-operatively. Quetiapine and blood pressure medications were discontinued after discharge. Conclusion: In this patient, the diagnosis of Cushing’s syndrome was missed when initially presenting with new onset hypertension in the setting of long-standing obesity. Despite months of symptoms compatible with the diagnosis, it was not until he developed acute psychosis and a careful history was obtained, that the diagnosis of Cushing’s syndrome was entertained. Psychosis is present in only 3-8% of reported cases of Cushing’s syndrome. This case illustrates the importance of including Cushing’s syndrome in the differential diagnosis of acute psychosis, especially in patients without previous psychiatric history. It also highlights the need of excluding secondary causes of hypertension in young adults, with particular attention to Cushing’s syndrome in those who present with obesity, even if long-standing. Presentation: 6/1/2024

"The Psychiatric Domain of Post-Intensive Care Syndrome: A Review for the Intensivist".

Post-intensive care syndrome (PICS) is a clinical syndrome characterized by new or worsening changes in mental health, cognition, or physical function that persist following critical illness. The psychiatric domain of PICS encompasses new or worsened psychiatric burdens following critical illness, including post-traumatic stress disorder (PTSD), depression, and anxiety. Many of the established predisposing and precipitating factors for the psychiatric domain of PICS are commonly found in the setting of critical illness, including mechanical ventilation (MV), exposure to sedating medications, and physical restraint. Importantly, previous psychiatric history is a strong risk factor for the development of the psychiatric domain of PICS and should be considered when screening patients to diagnose psychiatric impairment and interventions. Delirium has been associated with psychiatric symptoms following ICU admission, therefore prevention warrants careful consideration. Dexmedetomidine has been shown to have the lowest risk for development of delirium when compared to other sedatives and has been the only sedative studied in relation to the psychiatric domain of PICS. Nocturnal dexmedetomidine and intensive care unit (ICU) diaries have been associated with decreased psychiatric burden after ICU discharge. Studies evaluating the impact of other intra-ICU practices on the development of the psychiatric domain of PICS, including the ABCDEF bundle, depth of sedation, and daily spontaneous awakening trials, have been limited and inconclusive. The psychiatric domain of PICS is difficult to treat and may be less responsive to multidisciplinary post-discharge programs and targeted interventions than the cognitive and physical domains of PICS. Given the high morbidity associated with the psychiatric domain of PICS, intensivists should familiarize themselves with the risk factors and intra-ICU interventions that can mitigate this important and under-recognized condition.

Manic episode in a patient with pancreatic adenocarcinoma: a case report

IntroductionPsychiatric comorbidity is common in cancer patients, emphasizing the need for comprehensive care. While depressive symptoms in pancreatic cancer (PC) have been studied, there is limited attention given to manic symptoms. This case report aims to contribute to the knowledge of PC psychiatric comorbidities by describing a case of a 61-year-old patient with stage IV PC, with no personal or family psychiatric history, who presented a sudden onset manic episode.ObjectivesOur goal is to contribute to the growing knowledge of psychiatric comorbidities of PC focusing on manic symptoms by describing the case of a patient with stage IV PC without previous psychiatric history who presented a sudden onset of a manic episode.MethodsWe describe the mentioned clinical case. We also searched for previous case reports of maniac episodes in pancreatic cancer using a PubMed query.ResultsThe patient, a 61-year-old male with stage IV PC, presented at the Emergency Room with abrupt behavioural changes suggestive of a manic episode of two weeks of evolution. The patient had been undergoing chemotherapy and short 3-day cycles of corticosteroids for the past 9 months but had been off this treatment for 20 days when the episode began. Acute organic causes were ruled out. The patient was admitted to the psychiatric unit, where organic screening was expanded and treatment with antipsychotics and a mood stabilizer was initiated with subsequent remission of symptoms after two weeks.This article describes the case of a man with a PC diagnosis who had no prior psychiatric history and was admitted to the inpatient psychiatry unit due to a manic episode involving high-risk behavioral disturbances and megalomaniac psychotic symptoms. Several factors may have contributed to the onset of these symptoms, including corticosteroid use after chemotherapy and certain chemotherapy agents. However, due to temporal factors, these factors do not fully explain the episode.The exact biological mechanisms behind the manic symptoms remain unknown, but hypotheses include gene-environment interactions in bipolar disorder and immunodysregulation related to the production of inflammatory cytokines. We found in the literature four cases that have reported new-onset mania as an initial symptom of PC, but the causal relationship is unclear.ConclusionsNotably, this case differs from others due to the rapid remission of symptoms and the use of lithium therapy. While the underlying mechanisms are still unclear, this case contributes to understanding this rare complication of PC and may help in developing consensus on clinical management. Future research will further explore the pathophysiology of psychiatric symptoms in PC and appropriate therapeutic approaches.This case shows a manic episode as a rare psychiatric complication in PC. In the literature reviewed, four other similar cases have been observed.Disclosure of InterestNone Declared

