Close-in Research Articles

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

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

Epidemiological study on seroprevalence of syphilis in patients with mental diseases.

The objective of this study was to investigate the seroprevalence of syphilis and its possible influencing factors in patients with mental illness. A total of 24,414 patients with mental illness from 2019 to 2021 were included. Serum syphilis antibody test results and available demographic data were collected. Chi-square test and regression analysis were used to analyze the data. The seroprevalence of syphilis was 0.59% (95% CI 0.49-0.69%) in patients with mental illness in the study area. There were significant differences in the seroprevalence of syphilis in age, marital status, occupation, urban region, and mental disease classification. The seroprevalence of syphilis increased with age (p < 0.01). The seroprevalence of syphilis was higher in patients with "Nonorganic sleep disorders" and "Reaction to severe stress, and adjustment disorders". Adjusted logistic regression analysis showed that the seroprevalence of syphilis in patients with mental illness was associated with age, region, and psychiatric classification. Older age group was a risk factor for syphilis seropositivity. Compared with schizophrenia, "bipolar affective disorder" (OR = 1.707, 95% CI: 1.017-2.864, p = 0.043) and "severe stress response and adjustment disorders"(R = 4.912, 95% CI: 1.138-21.204, p = 0.033) were risk factors for syphilis antibody positivity. The patients with "nonorganic sleep disorders" and "reaction to severe stress, and adjustment disorders" had a high seroprevalence of syphilis. Age and psychosis types became the influencing factors of the positive rate of serum syphilis antibody in patients with mental illness.

Psychiatric Characteristics, Symptoms of Insomnia and Depression, Emotion Regulation, and Social Activity among Swiss Medical Students.

Background: Almost by default, young adult students are at increased risk of suffering from mental health issues, and this holds particularly true for medical students. Indeed, compared to the general population and non-medical students, medical students report higher scores for symptoms of depression. For Swiss medical students, research on the associations between psychiatric characteristics and symptoms of depression and insomnia, including cognitive-emotional processes and social activity, has been lacking so far. Given this, the aims of the present study were to relate self-declared psychiatric characteristics to symptoms of depression, insomnia, emotion regulation, and social activity. Methods: A total of 575 medical students (mean age: 22.4 years; 68.9% females) completed an online survey covering sociodemographic information (age and gender), study context (year of study), self-declared psychiatric characteristics and symptoms of depression, insomnia, emotion regulation (cognitive reappraisal vs. emotion suppression), and social activity. Data on insomnia sum scores and categories of historical samples (862 non-medical students and 533 police and emergency response service officers) were used for comparison. Results: Of the 575 participants, 190 participants (33%) self-declared psychiatric issues, such as major depressive disorder; anxiety disorders, including PTSD and adjustment disorders; eating disorders; ADHD; or a combination of such psychiatric issues. Self-reporting a psychiatric issue was related to higher symptoms of depression and insomnia and lower symptoms of social activity and cognitive reappraisal (always with significant p-values and medium effect sizes). Compared to historical data for non-medical students and police and emergency response service officers, medical students reported higher insomnia scores. In a regression model, current self-declared psychiatric issues, female gender, higher scores for insomnia, and lower scores for social activity were associated with higher scores for depression. Conclusions: Among a sample of Swiss medical students, the occurrence of self-declared psychiatric issues was associated with higher scores for depression and insomnia and lower cognitive reappraisal and social activity. Further, insomnia scores and insomnia categories were higher when compared to non-medical students and to police and emergency response service officers. The data suggest that medical schools might introduce specifically tailored intervention and support programs to mitigate medical students' mental health issues. This holds particularly true for insomnia, as standardized and online-delivered treatment programs for insomnia (eCBTi) are available.

Path loss, angular spread and channel sparsity modeling for indoor and outdoor environments at the sub-THz band

In this paper, we present new measurement results to model large-scale path loss, angular spread and channel sparsity at the sub-THz (141–145 GHz) band, for both indoor and outdoor scenarios. Extensive measurement campaigns have been carried out, taking into account both line-of-sight (LoS) and non line-of-sight (NLoS) propagation. For all considered propagation scenarios, omni-directional and directional path loss models have been developed, based on the so-called close-in (CI) free-space reference distance model. A power angular spread analysis is further presented. The sparsity of the wireless channel has also been studied by employing suitable metrics, namely the so-called Gini index (GI), the Ricean K-factor and the root mean square (RMS) delay spread.

