Somatic Treatment Research Articles

Beyond the traditional distinctions of genome editing: evaluating a vulnerability framework.

Over 40years ago, the 1982 Splicing Life report outlined the two distinctions that have orientated much of the normative and legal landscape of genetic intervention or genome editing since - that of somatic versus germline (or heritable interventions) and medical versus non-medical (or enhancement) applications. During this time, these distinctions have been used to ethically prioritize some areas of research and potential application, such as somatic treatments, while considering others for prohibition, such as germline enhancements. Nevertheless, somatic interventions may also be done for controversial enhancement purposes while some germline interventions may be done with greater prima facie justification (e.g., the enhancement of athletic ability versus the avoidance of Tay-Sachs disease). Even with new somatic treatments that are generally lauded, exemplified with the case of Casgevy, many issues still arise - such as cost and access, particularly salient on a global level. The concerns over a dystopian future of genetic haves and have nots, as a result of enhancement and/or germline interventions, that perhaps may happen, should not distract us from a greater attention to what is happening in the here and now. In this paper, we will highlight the limits of the two distinctions in terms of moving from questions of "should a technology be used" to "how should a technology be used." We argue that an additional focus on vulnerability and marginalization can be useful to support the attempt to better prioritize which interventions should be permitted or prohibited. We show how this can better dovetail with calls for effective (global) governance and reasonable consensus by focusing on the most urgent issues and developing policy accordingly, while leaving aside more abstract issues for further discussion.

Residual Depressive Symptoms in Treatment-Resistant Bipolar Depression Following Short-Term Ketamine Administration.

Residual symptoms are frequently observed in a significant number of patients with depression, indicating an unmet need for effective management strategies to achieve functional recovery. This observational study aimed to evaluate the impact of ketamine infusions on depressive symptoms in patients with bipolar disorder who continued their baseline psychotropic and chronic somatic treatments. Datasets of the two consecutive real-world registries (NCT04226963 for 2019-2022; NCT05565352 from 2023 onward) for the tertiary reference center for psychiatry at the Medical University of Gdańsk (Poland) for the safety and tolerability of ketamine use in mood and anxiety disorders were retrospectively analyzed. Depressive symptoms were assessed using the Inventory of Depressive Symptomatology Self-Report 30 (IDS-SR30). Residual symptoms were identified in patients who achieved a treatment response, defined as a 50% or greater reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) scores from baseline to the seventh infusion. Overall, 14 out of 22 patients met the criteria for response. The most commonly persistent depressive symptoms included sad mood (85.7%), view of my future (78.6%), difficulty falling asleep, and leaden paralysis/physical energy (both 71.4%), with the most severe being difficulty falling asleep (64.3%) and sad mood (42.9%). This observational post hoc analysis indicates that the most frequently observed residual depressive symptoms were low mood, altered view of future, sleep disturbances, and low energy levels. This study should be treated with caution as causality does not apply, however, it reports on a real-world population of subjects with treatment-resistant bipolar depression. Establishing standardized definitions for residual symptoms could enhance the quality and comparability of future research in this area.

Suicidal behavior with diseases of the endocrine system, eating disorders and metabolic disorders

The purpose of the work is to study: analyze modern data on the problem of suicidal behavior in the structure of diseases of the endocrine system, eating disorders and metabolic disorders. Materials and methods. The analysis of 52 sources. The search was carried out in special medical resources, namely: RusMed, Medline, PubMed, and Web of Science. In addition, electronic libraries such as eLibrary were involved.RU, CyberLeninka and the Library of dissertations and abstracts of Russia dslib.net. Results. An attempt has been made to study the phenomenon of suicidal behavior in the structure of diseases of the endocrine system, eating disorders and metabolic disorders. In addition to studying the prevalence of suicidal behaviors in the above diseases, the features and clinic of suicidal behavior depending on the duration and stage of somatic diseases were also described. The risk of suicidal behavior is higher than in the general population at all stages of the development of somatic disease and treatment, including remission, is underestimated by statistics. Conclusions. Diseases of the endocrine system, eating disorders and metabolic disorders should be considered by specialists as potentially dangerous conditions. Suicidal activity in the structure of these diseases remains very high and varies widely: from 0.10 to 65 %. The greatest suicidal activity is manifested in patients with the following diseases: diabetes mellitus, Hashimoto's thyroiditis, hypothyroidism, hyperthyroidism, obesity; Preventive strategies are proposed, which show the importance of screening suicidal behavior in the general medical network in view of the high incidence of suicides to specialists.

