Psychiatric Department Research Articles

Epidemiological, clinical, and forensic approach to a series of defendants examined in criminal psychiatric expertise

Introduction The transgression of the law can be a deliberate act by a lucid adult, but it can also be the result of a deficiency in judgment and discernment due to lack of age or insanity. Psychiatric expertises are more and more solicited in the penal field with the objective of identifying the causal link between mental illness and the criminal act.ObjectivesThe objective of this work was to give an overview of the subjects expertised, the offences and the pathologies encountered through the report of a psychiatric expertise activity in criminal law.MethodsIt is a retrospective descriptive study carried out on the criminal psychiatric expertises made for a forensic act in the psychiatric department of Mahdia during the period from January 1, 2003 to March 30, 2022.Results In total, we collected 101 defendants. The average age of our study population was 35±12.07 years. The majority of our study sample was male (98%), from an urban area (50%). 46.6% had primary education and only 11.2% had higher education. The defendants were single in 57.8% of the cases, and almost half (45.7%) had no occupation. Two-thirds of the accused (61.2%) had experienced emotional deprivation at a young age. The problematic use of psychoactive substances was found in 10.3%, as well as alcohol consumption in 46.6%. Moreover, 39.7% of the patients had a personal psychiatric history and 19% had been incarcerated at least once. The forensic acts were mostly against people (62.9%) dominated by physical aggression (33.6%) followed by homicide or its attempt in 19% of the cases. The majority of patients were not related to their victims (62.1%). The nosographic diagnosis found was a personality disorder in 32.75% of cases, followed by schizophrenic disorders in 22.4% of cases.ConclusionsPsychiatric expertise is a useful, complex and noble clinical act. Determining the predictive factors of a possible acting out allows to specify the objectives of interventions aiming at limiting the acts of violence, hospitalizations and incarcerations of patients suffering from mental disorders.Disclosure of InterestNone Declared

Paliperidone LAI-Induced Leukocytopenia: A Case Report

IntroductionAntipsychotics effectively manage psychotic symptoms but may have side effects. Patients with schizophrenia often lack insight into their condition, leading to nonadherence. Long-acting injectable (LAI) antipsychotics aim to overcome this, reducing relapse risks. Paliperidone LAI, a second-generation antipsychotic, has a lower side effect profile when compared to first-generation counterparts. Blood dyscrasias, like neutropenia and lymphopenia, increase infection susceptibility. This case report describes an instance of leukocytopenia arising during paliperidone LAI treatment, which quickly resolved after the discontinuation of the medication.ObjectivesThis case report describes an instance of leukocytopenia arising during paliperidone LAI treatment, which quickly resolved after the discontinuation of the medication.MethodsResultsCASEA 42-year-old female with schizophrenia, nonadherent to previously prescribed medication was admitted to our acute psychiatric department. She experienced positive symptoms (paranoid delusions), as well as disorganized thinking and behavior. Oral risperidone 4 mg two times a day was recommenced and titrated with mild improvement in her psychotic symptoms with the idea of switching to paliperidone LAI and eventually ceasing oral medication. Oral paliperidone was unavailable for prescription due to local restrictions. At admission her routine laboratory tests showed no abnormalities, but 5 days after receiving paliperidone LAI, routine laboratory tests showed a strong decrease in her WBC and absolute neutrophilic and lymphocytic count ( Lkc 2.89x109/L, Neut 1.57x 109/L, Lym 0.88x 109 /L ). Antipsychotic-induced blood dyscrasia was suspected and paliperidone depot was discontinued. The patient had rapid improvement in her WBC reaching the reference range in 10 days ( Lkc 4.23 x 109/L, Neut 2.51x10 9/L, Lym 0.98x 109/L). Sertindole was introduced consdering her history of a good therapeutic response to the drug, with improvement in psychotic symptoms. She is currently stable taking sertindole 16 mg/day, clonazepam 2 mg/day and alprazolam 0.5 mg/day.DISCUSSIONThe onset of neutropenia and lymphopenia post-paliperidone LAI initiation, resolving in 10 days,, indicate a direct association. Few cases report to date describe paliperidone-induced leukocytopenia, with rapid recovery post-discontinuation. Proposed mechanisms include bone marrow suppression and peripheral WBC destruction. It has been proposed that drug-induced neutropenia is often dose-dependent, which could explain why our patient exhibited tolerability to risperidone but developed cytopenia upon transitioning to depot paliperidone.ConclusionsWhile cases of agranulocytosis have been reported in association with the use of other antipsychotics these antipsychotics do not require the same monitoring as clozapine. Our case emphasizes the need for vigilant blood dyscrasia monitoring during antipsychotic therapy.Disclosure of InterestNone Declared

