Psychological Follow-up Research Articles

E54 The Ehlers-Danlos syndrome, a disease of late diagnosis: report two cases

Abstract Introduction Ehlers-Danlos syndromes (EDS) are a heterogeneous group of rare inherited collagen disorders. Clinical signs are dominated by generalized joint hyper laxity, skin hyper elasticity and tissue fragility. The diagnosis is clinical in the absence of genetic testing. There is no curative treatment but it is possible today to improve the quality of life of these patients. We report two cases of EDS from a non-consanguineous marriage, without similar cases in their families. Observations CASE 1: Mrs N.B, 31 years old, 2nd of 4 siblings, with a history of heterozygous beta thalassemia, she presented with mechanical gonalgias secondary to patellar dislocations associated with ankle sprains since the age of 5 years. On clinical examination: generalized hyper mobility (Beighton score 9/9), hyper elasticity of the skin, skin fragility, atrophic scarring, papery skin of the knees, hyper transparency of the skin, epistaxis at the slightest scratching, the rest of the somatic examination was unremarkable. The standard biological workup, X-ray and ultrasound of the knees and ankles were without abnormalities. Classic EDS (I and II) was retained according to the 2017 international classification. The patient responded to tier I analgesics. Case 2 Mrs B.L, 24 years old, the third of five siblings, with a history of bronchial asthma, presented with bilateral and symmetrical polyarthralgia affecting the large and small joints with mixed type spinal pain associated with spontaneous myalgia in a context of profound asthenia evolving for 14 years. On osteoarticular examination, generalized joint hypermobility was noted (Beighton score 9/9); on the cutaneous level, transparency and hyperextensibility of the skin with multiple ecchymoses due to tissue fragility associated with delayed healing with cutaneous hyperesthesia, all associated with exertional dyspnea, chronic abdominal pain and gastroesophageal reflux since the onset of his illness. Biologically, no inflammatory syndrome. The autoimmune workup (RF, ACPA, FAN) was negative and other investigations were without abnormalities. X-rays of the chest, hands, wrists and knees were unremarkable. The patient was classified as having hypermobile EDS (type III) according to the international classification of the disease. The patient responded only partially to analgesics (levels I, II and III) and to tricyclic antidepressants. Conclusion The diagnosis of EDS must be made early in order to ensure optimal symptomatic management. The management must be multidisciplinary, including an evaluation, a psychological follow-up, a treatment of the pain and physiotherapy.

PRÁTICAS INTEGRATIVAS COMPLEMENTARES NO TRATAMENTO DA SAÚDE MENTAL DE PACIENTES PÓS COVID-19: ensaio clínico randomizado

The aim of the study was to analyze the use of Complementary Integrative Practices (PICS) and psychological counseling in the treatment of mental health in post-COVID-19 patients. Clinical, interventional and qualitative-quantitative case study, with 15 patients divided into G1 (Acupuncture + myofascial release) and G2 (Laserpuncture + myofascial release), submitted to 12 sessions and psychological follow-up (Group therapy + 4 sessions of individualized psychotherapy) evaluated before and after treatment regarding emotional states (DASS-21). The female sex was prevalent in the studied population, in the age group of 25 to 29 years in G1 (28.57%) and 50 to 54 years in G2 (37.50%), higher education level, with comorbidities, predominance of married in G1 and single in G2. There was a statistically significant difference (p≤0.01) in the three DASS-21 subscales before and after treatments with G1 and G2, with no statistical difference between groups. There was an association between marital status and affective-emotional states, before the treatments, married people were associated with milder levels of stress, anxiety and depression, while single/divorced people had extremely severe levels. After the treatments, the married/divorced ones had levels close to normal, while the single ones reduced the levels to mild to moderate. It is concluded that the PICS associated with psychological follow-up had a positive impact on mental health in post-COVID-19 patients.

Perceptions of male partners on maternal near-miss events experienced by their female partners in Rwanda.

