Psychiatric Profile Research Articles

Treatment profiles and trajectories surrounding the diagnosis of major depressive disorder: a research protocol for a Danish register-based study.

Background: Major depressive disorder (MDD) is a prevalent illness that causes significant suffering and expenses at the personal and societal levels. The disorder is subject to heterogeneity reflected by diverse clinical phenotypes and assorted responses to treatment. Research on MDD treatments have focused on one treatment at a time, however many patients receive several different treatments. Considering the number of available treatment options, we hypothesize that it is possible to identify clinically meaningful groups of patients based on their psychiatric treatment. The objective of this study is therefore to identify psychiatric treatment profiles and trajectories of patients with major depressive disorder and, for the identified profiles and trajectories, to assess clinical and sociodemographic factors. Method: The study will be a population-based register study of patients with major depressive disorder in the Danish National Patient Register between 2011 and 2015. Using latent class analyses, we will identify homogenous groups of patients based on their psychiatric treatment patterns. These patterns constitute psychiatric treatment profiles which will be identified at six time-intervals, from 1.5 years before to 3 years after diagnosis of major depressive disorder. By cross-tabulating the identified treatment profiles, we will establish psychiatric treatment trajectories. Patients sharing profiles and trajectories will be characterized. Discussion: Identification of psychiatric treatment profiles and trajectories based on an unsupervised learning algorithm have the potential to reveal hidden patterns of psychiatric treatment. This will potentially pave the way for future studies of treatment combinations and a larger insight into the different courses of treatment. Furthermore, the assessment of clinical and sociodemographic factors may indicate different patient characteristics across treatment profiles and trajectories.

Risk of self-harm or suicide associated with specific drug use disorders, 2004-2016: a population-based cohort study.

Drug use disorders are associated with increased risk of self-harm. Risk differences associated with specific types of drug use disorders are yet to be comprehensively reported. This study aimed to examine the risk of self-harm or suicide associated with different drug use disorders in Hong Kong. Population-based cohort study. The Clinical Data Analysis and Reporting System (CDARS) managed by the Hong Kong Hospital Authority. Cases were people ages 10years or older who visited a hospital Accident and Emergency department between 1 January, 2004 and 31 December, 2016 with any of 10 specific drug use disorders (comprising opioid; ketamine; methamphetamine; sedative, hypnotic, or anxiolytic; amphetamine or related stimulant; cocaine; cannabis; hallucinogen; unspecified or other drug; and polydrug). Each case was matched with two controls, selected from a subset of people in CDARS sharing the same gender, age and psychiatric profile. A total of 8270 cases and 16 540 matched controls were included. Incidence and adjusted hazard ratio (aHR) of subsequent self-harm or suicide for each specific drug use disorder were estimated. The most prevalent drug use disorder was opioid use disorder (2523; 30.51%) and the least prevalent was hallucinogen use disorder (77; 0.93%). The crude incidence of self-harm or suicide ranged from 26.57 (95% CI, 14.23-44.55) per 1000 person-years for cannabis use disorder to 91.97 (77.32-108.37) for polydrug use disorder. The highest risk of self-harm or suicide was observed in ketamine (aHR, 16.36; 95% CI, 11.03-24.29) and opioid (15.97; 10.73-23.23) use disorders. In Hong Kong, all types of drug use disorders appear to be significantly associated with increased risk of self-harm or suicide, but risk levels vary by type of drug use disorder.

Psychiatric Manifestations in Patients with Biopterin Defects.