Urinary retention induced by psychotropics: A case report

IntroductionNeurological bladder is considered a functional disability that has a significant impact on the quality of life and psychological state of patients. Psychotropic drugs, in turn, can worsen the urinary dysfunction caused by this disease.ObjectivesOur objective is to illustrate, through the case of a patient suffering from a neurological bladder decompensated by the treatment of a characterized depressive episode, the link between these two pathologies.MethodsWe report the case of Ms. M.W., aged 51, with a history of high blood pressure stabilized under nebivolol and a neurological bladder diagnosed 10 years ago with episodic pollakiuria, admitted to the psychiatric department for repeated suicide attempts. She had never used psychoactive substances and had no family psychiatric history. The patient presented depressive symptoms evolving for 5 months. The diagnosis of a characterized depressive episode with melancholic features was made and the patient was treated with sertraline. From the first intake of the drug, the patient presented acute urinary retention (UR) requiring the placement of a permanent bladder catheter. The urinary symptoms improved upon stopping the treatment. Sertraline was changed to olanzapine and escitalopram. The patient stopped the treatment after one month because of the worsening of urinary symptoms requiring the installation of a suprapubic catheter. The urinary problem, together with the cessation of treatment, were responsible for a worsening of psychiatric symptoms leading to multiple suicide attempts. Given the advanced stage of the neurological bladder demonstrated by the urodynamic tests, our patient was treated with paroxetine, quetiapine and oxazepam along with psychotherapeutic education. The evolution was characterized by improvement in psychiatric symptoms and the urinary symptoms were stable.ResultsThe lack of improvement after treatment discontinuation could be explained by an underlying neurological bladder manifesting with pollakiuria. The current literature on UR induced by psychotropic treatments is quite rare limited in case reports. This effect occurs especially when selective serotonin reuptake inhibitors (SSRIs) are prescribed in combination with other antipsychotics. Unlike first generation antipsychotics, atypical antipsychotics have muscarinic receptor antagonist properties which can induce UR. Among atypical antipsychotics, olanzapine has been shown to have the greatest antimuscarinic effects. Regarding SSRIs, they are associated with a lower risk of UR than other antidepressants and sertraline had the highest risk of UR.ConclusionsSSRIs can induce UR particularly in combination with atypical antipsychotics. Coordination of care across multiple specialties and understanding the side effects of psychotropic medications can enable faster diagnoses and adequate management.Disclosure of InterestNone Declared

The effect of the Yara smartphone application on anxiety, sleep quality, and suicidal thoughts in patients with major depressive disorder in Iran: a randomized controlled trial

BackgroundDepression is one of the most common mental disorders that leads to anxiety, sleep disturbances, and suicidal thoughts. Due to the high cost of treatment and the reluctance of many patients to seek medical help, major depressive disorder (MDD) is becoming more prevalent. Therefore, alternative methods like smartphone applications can help prevent and improve depression symptoms. The present study aimed to determine the effect of the newly developed Yara smartphone application on anxiety, sleep quality, and suicidal thoughts in patients with MDD.MethodsThis randomized controlled trial with a pretest-posttest design was conducted on Iranian patients with MDD in 2022. Sixty-four patients were recruited using convenience sampling and randomly assigned to two control and intervention groups. The intervention was conducted using the Yara smartphone application for three months. Data were collected using the Spielberger State-Trait Anxiety Inventory (STAI), Pittsburgh Sleep Quality Index (PSQI), and Beck Scale for Suicidal Ideation (BSSI). Data were first entered into IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, N.Y., USA) and then analyzed using descriptive and analytical statistics.ResultsThere was no statistically significant difference in the mean score of anxiety and sleep quality between the intervention and control groups before the intervention (p ≥ .05). However, this difference in the mean score of anxiety and sleep quality was statistically significant in the two groups after the intervention (p < .05). The results showed no statistically significant difference in the mean score of suicidal thoughts between the two groups before and after the intervention (p ≥ .05). The use of the Yara smartphone application had a significant positive effect on anxiety and sleep quality in depressed patients (p < .001). At the same time, it had no significant effect on suicidal thoughts (p ≥ .05).ConclusionConsidering the positive effect of using the Yara smartphone application on reducing anxiety and improving sleep quality in depressed patients, this application can help alleviate the problems of depressed patients alongside existing treatment methods. Thus, this application is recommended for this group of patients in psychiatric clinics and departments. The Yara application's effectiveness was not approved on suicidal thoughts in this study so that further investigation would be necessary.Trial RegistrationIranian Registry of Clinical Trial approval code (IRCT# IRCT20131112015390N7).

