Somatic Comorbidity Research Articles

Distribution and clinical comparison of restrictive feeding and eating disorders using ICD-10 and ICD-11 criteria.

Within the eleventh edition of the International Classification of Diseases (ICD-11), diagnostic criteria for feeding and eating disorders were revised and new diagnoses including avoidant/restrictive food intake disorder (ARFID) are classifiable; however, nothing is known about how these changes affect the prevalence of feeding and eating disorders. This study compared the distribution and clinical characteristics of restrictive feeding and eating disorders between ICD-10 and ICD-11. The Eating Disorder Examination (EDE), its child version, and the EDE ARFID module were administered to N = 82 patients (0-17 years) seeking treatment for restrictive feeding and eating disorders and their parents. Clinical characteristics were derived from medical records, questionnaires, and objective anthropometrics. The number of residual restrictive eating disorders (rrED) significantly decreased from ICD-10 to ICD-11 due to a crossover to full-threshold disorders, especially anorexia nervosa (AN) or ARFID. Patients reclassified to ICD-11 ARFID were younger, had an earlier age of illness onset, more restrictive eating behaviors, and tended to have more somatic comorbidities compared to those reclassified to ICD-11 AN. Patients with rrED according to both ICD-10 and ICD-11 were younger, had an earlier age of illness onset, less shape concern, and more somatic comorbidities than patients who were reclassified from ICD-10 rrED to ICD-11 AN or ARFID. This study highlights the inclusive approach of ICD-11 criteria, paving the way for more targeted treatment, and ARFID's high clinical relevance. Future studies considering nonrestrictive feeding and eating disorders across the life span may allow further analyses on diagnostic crossover. Changes in diagnostic criteria for restrictive eating disorders within the newly published ICD-11 led to an increase in full-threshold disorders, while the number of rrED was significantly lowered compared to ICD-10 criteria. The results thus highlight the diagnostic utility of ICD-11 criteria and may help providing adequate treatment to children and adolescents with rrED.

Celecoxib for Mood Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The effects of celecoxib on a broad spectrum of mood disorders and on inflammatory parameters have not yet been comprehensively evaluated. The aim of this study was to systematically summarize the available knowledge on this topic. Data from both preclinical and clinical studies were analyzed, considering the efficacy and safety of celecoxib in the treatment of mood disorders, as well as the correlation of inflammatory parameters with the effect of celecoxib treatment. Forty-four studies were included. We found evidence supporting the antidepressant efficacy of celecoxib in a dose of 400 mg/day used for 6 weeks as an add-on treatment in major depression (SMD = -1.12 [95%Cl: -1.71,-0.52], p = 0.0002) and mania (SMD = -0.82 [95% CI:-1.62,-0.01], p = 0.05). The antidepressant efficacy of celecoxib in the above dosage used as sole treatment was also confirmed in depressed patients with somatic comorbidity (SMD = -1.35 [95% CI:-1.95,-0.75], p < 0.0001). We found no conclusive evidence for the effectiveness of celecoxib in bipolar depression. Celecoxib at a dose of 400 mg/d used for up to 12 weeks appeared to be a safe treatment in patients with mood disorders. Although an association between celecoxib response and inflammatory parameters has been found in preclinical studies, this has not been confirmed in clinical trials. Further studies are needed to evaluate the efficacy of celecoxib in bipolar depression, as well as long-term studies evaluating the safety and efficacy of celecoxib in recurrent mood disorders, studies involving treatment-resistant populations, and assessing the association of celecoxib treatment with inflammatory markers.

Alterations in inflammatory markers after a 12-week exercise program in individuals with schizophrenia-a randomized controlled trial.