Maternal near-miss refers to women who survive death from life-threatening obstetric complications and has various social, financial, physical, and psychological impacts on families. To explore male partners' perceptions of maternal near-miss experienced by their female partners and the associated psychosocial impacts on their families in Rwanda. This was a qualitative study involving 27 semi-structured in-depth interviews with male partners whose spouses experienced a maternal near-miss event. Data were analyzed using a thematic coding to generate themes from participants' responses. Six key themes that emerged were: male partner's support during wife's pregnancy and during maternal near-miss hospitalization, getting the initial information about the spouse's near-miss event, psychosocial impacts of spouse's near-miss, socio-economic impact of spouse's near-miss, post- maternal near-miss family dynamics, and perceived strategies to minimize the impacts of near-miss. Male partners reported emotional, social, and economic impacts as a result of their traumatic experiences. The impact of maternal near-miss among families in Rwanda remains an area that needs healthcare attention. The residual emotional, financial, and social consequences not only affect females, but also their male partners and their relatives. Male partners should be involved and be well-informed about their partners' conditions and the expected long-term effects of near-miss. Also, medical and psychological follow-up for both spouses is necessary for the enhancement of the health and well-being of affected households.

Violences sexuelles liées au terrorisme : prise en charge psychologique des femmes yézidies en Irak

From 2018 to 2022, the Lebanese Association of Victims of Terrorism (AVT-L), in collaboration with the United Nations (United Nations Office for Drug and Crime [UNODC]) and with the support of the government of the Netherlands, implemented a project to provide psychological care to victims of terrorism in Iraq. Ninety Yezidi women participated in this program. Each one of the participants had experienced sexual violence during the takeover of part of the Iraqi territory by the jihadists of the Islamic State group (ISIS) between 2014 and 2018. Following a semi-structured interview, these Yezidi women first participated in experience-sharing sessions for three consecutive days. Then, they benefited from an individual psychological follow-up for a period of 6 months. Over this ten-year period, the association's team has developed a protocol that combines art therapy with group and individual psychotherapy. The care is evaluated on a regular basis. From the first interview, the psychologist uses the results of the Traumaq, an evaluation tool that assesses trauma-related symptoms. Subsequently, the PCL-5 scale is used to measure the evolution of the symptoms. A considerable support that is studied in association with the participant's life story and the social, personal, and professional evolution of each person. At the end of the treatment, significant changes were observed, particularly for criteria B and D of the DSM-5. We recorded a reduction in intrusive memories, as well as an improvement in emotional and physical reactions to these memories. Feelings of guilt were reduced. Significant improvement in sleep and concentration was also noted. Participants experienced an improvement in their self-esteem, with a desire to pursue studies and be involved in active projects in their community. However, anger about injustice and a lack of compensation remained palpable. This work culminated in the accompaniment of a delegation of these women to make their voices heard at the United Nations headquarters in New York. In this paper, we will highlight the art therapy aspect of this program, especially that of using clay as the medium for the art therapy.

Evaluation of the psychological state of patients suspected of Lynch syndrome after the germline genetic testing result.