Psychiatric manifestations in patients with tetrahydrobiopterin (BH4) defects are common, and may occur even with treatment of the underlying disorder. The neurobiological background of these conditions has been linked to abnormalities of neurotransmitters, such as dopamine, serotonin, norepinephrine, and gamma-aminobutyric acid. Here, we review the psychiatric profile of all patients with BH4 defects followed in the pediatric and adult metabolic clinics at our center. Three patients with autosomal recessive (AR) guanosine triphosphate cyclohydrolase (GTPCH) deficiency and three patients with 6-pyruvoyl tetrahydropterin synthase (PTPS) deficiency were reviewed.All patients had behavioral disturbances and two had significant psychiatric comorbidities. These included attention deficit/hyperactivity disorder, anxiety, depression, aggression, or oppositional defiant disorder. One patient with PTPS deficiency had a severe psychiatric presentation, requiring inpatient admission and temporary placement into foster care for intensive behavioral therapy. Another with AR GTPCH deficiency was diagnosed with aggressive behavioral dysregulation requiring intensive psychiatric treatment. Management of the psychiatric manifestations of BH4 defects can be challenging, due to lack of information and studies of interactions between psychiatric medications on the deficient neurotransmitters and their receptors in these conditions. Further studies are needed to establish safety and efficacy of these treatments.

Individuals at Risk of Exercise Addiction Have Higher Scores for Depression, ADHD, and Childhood Trauma.

BackgroundExercise addiction is increasingly being recognized as a psychologically and physically burdensome set of symptoms. However, little is known about the psychiatric profiles of individuals who are at risk. It is well-established that individuals affected by substance use disorders frequently suffer from depression, attention deficit hyperactivity disorder (ADHD), and experiences of childhood trauma. The aim of this study is to determine whether this pattern of psychiatric disturbance is also present in individuals at risk for exercise addiction.MethodsIndividuals exercising for 10+ h/week were divided into those at risk and not at risk for exercise addiction based on their scores on the Exercise Dependence Scale (EDS). Demographic data and scores on the Beck Depression Inventory (BDI), a measure for ADHD in adults and the Childhood Trauma Questionnaire (CTQ) were also gathered.ResultsOne hundred and twenty-three individuals agreed to participate in the study, and completed the questionnaires. Twenty-nine (23.6%) of these individuals were classed as at risk for exercise addiction. There was a statistically significant difference between the at-risk and not at-risk groups on the combined dependent variable after controlling for hours of exercise per week, F(3, 95)= 10.198, p = 0.00, Wilk's Λ = 0.756, partial η2 = 0.244. Compared to those not at risk, individuals at risk for exercise addiction had significantly higher scores for symptoms of depression [t(121) = 4.944, p = 0.000], ADHD [t(121) = 2.915, p = 0.004], and childhood trauma [t(121) = 2.297, p = 0.024].ConclusionOur results suggest that exercise addiction may be accompanied by a disturbed psychiatric profile consistent with other addictive disorders. Clinical interviewing in individuals at risk for exercise addiction is a valuable and worthwhile next step in characterizing this phenomenon.

Psychiatric evaluations in offenders with mental illness: A case series

Background: The relation between mental illness and criminal offenses is controversial. In Taiwan, offenders with mental illness may be sentenced to custodial protection. Nevertheless, the recidivism rates remain high in such populations. Factors associated with recidivism among those offenders warrant further exploration. Methods: We retrospectively identified five persons with mental illness who had repeated forensic psychiatric evaluation for at least three times through reviewing forensic psychiatry records over the past decade at a psychiatric center. The related sociodemographic characteristics and psychiatric profiles in the 22 offenses were also collected and correlated with verdicts. Results: Those five offenders had family and personal histories of mental illnesses. They were relatively young at the first offense and unemployed, unmarried during the period of committing the offenses. Some offenders had a history of substance use, self-harm attempts, other criminal behaviors, and poor adherence to treatments before the offense. All the concluded characteristics of forensic psychiatric evaluations were consistent with the court judgments. Conclusion: Social dysfunction, poor adherence to treatments, history of substance use, and previous criminal records were prominent among those five repeated offenders.