Using Delphi method to address factors contributing to aggressive behaviour in mental health settings.

WHAT IS KNOWN ABOUT THE SUBJECT?: Nurses' perspectives and consensus on the possible key factors contributing to aggression at inpatient units can be summarized into patients' related factors, staff related factors and environment related factors. Results of the possible factors contributing to aggression at inpatient units reflect the complicated nature of this problem. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Perspectives of nurses as frontline mental health professionals on factors contributing to aggression as one of the psychiatric emergencies were considered through an iterative process. This approach gave nurses an opportunity to revisit their own views in each round to provide an in-depth reflection in the light of the contribution of others. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Nursing curricula should focus on nurses' communication skills and emotion regulation training. An open dialogue between nurses and people with mental health issues should be initiated to discuss the possible key factors contributing to aggressive behaviour at inpatient units from both standpoints. Mental health nurses' turnover at inpatient settings could be targeted through the design and implementation of aggression prevention protocols ABSTRACT: Introduction Aggression at inpatient units is a universal problem leading to hazardous outcomes. Aim To generate group consensus about factors contributing to aggressive behaviour among patients with mental health issues at inpatient units. Methods Nurses working at inpatient psychiatric departments were approached, and purposive sampling was employed to implement Delphi technique. A total of three Delphi rounds were conducted online. The average percent of majority opinions method was followed to measure consensus in which questions with a cut-off rate below 69.7% were included in the next round. Results Twenty-one nurse experts with different skills participated in this study. Consensus increased among nurse experts across rounds for the following items: Patients' misinterpretation of the attitude of the healthcare providers, severity of mental health issues, attitude and communication style of the healthcare providers, nurses limited emotional regulation capacity and the inadequate staff-patient ratio in psychiatric wards. Discussion The complicated nature of aggressive behaviour displayed by people with mental health issues is reflected on the results of the current study; patients' related factors, staff related factors and environment related factors constitute interacting facets for this issue. Implications for Mental Health Nurses Nurse scientists could use insights derived from this study to design studies aiming at assessment and management of aggression at inpatient units guided by implementation science frameworks. Additionally, open dialogues between nurses and people with mental health issues could be initiated about factors contributing to aggression at inpatient units. Mental health nursing training should focus on nurses' communication and emotion regulation skills.

Childhood adversity in a youth psychiatric population: prevalence and associated mental health problems

ABSTRACT Background: Childhood adversity can have lasting negative effects on physical and mental health. This study contributes to the existing literature by describing the prevalence rates and mental health outcomes related to adverse childhood experiences (ACEs) among adolescents registered for mental health care. Methods: Participants in this cross-sectional study were youths (aged 12–18 years) who were referred to outpatient psychiatric departments in the Netherlands. Demographic information was collected from the medical records. The Child Trauma Screening Questionnaire (CTSQ) was used to examine the presence of ACEs and posttraumatic stress symptoms (PTSS). To assess mental health problems, we used the Dutch translation of the Youth Self Report. Descriptive statistics and frequencies were used to calculate prevalence rates across the various ACEs domains. ANOVA and chi-square tests were used to explore the relationship between ACEs and mental health. Results: Of the 1373 participants, 69.1% reported having experienced at least one ACE and 17.1% indicated exposure to four or more ACEs in their lives. Although there was substantial overlap among all ACE categories, the most frequently reported were bullying (49.2%), emotional abuse (17.8%), physical abuse (12.2%), and sexual abuse (10.1%). Female adolescents (72.7%) reported significantly more ACEs than their male counterparts (27.0%). Furthermore, a higher number of ACEs was associated with significantly more self-reported general mental health problems, an elevated prevalence of both mood and post-traumatic stress disorders, and a greater presence of two or more co-existing psychiatric diagnoses (comorbid psychiatric classification). Conclusions: This cross-sectional study on childhood adversity and its association with mental health showed that ACEs are highly prevalent in youth registered for mental health care. This study provides support for a graded and cumulative relationship between childhood adversity and mental health problems.