Thyroid psychosis: when your hormones take over your mind: a case report

IntroductionHyperthyroidism, characterized by excessive production of thyroid hormones, is a common endocrine disorder that affects various body systems. While most commonly recognized for its classic symptoms such as weight loss, tremors, and palpitations, it is important to acknowledge that hyperthyroidism can also lead to a rare but significant complication: psychosis. Psychosis in the context of hyperthyroidism refers to the presence of delusions, hallucinations, and disordered thinking, which can significantly impact an individual’s mental health and overall well-being.ObjectivesThis case report aims to describe a rare case of hyperthyroidism-related psychosis in a patient including the clinical presentation, diagnosis, and management. Additionally, we aim to increase awareness of and promote further research into this condition.MethodsWe present a comprehensive case report detailing the clinical course of a 29-year-old male patient with no previous medical or psychiatric history, who sought urgent psychiatric evaluation at the Razi Hospital La Manouba’s emergency department due to escalating symptoms of agitation and paranoia persisting for three days. The patient, identified as Mr. S.O., a Tunisian male, presented with severe agitation and paranoia necessitating the use of restraints upon admission to the psychiatric emergency department. The initial physical examination revealed no notable abnormalities, except for the presence of tachycardia, which was subsequently confirmed on an electrocardiogram, arousing suspicion of a primary psychiatric illness.ResultsWhile the standard blood workup yielded unremarkable findings, the endocrine workup revealed decreased levels of thyroid-stimulating hormone (TSH) and elevated free thyroxine (FT4). Further laboratory investigations demonstrated elevated anti-thyroid-stimulating hormone receptor antibodies, leading to the diagnosis of Graves’ disease. Collaborative consultation with an endocrinologist resulted in the initiation of a treatment regimen consisting of methimazole, propranolol, and risperidone. Notably, within three days of the initiated therapy, the patient exhibited significant improvement in terms of reduced agitation, coherent speech, and the development of self-reflection regarding the episode, ultimately leading to his discharge on the seventh day of hospitalization. This case report serves to highlight the complexity of psychiatric presentations associated with underlying endocrine disorders and underscores the importance of interdisciplinary collaboration in achieving optimal patient outcomes.ConclusionsWhile mental health factors play a significant role in the development of psychosis, it is essential to recognize that underlying medical conditions may also contribute to its onset or exacerbation.Disclosure of InterestNone Declared