POSTGRADUATE PSYCHIATRIC EDUCATION: SOME CLAUSES ON IMPROVING ITS QUALITY / Հետդիպլոմային հոգեբուժական կրթություն. որակի բարելավման վերաբերյալ որոշ դրույթներ

In modern society, the requirements for the quality of implementation of the competency-based approach in various fields of activity are increasing. First of all, this requirement remains relevant for such an important and necessary sphere of life support as medicine. Today, as never before, the acute problem is the training of highly qualified medical personnel who will be able in the future to provide highly qualified, high-tech medical care that meets the current level of development of medical science and technology. Being a private branch of medicine, psychiatry reflects the laws of development of the formation, dynamics, pathomorphism of mental disorders, and also addresses the issues of therapy and prevention of the latter. It should be noted that the modern concept of medicine pays great attention to the formation of the specialty "general practitioner", where the specialist in his work often contacts with patients with a psychiatric and narcological profile. The above and many other circumstances indicate a lack of psychiatric knowledge and the need for increased hours of teaching psychiatry in medical higher educational institutions, in more intensive postgraduate medical training of psychiatry specialists, including general practitioners.

Does liraglutide have a place in psychiatry ?

The relative risk of developing MetS is higher in patients with severe mental illness (SMI) than in the general population. Similarly, the risk of developing obesity or type 2 diabetes (T2DM) is also higher in patients with SMI. GLP-1 receptor agonists, such as liraglutide, have been shown to be effective in the treatment of T2DM and, more recently, in obesity or overweight associated with at least one metabolic disease. Their psychiatric adverse effect profiles seem to be reassuring, thus not represent a limitation for prescribing in psy chiatry. We aimed to explore the therapeutic usefulness of liraglutide in patients with psychiatric disorders associated with somatic comorbidities such as obesity, T2DM or MetS.

Differences in Clinical Outcomes of Adults Referred to a Homeless Transitional Care Program Based on Multimorbid Health Profiles: A Latent Class Analysis.

Background: People experiencing homelessness face significant medical and psychiatric illness, yet few studies have characterized the effects of multimorbidity within this population. This study aimed to (a) delineate unique groups of individuals based on medical, psychiatric, and substance use disorder profiles, and (b) compare clinical outcomes across groups.Methods: We extracted administrative data from a health system electronic health record for adults referred to the Durham Homeless Care Transitions program from July 2016 to June 2020. We used latent class analysis to estimate classes in this cohort based on clinically important medical, psychiatric and substance use disorder diagnoses and compared health care utilization, overdose, and mortality at 12 months after referral.Results: We included 497 patients in the study and found 5 distinct groups: “low morbidity” (referent), “high comorbidity,” “high tri-morbidity,” “high alcohol use,” and “high medical illness.” All groups had greater number of admissions, longer mean duration of admissions, and more ED visits in the 12 months after referral compared to the “low morbidity” group. The “high medical illness” group had greater mortality 12 months after referral compared to the “low morbidity” group (OR, 2.53, 1.03–6.16; 95% CI, 1.03–6.16; p = 0.04). The “high comorbidity” group (OR, 5.23; 95% CI, 1.57–17.39; p < 0.007) and “high tri-morbidity” group (OR, 4.20; 95% CI, 1.26–14.01; p < 0.02) had greater 12-month drug overdose risk after referral compared to the referent group.Conclusions: These data suggest that distinct groups of people experiencing homelessness are affected differently by comorbidities, thus health care programs for this population should address their risk factors accordingly.

Neurodevelopmental and psychiatric disorders in females with Turner syndrome: a population-based study

