Severe Distress Research Articles

Comedy of tragedies in Nigerian popular culture

The intrinsic consequences of political actions on society become more obvious in a developing state like Nigeria, where consequences of governmental actions or inactions over the years had become tragedies causing severe emotional, mental, and material distress for its citizens, one of which is insecurity. Nigerians have consequently turned to comedy for relief as the country’s comedy content is largely centered on ridiculing politics and inefficiencies of the government. This study, therefore, attempted to ascertain the utility of comedy using as a politically-induced social problem; insecurity as a paradigm. Three (3) politically-induced contemporary comedy shows on YouTube were analyzed using Sentiment Analysis in Nvivo and a search on ‘insecurity’ and/or ‘security’ was initiated. The analysis showed a predominance of neutral comments (53%) followed by negative sentiments (29%) suggesting that most Nigerians remain unperturbed about their tragedies as Comedy remains a tool for comic relief rather than for social change.

Recent Advances in Monoclonal Antibody-Based Approaches in the Management of Bacterial Sepsis.

Sepsis is a life-threatening condition characterized by an uncontrolled inflammatory response to an infectious agent and its antigens. Immune cell activation against the antigens causes severe distress that mediates a strong inflammatory response in vital organs. Sepsis is responsible for a high rate of morbidity and mortality in immunosuppressed patients. Monoclonal antibody (mAb)-based therapeutic strategies are now being explored as a viable therapy option for severe sepsis and septic shock. Monoclonal antibodies may provide benefits through two major strategies: (a) monoclonal antibodies targeting the pathogen and its components, and (b) mAbs targeting inflammatory signaling may directly suppress the production of inflammatory mediators. The major focus of mAb therapies has been bacterial endotoxin (lipopolysaccharide), although other surface antigens are also being investigated for mAb therapy. Several promising candidates for mAbs are undergoing clinical trials at present. Despite several failures and the investigation of novel targets, mAb therapy provides a glimmer of hope for the treatment of severe bacterial sepsis and septic shock. In this review, mAb candidates, their efficacy against controlling infection, with special emphasis on potential roadblocks, and prospects are discussed.

Evaluating the effect of COVID-19 pandemic on the psychological health of young adults in India

COVID-19 pandemic has affected the mental health of individuals, particularly young adults. Using the ‘strength and difficulty questionnaire 17<sup>+</sup> extended version’, we studied the severity of psychological problems and the resultant distress in young adults; the relationship between the ‘difficulty’ and ‘impact’ scores; and the effect of distress in terms of a number of day-to-day activities affected during a pandemic. Data was collected from 743 college/university students (December 2020-February 2021) in India. Descriptive, relative frequencies, and nonparametric tests are applied here. Females were facing more psychological behavioral problems as compared to males as the<em> </em>p-value is less than 0.001. Males with age<20 years were least affected by COVID-19. Day-to-day activities are affected by almost 45% of young adults because of distress. ‘difficulty’ and ‘impact’ severity bands were significantly different from the previous standard proportions. No significant association was there between ‘difficulty’ and ‘impact’ scores (p-value<0.001). 53% of those contracting COVID-19 had severe distress as against 45% of those who did not. 46% of the respondents were in the ‘abnormal’ category and 59 out of 327 were facing ’a great deal’ problems in more than two areas.

The Same Day on Repeat: A Unique Case of Persistent Déjà Vu Phenomenon as a Long COVID Symptom in an Older Adult