e24201 Background: Lynch syndrome (LS) also known as Hereditary Non-Polyposis Colorectal Cancer (HNPCC) syndrome, is caused by a deficiency of Mismatch Repair Complex (MMR) enzymes. It is an autosomal dominant syndrome associated with an increased risk of developing colorectal cancer and other neoplasms, which can be confirmed using a germline molecular test. Psychological distress can be triggered regardless of the genetic test result. How the individual reacts emotionally and psychologically to the development can influence the processing of information and guidelines and adherence to preventive strategies. In this context, tracking anxiety symptoms provides opportunities for psychosocial follow-up planning. Objective: to evaluate levels of anxiety and depression in cancer patients suspected of having LS submitted to genetic testing. Methods: 84 patients with clinical criteria for LS were submitted to the germline genetic panel by NGS and immediately after the genetic test result, answered the Hospital Anxiety and Depression Scales (HADS). Data were expressed as mean±SD and compared using the Mann-Whitney, Kruskal-Wallis/Dunn, and Spearman correlation tests (SPSS v20.0, p < 0.05). Results: The mean levels of anxiety (5.59±3.31) were significantly higher than that of depression (4.63±3.58) ( p= 0.007), both domains were positively correlated ( p< 0.001, r= 0.447). Eighteen patients (21.4%) had pathogenic mutations in genes of the MMR complex. A positive diagnosis did not affect levels of anxiety or depression (pathogenic variant p= 0.617 and p= 0.478; Significance Uncertain-VUS p= 0.415 and p= 0.561, respectively). Females had higher levels of depression than males ( p= 0.047, with a relative risk of 1.65 times; CI95% = 1.05-13.19); however, other clinical and therapeutic characteristics did not significantly influence anxiety levels or depression. Conclusions: Colorectal cancer women are most sensitive to depression after germline genetic testing, despite the results. These findings reinforce the need for psychological screening of individuals undergoing genetic testing for LS and continuing psychological follow-up after receiving the genetic test.

Follow-up on volunteer responders dispatched for out-of-hospital cardiac arrests: Addressing the psychological and physical impact

IntroductionSmartphone technology is increasingly used to engage lay people as volunteer responders in resuscitation attempts. Attention has recently been drawn to how resuscitation attempts may impact bystanders. Attempting resuscitation in out-of-hospital cardiac arrests (OHCA) may be an overwhelming experience and, in some cases, difficult to cope with. We developed a volunteer responder follow-up program to systematically measure the psychological and physical impact on volunteer responders dispatched for OHCAs. Methods and ResultsThe nationwide Danish volunteer responder program dispatches volunteer responders for presumed cardiac arrests. 90 min after notification of a potential nearby cardiac arrest, all volunteer responders receive a survey, and are asked to self-report their mental state of mind after the event. The volunteer responders are also asked to disclose any physical injury they sustained in relation to the event. Volunteer responders who report severe mental effects are offered a defusing conversation by a trained nurse.Between 1 September 2017 and 31 December 2022, the Danish volunteer responder program has alerted 177,866 volunteer responders for 10,819 presumed cardiac arrest alerts. Of 177,866 alerted volunteers responders, 62,711 accepted the alarm. In the same period, 7,317 cancelled their registration.From January 2019 to 31 December 31 2022, a total of 535 volunteer responders were offered a defusing consultation. ConclusionThe Danish volunteer responder follow-up program is carried out to assess the psychological and physical risks of responding to a suspected OHCA. We suggest a survey-based method for systematic screening of volunteer responders that allow volunteer responders to report any physical injury or need of psychological follow-up. The person providing defusing should be a trained and experienced healthcare professional.

Improving Care After Sexual Assault: A Needs Assessment for a Standardized, Patient-Centered Educational Resource [ID: 1377465

INTRODUCTION: Prompt medical and psychiatric follow-up improves outcomes among survivors of sexual assault (SSAs). The American College of Obstetricians and Gynecologists recommends clinical and psychological follow-up within 1–2 weeks, yet only one-third receive such care within 1 year. In the setting of acute trauma, SSAs are unlikely to retain much information and discharge paperwork should be provided, including follow-up resources and patient education. Lack of standardization may result in wide variation of these handouts and negatively affect follow-up rates. METHODS: A retrospective chart review of discharge paperwork was performed of SSA patients presenting to a tertiary care emergency department from May to October 2022. Per World Health Organization guidelines for sexual assault (SA) follow-up, the elements evaluated included 1) acute SA treatment (human immunodeficiency virus, sexually transmitted infection, and pregnancy prophylaxis), 2) clinical and psychological follow-up resources, and 3) community resources for SSA. Institutional review board approval was obtained. RESULTS: A total of 39 SA handouts were evaluated. Only two-thirds (27/39) contained instructions regarding post-SA medications, 82% (32/39) included medical follow-up information, a quarter (10/39) included mental health resources, and one-third (13/39) included community resources. CONCLUSION: Timely follow-up after SA reduces patient morbidity. This initial needs assessment demonstrated a wide variation in completeness of discharge paperwork for SSA. As a result, a standardized handout was created, including a timeline of acute and long-term follow-up objectives and a comprehensive list of patient resources, which was incorporated into the electronic medical record system. This model can empower SSA to obtain follow-up care, improve outcomes, and address potential disparities in care.