In individuals with schizophrenia, inflammation is associated with depression, somatic comorbidity and reduced quality of life. Physical exercise is known to reduce inflammation in other populations, but we have only limited knowledge in the field of schizophrenia. We assessed inflammatory markers in plasma samples from individuals with schizophrenia participating in an exercise intervention randomized controlled trial. We hypothesized that (i) physical exercise would reduce levels of inflammatory markers and (ii) elevated inflammatory status at baseline would be associated with improvement in cardiorespiratory fitness (CRF) following intervention. Eighty-two individuals with schizophrenia were randomized to a 12-week intervention of either high-intensity interval training (HIIT, n = 43) or active video gaming (AVG, n = 39). Participants were assessed at baseline, post intervention and four months later. The associations between exercise and the inflammatory markers soluble urokinase plasminogen activator receptor, c-reactive protein, tumor necrosis factor (TNF), soluble TNF receptor 1 and interleukin 6 (IL-6) were estimated using linear mixed effect models for repeated measures. For estimating associations between baseline inflammation and change in CRF, we used linear regression models. Our main findings were (i) TNF and IL-6 increased during the intervention period for both groups. Other inflammatory markers did not change during the exercise intervention period; (ii) baseline inflammatory status did not influence change in CRF during intervention, except for a positive association between baseline IL-6 levels and improvements of CRF to post intervention for both groups. In our study, HIIT and AVG for 12-weeks had no reducing effect on inflammatory markers. Patients with high baseline IL-6 levels had a positive change in CRF during intervention. In order to increase our knowledge regarding association between inflammatory markers and exercise in individuals with schizophrenia, larger studies with more frequent and longer exercise bout duration are warranted.

Physical condition and activity of daily living among aging inpatients with mental disorders in Guangzhou, China: a cross-sectional study.

The number of elderly with mental disorders is increasing, but few studies have been concerned with the physical condition and activities of daily living (ADL) of these patients. This study aims to describe the physical condition and ADL of patients with mental illnesses (PMI) from different age groups, which provides evidence to improve mental health services for PMI. In this prospective cross-sectional study, the samples were divided into three groups of less than 60 years old (group 1), 60-74 years old (group 2), and over 75 years old (group 3) for comparison. Participants' ADL and physical condition were measure by Barthel Index (BI), Functional Activities Questionnaire (FAQ), Standardised swallowing assessment (SSA) and Short Form of Mini Nutrition Assessment (MNA-SF). The Brief Psychiatric Rating Scale (BPRS) and the Mini-Mental State Examination (MMSE) were used to measure psychological condition. Totally, 392 participants had been recruited, meanwhile 86% of them were diagnosed with at least one physical disease. There were statistically significant differences in the three groups of participants in BI (F = 50.603, P < 0.001), FAQ (F = 40.332, P < 0.001), SSA (F = 28.574, P < 0.001), and MNA-SF (F = 18.366, P < 0.001). Group 2 and group 3 had significantly lower scores in BI and FAQ than group 1, and the SSA scores were significantly higher than the participants in group 1. In the negative symptoms subscale of BPRS, the mean score of group 3 was significantly higher than groups 1 and 2. Negative symptom subscale has different degrees of correlation with BI (r = -0.537), FAQ (r = 0.643), SSA (r = 0.480), MNA (r = -0.325) and MMSE (r = 0.607). In addition, the participants with comorbidities were related to BI (r = -0.364). Somatic comorbidities play a pivotal role in the clinical characteristics of elderly patients with mental illness, thus greater effort should be paid to elderly patients suffering from mental illness with dysphagia, malnutrition, and cognitive decline. Further, the negative symptoms of elderly patients with mental disorders also deserve attention.

Eating disorders - what the gastroenterologist needs to know

Eating disorders are potentially life-threatening disorders that go along with severe psychiatric and somatic comorbidities. It is expected that the number of patients will dramatically increase in the post COVID-19 pandemic era.Four main eating disorders are mentioned in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) and the International Classification of Diseases 11 (ICD-11): anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) und avoidant restrictive food intake disorder (ARFID). Many traditional assumptions in eating disorders are currently challenged due to recent research results. The gastroenterologist is usually not the first point of contact for patients with eating disorders. However, he is crucial, especially in the management of gastroenterologic complications of eating disorders.Focus of the overview will be on relevant gastroenterologic aspects and less on the psychiatric treatment. Basics of the most common eating disorders will be repeated, opportunities in diagnosing an eating disorder and the most relevant gastroenterologic complications will be described. Obesity and its management, an entity that often goes along with an eating disorder, is not in the spotlight of the review.