IntroductionDéjà vu is a condition characterized by the experience of recognizing a current situation as familiar with the awareness that the recognition is inappropriate (Pasic et al. Psychiatria Danubina; 30, 21–25). This phenomenon has been well described in temporal lobe epilepsy, and is thought to be caused by abnormal synchronization in the corticolimbic network. While the etiology of neuropsychiatric symptoms in long COVID is still not well demarcated, studies have found that the virus attacks the temporal lobe and limbic system; therefore, we suggest that the ongoing symptoms of déjà vu, in this case, may be a manifestation of long COVID.ObjectivesTo illustrate a unique case of persistent déjà vu after severe infection with COVID-19 virus.MethodsThe patient is a 79-year-old female with a pertinent past medical history of generalized anxiety disorder, major depressive disorder, and prior hospitalization for delirium who presented with a chief complaint of being tired of living the same day. The patient was hospitalized eight months prior for a severe COVID-19 infection that now requires continuous oxygen therapy. Since leaving the hospital, the patient began to develop episodic confusion, memory impairment, and tinnitus which gradually improved. However, the patient developed severe distress due to a constant feeling of déjà vu characterized by a sense of familiarity with events in her daily life. There was no history of loss of consciousness, abnormal involuntary movements, or other semiology related to seizures. Due to distress caused by the déjà vu symptoms, the patient also endorsed depression, anxiety, and insomnia, with deterioration of quality of life.ResultsMRI showed mild volume loss and multifocal regions, including bilateral temporal lobes, of subcortical and periventricular high T2/FLAIR signal abnormality consistent with chronic white matter microangiopathy. MOCA score was 24/30, and the dissociative experiences scale score was 15.36/100. The patient continues to be treated for her depression, insomnia and anxiety with escitalopram 10mg daily and mirtazapine 7.5mg at night as a neuropsychological assessment and electroencephalogram are done.ConclusionsThe incidence of neurological symptoms is more than 80% in severe cases of COVID-19 (Douaud et al. Nature; 604,697–707). This patient was likely predisposed to developing these symptoms due to her age and psychiatric history. Déjà vu occurs in temporal lobe epilepsy, schizophrenia, and depersonalization disorders, all of which affect the limbic-temporal lobe networks (Pasic et al. Psychiatria Danubina; 30, 21–25). Signal abnormalities in the medial temporal lobe are one of the findings seen on MRI in patients with neuropsychiatric symptoms after severe COVID-19 infection. We propose that the persistent déjà vu phenomenon along with cognitive impairments described in this case are manifestations of long COVID.Disclosure of InterestNone Declared

An assessment of the psychosocial distress and problems faced by street children living in Kolkata city: a cross-sectional study

Background: Street children constitute a marginalized group in most societies. These children experience social and behavioural problems resulting from their environmental influences, school and peer interactions, home and family settings, or any combination of these. Keeping in view the prevalence of psychosocial distress among street children, this study was undertaken to assess the levels of psychosocial distress and problems faced by orphan and vulnerable children (OVC) living in Kolkata city. Methods: This was a cross sectional analytical study. A total of 127 children were interviewed with the help of pre-validated semi-structured questionnaire. GHQ-12 scale was used to measure the symptoms of the psychosocial distress. Bivariate analysis with the help of Chi-square test was done to determine variations in the psychosocial distress experienced by OVC by age, gender, duration of stay on streets, education. Results: The mean age of the study participants was 15±2 years. About one third of the children showed symptoms of severe psycho-social distress with 30% of children showing signs of intentional self-harm. Age, education and duration of living on the streets were some of the factors that showed significant correlation with the levels of psychosocial distress. Conclusions: The study concludes that although institutional care and support from NGOs takes care of basic amenities such as shelter, food and education, there is a need to address the psychological needs of the children through teacher sensitization programmes. A well-informed caregiver would be able to address the needs of children under his supervision and care.

Psychological Effects of Covid-19 Care; A Qualitative Study of Health Care Workers in Punjab Pakistan