Depression and Anxiety in Patients With Polycystic Ovary Syndrome: A Cross-Sectional Study in Saudi Arabia.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in females of childbearing age. It causes irregular menstruation, infertility, acne vulgaris, androgenic alopecia, and hirsutism. It is associated with a higher risk of mental disorders. This study aimed to determine the prevalence of depression and anxietyamong females with PCOS and the factors associated with these disorders. This cross-sectional study was conducted between 15th January and 19th November 2023. We invited Saudi women to do an online survey. We sent the survey link privately, got their permission, and explained the research to ensure privacy and reliability. Females with a previous psychiatric history were excluded. Depression, Anxiety, and Stress Scale-21 Items (DASS-21) were used to assess depression, anxiety, and distress. One-way analysis of variance (ANOVA) and two-sample t-tests were used to identify determinants of depression and anxiety. About 967 females participated, of whom 474(49%) were married, and 358 (37%) had a healthy weight. About 367 (37.9%)of participants were diagnosed with PCOS, and it was associated with age (26-35 years), divorce, and family history of PCOS (p < 0.05). About 112 (30.5%) of PCOS patients experienced extremely severe depression, and 144 (39.2%) had extreme anxiety. People in the age range of 15-25 years had a higher risk of depression and stress (p < 0.05). Divorced participants faced a higher risk of depression, anxiety, and stress than singles (p < 0.05). Those advised on diet and healthy lifestyles exhibited a higher risk of depression, anxiety, and stress than those who were not (p < 0.05). Additionally, being overweight was associated with a higher risk of depression (p < 0.05). The prevalence of PCOS was found to be 37.9% in our study, which may seem higher compared to the existing literature on PCOS. It is associated with being in the age group of 26-35 years, being divorced, and having a positive family history. Almost two-thirds of females with PCOS had depression, anxiety, and stress. Factors associated with the three disorders include divorce and management with diet and lifestyle modifications. Depression and stress were associated with young age. High body mass index (BMI) was associated with depression.

COVID-19 AND MANIA: A CASE WITH A ONE-YEAR FOLLOW UP.

COVID-19 may affect central nervous system. The symptoms related to the CNS may occur through the direct neuroinvasion of the virus, inflammation, autoimmunity, psychosocial stressors and treatment side effects. COVID-19 can increase the severity of existing mental illnesses and also trigger the onset of a new mental illness. In this case report, we present a 52-year-old male patient with no previous psychiatric history as well as no family history of mental illness. The patient's manic symptoms began while he was hospitalized due to severe COVID-19 pneumonia. The patient, who self-discharged himself from the hospital was brought to the emergency department involuntarily by his relatives 14 days later and was admitted to the psychiatry service. In this case report, possible etiological factors were discussed and the treatment course during the hospitalization and one year follow-up were presented. Our aim is to contribute to the literature by discussing possible etiological factors and management of mania that started during the treatment of COVID-19. COVID-19 can affect the central nervous system and be associated with psychiatric symptoms. Keywords: COVID-19, Mania, Bipolar Disorder, Central Nervous System.

Mental Health Consequences of the COVID-19 Outbreak Among Emergency Department Healthcare Workers.

Study Objective: The present study is aimed at providing an assessment of the changes in burnout, job strain, isostrain, sleepiness, and fatigue levels over time and identifying factors associated with these symptoms among healthcare workers in French emergency departments (EDs). Method: We conducted a prospective, multicenter study in four EDs and an emergency medical service. Participants completed questionnaires at inclusion and at 90 days to assess burnout, job strain, isostrain, sleepiness, and fatigue. Results: A total of 211 respondents (43.5%) completed the questionnaires at inclusion. At the beginning of the study, 84 (40.8%) participants presented symptoms of burnout, 86 (43.2%) had symptoms of job strain, and 58 (29.4%) of isostrain. Forty-two (20.1%) healthcare workers presented symptoms of sleepiness, and 8 (3.8%) had symptoms of fatigue. We found that symptoms of burnout were more frequent for healthcare workers with a previous psychiatric history (55.3% vs. 39.1%, p = 0.02) and were lower among participants who had at least one dependent child (33.1% vs. 48.3%, p = 0.013). Symptoms of job strain were higher among administrative staff compared to physicians (55.6% vs. 28.7%, p = 0.01) and among healthcare workers with managerial responsibilities compared to those without (45.6% vs. 28.8%, p = 0.015). Symptoms of isostrain were higher among administrative staff (42.3%) compared to paramedics (34.1%) and physicians (19.8%, p = 0.026). Conclusion: We identified that potential factors associated with the emergence of symptoms of burnout and job strain are suggested, underlining several areas of improvement for the prevention against mental health disorders in the specific population of ED healthcare workers. Trial Registration: ClinicalTrials.gov identifier: NCT04383886.