BackgroundTurner syndrome is the result of the partial or complete absence of an X chromosome in phenotypic girls. This can cause an array of medical and developmental difficulties. The intelligence quotient in females with Turner syndrome has previously been described as uneven, but considered within normal range. Although their social, intellectual, and psychiatric profile is described, it is unclear to what extent these females meet the clinical criteria for neurodevelopmental or psychiatric diagnoses. The aim of this study was to examine the prevalence of neurodevelopmental and psychiatric disorders in females with Turner syndrome.MethodsA retrospective cohort study was performed with a total of 1392 females with Turner syndrome identified through the Swedish National Patient Register and compared with 1:100 age- and sex-matched controls from the general population. The associations between Turner syndrome and diagnoses of neurodevelopmental and/or psychiatric disorders were calculated using conditional logistic regression and is presented as estimated risk (odds ratio, OR, 95% confidence interval, CI) in females with Turner syndrome compared with matched controls.ResultsFemales with Turner syndrome had a higher risk of neurodevelopmental or psychiatric disorder (OR 1.37, 95% CI 1.20–1.57), an eightfold increased risk of intellectual disability (OR 8.59, 95% CI 6.58–11.20), and a fourfold increased risk of autism spectrum disorder (OR 4.26, 95% CI 2.94‑6.18) compared with the controls. In addition, females with Turner syndrome had twice the risk of a diagnosis of schizophrenia and related disorders (OR 1.98, 95% CI 1.36–2.88), eating disorders (OR 2.03, 95% CI 1.42–2.91), and behavioral and emotional disorders with onset in childhood (OR 2.01, 95% CI 1.35–2.99).ConclusionsFemales with Turner syndrome have an increased risk of receiving a diagnosis of neurodevelopmental or psychiatric disorder. This warrants extensive assessment of intellectual and cognitive functions from early age, and increased psychiatric vigilance should be a part of lifelong healthcare for females with Turner syndrome.

Personalized networks of social anxiety disorder and depression and implications for treatment

IntroductionSocial anxiety disorder (SAD) and major depressive disorder (MDD) often co-occur; however, there is limited research evaluating how cognitive-affective and behavioral factors maintain SAD and MDD for specific individuals. Evidence suggests that individuals exhibit symptom-level heterogeneity, necessitating a person-specific approach to assessment and intervention. We compared group and person-specific models of SAD-MDD comorbidity and hypothesized that individuals would demonstrate person-specific patterns of comorbidity factors that differed from the group. MethodsCisgender women (N = 35) with SAD and a current or past major depressive episode were recruited. Ages ranged from 18 to 37 years old and a majority of women were White (n = 18; 51.43%). Brief ecological momentary assessment surveys related to SAD-MDD comorbidity were administered five times a day for a month (T = 4,357). ResultsMultilevel and person-specific network analyses were used to examine between-, within-, and person-specific patterns. Intra-daily depressed mood demonstrated the strongest connections to other variables and exhibited additional, unexpected temporal effects. All models demonstrated person-specific patterns relevant to SAD-MDD comorbidity. LimitationsThese results are descriptive in nature from women with a similar psychiatric profile. Future research integrating intensive EMA and personalized modeling within the context of experimental design is needed to determine the extent to which individuals truly differ from the group. ConclusionsPatterns of SAD-MDD comorbidity varied substantially across women, underscoring the potential for results from person-specific (idiographic) networks to inform the development and implementation of personalized directives for clinical assessment and intervention.

Influence of sex on tic severity and psychiatric comorbidity profile in patients with pediatric tic disorder.

To investigate sex-related differences in tic severity, tic-related impairments, and psychiatric comorbidities in childhood. In this cross-sectional study, tic severity/impairment and demographic factors were collected from 270 children and young people (aged 5-17y, mean 10y 6mo, SD 3y 4mo; 212 males and 58 females) with a tic disorder diagnosis at a specialty clinic. Psychiatric diagnoses and corresponding screening questionnaire scores were collected for attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), major depressive disorder, and anxiety disorders. Logistic regression was used to compare the effect of sex and age on psychiatric comorbid diagnoses. The Mann-Whitney U test and t-tests were used to assess differences in questionnaire score distribution between sexes. Females had more severe motor tics (12.55 vs 10.81, p=0.01) and higher global severity scores (38.79 vs 32.66, p=0.03) on the Yale Global Tic Severity Scale. Females were less likely to be diagnosed with ADHD (odds ratio=0.48, 95% confidence interval=0.26-0.89). No significant sex difference was observed in diagnosis rates or symptom severity scores for anxiety or OCD. Females had significantly higher scores than males on the Children's Depression Inventory, Second Edition. The higher level of motor tic severity and global severity in females further supports the differential natural history of tic disorders in females. Females with tic disorders may be underdiagnosed for ADHD.