The pandemic has caused severe psychological distress among Healthcare Workers. They were readily exposed to extreme workloads and physical and emotional turbulence throughout the pandemic which impacted them on both professional and personal fronts. Objectives: To explore the adverse impacts of Covid-19 on the mental health of the Healthcare Workers while delving into the relationship between occupational stress, communal norms, and mental health outcomes. Methods: It utilizes content gathered through observation and in-depth interviews of the frontline Healthcare Workers (n=32) that included doctors (n=14), nurses (n=12), and domestic staff (n=6) working in three COVID-19 treatment centers made in three major cities of Punjab, Pakistan, (Lahore, Faisalabad, and Sialkot) during Covid-19. Results: The results were divided into two themes followed by their sub-themes based on the results gathered through data collection tools. The themes were analyzed using the transactional model of stress and coping. The results reveal that the psychological distress faced by HCWs is directly related to occupational stress such as extreme workload/demand, while other challenges include fighting the community-imposed stigmas against the pandemic and social isolation. Conclusions: Psychological distress is a raising concern; current evidence reveals that low- and moderate-income communities, particularly in South Asian nations, have little or no understanding of workplace stress and its repercussions. Therefore, this study investigated Healthcare Workers’ perspectives on mental health concerning the pandemic.

Perceived Stress and Psychological Distress among Nurses during the COVID-19 Pandemic

The advent of COVID-19 has significantly affected healthcare workers’ mental health. This study was conducted to investigate the perceived stress and its relationship with psychological distress among nurses who took care of patients with the COVID-19 disease. This cross-sectional study was performed on 180 nurses in Ardabil province in 2020. Data were collected online through two standard questionnaires, making use of the Cohen Perceived Stress Scale and the Kessler Psychological Distress Scale (K10). Then, data were analysed based on descriptive and analytical statistics using SPSS software version 19 as well as independent t-tests, Spearman’s correlation coefficient, and multiple linear regression tests. The results of the Spearman’s correlation test indicated that there was a significantly positive correlation (rho = 0.79) between perceived stress and psychological distress (P <0.001). After adjusting the effects of other variables using a multiple linear regression test, the beta correlation coefficient was calculated, and the obtained value of 0.766 was regarded as statistically significant (P <0.001). Moreover, 63.9% of the nurses experienced moderate perceived stress, and 72.6% experienced severe mental disorders. The results of this study demonstrate that high perceived stress is considered as a strong predictor of psychological distress, and also the majority of the nurses working in frontline wards have experienced severe psychological distress. Therefore, it is recommended to take into account the workplace stress and prepare the ground (e.g., through preparing education, identifying at-risk individuals, as well as providing psychotherapy services and social support) to reduce the stress and promote the nurses’ mental health.

Saved by point of care echo.

A 40-year-old black male with a past medical history of sickle cell disease, cardiomyopathy, and pulmonary hypertension presents as a transfer from an outside facility to a tertiary care hospital for evaluation after a formal echocardiogram reported “biatrial enlargement and small cystic structure adjacent to the right atrium.” The patient arrived at the receiving hospital in acute severe distress with altered mental status, tachycardia, tachypnea, hypoxia, and hypotension with near agonal respirations on bilevel positive airway pressure. He was also noted to have bilateral jugular venous distention to the angle of mandibles and bilateral lower extremity edema. Given the acuity of the patient's condition, a bedside point-of-care (POC) ultrasound was done using the Rapid Ultrasound for Shock and Hypotension (RUSH) protocol. Bilateral lung slide was present with a bilateral A-line profile. Inferior vena cava (IVC) interrogation showed a markedly dilated non-distensible IVC. In the apical 4-chamber cardiac view, with color Doppler, it became obvious that there was a very large extracardiac cystic mass nearly completely compressing the right atrium (Video 1). Mitral valve inflow velocity was assessed via pulse wave Doppler and was found to demonstrate echocardiographic pulsus paradoxus (Figure 1). The emergency physician made the diagnosis of an extracardiac cystic mass compressing the right atrium causing pericardial tamponade rapidly at the bedside. A multidisciplinary team was mobilized by the emergency physician and the epicardial cyst was drained under ultrasound guidance in the emergency department resulting in 1300 cc of serous fluid with the restoration of the right atrium volume, normalization of the patient's vital signs, and return to his normal mental status. Pericardial tamponade occurs when there is an impairment of ventricular filling due to atrial compression by pericardial fluid or blood.1 Far more rarely, cardiac tamponade can be caused by extrinsic compression.2 Traumatic pericardial effusions typically occur rapidly and present as acute hemodynamic compromise in the setting of trauma. Medical causes of tamponade can be much more insidious given the usually slower accumulation of pericardial fluid. Pericardial tamponade presents typically as either cardiogenic or obstructive shock. Although physical exam findings such as Beck's triad, are often cited, echocardiography provides an invaluable tool in the detection of tamponade.3 In one case series, the sensitivity of the presence of all 3 components of Becks Triad was 0%, whereas any single element had a sensitivity 50%.4 Emergency physicians can rapidly diagnose pericardial tamponade with POC ultrasound and thus render lifesaving treatment, as in this case.