Transcultural approach to psychiatric and somatic comorbidities in the context of humanitarian medicine in Africa

Introduction: Mental health is an essential component of human well-being. Nowadays there is a tendency to contrast the biological disorder with the mental disorder; which is hardly the case because the first would affect the body, the soma while the second would affect the psyche. Mental disorders described in different psychiatric taxonomies appear to be of multiple etiologies. Objective: The objective of the study was to determine the prevalence of psychiatric disorders and their co-morbidities during general medical consultations at the Mokassa Developmental Health Center. Method: A quantitative and diagnostic study, which took place in the context of a humanitarian mission to Mokassa in Congo-Brazzaville in May 2012. The target population consisted of children, adolescents, adults, and people from the third age. Sampling was carried out by taxonomic triage in two phases, one in Brazzaville for the management of cases and the second phase which concerned the search and evaluation of referred patients. The data was analyzed using content analysis during the interviews. The diagnostic process was carried out using the semi-structured interviews method according to DSM-5 and data collection (interview, diagnosis, anamnesis). The recruitment of participants took place according to the rules of the charter. Helsinki. Results: 50 patients were included during the study period, ie 27 (54%) men and 23 (46%) women, the most representative age group was that of] 35.45] years (34%); the reasons for frequent consultations were behavioral problems (20%) and headaches (24%). 30% of the patients suffered from depression, 4% suffered from psychosis and 2% from bipolar and schizophrenic disorder. The most represented comorbidity was the Nile with 44%. Conclusion: Psychiatry has its place in humanitarian medicine and the mental health of the population of this island of Mossaka in the republic of Congo must be included in the strategic plan for the overall health of the Congolese authorities.

Associations Between Early Life Adversity, Reproduction-Oriented Life Strategy, and Borderline Personality Disorder

Borderline personality disorder (BPD) is often accompanied by a history of high-risk sexual behavior and somatic comorbidities. Yet, these features are most often considered in isolation and little is known about their underlying developmental pathways. Life history theory, a leading framework in evolutionary developmental biology, can help make sense of the wide range of behaviors and health issues found in BPD. To examine whether the emergence of BPD is associated with the prioritization of immediate reproductive goals over longer-term somatic maintenance goals, a life strategy that can be viewed as a developmental response to adverse early life experiences, providing rapid reproductive benefits despite costs to health and well-being. This study used cross-sectional data from the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions in 2004-2005 (n = 34 653). Civilian, noninstitutionalized individuals in the US, 18 years or older, and those with and without a DSM-IV diagnosis of BPD were included. Analysis took place between August 2020 and June 2021. Structural equation models were used to examine whether early life adversity was associated with the likelihood of a BPD diagnosis, either directly or indirectly through a life strategy whereby individuals trade somatic maintenance for immediate reproduction. Analyses were performed on a sample of 30 149 participants (females: 17 042 [52%]; mean [SE] age, 48.5 [0.09]; males: 12 747 [48%]; mean [SE] age, 47 [0.08]). Of these, 892 (2.7%) had a diagnosis of BPD and 29 257 (97.3%) did not have BPD. Mean early life adversity, metabolic disorder score, and body mass index were significantly higher among participants with a diagnosis of BPD. In an analysis adjusted for age, individuals with BPD reported having significantly more children than those without BPD (b =0.06; SE, 0.01; t = 4.09; P < .001). Having experienced greater levels of adversity in early life was significantly associated with a greater risk of being diagnosed with BPD later in life (direct relative risk = 0.268; SE, 0.067; P < .001). Importantly, this risk was further increased by 56.5% among respondents who prioritized short-term reproductive goals over somatic maintenance (indirect relative risk = 0.565; SE, 0.056; P < .001). Similar patterns of associations were found in male and female individuals. The hypothesis of a reproduction/maintenance life history trade-off mediating the association between early life adversity and BPD helps make sense of the high dimensionality that characterizes the physiological and behavioral correlates of BPD. Additional studies are needed to confirm these results using longitudinal data.

Actigraphic Correlates of Neuropsychiatric Symptoms in Adults with Focal Epilepsy.