Neurexan Prescription Is Associated with Lower Risk of Sleep Disorder Recurrence and Depression Prevalence as Compared to Z-Drugs and Benzodiazepines: A Retrospective Database Analysis in Germany.

Real-world evidence on the association between natural medicinal products and the recurrence of sleep disorders is currently limited, particularly when compared to the evidence reported for prescription hypnotics. In a retrospective cohort analysis, we investigated patients with sleep disorders prescribed either the natural medicinal product Neurexan (Nx4), benzodiazepines, or nonbenzodiazepines (Z-drugs) using the IQVIA Disease Analyzer database, which encompasses electronic medical records nationwide in Germany. A 1:1 matching procedure based on age, sex, prevalent depression, anxiety or adjustment disorder, and the number of medical consultations in the past 12 months resulted in four cohorts: patients prescribed Nx4 were matched with those prescribed Z-drugs (two cohorts with 8594 matched patients each), and another cohort of patients prescribed Nx4 were matched with those prescribed benzodiazepines (7779 matched pairs). Results from multivariable-adjusted Cox regression models demonstrated that Nx4 was associated with a significantly lower risk of recurrent sleep disorder diagnosis within 30-365 days after prescription compared to both Z-drugs (HR = 0.65, 95%CI = 0.60-0.70, p < 0.001) and benzodiazepines (HR = 0.85, 95%CI = 0.79-0.93, p < 0.001). Additionally, Nx4 was associated with a lower prevalence of depression compared to Z-drugs (HR = 0.90, 95%CI = 0.83-0.98, p = 0.020) and benzodiazepines (HR = 0.89, 95%CI = 0.82-0.97, p = 0.009). These findings suggest an association between Nx4 and improved sleep and mental health outcomes. However, due to inherent limitations in the study design, the causality of this relationship cannot be stated.

The global prevalence of mental health disorders among runaway and homeless youth: A meta-analysis.

A meta-analysis was performed to identify thepooled prevalence of mental health disorders (MHDs) among runaway and homeless youth (RHY). Relevant studies published between December 1, 1985, and October 1, 2023, were identified in the PubMed, Scopus, Web of Science, and Cochrane Library databases. A preliminary screening of 11,266 papers resulted in the inclusion of 101 studies. The pooled-prevalence estimates were obtained using a random-effects model. The findings showed varying lifetime prevalence rates of MHDs: 47% (conduct disorders and psychological distress), 43% (depression), 34% (major depressive disorders), 33% (post-traumatic stress disorder), 27% (personality disorders), 25% (attention-deficit/hyperactivity disorder), 23% (bipolar disorders), 22% (anxiety), 21% (oppositional defiant disorders), 15% (anorexia), 15% (adjustment disorders), 14% (dysthymia), 11% (schizophrenia), 9% (obsessive-compulsive disorders), and 8% (gambling disorder). The current prevalence rates were: 31% (depression), 23% (major depressive disorder), 23% (anxiety), 21% (post-traumatic stress disorder), 16% (attention-deficit/hyperactivity disorder), 15% (bipolar disorder), 13% (personality disorders), 13% (oppositional defiant disorders), 8% (schizophrenia), and 6% (obsessive-compulsive disorders). Regular screening and the implementation of evidence-based treatments and the promotion of integration and coordination between mental health services for adolescent minors and young adults with other service systems are recommended.

Cardiac disease-induced trauma and stress-related disorders.