Intensive Longitudinal Social Sensing in Patients With Psychosis Spectrum Disorders: An Exploratory Pilot Study.

Psychosis spectrum disorders are characterized by significant alterations in social functioning, which is a major factor for patient recovery. Despite its importance, objectively quantifying the complex day-to-day social behavior in real-life settings has rarely been attempted. Here, we conducted a pilot study with wearable sensors that passively and continuously register interactions with other participants. We hypothesized that the amount and pattern of social interaction was associated with the severity of psychotic symptoms. We recruited 7 patients with psychosis spectrum disorders and 18 team members from a Soteria-style ward. Each participant wore a radio frequency identification badge, sending and receiving signals from nearby badges, allowing passive quantification of social interactions. In addition, symptom severity was assessed weekly by the Positive and Negative Syndrome Scale (PANSS). During an 11-week period, we identified 17970 interactions among patients and staff. On average, patients spent 2.6h per day interacting, capturing relevant aspects of daily social life. Relative daily interaction time, average interaction duration, and clustering coefficient, a measure of local network integration, were significantly associated with lower PANSS scores. Self-reported interaction time did not correlate with measured interaction time or with PANSS, indicating the importance of objective markers. This pilot study demonstrates the feasibility of passively recording social interaction of patients and staff at high resolution and for a long observation period in a real-life setting in a psychiatric department. We show links between quantified social interaction and psychopathology that may facilitate development and personalization of targeted treatments.

Subjective and objective assessments of executive functions are independently predictive of aggressive tendencies in patients with substance use disorder

Background and aimsImpairments in executive functions have been found to influence violent behavior. Executive functions are crucial in the treatment of patients with substance use disorders because substance use generally impairs cognitive processes and is therefore detrimental for executive functions thereby reducing control of behavior and thus of consumption impulses. We studied correlations between subjective, i.e. self-report, and objective, i.e. behavior-based, assessment of executive functions and the predictive validity of these measures for aggression in patients with substance use disorder. MethodsThe study included 64 patients with a diagnosed substance use disorder who were convicted according to the German Criminal Code for crimes they committed in the context of their disorder and were therefore in treatment in forensic psychiatric departments in Germany. Multiple self-report and behavior-based instruments were used to assess executive functions, appetitive and facilitative aggression as well as clinical and sociodemographic variables. ResultsParticipants showed impaired executive functions, and measures of executive functions predicted aggressive tendencies and violent offenses. Despite ecological validity of the findings, the subjective and objective assessments of executive functions did not correlate with each other, which corroborates studies in other clinical settings. ConclusionsWe discuss that this finding may be due to the conceptual differences between subjective and objective measures. Therefore, self-report and behavior-based measures should not be used as proxies of each other but as complementary measures that are useful for comprehensive diagnostics of cognitive impairments and assessment of risks for violent behavior.

Examining sexual minority engagement in recovery community centers

IntroductionResearch indicates that sexual minority (SM) individuals with alcohol and other drug use disorders may underutilize recovery resources generally but be more likely to use recovery community centers (RCCs). To inform recovery supports, this study characterized SM and heterosexual RCC members by demographics and clinical and recovery support service utilization. MethodsCross-sectional secondary analyses compared SM and heterosexual RCC members in the northeastern U.S. (n = 337). Qualitative analyses coded the top three recovery facilitators. ResultsOf the 337 participants (Meanage[SD] = 40.98[12.38], 51.8 % female), SM RCC members were more likely than heterosexuals to endorse lifetime psychiatric diagnoses and emergency department mental health treatment (p < .01). RCC service utilization and qualitatively derived recovery facilitators were mostly consistent across groups. ConclusionsRCCs engaged SM individuals in recovery in ways consistent with heterosexuals. Despite otherwise vastly similar demographic characteristics across sexual identity, findings suggest a need for additional mental health resources for SM individuals in recovery.