Mood Disorders in Schizotypal Disorder with Leading Syndrome of Eating Disorders

Background: сoverage of the problem of mood disorders in patients with schizotypal disorder with leading eating disorders (EDs), in childhood and adolescence is relevant. However, concomitant disorders in eating disorder in childhood and adolescence and their dynamics have not been sufficiently studied. The aim: to study the clinical and psychopathological structure of mood disorders in patients with schizotypal disorder and eating disorders leading in the clinical picture. Patients and methods: the study included 50 patients (9 boys, 41 girls), aged 7 to 16 years. Inclusion criteria: 1) schizotypal disorder; 2) eating disorders; 3) mood disorders. Research methods: clinical-psychopathological, psychometric (HDRS, PANSS), follow-up, somatic observation. Results: in patients with schizotypal and mood disorders, the following variants of eating disorder were observed: anorexia nervosa (AN — first type), anorexia nervosa with dominance of bulimia (ANB — second type), anorexia nervosa with dominance of bulimia and vomitomania (ANB + B — third type). Mood disorders in the first type of eating disorder were characterized by a pronounced depressive triad, suicidal thoughts and stupor at the cachectic stage of the disease. Mood disorders in the second type of eating disorder were characterized by a mixed affective state: short unproductive mania, ideas of dysmorphophobia, ideas of attitude, followed by a prolonged depressive state with senesto-hypochondriacal disorders, asthenia, and an increase in cognitive impairment. Mood disorders in the third type of eating disorder were characterized by the presence, of pronounced delusional and dysmorphophobic disorders and ideas of attitude, psychopathic behavior, depersonalization-derealization disorders, asthenia and cognitive impairment. Affective pathology in schizotypal disorder with eating disorder, as well as body dysmorphic syndrome, persisted for a long time. The most severe course was observed in the third group of patients (NANB + B), which was due to a significant proportion of psychotic disorders in the structure of the syndrome and somatic complications due to vomiting behavior. Conclusions: patients with schizotypal disorder with leading symptoms of eating disorder and mood disorders require an integrated approach to therapy, including somatic and psychopharmacological treatment.

Experiences of receiving a medical consultation – an interview study among hospitalized psychiatric patients

Purpose People with mental illness often experience more physical health problems, compared to the general population. Therefore, we conducted medical consultations to hospitalized psychiatric patients. The purpose of our study was to investigate experiences of medical consultations from a patient perspective. Materials and methods We conducted 17 qualitative, semi-structured interviews with hospitalized psychiatric patients who received a medical consultation in the period of February to May 2023. The interviews were analyzed using Braun and Clarke’s thematic analysis. Results Patients perceived the medical consultation as important in bridging the gap between psychiatric and somatic treatment. The consultation created a sense of security, with patients emphasizing the importance of acknowledgment by the medical doctor. However, some patients were affected by their state of mind and their psychiatric treatment, resulting in memory impairment, which prevented fully utilization of the medical consultation. The support from psychiatric staff proved crucial for patients in initiating somatic interventions. The results are presented in the two overarching themes: (1) Experiences of a medical consultation in a psychiatric setting and (2) communication and support as influential factors for benefits of the medical consultation. Conclusion Our interview study reveals that hospitalized psychiatric patients experience a medical consultation as an important initiative. The relationship between the patient and the medical doctor, the patient’s state of mind, and the support of the psychiatric staff play significant roles. Incorporating these factors in the medical consultation enables a beneficial outcome that can improve the health of people with mental illness.

Treatment-emergent symptoms during short-term ketamine administration in treatment-resistant bipolar depression: A retrospective cross-sectional descriptive study

Symptoms that emerge during pharmacological treatment of bipolar depression are frequently observed, underscoring the necessity for comprehensive treatment monitoring. This observational study sought to observe the correlation of eight intravenous ketamine infusions with treatment-emergent depressive symptoms in treatment-resistant bipolar depression patients who maintained their baseline psychotropic and chronic somatic treatments. Depressive symptoms were evaluated using the Inventory of Depressive Symptomatology Self-Report 30 (IDS-SR30). Treatment-emergent symptoms TES were defined as symptoms absent at baseline but present at the conclusion of the study. The most common TES included decreased appetite, increased weight, hypersomnia, and diurnal mood variation. Conversely, feelings of sadness, altered perceptions of the future, decreased interest in sex, and physical discomfort were absent in all patients. Notably, 13.6 % of patients reported thoughts of death or suicide. Larger-scale studies, integrating clinician-rated and patient-reported outcome measures, are essential to deepen our understanding of treatment-emergent symptoms. Establishing regulatory or professional definitions for treatment-emergent symptoms is warranted to improve the robustness of future research endeavors.

Insights into treatment-specific prognostic somatic mutations in NSCLC from the AACR NSCLC GENIE BPC cohort analysis

BackgroundTreatment of non-small lung cancer (NSCLC) has evolved in recent years, benefiting from advances in immunotherapy and targeted therapy. However, limited biomarkers exist to assist clinicians and patients in selecting the most effective, personalized treatment strategies. Targeted next-generation sequencing–based genomic profiling has become routine in cancer treatment and generated crucial clinicogenomic data over the last decade. This has made the development of mutational biomarkers for drug response possible.MethodsTo investigate the association between a patient’s responses to a specific somatic mutation treatment, we analyzed the NSCLC GENIE BPC cohort, which includes 2,004 tumor samples from 1,846 patients.ResultsWe identified somatic mutation signatures associated with response to immunotherapy and chemotherapy, including carboplatin-, cisplatin-, pemetrexed- or docetaxel-based chemotherapy. The prediction power of the chemotherapy-associated signature was significantly affected by epidermal growth factor receptor (EGFR) mutation status. Therefore, we developed an EGFR wild-type–specific mutation signature for chemotherapy selection.ConclusionOur treatment-specific gene signatures will assist clinicians and patients in selecting from multiple treatment options.