This review aims to present an updated overview of cardiac disease-induced trauma and stress-related disorders such as acute stress disorder (ASD), adjustment disorder (AjD), and posttraumatic stress disorder (PTSD). First, the prevalence of these disorders, their diagnostic criteria, and their differences from other trauma-related disorders are described. Special challenges in diagnosis and treatment are identified, with various screening tools being evaluated for symptom assessment. Additionally, the risk factors studied so far for the development of symptoms of cardiac-induced posttraumatic stress disorder and the bidirectional relationship between posttraumatic stress disorder and cardiovascular diseases are summarized. Various therapeutic interventions, including pharmacological approaches, are also discussed. Finally, various areas for future research are outlined. Experiencing acardiovascular disease, particularly alife-threatening cardiac event, can potentially lead to stress-related disorders such as ASD, AjD, and cardiac disease-induced PTSD (CDI-PTSD). If left untreated, these disorders are associated with aworsening cardiac prognosis and higher mortality rates. Approaching treatment through atrauma-focused lens may be beneficial for managing CDI-PTSD and stress-related disorders. Future research should explore treatment options for both the patients and the caregivers as well as investigate the long-term effects of trauma-focused interventions on physical and mental health outcomes.

COVID-19 and fear of death: Has the pandemic changed our death orientation?

The recent COVID-19 pandemic set the stage for a major upheaval. The entire world found itself caught in the specter of death. This review article outlines a case vignette of an orthopedic surgeon who was admitted to a COVID-19 ward at the height of the pandemic and was caught between an unfamiliar world of a doctor as a patient tormented by the likelihood of being the next casualty. The term coronaphobia has gained widespread currency. It has become a catch-all phrase for the fear and emotional and social strain experienced by people in the face of the COVID-19 pandemic. Death has been conceptualized in terms of (1) impersonal, (2) interpersonal, and (3) intrapersonal states. People were affected in all three ways. With nearly 7 million deaths even impersonal death mattered. Nearly everyone experienced the loss of one or more family and friends through the pandemic. Many who suffered from the illness had to face the prospect of personal death. As we move from the pandemic to the endemic stage of COVID-19, we must keep in mind the widespread untimely and catastrophic exposure to death. Many complex psychological challenges had to be faced. The lingering effect on people may be worth keeping an eye on. Adjustment disorder, posttraumatic stress disorder, exacerbation or relapse of preexisting conditions, and prolonged grief may be of concern.

Performance of Artificial Intelligence Models (Bidirectional Encoder Representations from Transformers + TextCNN) in Detecting Eight Psychiatric Diagnoses from Unstructured Texts Chinese Electronic Medical Records

Objectives: Advances in artificial intelligence (AI) have revolutionized various industries, including health care. In this study, we intended to explore the capability of AI assistants in psychiatric diagnoses. To achieve this goal, we proposed a series of deep active learning models, namely bidirectional encoder representations from transformers (BERT) – TextCNN. These models combine the strengths of two powerful techniques: BERT and convolutional neural network (CNN) for the text. Methods: We collected 21,003 Chinese psychiatry electronic medical records (EMRs) and developed two types of models: a multi-diagnosis classifier and eight single-diagnosis classifiers for schizophrenia (SCZ), major depressive disorder (MDD), manic state (MANIA), adjustment disorder (ADJ), substance use disorder (SUD), personality disorder (PD), attention-deficit/hyperactivity disorder (ADHD), and autistic spectrum disorder (ASD). Their performance was compared through plotting receiver operating characteristic curves and assessing the performance, area under curve (AUC) using the DeLong test. Results: This study showed the excellent performance of our BERT + TextCNN models in detecting almost all eight psychiatric diagnoses, achieving AUCs being greater than 0.9, except for the single-diagnosis classifier for ADHD (AUC = 0.83). Conclusion: This study highlights the promising applicability of the BERT + TextCNN model as a diagnostic assistant for psychiatry diagnoses derived from EMRs. Being consistent with previous findings, the single-diagnosis classifiers generally outperform the multi-diagnosis classifier in predicting most diagnoses, though not all. Further studies are warranted to confirm whether the specific characteristics of illnesses contribute to the performance gap between multi- and single-diagnosis classifiers.

Influence of Education on Dental Anxiety and Fear in Mental Disorders after Viewing a Molar Extraction in Three Types of Mental Disorder Compared to Persons with No Mental Disorder.