From diagnosis to treatment of post-polio syndrome: A case study

Introduction: Acute anterior poliomyelitis (AAP) can affect people of any age, despite being uncommon before six months. The viral invasion destroys the lower motor neurons of the spinal cord, brain, and brainstem. As a result, it leads to partial or complete flaccid and asymmetrical paralysis of the lower limb and spine muscles. Big names like Frida Kahlo and US President Franklin D Roosevelt were diagnosed with polio. Case Report: We present the case of a patient with AAP diagnosed at two years of age. As an adult, he gave osteomyoarticular sequelae, insomnia, new central (adynamia), peripheral fatigue, cold intolerance, joint and neuropathic pain. The patient received a clinical diagnosis of post-polio syndrome (PPS) after fulfilling Dalakas criteria. The physical examination showed some hallmarks of AAP, in addition to those primarily affected by PPS. Conclusion: Post-polio syndrome is a disorder characterized by new neuromuscular deficits that present years after the resolution of polio infection. However, far beyond the physical pain, the psychosocial impact is staggering. Therefore, in addition to surgical intervention and physical therapy, attention should be paid to the psychological follow-up of this patient, who is most often elderly.

Bariatric Surgery and Psychological Health: A Randomised Clinical Trial in Patients with Obesity and Type 2 Diabetes

PurposeThis study investigated the impact of either Roux-en-Y gastric bypass with silastic ring (SR-RYGB) or sleeve gastrectomy (SG) types of bariatric surgery on psychological health and explored the role of pre-existing depressive symptoms on weight loss.Materials and MethodsA total of 114 participants with obesity and type 2 diabetes were randomized to receive SR-RYGB or SG at a single centre. Data from the Hospital Anxiety and Depression Scale (HADS), RAND 36-item Health Survey and body weight were collected before surgery and annually for 5 years.ResultsSixteen patients were lost to follow-up at 5 years. Of the 98 patients who completed 5-year psychological follow-up assessments, 13 had mild to severe depressive symptoms (SR-RYGB n = 6, SG n = 7). SR-RYGB and SG resulted in similar psychological health improvement but percent weight loss at 5 years was greater for SR-RYGB by 10.6% (95% CI: 7.2 to 14.0, P < 0.0001). Scores for depressive symptoms and most RAND-36 domains improved significantly from baseline to 5 years in both groups. Patients with pre-existing depressive symptoms had similar percent weight loss at 5 years compared to patients without depressive symptoms, irrespective of procedural type.ConclusionPatients receiving either SR-RYGB or SG had comparable psychosocial functioning, which was maintained to 5 years post-surgery. Pre-existing depressive symptoms did not affect weight loss achieved at 5 years. These findings confirm previous longitudinal studies demonstrating that bariatric surgery is generally associated with improved psychosocial functioning.Graphical

Sexual violence related to terrorism: Psychological care for Yazidi women in Iraq