Neuroticism is associated with entorhinal cortex volume in cognitively unimpaired older adults

AbstractBackgroundNeuroticism, the tendency toward negative mood states, is associated with Alzheimer’s Disease (AD) and tau pathology within entorhinal cortex (EC) in mild cognitive impairment and healthy older adults. However, studies of the link between neuroticism and structural neurodegeneration of EC have been negative. This may result from failure to account for subsyndromal affective symptoms or previous psychiatric history, as neuroticism is closely related to mood conditions that in turn, affect similar brain regions vulnerable to AD. We examined the association between neuroticism and EC volume while accounting for cognition, affective symptoms, and other personality traits in cognitively unimpaired (CU) older adults without history of major psychiatric conditions.Method42 CU adults (age = 71.1 years, 27 females) with normal neuropsychological test performance and no known neurological conditions and current or past psychiatric disorders completed Geriatric Depression Scale, State‐Trait Anxiety Inventory, NEO Five‐Factor Inventory‐3 which assesses neuroticism, openness, conscientiousness, extraversion, and agreeableness, Montreal Cognitive Assessment (MoCA), and structural magnetic resonance imaging of whole brain at 3T. Regression analyses examined the unconditional ability of neuroticism to predict bilateral EC volume, and while considering the potential contribution of cognition (MoCA, California Verbal Learning Test Delayed Recall), affective state, other personality traits, and age, gender, and education. P&lt;.10 was set as the significance threshold for β estimates.ResultIn univariable modelling, neuroticism was predictive of left EC volume (β = ‐17.4, p = .025), explaining 9.8% of its variability [F(1, 40) = 5.45, p = .025]. Neuroticism remained a significant predictor of left EC volume (β = ‐1.9, p = .045) after factoring in demographic, cognitive and affective/personality variables. Additional left EC predictors were extraversion and state anxiety (β = ‐2.61, p = .01; β = 1.71, p = .045 respectively). Neuroticism was not predictive of right EC in univariable or multivariable modelling, but agreeableness emerged as a significant predictor (β = ‐1.68, p = .091).ConclusionNeuroticism was predictive of left EC volume in CU adults without current or past history of psychiatric disorders, independent of cognition, affect, and other personality traits. These findings, which have not been previously reported, extend previous epidemiological evidence of increased AD risk due to neuroticism and suggest the importance of considering the impact of mood symptoms and psychiatric history in this context.

Steroid-induced Psychosis in a Patient without a Previous Psychiatric History

This is a 45-year-old Hispanic male with retinitis pigmentosa, no previous psychiatric history, and no known substance use disorder who was treated with 80 mg of oral prednisone, tapered off over 6 weeks before undergoing eye surgery. One week after completing the treatment, he went missing, and when he was found, he described visual and auditory hallucinations, as well as paranoid thoughts. He demonstrated a calm affect, flat mood, decreased expressiveness, poor eye contact, and fluent speech. The thought process was linear and goal-directed. Thought content was negative for hallucinations and paranoia, but delusional, with limited judgment and insight into his current situation. Negative suicidal or homicidal ideations. He was admitted to the hospital for further work up for encephalopathy. Images and laboratory results were irrelevant. The patient's encephalopathy completely resolved the following day, and no antipsychotic medications were administered. The psychiatric assessment was compatible with steroid-induced psychosis based on the acute onset, the brief psychotic episode with complete resolution of symptoms (5 days), precipitated by stressors (combined effects of an incapacitating disease). With this case presentation, we want to raise awareness among primary care physicians of the occurrence of steroid-induced psychosis and highlight the importance of patient education including their caregivers, as the cornerstone for an early recognition and prompt management of neuropsychiatric adverse events of glucocorticosteroids.

The Prevalence and Characteristics of Intrafamilial Child and Adolescent Homicides in Greece over 11 Years (2010-2020).