Lack of Useful Predictors of Dignity-Related Distress Among the Critically Ill as Assessed With the Patient Dignity Inventory.

Many intensive care unit patients are awake (ie, alert and engaging in conversation), actively experiencing many facets of their critical care. The Patient Dignity Inventory can be used to elicit sources of distress in these patients. We examined the administrative question as to which awake intensive care unit patients should be evaluated and potentially treated (eg, through palliative care consultation) for distress. Should the decision to screen for distress be based on patient demographics or treatment conditions? This was a retrospective cohort study of 155 adult patients from 5 intensive care units of one hospital from 2019 to 2020. Each patient had ≥48 hours without delirium, dementia, or sedation. The Patient Dignity Inventory has 25 items to which patients responded on a 1 (not a problem) to 5 (an overwhelming problem) scale. Multiple complete, stepwise forward, and stepwise backward logistic regression models were created among patient and treatment variables for predicting thresholds of the mean among the 25 items. There were 50% (78/155; 95% confidence interval [CI], 42-58) of patients with significant dignity-related distress (mean score ≥1.60). There were 34% (52/155; CI, 26-42) of patients with severe dignity-related distress (mean score ≥1.92; previously associated with often feeling like wanting to die). Models including combinations of vasopressor medication (protective of distress), tracheostomy (greater risk of distress), and female gender (greater risk of distress) had some predictive value. However, all combinations of potential predictors had misclassification rates significantly >20%. Identification of subsets of patients with little potential benefit to screening for dignity-related distress would have a reduced workload of palliative care team members (eg, nurses or social workers). Our results show that this is impractical. Given that approximately one-third of critical care patients who are alert and without delirium demonstrate severe dignity-related distress, all such patients with prolonged intensive care unit length of stay should probably be evaluated for distress.

Recreational Drug Use and Distress From Hallucinations in the General Dutch Population.

Distress associated with auditory (AH) and visual (VH) hallucinations in the general population was found to be predictive of later need for mental healthcare. It is, therefore, important to understand factors relating to the distress individuals experience from their hallucinations. Hallucinations can easily occur under substance-induced states, but recreational drug use is also known as a self-medication strategy. The current study, therefore, investigated whether recreational drug use by individuals from the general population is associated with the degree of distress experienced from AH and/or VH. Drug use and distress severity associated with AH (N = 3.041) and/or VH (N = 2.218) were assessed by means of an online survey in the general Dutch population (>14 years of age). Multiple linear regression revealed that while past month consumption of alcohol was associated with less AH- and VH-related distress, past month cannabis use was associated with more AH- and VH-related distress. Furthermore, past month use of nitrous oxide was associated with more severe VH-related distress. Recreational use of alcohol, cannabis, and nitrous oxide may play important differential roles in the degree of distress associated with AH and VH in individuals from the general population. The consumption of these substances could form a potential risk factor for the development of distressing hallucinations or function as a signal marker for their occurrence. Due to the cross-sectional design of the current study, the causal relation between recreational drug use and distressing hallucinations remains to be elucidated.