Disability in patients with epilepsy (PWE) is multifactorial: beyond seizure frequency/severity, PWE are prone to a range of neuropsychiatric, cognitive, and somatic comorbidities that significantly impact quality of life. Here, we explored how variations in seizure severity and the burden of self-reported somatic/neuropsychiatric symptoms correlate with disruptions to 24h activity patterns (rest-activity rhythms, RARs), determined through wrist accelerometry/actigraphy. Multiday wrist-actigraphy recordings were obtained from 59 adult patients with focal epilepsy (44% male, ages 18-72), who contemporaneously responded to validated psychometric instruments to measure anxiety, depression, sleepiness, and somatic symptoms. We conducted a similar in silico psychometric-actigraphic correlation in a publicly available dataset of 1747 Hispanic subjects (35% male, ages 18-65) from the Study of Latinos (SOL) Sueño Ancillary Study. RARs were analyzed via a sigmoidally-transformed cosine model (quantifying amplitude, steepness, acrophase and robustness) and non-parametric measures to estimate RAR stability, fragmentation, and sleep. Compared with matched SOL subjects, RARs from PWE subjects featured a significantly lower amplitude, a wider rest phase and significantly more total daily sleep. Within PWE, similar RAR distortions were associated with seizure intractability and/or anticonvulsant polytherapy, whereas high anxiety, depression, and somatic symptom scores were associated with lower RAR robustness and acrophase delay. We applied the SOL dataset to train logistic regression models to dichotomously classify subjective anxiety, depression and sleepiness symptoms using demographic and RAR parameters. When tested on PWE, these models predicted prevalent anxiety and depression symptom burden (accuracy ~70%) but failed to predict subjective sleepiness. Together, these results demonstrate that RAR features may encode prevalent depression and anxiety symptoms in patients with focal epilepsy, potentially offering wearable-derived endpoints to adjunct clinical care and drug/device trials. With larger PWE-specific actigraphic-psychometric datasets, we may identify RAR signatures that may more precisely correlate with varying seizure frequency, the burden of anticonvulsant therapy and prevalent mood/anxiety symptoms.

Epidemiological Profile of 60-year-old Drug Addicts at the Center for Integrated Addiction Care at Fann Hospital from 2015 to 2019

Studies on the use of psychoactive substances among the elderly are almost non-existent and yet ageing alone could be a determinant of addiction to these substances for this category of population. Our work consists in determining the epidemiological profile of people aged 60 years and over who use psychoactive substances and who are followed up at the integrated addiction management center of the Fann University Hospital in Dakar. This was a retrospective, descriptive, and analytical cross-sectional study of people aged 60 years and older who were followed up at the integrated addiction management center during the period from March 1, 2015 to August 1, 2019. The proportion of elderly people was 6% with a male predominance (91.4%). The majority of users was urban (71.4%), lived with their families (74.3%), and had stayed abroad (65.7%). Only 0.3% of the users started using APS after the age of 60 and the majority of them had been abroad (80.4%). Heroin was the most used drug (50%), with the determinants being a stay abroad and an urban environment, whereas for cannabis it was the absence of a stay abroad and a rural environment. Dependence was severe for 91.3% of the users. Psychiatric comorbidity concerned 15% of the users, dominated by depressive and anxiety disorders, while somatic comorbidity was 42.1%, dominated by viral and metabolic diseases. Withdrawal had concerned only 7.1% of users. The prescribed treatment consisted only of methadone for (32.9%) of the users. Elderly people using psychoactive substances had started this consumption before the age of 60 years and recommendations were formulated for their protection against these substances. Key words: elderly people, psychoactive substances, addiction, integrated addiction care center, Fann Hospital in Dakar.