Risk of psychiatric disorders in patients taking isotretinoin: A nationwide, population-based, cohort study in Taiwan

BackgroundAfter isotretinoin's approval to treat patients with recalcitrant acne, there have been continued debates around its psychiatric safety profile. This study aimed to assess the risk of psychiatric disorders in patients with acne who are taking isotretinoin. MethodsWe used de-identified information from Taiwan's National Health Insurance Research Database from 2000 to 2015 to examine the risk for psychiatric disorders among patients with acne who were taking isotretinoin. We performed subgroup analyses based on the dosage and duration of isotretinoin administration. ResultsThis study included 29,943 participants during a 16-year follow-up period. We found no significantly increased risk for psychiatric disorders among patients taking isotretinoin compared with patients who did not receive isotretinoin treatment (adjusted hazard ratio [aHR]: 1.009, 95% confidence interval [CI]: 0.422–1.696). Subgroup analyses showed no significantly increased risk for psychiatric disorders in patients taking different doses of isotretinoin (≤ 20 mg per day, aHR: 0.892, 95% CI: 0.371–1.501; > 20 mg per day, aHR: 1.068, 95% CI: 0.446–1.798). There was also no significant increase in risk for patients undergoing isotretinoin treatment over different periods (≤ 6 months, aHR: 0.924, 95% CI: 0.392–1.612; > 6 months, aHR: 1.196, 95% CI: 0.488–2.004). LimitationsWe did not analyze the risk of suicidal ideation, and it could be underestimated in medical claims databases. ConclusionsWe found no increased risk of psychiatric disorders among Taiwanese patients with acne who were taking isotretinoin. Higher dosage or longer duration of isotretinoin treatment did not increase the risk for developing a psychiatric disorder.

HCN1 Ion Channel in the Hippocampal CA1 Region Was Involved in Ketamine-Induced Antidepressant Action and Increased BDNF Levels in Mice

Bilateral subthalamic nucleus deep brain stimulation improves motor symptoms and treatment-related complications in patients with Parkinson’s disease. However, some patients have trouble adjusting socially after successful neurosurgery, in part because of “unrealistic” expectations and psychiatric disorders. Preoperative psychological interventions focusing on these aspects could be beneficial for such patients.We compared the outcomes of 2 psychosocial approaches—1 based on cognitive restructuration and 1 consisting of 2 interviews—with those of a control group without preoperative preparation. All patients underwent a psychometric evaluation 2 months before surgery (M−2) and again at 3 (M+3) and 6 months (M+6) after surgery. The psychometric evaluation focused on social adjustment using the social adjustment scale–self-report. The psychiatric profile of the patients was also assessed.Of 73 patients initially enrolled, 62 performed the initial inclusion visit (M−2) and the 2 postoperative visits (M+3, M+6). For these 62 patients (52% male), the overall mean age was 59 ± 6.13 years, and the mean disease duration was 9.44 ± 3.62 years. No specific differences were observed for social adjustment between the groups or visits (M−2, M+3, M+6); however, an interaction was found in the cognitive restructuration group at M+6 for the family dimension of the social adjustment scale–self-report.Our results suggest that even if no overall increase in the social adjustment score was observed, patients with Parkinson’s disease eligible for neurosurgery should undergo preoperative psychosocial therapy to define their expectations and help them in their psychological restructuration. This type of therapy, complementary to psychoeducation, could represent an opportunity to prevent postoperative deception and social maladjustment.