A Model Framework for the Estimation of Animal ‘Suffering’: Its Use in Predicting and Retrospectively Assessing the Impact of Experiments on Animals

This paper presents and illustrates, with a working example, a hypothesis for the assessment of ongoing severity before and during an experiment that will enable humane endpoints and intervention points to be applied accurately and reproducibly, as well as helping to implement any national legal severity limits in subacute and chronic animal experiments, e.g., as specified by the competent authority. The underlying assumption of the model framework is that the degree of deviation from normality of specified measurable biological criteria will reflect the level of pain, suffering, distress and lasting harm incurred by or during an experiment. The choice of criteria will normally reflect the impact on an animal and have to be chosen by scientists and those caring for the animals. They will usually include measurements of good health such as temperature, body weight, body condition and behaviour, which vary according to the species, husbandry and experimental protocols and, in some species, unusual parameters such as time of the year (e.g., migrating birds). In animal research legislation, endpoints or severity limits may be specified so that individual animals do not suffer unnecessarily or endure severe pain and distress that is long-lasting (Directive 2010/63/EU, Art.15.2). In addition, the overall severity is estimated and classified as part of the harm: benefit licence assessment. I present a mathematical model to analyse the measurement data to determine the degree of harm (or severity) incurred. The results can be used to initiate alleviative treatment if required or if permitted during the course of an experiment. In addition, any animal determined to have breached the severity classification of a procedure can be humanely killed, treated or withdrawn from the experiment. The system incorporates the flexibility to be used in most animal research work by being tailored to the research, the procedures carried out and the species under investigation. The criteria used to score severity can also be used as additional scientific outcome criteria and for an analysis of the scientific integrity of the project.

Factors associated with suicidal ideation and suicide attempts by Australian dental practitioners.

To investigate factors associated with suicidal ideation and suicide attempts amongst Australian dental practitioners. A self-reported online survey of 1474 registered dental practitioners in Australia was conducted from October to December 2021. Participants reported thoughts of suicide in the preceding 12 months, prior to the preceding 12 months and prior suicide attempts. Overall, 17.6% reported thoughts of suicide in the preceding 12 months, 31.4% prior to the preceding 12 months, and 5.6% reported ever having made a suicide attempt. In multivariate models, the odds of suicidal ideation in the preceding 12 months were higher in dental practitioners who were male (OR=2.01), had a current diagnosis of depression (OR=1.62), were experiencing moderate (OR=2.76) or severe psychological distress (OR=3.58), had self-reported illicit substance use (OR=2.06) or had previous self-reported suicide attempts (OR=3.02). Younger dental practitioners had more than twice the odds of recent suicidal ideation than those aged 61+ years, with higher resilience having decreasing odds of suicidal ideation. This study did not address help seeking behaviours directly related to suicidal ideation, so it is not clear how many participants were actively seeking mental health support. The response rate was low and results may be subject to responder biases, with practitioners experiencing depression, stress and burnout being more willing to participate. These finding highlight a high prevalence of suicidal ideation amongst Australian dental practitioners. It is important to continue to monitor their mental health and develop tailored programs to provide essential interventions and supports.

Impact of psychological distress on emergency room utilization and mortality among prostate cancer survivors.