543 Mucous membrane pemphigoid is associated with multiple somatic and psychiatric comorbidities

543 Mucous membrane pemphigoid is associated with multiple somatic and psychiatric comorbidities

DEPRESSION AND ANXIETY IN HEMODIALYSIS PATIENTS

Objective:Depression and anxiety represent the most common expression of psychological distress in dialysis patients, and this distress is associated with a high mortality rate. Its prevalence, which varies from one study to another, remains underestimated. The objective of our study is to estimate the prevalence of depression and anxiety, in a population of chronic hemodialysis patients, and to identify the sociodemographic, clinical factors associated with them. Materials and Methods: Our study was carried out in the hemodialysis unit of the nephrology department of the Mohammed V military training hospital (HMIM V) in Rabat. It is a descriptive cross-sectional study conducted during June and July 2018, in 35 patients with chronic kidney failure, managed in periodic hemodialysis and who had given their free and informed consent to participate in the study. We used the Hospital-Anxiety and Depression Scale for the diagnosis of anxiety and depression. Results:Depression was found in 16 patients (45.7%) including 8 men and 8 women. The occurrence of depression was significantly related to gender, professional status, and the existence of somatic comorbidities. Anxiety was found in 21 patients (60%), including 10 men and 11 women. The occurrence of anxiety was significantly related to age, professional status, duration of professional status, duration of hemodialysis, existence of somatic comorbidities and professional status.

Functional Somatic Disorders, Their Subtypes, and Their Association With Self-Rated Health in the German General Population.

The heterogeneous conceptualizations and classifications of persistent and troublesome physical symptoms impede their adequate clinical management. Functional somatic disorder (FSD) is a recently suggested interface concept that is etiologically neutral and allows for dysfunctional psychobehavioral characteristics as well as somatic comorbidity. However, its prevalence and impact are not yet known. We analyzed 2379 participants (mean age = 48.3 years, 52.5% female) from a representative German community survey using operationalized FSD criteria. These criteria defined FSD types based on somatic symptom count, type, and severity assessed by the Bodily Distress Syndrome Checklist. In addition, the associations of those types with health concerns, comorbidity, psychological distress, and self-rated health were determined. There were four clearly demarcated groups with no relevant bothering symptoms, with one or with few bothering symptoms from one organ system, and with multiple bothering symptoms from at least two organ systems. Psychological distress, health concerns, and comorbidity steadily increased, and self-rated health decreased according to the number and severity of symptoms. Somatic symptom burden, health concerns, and comorbidity independently predicted self-rated health, with no interaction effect between the latter two. Our data support an FSD concept with two severity grades according to persistent and troublesome symptoms in one versus more organ systems. The delimitation of subtypes with psychobehavioral characteristics and/or with somatic comorbidity seems useful, while still allowing the demarcation of a group of participants with high symptom burden but without those additional characteristics.

Inhalation anesthesia in laser surgery of retinopathy of prematurity

Purpose: to assess the efficacy of inhalation anesthesia with laryngeal mask in extremely premature infants with low or extremely low birthweight and somatic comorbidities during the surgery of retinopathy of prematurity (ROP) in the active phase of the disease. Materials and methods. 477 infants of 25 to 32 weeks’ gestational age were treated by delimiting retinal laser photocoagulation. Inductive anesthesia with Sevoflurane (BAXTER HEALTHCARE Corp, USA) was followed by placing a laryngeal mask. The delimiting retinal laser photocoagulation was performed using laser devices with an adapter on a binocular forehead ophthalmoscope Supra (Quantel Medical, France) and LachtaMylon (Lasermedservis, Russia,). After the surgery, the recovery from sedation and return of consciousness took 7 to 10 minutes. Results. An inhalation of Sevoflurane with the adoption of a laryngeal mask airway significantly decreases complications of anesthesia in premature infants with comorbidities and reduces the length of hospital stay. The quick clearance of Sevoflurane makes it possible to begin feeding the infant one hour after the surgery. Conclusion. Inhalation anesthesia with Sevoflurane is a method ensuring that preterm infants receive adequate anesthesia in the treatment of retinopathy of prematurity in its active phase.