Objective: The goal of this study is to validate the psychometric properties of the Modified Dental Anxiety Scale (MDAS) and the Dental Fear Scale (DFS) at three different times: seven days before, immediately after, and seven days after watching a video of surgical extraction of a lower third molar in a sample with four strata: anxiety disorder, adjustment disorder, mixed anxiety-depressive disorder, and no mental disorder ages 18-70 in a psychiatric clinic in Malaga. Methods: The Research Ethics Committee of the Virgen Macarena-Virgen del Rocío Hospitals approved the study. After being interviewed by a psychiatrist and subsequently completing the Hamilton Rating Scales for Anxiety and Depression, the participants were divided into 4 strata (60 persons in each). The influence of education level was then analyzed. Results: The scales demonstrated good psychometric properties, with higher MDAS and DFS scores for lower levels of education and mixed anxiety-depressive disorder. Conclusions: Patients who show higher levels of dental anxiety and dental fear will be those with lower education levels, as well as those who suffer from mixed anxiety-depressive disorder.

Consultation Liaison Psychiatry for Covid-19 Inpatients: A Hospital Based Study

Background The COVID-19 pandemic has had a significant impact on mental health worldwide. The effects of the pandemic on mental wellbeing have been multifaceted and varied from person to person. Neuropsychiatric symptoms have been described in the acute phase of the illness and as long-term consequences. The objective of this study is to describe the characteristics of COVID-19 patients referred to our liaison psychiatry service in College of Medical Sciences and Teaching Hospital, Chitwan, Nepal.MethodsThis is a hospital based cross-sectional descriptive study. This study was carried out within the Department of Psychiatry of College of Medical Sciences and Teaching Hospital, in Chitwan district of Nepal, over a period of 2 months from March 2021 to May 2021. Data from each psychiatric consultation within our consultation-liaison service were consecutively obtained during the study period. Psychiatric diagnosis was made as per the ICD-10/ DCR criteria. Data was analyzed using SPSS.ResultsAmong 35 patients who received psychiatric consultation, the mean age of the patient was 48.91± 13.01. Majority, sixty two percent were male and from Chitwan District. The majority of the patients, around 37%, were diagnosed with anxiety disorder followed by 22.9% delirium, 11.4% acute stress reaction, 8.6% depressive illness and adjustment disorder. Conclusions This study concluded that there was a high prevalence of psychiatric illness among COVID-19 patients. Therefore, by conducting screening for psychiatric symptoms in COVID 19 patients' healthcare professionals can i entify individuals who may require additional mental health support and intervention. Early detection and intervention for psychiatric symptoms can help prevent worsening of mental health conditions, improve overall wellbeing and enhance the effectiveness of treatment.

Upper airway obstruction and nocturnal enuresis in children: Why is it important?

Objectives: Nocturnal enuresis (NE) is a common urological complaint among children. The most common cause of obstructive airway disease in children is enlarged tonsils and adenoids. Although the relationship between the presence of NE and sleep disorders is unclear, some studies show that enuresis improves after airway obstruction is resolved. We aimed to investigate the relationship between upper airway obstruction and NE in children. Methods: Between September 2020 and June 2021, 66 pediatric patients diagnosed with persistent NE were included in the study. A total of 57 healthy patients were included in the control group. The presence of snoring and apnea, the presence of Attention-Deficit/Hyperactivity Disorder (ADHD)/social adjustment disorder, academic achievement, and family members’ history of NE were asked through questionnaires filled out by the families. An upper airway examination was done with a flexible nasopharyngoscope. Results: The mean ages of the study patients and healthy controls were 8.32±2.1 and 8.18±2.3 years. The female/male ratio was (25/41) and (33/24), respectively. Of the case group, 62.1% were male, and 78.8% were under nine years old. The frequency of snoring/apnea in children with enuresis was 27.3%, while it was 19.3% in the control group (p=0.299). It was found that more enuresis developed in children with high BMI (p=0.044). Family history was higher in the NE group than in the control group, but it was not statistically significant (p=0.173). Conclusion: Nocturnal enuresis is commonly associated with obstructive sleep apnea. Upper airway obstruction, obesity, and male gender are important risk factors for NE.