343 Background: The population of prostate cancer (PCa) survivors has grown over the recent decades, with many reporting long-term treatment-related physical, emotional, and financial adverse effects resulting in greater psychological distress compared to males without a history of PCa. This study analyzes the prevalence of psychological distress among PCa survivors and its impact on emergency room (ER) utilization and overall survival. Methods: We identified a cohort of 3,453 PCa survivors from the 2000-2018 National Health Interview Survey (NHIS) linked to the National Death Index Mortality Files through Dec 31, 2019. Deaths that occurred during the first two years of follow-up were excluded from analyses to minimize the likelihood of reverse causation. The Kessler Psychological Distress Scale (K6) was used to quantify psychological distress. Severe, moderate, and none/low mental distress have been validated for thresholds K6≥13, 13> K6 ≥5, and 5> K6 ≥0. Its association with self-reported ER utilization during the 12 months preceding the survey and all-cause mortality was estimated using weighted multivariable logistic regression and Cox proportional hazards regression, respectively. Models were adjusted for age, sex, race, educational attainment, comorbidities, region, year of survey, smoking status, health insurance, functional limitations, and time since cancer diagnosis. Results: Among the 3,453 PCa survivors (mean [SD] age 68.5 [7.2] years; 2479 (77.9%] non-Hispanic White, 655 (14.1%) non-Hispanic Black; median time since cancer diagnosis:5 years), 435 (11.3%) and 96 (2.4%) reported moderate and severe psychological distress respectively. PCa survivors with psychological distress tend to be younger, less educated, single, and with multiple comorbid conditions, and functional limitations. 812(22.8%) of PCa survivors visited the ER during 12 months preceding the survey. During a median follow-up of 81 months, 937(25.5%) of survivors died of all causes. After adjusting for covariates, PCa survivors with severe psychological distress were at a higher risk of ER utilization and all-cause mortality than those with moderate or no distress. Conclusions: Psychological distress was associated with increased risk of ER utilization and all-cause mortality among PCa survivors. Greater efforts are needed to understand, recognize, and alleviate such distress, as well as to enhance social and mental/physical health support in this rapidly growing community of vulnerable cancer survivors. [Table: see text]

Questionnaire-based screening for mental distress in epilepsy: Outline and feasibility of an outpatient screening and intervention pathway

ObjectiveMental distress is present in a significant proportion of people with epilepsy (PWE), with a negative impact across life domains. It is underdiagnosed and under-treated despite guidelines recommending screening for its presence (e.g., SIGN, 2015). We describe a tertiary-care epilepsy mental distress screening and treatment pathway, with a preliminary investigation of its feasibility. MethodsWe selected psychometric screening instruments for depression, anxiety, quality of life (QOL), and suicidality, establishing treatment options matched to instrument scores on the Patient Health Questionnaire 9 (PHQ-9), along ‘traffic light’ lines. We determined feasibility outcomes including recruitment and retention rates, resources required to run the pathway, and level of psychological need. We undertook a preliminary investigation of change in distress scores over a 9-month interval and determined PWE engagement and the perceived usefulness of pathway treatment options. ResultsTwo-thirds of eligible PWE were included in the pathway with an 88% retention rate. At the initial screen, 45.8% of PWE required either an ‘Amber-2’ intervention (for moderate distress) or a ‘Red’ one (for severe distress). The equivalent figure at the 9-month re-screen was 36.8%, reflective of an improvement in depression and QOL scores. Online charity-delivered well-being sessions and neuropsychology were rated highly for engagement and perceived usefulness, but computerized cognitive behavioral therapy was not. The resources required to run the pathway were modest. ConclusionOutpatient mental distress screening and intervention are feasible in PWE. The challenge is to optimize methods for screening in busy clinics and to determine the best (and most acceptable) interventions for screening positive PWE.

Ethical Need for a Fertility Decision-Aid for Transgender Adults of Reproductive Age

Ethical Need for a Fertility Decision-Aid for Transgender Adults of Reproductive Age

The COVID-19 Pandemic and Youth Suicide: 2020-2021.

Suicide is a leading cause of death among youth in the United States. The coronavirus disease 2019 (COVID-19) pandemic raised concerns that suicide rates will increase. The National Fatality Review-Case Reporting System documents circumstances of child deaths reviewed by multidisciplinary teams. In April 2021, a question asking whether COVID-19 directly or indirectly impacted the child's death was added to the National Fatality Review-Case Reporting System. The objective of this study was to identify factors related to suicide deaths among youth during the COVID-19 pandemic. This exploratory study of youth aged 10 to 17 years occurring during 2020 to 2021 compared demographic and incident characteristics, life stressors, social/mental health histories, and pandemic-related disruptions to school, health, and mental health for COVID-19-impacted suicides and non-COVID-19-impacted suicides using descriptive statistics. χ2 statistics assessed statistical significance in differences across the 2 groups. A total of 552 suicides were included for study. Higher proportions of COVID-19-impacted suicides (n = 144) were by hanging (51% vs 40%) and occurred in suburban areas (57% vs 45%) compared with non-COVID-19-impacted suicides (n = 408). COVID-19-impacted youth also experienced significantly more isolation (60% vs 14%), school problems (42% vs 19%), depression (43% vs 24%), and/or anxiety disorder (23% vs 12%) diagnoses. A subset of youth experienced significant effects of the pandemic and associated measures implemented to mitigate the spread of COVID-19. They were proportionally more likely to experience isolation, school and mental health care disruptions, behavior changes, and severe emotional distress; all signs of increased risk for suicide.