Developing an individualized treatment rule for Veterans with major depressive disorder using electronic health records.

Efforts to develop an individualized treatment rule (ITR) to optimize major depressive disorder (MDD) treatment with antidepressant medication (ADM), psychotherapy, or combined ADM-psychotherapy have been hampered by small samples, small predictor sets, and suboptimal analysis methods. Analyses of large administrative databases designed to approximate experiments followed iteratively by pragmatic trials hold promise for resolving these problems. The current report presents a proof-of-concept study using electronic health records (EHR) of n = 43,470 outpatients beginning MDD treatment in Veterans Health Administration Primary Care Mental Health Integration (PC-MHI) clinics, which offer access not only to ADMs but also psychotherapy and combined ADM-psychotherapy. EHR and geospatial databases were used to generate an extensive baseline predictor set (5,865 variables). The outcome was a composite measure of at least one serious negative event (suicide attempt, psychiatric emergency department visit, psychiatric hospitalization, suicide death) over the next 12 months. Best-practices methods were used to adjust for nonrandom treatment assignment and to estimate a preliminary ITR in a 70% training sample and to evaluate the ITR in the 30% test sample. Statistically significant aggregate variation was found in overall probability of the outcome related to baseline predictors (AU-ROC = 0.68, S.E. = 0.01), with test sample outcome prevalence of 32.6% among the 5% of patients having highest predicted risk compared to 7.1% in the remainder of the test sample. The ITR found that psychotherapy-only was the optimal treatment for 56.0% of patients (roughly 20% lower risk of the outcome than if receiving one of the other treatments) and that treatment type was unrelated to outcome risk among other patients. Change in aggregate treatment costs of implementing this ITR would be negligible, as 16.1% fewer patients would be prescribed ADMs and 2.9% more would receive psychotherapy. A pragmatic trial would be needed to confirm the accuracy of the ITR.

Non-fatal self-harm and suicide following postpartum psychiatric emergency department visits: A population-based retrospective cohort study

In a population-based cohort of postpartum individuals in Ontario, Canada, this study aimed to determine the risk of non-fatal self-harm and suicide within one year of an initial postpartum psychiatric emergency department (ED) visit (2008–2020), and the key associated factors. Of 16,475 postpartum individuals with psychiatric ED visits, 714 (4.3 %) had non-fatal self-harm within one year, and 23 (0.15 %) died by suicide. Risk was substantially higher for those with self-harm at the initial presentation. Further efforts to connect individuals with postpartum psychiatric ED visits with needed inpatient care and outpatient follow-up are required to reduce non-fatal self-harm and suicide risk.

Sexual dysfunction, marital relationship, and subjective quality of life among women with schizophrenia: Analytical case-control study.

Women with schizophrenia have a high risk of adverse sexual health outcomes. The chronic course of schizophrenia draws attention to assessing the quality of life and marital relationships of patients with schizophrenia. However, there is a crunch of data in the Indian setting. This study aimed to investigate the prevalence of sexual dysfunctions (SDs) and determine the marital relationship and quality of life among women with schizophrenia. The study followed an analytical case-control design. The study was conducted at the inpatient psychiatric department of one of the apex tertiary healthcare centers located at the foothills of the Northern Himalayas. The study purposively included 136 participants (68 cases and 68 controls). The control group included healthy women aged 18-45 currently staying with sexual partners. Data were collected using pretested and standardized self-report questionnaires. The median age of the case group was 36 (interquartile range (IQR), 29-42) years, while that of the control group was 29 (IQR 26-34) years. The prevalence of SD was significantly higher (P = 0.001) in cases (95.3%) than in controls (73.4%). Compared to healthy controls, women with schizophrenia have a significantly higher rate of SD in sexual desire (P = 0.001), getting arousal (P < 0.001), lubrication (P < 0.001), achieving orgasm (P < 0.001), and sexual satisfaction (P < 0.001) (except pain). In addition, the marital relationship was better managed (P < 0.001) in healthy controls compared with cases. The healthy control group significantly expressed a better quality of life in physical (P < 0.001), psychological (P < 0.001), and maintaining social (P < 0.001) relationships (except environment domains). In multivariable logistic regression analysis, employment status significantly predicted SDs (odds ratio (OR), 25.78; 95% confidence interval (CI), 2.09, 318.10; P < 0.05) in participants. The prevalence of SD is significantly high among female participants. Hence, treating physicians should pay attention to sexual function during the screening and treatment of patients with schizophrenia.