Risk factors for suicidal behavior in patients hospitalized for adjustment disorders.

Adjustment disorder (AD) is a common psychiatric diagnosis, but it is often considered less severe than other diagnoses. However, it is strongly associated with suicidal behavior. To identify the factors linked to suicidal behavior in patients hospitalized for AD. This is a retrospective, descriptive, and analytical study conducted in the psychiatric department of Mahdia's hospital over a period of nine years. The study included patients who were hospitalized for the first time due to adjustment disorder, according to DSM-5 diagnostic criteria. The study population included 129 patients. AD was prevalent among young (median age 29 years) and female patients (75.2%). Almost half of the cases were single (48.1%) and having a history of suicidal behavior (48.3%). Sixty patients (46.5%) were hospitalized following a suicidal attempt (SA) and drugs were used as a way in half of the cases (50%). Conflicts were the dominant factor precipitating the SA in 88.3% of cases. Factors linked to suicidal behavior in patients with AD were being in an intimate relationship and the presence of family conflicts. Indeed, the risk of suicidal behavior was found to be increased by 3.15 times in patients with AD who experienced family conflicts. Besides, being in an intimate relationship in patients with AD multiplies the risk of suicidal behavior by 5.863. Given the high risk of suicide associated with AD, it is essential to have a more in-depth understanding of the suicidal process and AD through new studies.

Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge

There is a need for representative research on serious adverse outcomes following discharge from psychiatric hospitalization. To compare rates of premature death, suicide, and nonlethal intentional self-harm after psychiatric discharge with rates in the general population and investigate associations of these outcomes with relevant variables associated with the index psychiatric hospitalization. This retrospective cohort study included all residents from Catalonia, Spain (7.6 million population), who had psychiatric hospitalizations between January 1, 2014, and December 31, 2018, and were older than 10 years at the index (first) hospitalization. Follow-up was until December 31, 2019. Statistical analysis was performed from December 1, 2022, through April 11, 2024. Socioeconomic status, psychiatric diagnoses, duration of index hospitalization, and number of previous psychiatric hospitalizations. Postdischarge premature death (ie, all-cause death before age 70 years) and suicide (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code range X60-X84), identified using mortality data, and postdischarge nonlethal intentional self-harm, identified using electronic health record and self-harm case register data. Standardized mortality ratios (SMRs) compared rates of premature death and suicide between the cohort and the general population. Fully adjusted, multivariable, cause-specific Cox proportional hazards regression models for the 3 outcomes were fitted. A total of 49 108 patients discharged from psychiatric hospitalization were included (25 833 males [52.6%]; mean [SD] age at discharge, 44.2 [18.2] years). During follow-up, 2260 patients (4.6%) died prematurely, 437 (0.9%) died by suicide, and 4752 (9.7%) had an episode of nonlethal intentional self-harm. The overall SMR for premature death was 7.5 (95% CI, 7.2-7.9). For suicide, SMR was 32.9 (95% CI, 29.9-36.0) overall and was especially high among females (47.6 [95% CI, 40.2-54.9]). In fully adjusted sex-stratified hazard models, postdischarge premature death was associated with cognitive disorders (adjusted hazard ratio [AHR], 2.89 [95% CI, 2.24-3.74] for females; 2.59 [95% CI, 2.17-3.08] for males) and alcohol-related disorders (AHR, 1.41 [95% CI, 1.18-1.70] for females; 1.22 [95% CI, 1.09-1.37] for males). Postdischarge suicide was associated with postdischarge intentional self-harm (AHR, 2.83 [95% CI, 1.97-4.05] for females; 3.29 [95% CI, 2.47-4.40] for males), with depressive disorders (AHR, 2.13 [95% CI, 1.52-2.97]) and adjustment disorders (AHR, 1.94 [95% CI, 1.32-2.83]) among males, and with bipolar disorder among females (AHR, 1.94 [95% CI, 1.21-3.09]). Postdischarge intentional self-harm was associated with index admissions for intentional self-harm (AHR, 1.95 [95% CI, 1.73-2.21] for females; 2.62 [95% CI, 2.20-3.13] for males) as well as for adjustment disorders (AHR, 1.48 [95% CI, 1.33-1.65] for females; 1.99 [95% CI, 1.74-2.27] for males), anxiety disorders (AHR, 1.24 [95% CI, 1.10-1.39] for females; 1.36 [95% CI, 1.18-1.58] for males), depressive disorders (AHR, 1.54 [95% CI, 1.40-1.69] for females; 1.80 [95% CI, 1.58-2.04] for males), and personality disorders (AHR, 1.59 [95% CI, 1.46-1.73] for females; 1.43 [95% CI, 1.28-1.60] for males). In this cohort study of patients discharged from psychiatric hospitalization, risk for premature death and suicide was significantly higher compared with the general population, suggesting individuals discharged from psychiatric inpatient care are a vulnerable population for premature death and suicidal behavior.