Effects of Bilateral STN-DBS on Psychiatric Profile, Cognitive Aspects, and Quality of Life in Patients with Parkinson's Disease

Background: Apart from motor manifestations, Parkinson's disease (PD) and associated treatment modalities including DBS are associated with less studied psychiatric and cognitive symptoms. Aim: This study aims to evaluate psychiatric profile, cognition, and quality of life in patients with advanced PD and the effects on STN-DBS on them. Study Design: A prospective, single center, observational study using a direct, structured interview of PD patients. Materials and Methods: All consecutive patients undergoing bilateral STN-DBS between the period June 2017 and December 2019 were evaluated with mini international neuropsychiatric interview (MINI), Addenbrooke's Cognitive Examination (ACE), and PD questionnaire-39 (PDQ-39) before surgery. All these patients were evaluated at 6 weeks postsurgery with MINI and with MINI, ACE and PDQ-39 at 6 months postsurgery. Lead position in magnetic resonance imaging was correlated with psychiatric manifestations. Paired t-test and Wilcoxon sign-rank test were used to study the difference between means. Results: There were a total of 40 cases operated in the study period. There were two patients who had cerebral hemorrhage and two had leads removed due to infection and these patients were excluded from the final analysis. Out of 36 patients, depression was noted in 7 (19.4%), psychosis in 5 (13.8%), anxiety in 10 (27.7%), and suicidal ideation in 2 (5.5%) cases. Postoperatively, 85% of patients with depression, 80% with psychosis, and 80% of patients with anxiety disorders improved. One patient developed new-onset depression and one patient developed visual hallucination. Two patients had acute deterioration in the immediate postoperative period. The patient who developed depression and hallucination had their leads medially located. Mild cognitive decline was noted in verbal fluency which was significant (P = 0.003), and however, there was a significant improvement in quality of life (P = 0.001). Conclusions: Bilateral STN-DBS is a safe and effective therapeutic option and improves psychiatric disorders if the leads are appropriately placed. Although mild cognitive decline occurs, there is overall significant improvement in quality of life.

Psychiatric Characteristics Across Individuals With PTEN Mutations.

Germline heterozygous PTEN mutations have been associated with high prevalence of autism spectrum disorder (ASD) and elevated rates and severity of broadly defined behavioral problems. However, limited progress has been made toward understanding whether PTEN mutation is associated with specific psychiatric co-morbidity profiles when compared to idiopathic ASD. The current study aimed to utilize a cross-measure approach to compare concurrent psychiatric characteristics across children and adolescents with PTEN mutation with (PTEN-ASD; n = 38) and without ASD (PTEN-No ASD; n = 23), and ASD with macrocephaly but no PTEN mutation (macro-ASD; n = 25) using the Child Behavior Checklist (CBCL) and the Aberrant Behavior Checklist (ABC). There were significant group effects for the CBCL Internalizing and Externalizing broad symptom score, the majority of specific CBCL syndrome scores, and all ABC subscale scores. Post-hoc comparisons revealed greater behavioral symptoms in the ASD groups (PTEN-ASD and macro-ASD) compared to the PTEN-no ASD group on nearly all subtest scores examined. There were no statistically significant differences between the PTEN-ASD and macro-ASD groups; however, there was a trend for the macro-ASD group showing higher levels of aggressive behaviors. Our findings provide evidence of specific behavior profiles across PTEN-No ASD, PTEN-ASD, and macro-ASD groups and highlight the importance of early identification of behavioral vulnerabilities in individuals with PTEN mutations in order to provide access to appropriate evidence-based interventions.

Psychiatric Profile and Response to Combined Pharmacologic and Psychotherapeutic Treatment in Psychogenic Purpura.