Impact of Somatic and Addictive Comorbidities on the Quality of Life of Patients With Schizoaffective Disorder: A cross-sectional study

IntroductionSchizoaffective disorder is a mental health disorder frequently associated with somatic and addictive comorbidities. This association can be dangerous as it may change the expression of the disease and its prognosis and may even affect the quality of life (QOL) and the overall functioning of patients.ObjectivesThis study aimed to investigate the impact of somatic and addictive comorbidities on QOL and the overall functioning of patients with schizoaffective disorder.MethodsThis paper is a cross-sectional descriptive study conducted at the Department of Psychiatry within outpatient settings over six months. We evaluated the QOL using the SF-36 and Global Assessment of Functioning scale (GAF). We included all patients suffering from a schizoaffective disorder and excluded patients with associated mental impairment, those we could not assess because of another disability, and those with missing records.ResultsFifty-two patients with schizoaffective disorder met our inclusion criteria with an average age of 38. This study found somatic comorbidities in 30.8% of patients, where diabetes ranked first (13.5%), followed by high blood pressure (9.6%). We noted addictive comorbidities in 63.5% of patients, with tobacco, alcohol, and Cannabis being the most consumed substances, with respective rates of 57.7 %,28.8 %, and 13.5%.The QOL assessment revealed an impaired QOL score in 80.8% of patients, whereas 65.4% had a GAF score lower than 70 indicating a deterioration of functioning level. Our results showed that dimension D1 (physical activity) of the SF-36 was strongly influenced by somatic comorbidities, according to an analytical investigation of the association between these two variables (p = 10-4). We also found that the deterioration in the patient’s global functioning was not significantly related to somatic comorbidities (p = 0.28). Furthermore, our studies showed no association between impaired quality of life and substance abuse.ConclusionsSomatic comorbidities and substance abuse have a detrimental effect on patients with pre-existent schizoaffective disorder, and the goals of patient care with a schizoaffective illness go beyond the remission of clinical symptoms to the improvement of quality of life and socio-professional functioning.Disclosure of InterestNone Declared

The wrinkles of the soul- a psychoneuroimmunological approach to aging

IntroductionPsychoneuroimmunology is a discipline that has emerged over the past decades as a broad interdisciplinary field that closely observes the relationship between the psychological state, the nervous system, the endocrine system, and the immune system. The natural aging process leads to alterations in the immune functions, involving lymphocyte dysregulation, and therefore leading to a higher risk of developing coronary artery diseases, infectious diseases or even cancer.ObjectivesThe aim of our inquiry is to evaluate the existing body of work with a focus on studies that observed the intricate connections between psychosocial factors and immunity.MethodsWe performed a systematic review on PubMed and a targeted literature search concentrating on all the factors involved in immunosenescence and their consequences.ResultsThe causality between emotional stressors (acute or chronic), lack of social support, adverse life events, coping mechanisms, personality traits, as well as endocrine changes and multiple age-related pathologies is often undeniable. Other relevant factors include nutrition, sleep, physical activity and substance use. As people grow older, they face a number of psychosocial stressors, such as retirement, social isolation, loss of independence, low income, a decrease in productivity and also somatic comorbidities. These factors, together with an age-related decline in immune function, can constitute not only a psychosocial disadvantage of the elderly, but also a risk factor able to trigger further deterioration of the immune system.ConclusionsAge-associated alterations of the immune response represent a complex concept. Given that we are dealing with the phenomenon of aging in the general population, the field of psychoneuroimmunology can make a significant contribution in establishing the different mechanisms through which seniors can cushion the impact of stressors in regards to health and illness. Therefore, we can pave the way for an individualized approach and support for patients, as well as provide better therapeutic outcomes.Disclosure of InterestNone Declared

Elderly depression in front-line health services:A descriptive and evaluative cross-sectional study