Temporal Trends in Mental Disorder Rates among Patients with Colorectal Cancer: A Comprehensive Analysis.

Background: Colorectal cancer (CRC) stands as one of the most prevalent and burdensome malignancies worldwide. Similar to other cancers, CRC has been associated with the development of psychiatric diseases, including anxiety and depression. However, temporal trends in psychiatric disorders rates within CRC patients have not been investigated so far. Methods: The present study included 15,619 individuals with colorectal cancer and 78,095 propensity score-matched individuals without cancer, who were identified within the Disease Analyzer (IQVIA) database in Germany between 2005 and 2022. Cox regression analysis was conducted to assess the association between CHC and subsequent psychiatric diseases, including depression, anxiety disorders, and adjustment disorder, by period (2005-2010, 2011-2016, 2017-2022). Results: The 12-month cumulative incidence of any psychiatric disorder diagnosis in the CRC cohort increased from 6.3% in 2005-2010 to 8.2% in 2017-2022. The strongest increase was observed for reaction to severe stress and adjustment disorder (1.0% in 2005-2010 to 2.6% in 2017-2022). Notably, the strong increase in psychiatric disorders was not specific for cancer patients since a slight increase in psychiatric disorders was also observed in the non-cancer cohort. Regression analyses revealed that CRC was strongly and significantly associated with an increased risk of depression, anxiety disorders, reaction to severe stress and adjustment disorders, as well as any psychiatric disorder. Of note, the extent of the association was stronger in 2017-2022 compared to 2005-2010, clearly proving a "real" increase in the rates of psychiatric disorders over time. Conclusions: This study presents novel data from a large cohort of outpatients in Germany, providing strong evidence for an increase in psychiatric disorders in the recent years. These findings contribute to the existing body of literature and should trigger the recognition of psychiatric problems in cancer survivors.

The longitudinal dispositions of people diagnosed with adjustment or severe stress disorders

BackgroundAdjustment and stress-related disorders are prevalent among psychiatric service users. Despite their prevalence, little is known about their prognosis. To reduce that gap, the present article documents the service use and diagnostic outcomes of people with adjustment or stress-related disorders presenting at Singapore’s largest psychiatric emergency department.MethodsAdministrative data from 2014 to 2021 was retrieved to follow a group of 683 service users whose first-ever psychiatric presentation in 2014 warranted a diagnosis of adjustment or stress-related disorder. People were grouped a priori depending on whether different diagnoses were recorded within 7 days, 9 months, after 9 months or not at all. Survival curves characterized conversion to other diagnoses and engagement with healthcare services. Service use outcomes include the number of hospitalizations, outpatient appointments, emergency department visits, and prescriptions.ResultsSixty-one percent (n = 417) never received another diagnosis over the 8-year period. This group used emergency services most and received the most pharmacotherapy shortly after their first visit. Of those who received another diagnosis, depression, personality disorders, and psychotic disorders were the most common. Those who received another diagnosis within 7 days (n = 70, 10%) received it on their first day of hospitalization (IQR 1–1), making the most use of inpatient services. The group who received another diagnosis within 9 months (n = 105, 15%) did so after 42 days (IQR 26–84) and had the highest relative number of deaths. Those who received another diagnosis after 9 months (n = 91, 13%) did so after 1,134 days (IQR 613–1,823) and had the longest period of engagement but made the least use of any psychiatric service, potentially suggesting a group whose early index diagnosis heralded vulnerability to future disorders.ConclusionsA large group of service users with acute stress or adjustment disorders will likely never be given another psychiatric diagnosis and appear to disengage following an initial period of high-intensity service use. The group that received a different diagnosis after the 9-month mark had prolonged contact with services but low intensity of service use and may represent a target for preventative intervention to help them improve their stress-managing skills and avoid developing other disorders.