ObjectivesFrom 2018 to 2022, the Lebanese Association of Victims of Terrorism (AVT-L), in collaboration with the United Nations (UNODC, United Nations Office for Drug and Crime) and with the support of the government of the Netherlands, conducted a project to provide psychological care to victims of terrorism in Iraq. PatientsNinety Yezidi women participated in this program. Each participant had experienced sexual violence during the control of part of Iraqi territory by the jihadists of the Islamic State group (ISIS) between 2014 and 2018. After a semi-structured interview, these Yezidi women first participated in experience-sharing sessions for three consecutive days. Then, they benefited from an individual psychological follow-up for 6 months. Materials and methodsOver the last ten years, the association's team has developed a protocol that combines art therapy with group and individual psychotherapy. The care is regularly evaluated. From the first interview, the psychologist uses the results of the Traumaq. An evaluation tool that assesses trauma-related symptoms. Subsequently, the PCL5 scale is used to measure the evolution of the symptoms. A considerable support that is studied in resonance with the life story and the social, personal, and professional evolution of each person. ResultsAt the end of the psychological support sessions, significant changes were observed, particularly for criteria B and D of the DSM-5. We recorded a reduction in intrusive memories, as well as an improvement in emotional and physical reactions to these memories. Feelings of guilt had subsided and a significant improvement in sleep and concentration was noted. Participants experienced an improvement in their self-esteem, with a desire to pursue studies and active projects in their community. However, anger regarding injustice and lack of compensation remains palpable. This work culminated in supporting and accompanying these women in making their voices heard at the United Nations headquarters in New York. ConclusionsIn this paper, we will highlight the beneficial aspects of art therapy used in this program. We will emphasize the value of clay art therapy particular within this context.

Losing psychiatric or psychological follow-up during the first COVID-19 confinement in Portugal: outcomes in mental health

IntroductionThe COVID-19 outbreak imposed several periods of lockdown to stop the pandemic, with a determinant impact on access to mental health services. In Portugal, the first State of Emergency was declared on the 18th of March 2020, with the obligation of mandatory confinement and circulation restriction. Restrictive measures were alleviated on the 2nd of May 2020.ObjectivesWe aimed to investigate the impact of the first confinement on the maintenance or loss of psychiatric and psychological follow-up. Also, we aimed to explore the outcomes in the mental health of losing psychiatric or psychological consultations.MethodsWe conducted an online survey among the Portuguese population to evaluate demographic, clinical and mental health variables (STAI, DASS-21, PHQ, OCI-R, Quality of Life [QoL] and PSS). Individuals were invited to answer the survey at two timepoints: third week of March 2020 and third week of May 2020. Concerning the first timepoint, we used independent t-tests to compare the mental health variables in the individuals who loss and who did not lose consultations. Then, we evaluated the impact of losing consultations across time in those individuals who continued responding in the second timepoint, through a Linear Fixed Model. All the analyses were performed using JASP software.ResultsFrom the total sample (n=2040), 334 individuals (84.4% female gender) had psychiatric and/or psychological consultations previously to the confinement. In March 2020, the individuals who maintained the consultations (35.0%) showed best mental health indicators in the QoL Self Evaluation (p=0.002), QoL Satisfaction (p=0.037), STAI State (p&lt;0.001), DASS-21 (p=0.001), PHQ (p&lt;0.001), OCI-R (p=0.002) and PSS (p&lt;0.001). Among the matched individuals who answered the survey in May 2020 (n=93), we found that the group who maintained follow-up (n=24) did not improve significantly more than the other group (n=69) for any of the mental health variables in study.ConclusionsThe results indicate that stopping psychiatric and psychological follow-up represented worse mental health outcomes at the beginning of the first confinement. However, anxiety feelings improved at the end of the first confinement, which happened independently of psychiatric/ psychological follow-up.Disclosure of InterestNone Declared

Binge eating, depressive symptoms and suicidal ideation in obese candidates for bariatric surgery