CORRELATION OF SERUM LACTATE LEVELS WITH SURVIVAL IN PATIENTS WITH SEPSIS

Introduction: Sepsis is defined as a potentially fatal organ dysfunction caused by an unbalanced host response to infection. The primary objective of the study is to correlate serum lactate with the results of sepsis. The secondary objective of the study is to find associations of lactate in serum with the various etiological factors of sepsis and to correlate serum lactate with severity of sepsis. Material and Methods: This prospective cross-sectional study was conducted in Intensive Care Unit (ICU) and EmergencyDepartment (ED) for sepsis in NRI institute of medical sciences. A sixty five patients of both genders were included in the study. The study period were around 18 months from March 2021 to September 2022. Clinical examination and biochemical tests for blood levels of triglycerides, HDL and fasting blood glucose levels were done.Permission from Institutional Ethical Committee(IEC) were obtained. After getting permission from the Institutional Ethical Committee(IEC), information regarding the study were explained to the patients. Written and informed consent was obtained from them. Patients newly started on antidepressant treatment will be selected psychiatric department. Results: In the present study about 69%were in the age of 25 to 50 years. About 28% were in the age of more than 50 years. Only 3% were in the age of less than 25 years.Mean age is 48.87 and standard deviation is 3.21.About 65% were males and 35% were females.About 12% of patients required ventilation. About 77% survived. The relationship between serum lactate levels and outcome is statistically significant (P=&lt;0.05) Conclusion: The fundamental goals of sepsis and septic shock care are early detection and immediate fluid resuscitation.

Ischemic Heart Disease as an Important Risk Factor for Depression—A Case Report

The link between the mind and cardiac disease has been studied throughout the ages. Patients diagnosed with ischemic heart disease may develop psychological and psychiatric symptoms such as depressed mood, anxiety, and insomnia that can drastically affect life quality. Unfortunately, during cardiac rehabilitation, there is a lack of psychiatric care. To improve a patient’s quality of life, this intriguing relationship between ischemic heart disease and depression must be closely monitored, because risk factors and pathophysiological mechanisms may be common. This case report article is about a 47-year-old Romanian woman with acute coronary syndrome revascularized with angioplasty and stent implantation 3 months ago, admitted to the Arad Emergency County Clinical Hospital, Psychiatric Department, with depressive symptoms. Our patient was treated with an antidepressant, an anxiolytic, a mood stabilizer, a hypnotic, a nootropic, aspirin, dual platelet inhibition, a beta-blocker, a converting enzyme inhibitor, a statin, and oral antidiabetics medication, as well as having psychotherapy sessions. The treatment was well tolerated, with an improvement in the social and professional functionality of the patient. In conclusion, people with ischemic heart disease have a higher risk of developing depression, but patients with depression also have a higher risk of developing ischemic heart disease. This confirms the importance of an individualized multidisciplinary approach to management because the collaboration between psychiatrists and cardiologists can be an additional benefit to patients. This article may pave the way for further research into the association between ischemic heart disease and depressive disorders, which could provide significant advantages to patients. Interdisciplinarity contributes to the development of innovative techniques of prevention and treatment, reducing worldwide morbidity and mortality.

Foreign body within the upper esophagus of a patient not consenting to surgical treatment – case report and legal proceedings in light of current case law

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; Patients intentionally inserting foreign bodies into the lumen of their gastrointestinal tract usually aim at achieving certain benefits, such as postponement or avoidance of punishment.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; In view of the ever-increasing number of proceedings (including criminal proceedings) against health care professionals, the authors carried out a review of the available literature on: medical actions undertaken in cases of foreign bodies within the esophagus, current legislation and jurisprudence as practiced in the Republic of Poland within the context of model legal proceedings in cases involving patients raising doubts about being fully conscious and not consenting to necessary treatment.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Case report:&lt;/b&gt; The article presents a case of a patient with an esophageal foreign body who had not consented to the proposed surgical treatment. Doubts as raised within the otorhinolaryngological team with regard to the patient’s state of consciousness were not dispelled as the result of psychiatric consultation. Following a meticulous analysis of the current jurisprudence of the Polish judicial system and obtaining a court’s permission to intervene, the procedure (esophagoscopy with removal of esophageal foreign body) was performed. After exclusion of any life-threatening complications, the patient was transferred to the Psychiatric Department.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; In the current state of the law, performing a procedure to remove a foreign body from the esophagus without prior court approval could qualify as a violation of patient’s rights. In such case, legal liability of the physician would arise regardless of the fact that the patient would have received care in accordance with the current medical knowledge and practice.&lt;/br&gt;