Evaluation of the Characteristics of Psychiatric Consultation in a General Hospital in Tehran, Iran, over Eight Years and Comparing the Characteristics during 2008-2017

Background: This study aimed to investigate the characteristics of psychiatric consultations in a general hospital. Methods: All the patients hospitalized in Rasoul Akram Hospital from April 2011 to March 2019 who were asked for a psychiatric consultation were studied. Patients’ information was obtained from the patients’ records. The records of the year 2008 were also used to compare the characteristics between the years 2008 and 2017. Results: Over an eight-year period, 0.61% of the patients received psychiatric consultations. 54% of the consulted patients were male and 46% were female. The mean age of the patients was 44.7±18.72 years. The highest requested consultations (28.4%) were from the internal department followed by the surgery department (11.8%). The highest frequency of the reasons for requesting consultation was presence of psychiatric symptoms (27.5%). The most common psychiatric diagnosis was adjustment disorder (18.4%) followed by major depressive disorder (14.2%). Comparing consultations in the year 2008 with 2017 demonstrated that 1.57% of the patients admitted in 2008 and 1.17% of the patients in 2017 received psychiatric consultations, and in both years, the number of male patients was higher than females, the highest demand for consultation was from the internal department, and the most common reason for seeking consultation was the presence of psychiatric symptoms and then depressive symptoms. In 2008, the most common diagnosis was major depressive disorder and in 2017 was substance use disorder. Conclusion: The consultation rate was alarmingly low in this study compared to the other studies.

Patterns of Mental Health Service Utilisation: A Population-Based Linkage of Over 17 Years of Health Administrative Records

A cross-sectoral partnership was formed in 2021 in support of the recommendations in an audit on access to state-funded mental health services. In this first paper, we aimed to describe the demographic and service utilisation of adults with a mental health diagnosis in the Western Australian state-funded health system from 2005 to 2021. Inpatient, emergency department, specialised (ambulatory) community mental health service, and death records were linked in individuals aged ≥ 18 years with a mental health diagnosis in Western Australia. Altogether, 392,238 individuals with at least one mental health service contact between 1st January 2005 and 31st December 2021 were included for analysis. Females, Aboriginal and/or Torres Strait Islander people, and those who lived outside major cities or in the most disadvantaged areas were more likely to access state-funded mental health services. While the number of individuals who accessed community mental health services increased over time (from 28,769 in 2005 to 50,690 in 2021), the percentage increase relative to 2005 was notably greater for emergency department attendances (127% for emergency department; 76% for community; and 63% for inpatient). Conditions that contributed to the increase for emergency department were mainly alcohol disorder, reaction to severe stress and adjustment disorders, and anxiety disorders. Sex differences were observed between conditions. The pattern of access increased for emergency department and the community plus emergency department combination. This study confirmed that the patterns of access of state-funded mental health services have changed markedly over time and the potential drivers underlying these changes warrant further investigation.

Psychological consequences of stress in pregnant women during the confinement of covid-19 in Peru. A review study

The present research sought to identify and determine the psychological consequences of stress in women through a systematic review. According to data extracted from the Portal Instituto Nacional Materno Perinatal del Perú in 2020, during the COVID-19 confinement there is an increase in Mixed Anxiety and Depression Disorder with 29.31%, Post-Traumatic Stress Disorder 4.47%, adjustment disorder with 14.47%, stress-related problems, not classified elsewhere with 15.57%. In Peru: the psychological consequences correspond to the fact that pregnant women have depression in 29.31%, post-traumatic stress disorder in 4.47%, adjustment disorder in 14.47%, stress-related problems, and those not classified elsewhere in 15.57%. It is concluded that there was an increase in the psychological consequences of stress in pregnant women due to social isolation, since pregnant women were deprived of the activities they carried out, even more so due to the emotional and physical changes that occur during their stage.