PurposeThe aim of the present study was to determine possible associations between binge eating, depressive symptoms and suicidal ideation in obese candidates for bariatric surgery.MethodsA cross-sectional study was conducted with 254 obese patients recruited from the general surgery service for bariatric procedures at the hospital affiliated with the Federal University of Pernambuco, Brazil. Evaluations were performed using the Binge Eating Scale (BES), Beck Depression Inventory, Beck Scale for Suicidal Ideation (BSSI) and a questionnaire addressing sociodemographic characteristics.ResultsMost patients were women (82%), 48% had a moderate binge eating disorder, 42% a severe binge eating disorder, 32% had symptoms suggestive of mild, moderate or severe depression and 6% had suicidal ideation. Severe binge eating was positively associated with depressive symptoms (p < 0.001) and suicidal ideation (p < 0.05). Cases of severe binge eating were more frequent in young adults, but not necessarily associated with symptoms of depression or suicidal ideation in this portion of the sample.ConclusionsThe present findings underscore the need for psychological and psychiatric follow-up of obese candidates for bariatric surgery using appropriate assessment scales to guide therapeutic approaches.Level IIIEvidence obtained from cross-sectional study.

Cognitive and psychological outcomes and follow-up in severely affected COVID-19 survivors admitted to a rehabilitation hospital.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) represents the most recent severe pandemic resulting in coronavirus disease 2019 (COVID-19). COVID-19 can damage the central nervous system, requiring admission to intensive care units (ICU) and aggressive treatments (long-term ventilatory assistance and sedation) to stabilize vitals. Most post-COVID-19 patients experience cognitive impairments and mood or stress disorders. We aimed to study the frequency of cognitive deficits in COVID-19 survivors, the relationship between clinical factors in the acute phase and cognitive outcomes, affective states, and quality of life. We explored cognitive reserve (CR) role, as a post-COVID-19 resilience factor. Twenty-nine COVID-19 inpatients were assessed using a neuropsychological battery, mood scales, quality of life, and social integration questionnaires. Twenty-five were retained through telephone follow-up to monitor cognitive sequelae, affective states, and reintegration levels roughly 8months after hospital discharge. We administered the Cognitive Reserve Index questionnaire. We found most patients display no cognitive deficits. When they did, multi-domain impairment occurred most frequently, especially involving executive functions. Results revealed a significant correlation between depression levels and the interval between ICU admission and tracheal tube removal. We found increased levels of depression and anxiety at follow-up, a significant relationship between resuming daily life activities, high CR, and executive functions. These findings suggest the importance of psychological support in the long term and the modulating role of cognitive reserve in quality of life after infection.

Post-traumatic stress among COVID-19 survivors: A descriptive study of hospitalized first-wave survivors.

The coronavirus Severe Acute Respiratory Syndrome Coronavirus Type 1 induces a severe respiratory disease, coronavirus disease 2019 (COVID-19). After Severe Acute Respiratory Syndrome Coronavirus Type 1 and Middle East Respiratory Syndrome infection, increased post-traumatic stress disorder (PTSD) rates were described. This single-centred, prospective study aimed to evaluate the rates of PTSD in patients who were hospitalized for COVID-19. Inclusion criteria were COVID-19 patients hospitalized in the intensive care unit (ICU) or in a standard unit with at least 2 L/min oxygen. Six months post-hospitalization, subjects were assessed for PTSD using a validated screening tool, the Post-Traumatic Stress Checklist-5 (PCL-5). A total of 40 patients were included. No demographic differences between the ICU and non-ICU groups were found. The mean PCL-5 score for the population was 8.85±10. The mean PCL-5 score was 6.7±8 in the ICU group and 10.5±11 in the non-ICU group (P=0.27). We screened one patient with a positive PCL-5 score and one with a possible PCL-5 cluster score. Nine patients had a PCL-5 score of up to 15. Seven patients reported no symptoms. Seven patients accepted a psychological follow-up: one for PTSD, three for possible PTSD and three for other psychological problems. The PCL-5 tool can be used by lung physicians during consultations to identify patients for whom follow-up mental health assessment and treatment for PTSD are warranted. Lung physicians should be aware of the risk of PTSD in patients hospitalized for COVID-19 and ensure appropriate screening and follow-up care.