Intrafamilial child/adolescent homicide is the murder of a child/adolescent by one or more family members. This study delves into the medical and sociological consequences of child homicide, shedding light on the broader impact beyond individual families, which extends into the local community. Two Internet search engines and the search engines of major national news websites were surveyed to identify the number of intrafamilial child/adolescent homicide cases that occurred in Greece from January 2010 to December 2020. Over the study period, 34 victims of intrafamilial child/adolescent homicides were identified. The above deaths reflect an intrafamilial child/adolescent homicide rate of 0.15 homicides per year per 100,000 inhabitants. Most of the perpetrators (51.4%) were male, and the victims were equally divided into males and females. The ages of the perpetrators ranged from 13 to 61 years, and the ages of the victims ranged between 0 and 17 years. Most perpetrators (54.5%) had a previous psychiatric history and in many cases, they committed (33.3%) or attempted (15.2%) suicide after the homicide. The most common method of homicide was strangulation (usually combined with suffocation) (25%), followed by abandonment (15.6%). The most commonly reported motives were spousal revenge (26.5%) and psychotic disorders (26.5%). Raising awareness for intrafamilial child and adolescent homicide is of the utmost importance for the prevention of this dreadful phenomenon.

Delirium and Previous Psychiatric History Independently Predict Poststroke Posttraumatic Stress Disorder.

Delirium is an acute brain dysfunction that has been correlated with adverse mental health outcomes, such as depression and posttraumatic stress disorder (PTSD). However, delirium has not been studied in relation to mental health outcomes after cerebrovascular events. This study aimed to examine the incidence of PTSD after nontraumatic intracerebral hemorrhage (ICH) and identify new predictors of poststroke PTSD symptoms. Clinical data were collected from 205 patients diagnosed with nontraumatic ICH. Demographics and hospital course data were examined. Univariate and multivariable correlational analyses were performed to determine predictors of PTSD symptoms. PTSD symptoms were assessed using PTSD checklist-civilian version (PCL-C) scores. Diagnostic criteria for a positive PTSD screen (PCL-C score ≥44) were met by 13.7%, 20.2%, and 11.6% of nontraumatic patients with ICH at 3, 6, and 12 months, respectively. On univariate analysis, younger age, female sex, unemployed, and in-hospital delirium were correlated with higher PCL-C scores. In multivariable models, younger age, female sex, unemployed, in-hospital delirium, and a previous anxiety or depression diagnosis were associated with higher PCL-C scores at different follow-up times. Modified Rankin Scale scores were also positively correlated with PCL-C scores at each time point. Delirium, previous psychiatric history, younger age, female sex, and unemployment status were found to be associated with a greater degree of posthemorrhagic stroke PTSD symptoms. More significant PTSD symptoms were also correlated with greater functional impairment. A better understanding of patient susceptibility to PTSD symptoms may help providers coordinate earlier interventions.

A Case Report on Alcohol Dependence Syndrome with Relation to Insomnia

Alcohol dependence is a pattern of substance use, leading to clinically significant impairment or distress; chronic alcohol abuse has been known to disrupt the normal sleep cycle and lead to sleep disorders, including sleep terror disorder. A male patient of age 42 years was a known alcoholic for 24 years, and the patient does not have any previous psychiatric history. Then, he stopped drinking for four days and developed insomnia. The patient gave an account of emotional outbreaks from 2 days; vital signs included blood pressure 140\90 , pulse rate 81 bpm, respiratory rate 20 , and oxygen saturation 97%@RA and the patient's GRBS level was 210 mg\, and the patient was immediately given with medication in. 4mg (IV), . (2 amp in 100 ml NS, BD), . Panto 40mg (IV), the same drug, was continued for three days, and there was no complaint of visual hallucinations. The patient felt symptomatically better and was discharged on the 4th day with no fresh complaints. The patient was advised to continue Tab. 2mg for three days. The preliminary case investigation evaluated the link between insomnia and alcohol dependence syndrome (ADS).

Prevalence of Psychoactive Substance use among Adults Ages of 20 to 40 Years at the Georgetown Public Hospital Corporation