Correlation of Psychological Factors, Obesity, Serum Cortisol, and C-Reactive Protein in Patients with Fibromyalgia Diagnosed with Obstructive Sleep Apnea and Other Comorbidities.

Fibromyalgia (FM) is a chronic pain disorder and is associated with disability, and high levels of pain and suffering. FM is known to co-occur with obesity and obstructive sleep apnea (OSA). Individuals with FM often experience symptoms of pain, depression and anxiety, sleep disturbances, and fatigue. These symptoms may be exacerbated by OSA and contribute to the symptoms' severity in FM. Obesity is a common comorbidity in OSA patients, and as FM and OSA are related in some patients, obesity also may contribute to FM symptom severity. For healthcare providers to effectively manage FM patients, a better understanding of the co-occurrence between these FM comorbidities and psychological factors is needed. This study was approved by IRB and conducted using a retrospective EPIC chart review. To identify FM, the following ICD-9 codes were used: (729.1) and ICD-10 (M79.7) codes. To identify patients with OSA, the following ICD-9 codes were used: (327.23) and ICD-10 (G47.33). Body Mass Index (BMI), the total number of medical diagnoses, and psychiatric conditions were documented for each patient. The prevalence of psychiatric conditions including depression and anxiety was compared between patients with and without obesity (BMI > 30), and patients with fewer than 25 medical diagnoses and those with 25 or more diagnoses. A chart review was conducted to identify patients with fibromyalgia with prior serum cortisol testing within the last ten years. Cortisol levels were compared and patients were divided into six groups: 1. FM without identified psychiatric conditions; 2. FM with psychiatric diagnosis of adjustment disorders and insomnia; 3. FM with psychiatric diagnosis of depressive disorders; 4. FM with psychiatric diagnosis of bipolar disorders; 5. FM with psychiatric diagnosis of mixed anxiety and depression; 6. FM with psychiatric diagnosis of anxiety disorders. Available C-reactive protein (CRP) values were gathered. The total FM and OSA population was N = 331. The mean age of the patient population was 63.49 years old, with 297 being female. The diagnoses mean was 31.79 ± 17.25 and the mean total psychiatric diagnoses was 2.80 ± 1.66. The mean BMI was 36.69 ± 8.86, with obesity present in 77.95% of the patients. A total of 66.99% of patients had comorbid anxiety and depression with 25 or more medical problems vs. 33.01% of patients who had fewer than 25 medical problems (odds ratio = 1.50). Patients with a BMI < 30 (N = 71) had rates of anxiety and depression at 64.79% and a mean total of 2.79 ± 1.66 psychiatric diagnoses, whereas patients with a BMI > 30 (N = 258) had rates of anxiety and depression at 61.63% (odds ratio = 1.28) and a mean total of 2.80 ± 1.66 psychiatric diagnoses. The most common other psychiatric conditions among FM/OSA patients included hypersomnia and substance use disorders. Cortisol data: Available cortisol results: FM n = 64, female: 59, male: 5, mean age: 63, average BMI: 38.8. The averages for serum cortisol alone for groups 1-6, respectively, are 9.06, 5.49, 13.00, 14.17, 12.25, and 16.03 μg/dL. These results indicate a relatively upward cortisol serum value by the addition of several psychiatric conditions, with the most notable being anxiety for patients with FM. CRP values were available for 53 patients with an average CRP of 4.14. Higher rates of anxiety and depression were present in FM patients with 25 or more diagnoses. The odds ratios indicate that a patient with 25 or more medical problems was 1.5 times more likely to have anxiety and depression than those with fewer diagnoses. Additionally, those with a BMI > 30 were 1.3 times more likely to have anxiety and depression than those with a normal BMI. addressing psychological factors in FM and OSA is important as high healthcare utilization is common in patients with FM and OSA.