Implementing online psychological follow-up after discharge from pediatric hospitalization: experience report

Implementing online psychological follow-up after discharge from pediatric hospitalization: experience report

Breastfeeding and human milk bank in a neonatal intensive care unit: impact of the COVID-19 pandemic in an Italian cohort of very low birth weight infants

BackgroundParental stress in neonatal intensive care units (NICU) is well known, as is the stress induced by the COVID-19 pandemic. This combination might increase stress to the extent of affecting the availability of maternal expressed milk and the success of establishing breastfeeding. This is particularly relevant in very preterm infants.MethodsWe conducted a single-centre retrospective analysis in two cohorts of very low birth weight infants born in a hospital in Italy. Babies born before the pandemic (September 2017 – December 2019) (n = 101) and during the pandemic (March 2020 – December 2021) (n = 67) were included in the analysis. We compared the rate of babies fed with maternal milk (both expressed and / or donated) at the achievement of full enteral feeding and the rate of those exclusively breastfed at discharge in the two groups. Then, we analysed the impact of donated human milk availability on infant formula use. We also compared mother’s need for psychological support during NICU stay and the duration of psychological follow-up after discharge.ResultsIn our NICU the availability of expressed maternal milk significantly decreased during the COVID-19 pandemic (86.1% before the pandemic vs 44.8% during the pandemic, p < 0.001) at the time of full enteral feeding achievement. Thanks to the availability of donated human milk, the rate of formula-fed babies remained almost unchanged (13.9% vs 14.9%). At discharge, the rate of breastfeeding was similar (73.3% vs 72.7%). The maternal need for psychological support was significantly higher during the pandemic (33% vs 64%, p < 0.001), as well as the duration of follow-up > 6 months (1% vs 15%, p < 0.001). No differences in the main clinical outcomes were found.ConclusionPandemic-induced stress had a significant impact on the availability of expressed maternal milk in NICU. However, the presence of human donated milk was fundamental in preventing increased use of infant formula during NICU stays. This underlines how strategies to implement the widespread establishment of donor milk banks on a national level are warranted. Further research is desirable to optimise the use of donated human milk banks during emergency situations.

Determinants of Treatment Outcome, Follow-Up, and Abstinence Rates Among Patients With Alcohol Use Disorder: A Prospective Study.

Background The treatment of alcohol use problems needs to have a multidimensional approach for early recovery and better outcome. Objective The study aimed to study the socio-demographic, clinical, and psychological factors associated with the three-month clinical outcomes among patients with alcohol use disorder treated in a tertiary care general hospital psychiatric unit in southern India. Methods This is a prospective three-month follow-up study. Patients fulfilling the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria for alcohol use disorder were selected for the study. The baseline severity of alcohol use was assessed by the Severity of Alcohol Dependence Questionnaire, alcohol craving by Alcohol Craving Questionnaire (ACQ), impulsivity by Barratt Impulsiveness Scale, anxiety and depression by Hospital Anxiety and Depression Scale and personality traits by Personality inventory for DSM-5. Craving was assessed at 2, 4, 8 and 12 weeks post-discharge. Results A total of 110 patients participated in the study. After 3 months of follow-up, 75.5% of the patients remained abstinent throughout the follow-up period. The sample was divided into two groups based on the abstinent status at 12 weeks. Both the abstinent and relapsed users were compared based on socio-demographic, marital, family, illness-related, alcohol-usage, and psychological characteristics, the baseline and follow-up craving indices. There were no statistically significant differences between the two groups based on socio-demographic characteristics. Compared to the relapsed group, the abstinent individuals displayed increased adherence to follow-up visits and attended more frequent individual therapy sessions, however, there were no significant differences between the two groups in the number of group therapy sessions attended.Also, the abstinent group demonstrated lower subjective craving at both the baselineand during follow-up. The relapsed users had reported a significantly greater proportion of history of suicide in the family. Further correlational analyses were done to find the direction of associations between psychological characteristics and alcohol-usage characteristics. High attentional impulsivityand motor impulsivitywere associated with early age of first use. High attentional impulsivity, motor impulsivityand impulsive planningwere associated with early age of dependence. Early age of dependence was associated with increased levels of antagonism and psychoticism. Younger onset of alcohol use was associated with increased levels of craving at baseline. The baseline alcohol use severity and the baseline craving towards alcohol were positively correlated with follow-up craving indices as per ACQ and craving index (CI) scales. Conclusion The patients who were abstinent displayed reduced subjective craving towards alcohol at baseline and were more adherent in attending individual and group therapy sessions. Among the relapsed users, most relapsed before four weeks and had a family history of alcohol dependence, family history of psychosis, and suicide, which is indicative of high genetic loading of substance abuse leading to early initiation and early onset of alcohol dependence. The effects of genetic loading could be possibly mediated by traits of high impulsivity, psychoticism, and antagonism.