Objective: Psychogenic purpura is a rare psychocutaneous entity characterized by painful atraumatic, ecchymotic, and purpuric lesions that commonly occur in young women. The objective of this study is to describe the clinical presentation, psychiatric profile, and response to therapy (pharmacologic and psychotherapeutic) in patients with psychogenic purpura.Methods: Twenty-three patients, referred from various clinical departments with unexplained purpura or ecchymotic lesions, were assessed in the department of psychiatry of a tertiary care institute in eastern India over a period of 3 years (May 1, 2017, to April 30, 2020). Relevant systemic evaluation and routine biochemical and laboratory tests including complete blood count, bleeding time, clotting time, prothrombin time, coagulation profile, and platelet function test were conducted for all patients to rule out an underlying organic cause. Associated psychiatric comorbidities were diagnosed as per the International Classification of Diseases, 10th edition. All patients who were eventually diagnosed with psychogenic purpura received appropriate treatment (pharmacologic and psychotherapy) and were followed up for 1 year.Results: Seven female patients (age range, 14-70 years, mean age = 30.28 ± 17.42 years) were diagnosed with psychogenic purpura. All patients had significant stressors prior to the appearance of lesions. Facial involvement was reported in 2 patients (28.6%). Multiple sites were affected in 4 patients (57.1%). The underlying psychiatric conditions diagnosed were depressive disorder (42.9%), generalized anxiety disorder (28.6%), dissociative convulsion disorder (14.3%), and panic disorder (14.3%). Associated personality disorder was noted in 2 patients (28.6%). All patients were started on selective serotonin reuptake inhibitors and concurrent psychotherapy. A short course of benzodiazepine was used in all patients and was subsequently tapered off. At 1-year follow-up, 2 patients reported recurrences, while others continued to do well with no similar episodes.Conclusions: Appropriate psychiatric evaluation and necessary intervention in patients with psychogenic purpura lead to improved patient outcomes.

L’article 122-1 et après ? Devenir des patients reconnus irresponsables sur le plan pénal, entre 2015 et 2019, dans l’Ouest de la France

ObjectivesArticle 122-1 of the French Penal Code regulates the status of non-criminally responsible (NCR) subjects due to an abolition of their judgment. Although little epidemiological data are available regarding the application of article 122-1, the French judicial literature reports a 0.2 to 0.5% rate of non-conviction due to psychiatric reasons. More recent studies report a higher rate, around 5%. The goal of our study was to determine the future of subjects considered to be NCR due to the abolition of their judgment, following article 122-1 §1 of the French Penal Code and to highlight a link between their pathology, their offenses and their management. Materials and methodsThis is a retrospective chart review, that included all the forensic assessments that took place between 2015 and 2019, of an expert psychiatrist, practicing at the Rennes Court of Appeal, and that resulted in a judgment of non-criminal responsibility. Information was retrieved from the Regional Health Agencies of the western region of France about the evolution of these subjects since their examination by the expert. Medico-psycho-criminological data was gathered, including the psychiatric profile, the committed offenses and the expert's conclusions regarding criminal accountability or non-criminal responsibility as well as the need for referral to the medical care or judicial system. Results58 of the 103 initially identified charts were retained. Our sample consisted mainly of single men with no children, lacking professional qualifications but mostly employed. A majority of them had a positive psychiatric history, a history of substance use but no criminal history or childhood trauma. The ages ranged from 17 to 82 years, the mean age being 41 years (SD=16 years). When the psychiatric expertise identified an abolition of judgment and non-criminally responsibility, 51.46% (95% CI: [41.40-61.43]) of the subjects were referred to in-patient psychiatric treatment. In 2020, 19,42% of subjects were hospitalized in a psychiatric unit, 18,45% were on compulsory outpatient treatment and 17,48% were no longer on compulsory treatment. Psychotic disorders were identified in 75,73% of the sample. For the same offense, this psychotic sub-population was more often hospitalized than the non-psychotic sub-population. Additionally, psychotic subjects were more often hospitalized in the event of a crime (injury to persons or sexual crimes) than of misdemeanor (31,83%). ConclusionsWhile we expected an overwhelming majority of hospital management following the recognition of the non-criminal responsibility, our study does not highlight a predominant outcome. Nonetheless, our initial hypothesis was confirmed by the trends we were able to identify: subjects considered to be non-criminally responsible tend to stay hospitalized, especially when they are psychotic and have committed a crime.

Psychiatric comorbidity and quality of life in patients with epilepsy on anti-epileptic monotherapy and polytherapy.