Background: Guyana is a developing nation with a population of under one million. Yet, 15 to 20 percent of the population suffer from some form of mental health condition. Oftentimes persons turn to psychoactive substances to deal with their mental health condition. This study aimed to investigate the prevalence of psychoactive substance use, as well as, to identify psychoactive substances and risk factors among adults attending the psychiatric outpatient clinic at the Georgetown Public Hospital (GPHC). Methodology: A review of outpatient clinic charts belonging to patients ages 20 to 40 years, who were enrolled from January 1st to December 31st, 2019 at the psychiatric clinic (GPHC) regardless of their presenting complaint or diagnosis was carried out. Those that had records of psychoactive substance use were collected for analysis in this study. Sociodemographic characteristic and type of psychoactive substances were assessed using descriptive analysis. Results: Of 200 patient charts reviewed, 150 (75%) had records of psychoactive substance use. The majority of psychoactive substance users were Afro-Guyanese (42.7%), Christians (71.3%) and male (76.7%) with an average age of 28 years. Additionally, most patients had only primary education (59.3%) and were not in a relationship (80.7%). Moreover, the majority patients experienced a major traumatic life event (60%) and were from dysfunctional families (13.3%). The findings also showed that 47.3% of persons with a previous psychiatric history used psychoactive substances, while 36% developed a substance-induced psychotic disorder. Cannabis (78%) was identified as the most frequently used drug, followed by alcohol (50.7%) and tobacco (45.3%). Conclusion: There was a high prevalence of psychoactive substance use among patients enrolled in the psychiatric clinic, GPHC. With the majority of patients having known risk factors for psychoactive substance use. Also, results highlighted that some patients developed psychotic disorders post substance use. This emphasizes the need for more mental health awareness strategies targeted at adults and the need for effective drug rehabilitation programs, which can help reduce the use of psychoactive substances among adults in Guyana. Keywords: Young Adults, Psychoactive Substance, Mental Health, Guyana

Gornje gastrointestinalno krvarenje, neuobičajena prezentacija Zlatokosinog sindroma

Gastrointestinal bezoars in the pediatric age group have an unusual presentation, and their clinical manifestation is mainly associ- ated with obstructive conditions of the gastrointestinal tract, and are generally made up of hair and food debris. In a smaller num- ber, it has been seen that from its usual location, which is the stomach, bezoar structures could extend into the duodenum, jejunum, ileum, and even colon, giving the appearance of a “Rapunzel tail”. We present the case of a 7-year-old girl with an atypical initial presentation of Rapunzel syndrome, secondary to a trichobezoar. The patient did not have previous psychiatric history, nor reports of any disturbance at school. She was admitted to the emergency room due to upper gastrointestinal bleeding and required a subsequent transfusion of blood products. During her hospitalization, an up- per digestive endoscopy was performed, with the diagnosis of Rapunzel syndrome, in addition to the presence of two Forrest II-C, III gastric ulcers and severe erythematous gastritis in the region of the antrum and body. Medical treatment was started without suc- cess, for which the bezoar had to be surgically removed. Therefore, we want to point out the importance of deepening certain aspects such as the medical history and background in this type of patient, since it is a disorder linked to behavioral and mood alterations; likewise, remember the less frequent clinical symp- toms such as upper gastrointestinal bleeding, but which in turn can be lethal if we don’t act promptly. In the same way, the compre- hensive approach with the support of the family and the intervention of psychology and/or psychiatry is vital to prevent recurrences.

#4437 ASSESSMENT OF THE PSYCHOLOGICAL EXPERIENCE OF KIDNEY TRANSPLANT PATIENTS DURING THE COVID-19 PANDEMIC

Abstract Background and Aims The coronavirus (COVID 19) pandemic has caused a major health crisis, and quarantined half of the world's population, therefore it contributed to the appearance or aggravation of mental distress such as anxiety, depressive disorders and deterioration of the quality of sleep especially in the immunocompromised population and especially in the kidney transplant patients. Among the causes of these disorders are the risk of infection and the relatively high mortality rate associated with this virus. The aim of our study is to investigate anxiety and depression scores in renal transplant patients during the COVID 19 pandemic and compare them to those of the general population to highlight the impact that the pandemic has had on this vulnerable population. Method This is a descriptive and analytical case-control study of a group of 113 patients divided into 2 groups: group of kidney transplant patients and that of the general population. A questionnaire collecting sociodemographic data was used. Anxiety symptoms were assessed by the GAD anxiety scale. Depressive symptoms were assessed using the Beck's scale abbreviated. Results In our study, the rates of anxiety and depression in the general population group were around 33.3% and 18.3% respectively. This rate was significantly higher in subjects with previous psychiatric history. These rates were higher in women with an anxiety rate of 18.3% versus 15% in men and a depression rate of 11% in women versus 7% in men and were significantly higher in subjects with previous psychiatric history. In the group of kidney transplant patients the rates of anxiety and depression were high compared to the general population, with a rate of anxiety at 66% and depression at 26.4% (p&amp;lt;0.001). Conclusion This study raised the major negative impact of the covid 19 pandemic on the increase of psychiatric disorders in this at-risk population compared to the general population. This requires a multidisciplinary and adapted management of these vulnerable patients, associating a joint nephrological and psychiatric follow-up in order to preserve their quality of life and their mental health.