Prehospital emergency medicine for children receiving palliative home care in Germany-a cross-sectional, exploratory study of EMS providers.

The prevalence of children with life-limiting conditions is rising, and since the amendment of the social insurance code in Germany, palliative home care teams have treated an increasing number of children. These teams provide 24/7 readiness, yet some parents still call the general emergency medical service (EMS) for various reasons. EMS is exposed to complex medical problems in rare diseases. Questions arose about the experiences of EMS and whether they felt prepared for emergencies involving children treated by a palliative care team. This study used a mixed methods approach to focus on the interface between palliative care and EMS. First, open interviews were conducted, and a questionnaire was developed based on the results. The variables included demographic items and individual experiences with patients. Second, a case report of a child with respiratory insufficiency was presented to assess the spontaneous treatment intentions of EMS providers. Finally, the need, relevant topics, and duration of specific training in palliative care for EMS providers were evaluated. In total, 1,005 EMS providers responded to the questionnaire. The average age was 34.5 years (±10.94SD), 74.6% were male. The average work experience was 11.8 years (±9.7), 21.4% were medical doctors. Experience with a call of a life-threatening emergency involving a child was reported by 61.5% and severe psychological distress during such a call was reported by 60.4%. The equivalent distress frequency for adult patient calls was 38.3%. (p < 0.001). After review of the case report, the EMS respondents suggested invasive treatment options and rapid transport to the hospital. Most (93.7%) respondents welcomed the consideration of special training in pediatric palliative care. This training should include basic information about palliative care, an analysis of cases involving palliatively treated children, an ethical perspective, practical recommendations, and available (24/7) local contact for further guidance and support. Emergencies in pediatric palliatively treated patients were more common than expected. EMS providers perceived the situations as stressful, and there is a need for specific training with practical aspects.

Physician distress when treatments fail. Survey on physician distress when treating persons with drug-resistant epilepsy and knowledge of neuropalliative care

ObjectiveDrug-resistant epilepsy can be difficult to cure and may pose emotional challenges for epilepsy providers. Neuropalliative care (NPC) can augment quality of life (QOL) in persons with neurological diseases and may add meaningful elements to the treatment repertoire of epilepsy specialists even if seizures continue. However, NPC has not been widely implemented in epilepsy. Our study aimed to determine whether physicians of persons with drug-resistant epilepsy (PWDRE) experience distress when faced with treatment failure (Engel class ≥ 2), either failure of medications-only (PWDREmo) or of both medications and surgery (procedures with curative intent (PWDREms)). Furthermore, we evaluated physician knowledge about and referrals to NPC following treatment failures to help improve patient QOL despite ongoing seizures. MethodsAn anonymous online survey was distributed to US epilepsy physicians through the American Epilepsy Society website and personal email to assess levels of distress experienced when caring for PWDREmo and PWDREms (7-point Likert scale [“1” = “no distress”, “7” = “most distress ever felt”]), and knowledge and use of NPC. ResultsEighty-two physicians completed the survey. Most experienced distress when epilepsy treatments failed: 59% felt moderate distress (≥4) with PWDREmo (median “4”, mean 3.74, range 1–7), 90% suffered moderate to severe distress (5, 5.17, 1–7) with PWDREms. Distress over PWDREms was significantly greater than distress over PWDREmo (p < 0.0001). Forty-three percent reported confidence in their knowledge about NPC. Only 15% were likely to refer PWDREmo to NPC, while 44% would consider it for PWDREms. ConclusionAmong survey responders, physician distress was high when confronted with treatment failures, especially the failure of epilepsy surgery. Fewer than half of responders were likely to refer patients to NPC. Further research is necessary to determine extent, reasons, and effects of physician distress and whether improved understanding of and patient access to NPC would help alleviate physician distress when faced with treatment failures in PWDRE.