Dance/movement therapy for improving metabolic parameters in long-term veterans with schizophrenia

Accumulating evidence has supported the implementation of dance/movement therapy (DMT) as a promising intervention for patients with schizophrenia (SCZ). However, its effect on body weight and metabolic profile in SCZ remains unclear. This study aimed to evaluate the outcome of a 12-week DMT session on weight and lipid profile in patients with SCZ using a randomized, single-blinded, controlled trial design. This study encompassed two groups of long-term hospitalized patients with SCZ, who were randomly assigned to the DMT intervention (n = 30) or the treatment as usual (TAU) group (n = 30). Metabolic markers, including weight, body mass index (BMI), fasting glucose, triglycerides, and total cholesterol were measured in both groups at two measurement points (at baseline and the end of the 12-week treatment). We found that DMT intervention significantly decreased body weight (F = 5.5, p = 0.02) and BMI (F = 5.7, p = 0.02) as compared to the TAU group. However, no significance was observed in other metabolic markers, including fasting glucose, triglycerides, and total cholesterol after treatment (all p > 0.05). Our study indicates that a 12-week, 24-session DMT program may be effective in decreasing body weight and BMI in long-term hospitalized patients with SCZ. DMT intervention may be a promising treatment strategy for long-term inpatients in the psychiatric department.

Psychotraumatic disorders among defense and security forces personnel in the context of terrorism in Burkina Faso

IntroductionPsychotraumatic syndrome is a complex psychological disorder combining anxiety symptoms and memory disturbances, organised around symptoms of reliving traumatic memories. It occurs after an individual is confronted with a stressful event, usually involving a threat to life. The aim of this study was to assess the prevalence of psychotraumatic disorders and to identify the factors associated with the occurrence of PTSD in the psychiatric department in a country faced with the issue of terrorism. MethodologyThis was a retrospective, descriptive and analytical study based on the files of DFS staff seen in the psychiatry department (N = 257) between 1st January 2010 and 1st January 2020. All DFS staff seen during the study period with a usable medical record were included in this survey. We did not include civilian patients, security guards or volunteers for the defence of the homeland in this study. Psychotraumatic disorders were diagnosed according to the diagnostic criteria of the International Classification of Diseases (ICD-10). ResultsThe study population was made up of more military than paramilitary personnel (52.91 % versus 47.08 %). The mean age of the population was 34.89 ± 11.98 years, with a male predominance (93.39 %) and a sex ratio of 14.11. In this study, at least one traumatic event was identified by 71.98 % of respondents, with terrorist attacks (33.46 %) being the most common. The study found a gradual increase in the frequency of consultations and in the prevalence of PTSD among FSD officers. The prevalence of psychotraumatic disorders was 34.24 %, including 28.40 % PTSD and 5.84 % ASD. Psychotraumatic disorders were associated with variables such as age≤ 30 years, rural area of assignment, being a police officer, having a length of service < 5 years, suffering a mine explosion, witnessing a fatal incident involving a colleague, suffering a terrorist attack, being a victim or a witness. Conclusionpsychotraumatic disorders are on the rise in occurrence with terrorist attacks since 2015 requiring special attention among defence and security forces personnel in Burkina Faso.