Cognitive impairment and depressive symptoms in severe COVID‐19 elderly survivors: Preliminary results from 1‐year follow‐up assessment

AbstractBackgroundStudies have pointed towards the presence of neuropsychiatric sequelae after COVID‐19 infection, yet in the midst of the biggest health threat of this generation there are relatively few long‐term studies which have endeavored to identify such complications, known to have a negative impact on quality of life. In this context, this study aims to identify cognitive impairment (CI) and depressive symptoms in severe COVID‐19 elderly survivors, 1‐year after hospital discharge and also to analyse the association between CI and depressive symptoms.MethodThis study is part of the longitudinal MAPA project still ongoing at a University Hospital in Porto, Portugal. Patients with &gt;60 y.o., admitted into Intensive Care Medicine Department (ICMD), due to COVID‐19 (1st wave), were included. Exclusion criteria were: ICMD length of stay ≤24h, terminal illness, major auditory loss or inability to communicate at the follow‐up assessment. Participants were evaluated 1‐year after hospital discharge, with a research protocol, which includes Patient Health Questionnaire (PHQ‐9; depressive symptoms) and Six Item Cognitive Impairment Test (6CIT; CI).ResultThirty‐eight patients were included (median age = 71years). Mostly were male (66%), married (66%) and with low education (58% = 0‐4years). About 53% had previous psychiatric history (none had clinical registry of CI or dementia). Most patients (71%) needed deep sedation and invasive mechanical ventilation (71%). CI and depressive symptoms were observed in 18.4% of the sample, for both. Patients with depression had more CI (42.9%vs12.9%), however this difference was not statistically significant.ConclusionThese findings showed that an important proportion of severe COVID‐19 elderly survivors suffers from depressive symptoms and CI, 1‐year post‐discharge, which are in line with other studies. These results underline the need to better clarify the long‐term relationship between depression and CI in severe COVID‐19 survivors.

Prognosis of patients with subjective cognitive decline in an unselected clinical sample

AbstractBackgroundIndividuals with subjective cognitive decline (SCD) perceive that their cognition has worsened, but score normally on standardized cognitive tests. It is increasingly recognized that SCD has variable prognosis with the risk of progression to dementia being twice that of age‐matched controls without SCD. This study aimed to characterize an unselected sample of patients with SCD (n = 433) drawn from a larger memory clinic cohort (n = 2,262) and to compare baseline SCD profiles based on follow‐up diagnosis.MethodThis study used routinely‐recorded data from the Essex Memory Clinic (UK). Baseline data included age, sex, years of education, medical and psychiatric history, and physical examination results. A range of neuropsychological measures were administered, and repeated at 12/24‐month intervals. All included patients had at least one follow‐up visit. A consensus diagnosis was made by three clinicians at each visit and was supported by structural CT/MRI investigations. Group comparisons were made using two‐tailed t‐tests, Chi‐squared or Fisher’s exact tests.ResultThe Table presents the results in full. Of 434 patients with SCD diagnosis at baseline, 189 did not progress (SCD‐stable), 169 progressed to dementia (Alzheimer’s = 113; Lewy body = 31; Vascular = 15; Frontotemporal = 4; Other = 6) and a further 76 to mild cognitive impairment (MCI) during follow‐up (median 2.9 years). At baseline there were significant differences between SCD‐stable patients and those who progressed. Patients who progressed to dementia were older than the other two groups. Patients who progressed to MCI/dementia had worse episodic memory (Logical Memory Test delayed and word list recall) and took longer to complete Trail‐Making Test‐A. The SCD‐stable group had higher baseline anxiety and were more likely to have previous psychiatric history versus patients who declined.ConclusionIn this unselected clinical sample from a non‐academic setting, we have replicated and extended previous findings from research cohorts. Whilst anxiety is a risk factor for dementia, anxiety in the context of SCD is associated with a better prognosis and may be an expression of a subclinical affective disorder rather than prodromal neurodegenerative disease. This project demonstrated clear differences at the group level and the next step is to build data‐driven prognostic models that can be applied to individual patients in a clinical setting.