Introduction Depression is a common pathology in the elderly, often unrecognized and mostly affiliated to the consequences of aging,especially in front-line services. It induces somatic and functional impact and even a suicidal risk. When unrecognized or neglected, depression can reduce life expectancy and increases the use of healthcare and the institutionalization. Objectives -Determine the point-prevalence of depression in the elderly in a front-line heath service in Tunis. - Identify risk factors of depression in the elderly. Methods A descriptive and evaluative cross-sectional study on a sample of patients aged 65 or more, in a tunisian front-line service of general health care regardless of the medical reason. Sociodemographic and clinical forms along with the PHQ-9 scale (Patient health questionnaire-9) - validated in tunisian dialect- were used. Results Thirty patients have participated in our study (21 men and 9 women). The average age was 73.23 years. Chronic pathologies were found in 96.66% of cases. The found risk factors are: female sex in 70% of cases, loneliness and isolation in 10% of cases, widowhood in 50% of cases, grieving in 6.6% of cases and somatic comorbidity in 96 .66% of cases. The overall prevalence of depressive symptoms was 53.33%. This is correlated with advanced age and female sex (57.14% in women vs 33.33% in men). The depressive symptomatology found, was mild in 18.5% of cases, average in 62.5% of cases and moderately severe in 18.5% of cases. Conclusions Depression is a frequent pathology in the elderly with multiple risk factors. The aging of the Tunisian population on one hand and the change of the social model (family nucleus) on the other, encourage the early detection of depression in the elderly and the training of the health professionals in order to limit its prevalence. Disclosure of Interest None Declared

Hepatitis B Vaccination in Psychiatric patients in Morocco

IntroductionSevere mental illnesses such as schizophrenia, bipolar disorder and depressive disorder are common worldwide and often have a chronic course.Due to psychiatric ( for example : substance use disorders ) and somatic ( for example : obesity, cardiovascular disease, diabetes ) comorbidities, mortality is higher in these patients than in the general population.Viral diseases are, in addition to cardiovascular diseases and metabolic alterations, among the most common somatic comorbidities in people with severe mental illness.ObjectivesThe objective of our work was to study the prevalence of vaccination against the viral hepatitis B virus in these patients.MethodsFor this purpose, we conducted a cross-sectional study of 200 patients hospitalized in the emergency department of our training center. First, we collected sociodemographic and clinical data on patients admitted to psychiatric emergencies: sex, age, diagnosis, duration of evolution, history (medical and surgical, psychiatric, suicide attempts, problematic substance use, previous incarceration). In a second step, we tested for anti-HBS antibodies.Resultsthe majority of our patients were male, the first diagnosis was schizophrenia.92% of our patients had a substance use disorder, mainly tobacco, followed by cannabis and then alcohol.Several patients reported having unprotected sex.58% of patients were vaccinated against hepatitis B, these patients were young for the most part. the majority of our patients were male, the first diagnosis was schizophrenia.92% of our patients had a substance use disorder, mainly tobacco, followed by cannabis and then alcohol.Several patients reported having unprotected sex.58% of patients were vaccinated against hepatitis B, these patients were young for the most part.Conclusions: Disclosure of InterestNone Declared

Development of depression in patients hospitalized for COVID-19 infection

IntroductionCoronavirus pandemic (COVID-19) has caused a great psychological impact all over the world. With this research, we want to discover the incidence and associated risk factors for depressive symptoms among hospitalized patients. The objective is to investigate patients with criteria of a severe clinical picture and expressed systemic inflammatory response to SARS-CoV-2 coronavirus infection and if they develop mental disorders- depression, measured by Depression, anxiety and stress scale- DASS-21 scale. With this research, we also calculate the index of the immune-inflammatory response SII and test the hypothesis that people with higher SII will develop mental disorders more often. Demographic variables, comorbidities, COVID-19 severity criteria, and the intensity of the organism’s inflammatory response have also been examined. Psychiatric questionnaires were for the first time applied directly to patients with coronavirus infection during hospitalization.ObjectivesTo identify possible risk factors for depression and to investigate the association between disease severity and the occurrence of psychopathology among COVID-19 hospitalized patients.MethodsThe subjects are patients suffering from COVID-19, older than 18 years who were hospitalized in the respiratory center KB Dubrava. After an interview and informed consent, demographic data was taken and two psychological questionnaires had been applied. Variables: patient characteristics -demographic data, experience of vulnerability, information on whether they have been previously treated psychiatrically, symptoms of anxiety, depression, stress, somatic comorbidities Intensity of systemic inflammation Severity of COVID-19.ResultsA total of 169 patients hospitalized were analyzed. The median age of the patients was 65. There were (62.1%) men and (37.9%) women. On admission, most patients had a severe (134, 79.3%) or critical (17, 10.1%) form of COVID-19. The median Charlson comorbidity index was 3 points. Arterial hypertension was present in 101 (59.8%), diabetes mellitus 42 (24.9%), hyperlipoproteinemia 30 (17.8%), obesity 61 (36.1%), malignant disease 17 (10.1%) patients. 11 (6.5%) smoked and 7 (4.1%) patients consumed alcohol. The median CRPa was 72.75 mg /L. Median SII was 1741. During hospitalization, the median DASS21 score for depression was 14, for anxiety 8, and for stress 6. Regarding depression, it was absent in 49 (29%), mild in 27 (16%), moderate in 47 (27.8%), severe in 18 (10.7%) and extremely severe in 28 (16.6%) patients during hospitalization.ConclusionsPatients with symptoms of depression during hospitalization felt statistically significantly more likely to be in danger of life due to COVID-19, had a more pronounced intensity of symptoms of COVID-19 upon admission. Additionally, patients with higher DASS 21 scores for depression were significantly more likely to be female, had COPD and required oxygen supplementation at higher flows.Disclosure of InterestNone Declared