Objective:The bio-psycho-social factors affecting the quality of life in patients with epilepsy can be numerous but are often overlooked. The behavioral side effects of anti-seizure medications can be one such potential factor. The aim of the study is to address the effect of the number of anti-seizure medications on the development of psychiatric comorbidity and quality of life in patients with adequate seizure control.Materials and Methods:The study recruited 100 participants with generalized tonic-clonic seizures from a tertiary care center in North India, who were seizure-free from the last 1 month. The study participants were divided into two groups based on whether they were on monotherapy or polytherapy. The two groups were matched for their socio-demographic and clinical profile. We assessed for psychiatric comorbidity in each group using Mini International Neuropsychiatric Interview. All the study participants were given Hindi translated version of quality of life in the epilepsy-31 questionnaire for objective assessment of the quality of life.Results:The patients receiving anti-epileptic polytherapy had significantly higher prevalence of psychiatric comorbidity than patients on monotherapy. Furthermore, the patients on polytherapy scored significantly less on the cognitive domain of quality of life as well as the overall quality of life domain in the epilepsy-31 questionnaire.Conclusion:The patients with epilepsy must be evaluated for psychiatric comorbidity and side effect profile of anti-seizure medications to improve the quality of life. This is particularly more important for patients who are on anti-epileptic polytherapy even if the seizure control is adequate.

Psychiatric morbidity among adult transgender people in Iran

Psychiatric morbidity among transgender and gender diverse people is thought to be to an important extent related to socio-cultural intolerance, but such morbidity has been understudied in non-western socio-political contexts. This study aims to report the psychiatric profiles of clients who are seeking gender-affirming treatment in a gender clinic in Iran. All transgender people who were consecutively referred to the Mashhad University of Medical Sciences in Mashhad, Iran, between February 2015 and December 2016 were investigated. Clients were evaluated during at least four sessions when sociodemographic and psychiatric characteristics were collected. Out of 209 clients, 205 were included (transmen (TM), N = 110; transwomen (TW) N = 95). A subset of these were assessed using Structured Clinical Interview based for DSM-5 (n = 154). The mean age of participants was 24.41 (SD = 6.316; range, 15–43). There was no significant difference between transmen and transwomen (p = 0.960); 48% (80 out of 154) of participants were found to have at least one current psychiatric condition currently, and 67% (138 out of 205) during their lifetime. Depressive and trauma- and stressor-related disorders were the most common conditions. Prevalence rates were similar in both genders. In both TM and TW groups, as many as 70% of the clients reported that they had experienced suicidal ideation. These findings are surprisingly similar to those of western studies despite the more extreme difficulties Iranian transgender people face in their lives in a non-western socio-political context.

Psychiatric Symptoms of Children and Adolescents With Mitochondrial Disorders: A Descriptive Case Series.

Background: Mitochondrial disorders (MD) are a group of clinically heterogeneous genetic disorders resulting from dysfunction of the mitochondrial respiratory chain. Cognitive impairment is a common feature in adults with MD and psychiatric symptoms are associated with MD in up to 70% of the adult population. The aim of this study is to describe the psychiatric profile in children and adolescents with MD by focusing on the description of psychiatric symptoms.Methods: A cohort of 12 children and adolescents was prospectively recruited between February 2019 and February 2020 in the Reference Center for Mitochondrial Disorders of Angers (France). Participants and their parents completed an anamnestic form to provide socio-demographic data and completed the Global Assessment of Functioning scale, the Brief Psychiatric Rating Scale, the Child Depression Inventory, the Revised Children's Manifest Anxiety Scale, and the Conner's Rating Scale to evaluate the inattention/hyperactivity symptoms as well as the Quality of Life scale.Results: Four children (33.3%) were diagnosed with depressive symptoms. With regarding to anxiety, 6 children (50%) reported anxiety issues during the psychiatric interview and 3 children (25%) were suffering from anxiety according to the RCMAS scale. Compared to other children with chronic illnesses, the individuals in our cohort reported a lower overall quality of life score and lower scores in physical and social subscales.Conclusion: Our study shows that MD can lead to psychiatric disorders in children and adolescents, in particular anxiety and depression, as well as poor quality of life. This highlights the need for regular psychiatric assessments in individuals with developing brains, such as children and adolescents. We do not, however, have data regarding the neuropsychological profile of this population.