P.120 Traumatic penetrating head injury by crossbow projectiles: a case report and literature review

Background: Penetrating head injury secondary to crossbows is a rare encounter in neurosurgical practice with only few cases reported in the literature. Methods: Chart review and literature review. Results: A 31-year-old man with a previous psychiatric history sustained a self-inflicted injury using a crossbow he bought from a department store. The patient arrived neurologically intact. He was not able to verbalize due to jaw fixation with the arrow. The trajectory of the object showed an entry point at the floor of the oral cavity and an exit through the calvarium just off the midline. The oral and nasal cavities, along with the palate and the skull base, and the left frontal lobe were all breached (figure). No vascular injury was identified on imaging (figure). The arrow was surgically removed in the operating room after establishing an elective surgical airway. A planned delayed CSF leak repair was performed. The patient made a substantial recovery and was discharged home in good status. Conclusions: - Multidisciplinary team is key.Vascular imaging should be done pre and post-intervention.Surgical approach is determined by the trajectory.Psychiatric illness and access to weapons are major risk factors.Elective surgical airway might be indicated.

Prolonged Unmet Mental Health Needs of the 2017 Pohang Earthquake Survivors.

Two years after the 2017 Pohang earthquake, some people sought follow-up mental health support. The demographic and clinical characteristics of this unique group of people were investigated to identify some insights on the predisposing factors of the longterm need for psychiatric help after a severe earthquake disaster. De-identified data from those seeking mental health support 2 years after the 2017 Pohang earthquake were used. The descriptive statistics of demographic and clinical characteristics of the study group was identified and paired with general population data obtained from open and public governmental websites. Sex, age distribution, destruction of house, and psychiatric disorder were compared between the follow-up sample and general population. The proportion of women in the group seeking support was two times higher than that in the general population, and people ages between 50 and 70 years commonly sought support. The severity of home destruction was higher among people who sought and needed follow-up mental health support programs than in the general population. There was a higher proportion of people with psychiatric disorders in the group seeking support than in the general population. The need for long-term mental health support 2 years after an earthquake was higher in women than in men and those aged between 50 and 70 years, and those with a previous psychiatric history and with a higher severity of home destruction, which lead to necessitating leaving the home. Future earthquake response should include screening and psychiatric treatment referral and residential support in vulnerable people.

Predicting future onset of depression among middle-aged adults with no psychiatric history.

Depression is a major cause of disability worldwide. Recent data suggest that, in industrialised countries, the prevalence of depression peaks in middle age. Identifying factors predictive of future depressive episodes is crucial for developing prevention strategies for this age group. We aimed to identify future depression in middle-aged adults with no previous psychiatric history. To predict a diagnosis of depression 1 year or more following a comprehensive baseline assessment, we used a data-driven, machine-learning methodology. Our data-set was the UK Biobank of middle-aged participants (N = 245 036) with no psychiatric history. Overall, 2.18% of the study population developed a depressive episode at least 1 year following baseline. Basing predictions on a single mental health questionnaire led to an area under the curve of the receiver operating characteristic of 0.66, and a predictive model leveraging the combined results of 100 UK Biobank questionnaires and measurements improved this to 0.79. Our findings were robust to demographic variations (place of birth, gender) and variations in methods of depression assessment. Thus, machine-learning-based models best predict diagnoses of depression when allowing the inclusion of multiple features. Machine-learning approaches show potential for being beneficial for the identification of clinically relevant predictors of depression. Specifically, we can identify, with moderate success, people with no recorded psychiatric history as at risk for depression by using a relatively small number of features. More work is required to improve these models and evaluate their cost-effectiveness before integrating them into the clinical workflow.