Severe distress & denial among Asian patients with Type 2 Diabetes Mellitus in the primary care: A prospective, multicentre study

AimsTo determine the point-prevalence and distribution of diabetes distress among primary care Asians with Type 2 Diabetes Mellitus (T2DM) and evaluate its association with cardiovascular risk. MethodsThis was a prospective, multicentre study conducted in two outpatient clinics. Patients aged ≥ 21 years with uncontrolled T2DM (HbA1c > 7.0 % [53 mmol/mol]) and polypharmacy were stratified based on their Framingham Risk Score (FRS–high ≥ 10 %, low < 10 %) and matched in accordance to their baseline HbA1c. Cardiovascular risk was estimated using FRS while diabetes distress was measured using Problem Areas in Diabetes (PAID) scale (denial 0–10, severe distress ≥ 40). ResultsOf 1940 patients approached, 210 were recruited. A final 132 (62.9 %) participants were eligible for analysis. Median PAID score was 17.5 (IQR 6.25–41.56), with an even distribution in each distress category. There was no significant difference in PAID scores between the high and low FRS groups (20.00vs13.75, p = 0.446). Additionally, PAID score distribution within each group was similar (McNemar-Bowker test, p = 0.477). However, a high prevalence of severe distress (31.4 %) and denial (33.8 %) was detected. Among those in denial, 58.7 % had accompanying intermediate-high 10-year cardiovascular risk. ConclusionIn our sample of Asian primary care patients, a high prevalence of severe diabetes distress and denial was detected although no clear association between cardiovascular risk and diabetes distress was found. Future studies should assess the longitudinal changes and impact of other risk factors in diabetes distress.(Abstract: 199 words)

Depression, PTSD, and suicidal ideation among ex-ultra-Orthodox individuals in Israel

ABSTRACT Introduction: Disaffiliating from an ultra-Orthodox society is complex and challenging. The process includes dealing with culture shock, traumatic experiences, education gaps, and disconnection from familiar surroundings. Thus, ex-ultra-Orthodox individuals (ex-ULTOIs) may face loneliness, lack of belongingness, and loss of meaning, which may relate to high psychological distress such as depression and suicide ideation. In the present study, we sought to shed light on the distress of ex-ULTOIs in Israel and to understand the disaffiliation-related characteristics that may relate to their distress levels. Method: The sample comprised 755 participants, aged 19–54, who left their ultra-Orthodox Jewish lifestyle and communities. Participants completed self-report questionnaires tapping depression, anxiety, posttraumatic stress disorder (PTSD) symptoms, suicide ideation and behaviour, as well as demographics and disaffiliation-related characteristics. Results: Nearly half of the sample (N = 332, 45.9%) reported symptom intensity meeting the current criteria for major depressive disorder. Moreover, 46.7% reported symptoms meeting PTSD criteria, and 34.5% reported having suicidal ideations in the past year. Hierarchical regression analyses revealed that the intensity of past negative life events, the nature of motives for disaffiliation, and the longer duration of the disaffiliation process contributed to the severity of distress. Conclusions: The study's findings reveal that ex-ULTOIs suffer from high mental pain levels, particularly depression, PTSD, and suicidal risk. Importantly, experiencing disaffiliation as traumatic and longer durations of the process may facilitate greater mental pain and distress symptoms. These findings emphasize that ex-ULTOIs must be continually assessed, especially when their disaffiliation processes are experienced as traumatic.