Facilitators and Barriers That Transfemoral Amputees Experience in Their Everyday Life: A Norwegian Qualitative Study.

Living with a lower limb amputation influences multiple facets of life due to altered function. Individuals achieve a varied level of function post amputation, depending on several variables like age, level of function prior to amputation, and available personal and environmental resources. Releasing the potential to live life to the fullest despite a disability is important to the individual. The primary objective of this study is to identify barriers and facilitators for function which lower limb amputees experience in their lives several years after amputation, from the amputee's perspective. This knowledge can contribute to further development of the clinical pathway for lower limb amputees in a Norwegian rehabilitation hospital. The study has a descriptive and exploratory qualitative design with a phenomenological hermeneutical approach. Semistructured, individual interviews were conducted for data collection. Thematic analysis inspired by Braun and Clarke was used for data analysis. The sample consisted of eight transfemoral amputees (70 ± 6.9 (58-77 years)) living in the southern part of Norway. Average time since amputation was 11 years. The results have been categorised into two main themes with subthemes: (1) facilitators: personal resources, a well-fitted prosthesis, rehabilitation, social network, balance in activity/rest, and accessibility and (2) barriers: walking distance, poorly fitted prosthesis, pain, comorbidities, climate/terrain/falling, reduced local competence on amputation, and pandemic. Lower limb amputees experience barriers in their everyday life, but they also develop strategies to cope with their disability. Clinical implications can include increased nutritional guidance, structural psychological mapping and follow-up, structured follow-ups over a significant period of time, and extended use of digital consultation.

Massive Single Lesion in a Patient With Sickle Cell Disease

Massive Single Lesion in a Patient With Sickle Cell Disease

COVID-19 Long-Term Effects: Is There an Impact on the Simple Reaction Time and Alternative-Forced Choice on Recovered Patients?

A comparative single-evaluation cross-sectional study was performed to evaluate cognitive damage in post-COVID-19 patients. The psychophysics tests of Two-Alternative Forced Choice (2AFC) and Simple Reaction Time (SRT), under a designed virtual environment, were used to evaluate the cognitive processes of decision-making, visual attention, and information processing speed. The population under study consisted of 147 individuals, 38 controls, and 109 post-COVID patients. During the 2AFC test, an Emotiv EPOC+® headset was used to obtain EEG signals to evaluate their Focus, Interest, and Engagement metrics. Results indicate that compared to healthy patients or recovered patients from mild-moderate COVID-19 infection, patients who recovered from a severe-critical COVID infection showed a poor performance in different cognitive tests: decision-making tasks required higher visual sensitivity (p = 0.002), Focus (p = 0.01) and information processing speed (p < 0.001). These results signal that the damage caused by the coronavirus on the central nervous and visual systems significantly reduces the cognitive processes capabilities, resulting in a prevalent deficit of 42.42% in information processing speed for mild-moderate cases, 46.15% for decision-making based on visual sensitivity, and 62.16% in information processing speed for severe-critical cases. A psychological follow-up for patients recovering from COVID-19 is recommended based on our findings.