Schizophrenia and myasthenia gravis: a case report

IntroductionDespite a variety of pharmacological and psychotherapeutic interventions, treatment of schizophrenia can still be challenging, even more when certain comorbidities are present. Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junctions caused by antibodies against acetylcholine and tyrosine kinase. While co-occurrence of schizophrenia and MG is rare, treatment can be complicated as specific treatment of one condition can lead to worsening of other (e.g. anticholinergic side effects of psychopharmacotherapy, psychiatric side effects of corticosteroids).ObjectivesTo discuss treatment difficulties in the case of a patient with schizophrenia and multiple somatic comorbidities, including MG.MethodsA case report and a review of literature.ResultsWe report a case of a 50-year-old female patient who was admitted to psychiatric hospital due to psychotic decompensation presented with dysphoria, paranoid delusions, agitation, verbal aggression and hostility. Clinical presentation and psychopharmacological treatment were complicated with her comorbid disorders, MG, which was recently treated because of a relapse, and hypothyroidism, which worsened as she neglected her regular check-ups. Multidisciplinary approach was needed to control the symptoms of her comorbid disorders, which, especially MG, limited psychopharmacological options. Combination of antipsychotics (aripiprazole, haloperidol) and mood stabilizer (sodium valproate) led to clinical improvement of psychotic symptoms. However, poor insight remained- the patient insisted on demission and was not interested in suggested psychotherapeutic and sociotherapeutic programs.ConclusionsIn complex cases like this, multidisciplinary approach is essential for adequate treatment of both psychiatric and comorbid somatic disorders. Conditions like MS can prolong treatment or even worsen the symptoms of a psychiatric disorder, especially since they limit the use of psychopharmacotherapy. Due to this, psychotherapeutic interventions could be even more important to keep a stable remission with a good insight and adherence to both psychiatric and somatic treatment.Disclosure of InterestNone Declared

Comorbid somatic conditions among older patients with major mental illness: A retrospective inpatients study.

IntroductionPsychiatric admissions of elderly subjects with mental disorders is a difficulty in management and treatment. This problem is essentially related to somatic comorbidities of this population.ObjectivesTo compare the demographic characteristics, comorbid conditions and functional status of younger and older individuals with major mental illnesses admitted to psychiatry.MethodsUsing the records of patients admitted between 2015 and 2020 to the psychiatric department "G" of Razi Hospital, we collected the demographic characteristics, comorbid conditions and functional impairments for patients admitted to psychiatry and aged over 65 years. We compared these characteristics to those collected in the total population of admitted patients.ResultsThe study population consisted of 75 elderly patients. Compared to the youngest patients there was a greater male majority, a higher rate of severe cognitive impairment, higher rates of chronic medical illnesses, such as congestive heart failure.ConclusionsOur findings suggest an urgent need for integrated psychiatric and medical care for elderly subjects with major mental illness. Future research is needed to adapt evidence-based integrated models of collaborative mental health care.Disclosure of InterestNone Declared