The Effects of Mobile Learning and Group Discussion for Psychotropic Drug Education on Nursing Students’ Learning, Satisfaction, and Attitude: An Educational Intervention

Background: Familiarity with and management of drug side effects is among nurses' main educational needs with respect to pharmacological care in psychiatry departments. Objectives: This study aimed to determine the effects of psychotropic drug education through mobile learning and group discussion on nursing students’ learning, satisfaction, and attitude. Methods: This educational intervention was done at EbneSina Psychiatric Hospital, affiliated with Shiraz University of Medical Sciences, in 2018. A total of 28 students were randomly divided into 2 groups, each containing 16 and 12 subjects. The first group underwent the educational intervention through mobile learning. The second group received the educational intervention through group discussion. The students’ learning and satisfaction were assessed and compared before and 2 weeks after the intervention. Attitudes were also assessed within the mobile learning group. Data were analyzed using paired and independent sample t-tests. Results: The results revealed a significant difference in satisfaction between the 2 groups after the intervention (38.69 ± 4.78 in the mobile learning group vs 33.13 ± 5.51 in the discussion group; P = 0.02). However, no significant difference was found after adjustment for baseline, age, and sex. The results also indicated that the students in the mobile learning group developed a significantly more positive attitude after the intervention compared to the baseline (P = 0.038). Conclusions: The study findings indicated that the utilization of smartphones for learning about psychotropic drug management in psychiatric departments might be effective in enhancing student's learning outcomes, satisfaction, and attitude. Thus, further studies with larger sample sizes are recommended to be conducted on other medical and nursing apprenticeships.

Insomnia and Alexithymia in Chinese Adolescents with Major Depressive Disorder: A Cross-Sectional Study of Sex Differences and Associations.

Insomnia is related to alexithymia in adults, but the relationship between insomnia and alexithymia in adolescents with major depressive disorder remains unclear. This study aimed to investigate the sex differences and the association between insomnia and alexithymia in adolescents with major depressive disorder. From October 2020 to April 2022, adolescent patients with major depressive disorder were recruited from psychiatric departments of seven hospitals in Anhui Province, China. Their general demographic and clinical information were collected. The 20-item Toronto Alexithymia Scale, the Center for Epidemiologic Studies of Depression Scale, and the Insomnia Severity Index Scale were used to assess their alexithymia, depression, and insomnia symptoms, respectively. The analysis of variance (ANOVA), Student's t-test and Mann-Whitney U-test were used for continuous variables and chi-square tests for categorical variables. Pearson's correlation analysis and Spearman correlation analysis were used to examine the correlation between ISI and demographic and clinical variables. Multiple binary logistic regression analyses with the "Enter" method were carried out to explore the correlations of insomnia. The prevalence of insomnia in female adolescent patients was similar to that of male patients (χ2=1.84, p = 0.175). Compared with those without insomnia, patients with insomnia had worse family relationships (F = 7.71, p = 0.021), perceived heavier academic stress (F = 6.32, p = 0.012), more likely to take sedative-hypnotics (F = 5.51, p = 0.019), had higher levels of depression (F = 81.57, p < 0.001) and alexithymia (F = 28.57, p < 0.001). Correlation analysis showed that alexithymia was significantly associated with insomnia in adolescent patients (r = 0.360, p < 0.01). Binary logistic regression analyses showed that, alexithymia was significantly associated with insomnia in female patients (OR = 1.050, p < 0.05) but not male patients. In female adolescent patients, alexithymia is a risk factor of insomnia, which is of great importance in the understanding of the psychopathological mechanisms, treatments and psychological interventions of insomnia in adolescents with major depressive disorder.

The impact of COVID-19 pandemic and lockdown on emergency psychiatry department admissions.

This study aimed to explore the impact of the coronavirus disease 2019 pandemic and lockdown period measures on patients' visits to the psychiatric emergency department (PED) of a University Hospital in İstanbul. We compared the number and characteristics of patients during the initial lockdown with visits in the pre- and post-lockdown months. We also investigated the number of monthly PED visits and hospitalizations between March 11, 2020 and 2021 and compared it to the same period in 2019 and between March 2021 and 2022. PED visits in the initial lockdown period in our university increased by 109% compared to the prelockdown months in the previous year. Anxiety and depressive disorders were responsible for most of this increase. The decline in PED visits was 3.1% and 42% during the first and second year of the pandemic, respectively; however, among the major diagnostic categories, we found that the rates of anxiety, depressive disorders, and obsessive-compulsive disorder increased significantly in the first year, while psychotic disorders declined and bipolar disorders remained the same. In the second year, there was a trend toward prepandemic year ratios. These findings show that the pandemic affects PED admissions in different ways at different periods. These data may also help shaping the public policies necessary to meet the evolving needs in the field of mental health of society at different public crises in the future.