Association between somatic mutation pathways and treatment response in patients with biliary tract cancers (BTCs).

e16196 Background: Comprehensive somatic genomic profiling has become the standard of care for patients with BTCs, serving to identify targetable mutations and aiding in prognostication. While previous studies have identified individual somatic mutations such as TP53, CDKN1A, and KRAS as negative prognostic markers, little is known about their role as predictive biomarkers. This study aimed to investigate the predictive potential of somatic mutations and pathways using commercially available next-generation sequencing. Methods: We conducted a retrospective cohort study at Beth Israel Deaconess Medical Center (BIDMC) from January 2016 to January 2023, with data censoring in January 2024. Patient characteristics, including age, gender, race, stage, site of metastasis, performance status, and survival status, were collected. Somatic genomic alterations data were extracted from FoundationOneCDx, a commercially available NGS platform designed to capture 324 genetic alterations validated for therapy targets or unambiguous drivers of oncogenesis. Genetic alterations were classified into 14 oncogenic pathways constructed based on the TCGA and Reactome databases. Multivariate Cox proportional hazards regression analysis was performed between pathway alterations, progression-free survival and overall survival, accounting for selected covariates with p < 0.05 or potential known confounders. Results: Among 97 BTCs, 90 were successfully sequenced. Among these, 40 patients received gemcitabine and cisplatin, and 28 received fluorouracil and oxaliplatin (FOLFOX) therapy. Intrahepatic cholangiocarcinoma was present in 70% of cases, perihilar or distal cholangiocarcinoma in 27%, and gallbladder carcinoma in 3%. At presentation, 18% had stage I disease, and 44% had stage IV. The median follow-up time was 15 months. A total of 339 genomic alterations were identified, with 8% of samples harboring FGFR fusion or mutation, 9% IDH1 mutation, 6 % HER2 amplification, 30% KRAS mutation, and 32% with TP53 mutation. The most affected pathways were the cell cycle (66%) and DNA repair (50%). In multivariate regression analysis accounting for age, ECOG, and anatomical location, TP53 mutation was associated with shorter progression-free survival on gemcitabine and cisplatin treatment (n = 11, 2 vs. 6 months, HR 4.19, 95% CI 1.51 – 11.7, p < 0.01), whereas cell cycle pathway mutation was associated with longer progression-free survival (n = 14, 6 vs. 5 months, HR = 0.43, 95% CI 0.19-0.96, p < 0.05). No association was found between oncogenic pathways and treatment response to FOLFOX therapy. Conclusions: TP53 mutation is associated with a worse response, whereas cell cycle pathway mutations are associated with an improved response to gemcitabine and cisplatin therapy in patients with BTCs. Further research is needed to understand the mechanisms contributing to these observed effects.

Transmitting awareness from the body into writing: bringing the Feldenkrais method into the university classroom

ABSTRACT We propose inviting the body into the university writing process through somatic pedagogical practices. This study investigates an effort to write from our body and through our body in a course where students used the body as a site of creation. Challenging mind-body dualism and the erasure of bodily ways of knowing, students participated in Feldenkrais exercises to enhance awareness through movement by heightening habitual perception. Subsequently, students’ writing revealed increased admittance of uncertainty and reflexive engagement. They reflected on their own positionalities while considering the perspectives of hypothetical others, invoking augmented senses of social responsibility. In essence, they transferred physically experienced agency through functional movement to personal agency within hierarchical systems of power. This study suggests that somatic pedagogical interventions have the potential to activate reflexivity, foregrounding causal relations that begin with self-guided, felt realities in the body.

Anxiety in the emergency medical practice – its psychiatric and somatic origin, comorbidities, behavior and treatment

Anxiety conditions and disorders are common in the general population, and patients suffering from them often seek the services of emergency departments. Anxiety is a psychopathological symptom that accompanies not only psychiatric conditions, but a wide range of somatic diseases, and a combination of both. The biochemical and pathophysiological mechanisms of psychosomatic interrelationship and comorbidity are complex and multi-layered. Thus, diagnosing the root cause of anxiety is a clinical challenge. Early, and on time, recognition of an anxiety disorder helps to avoid unnecessary investigations, ensures correct treatment and saves hospital resources. Careful use of medications, psychoeducation and referral to a specialist improves patient outcome with this potentially debilitating disease. In this article, the authors aim to present in a synthesized form the main epidemiological data on the prevalence of anxiety symptoms and disorders, anatomical localization and biochemical mechanisms and relationships in the pathogenesis of anxiety symptoms, as well as to derive the main guidelines for recognizing and differentiating clinicopathological constellations in somatic conditions in emergency medical practice. Materials and methods. Existing published studies from an international database, related to the subject of the article, have been thoroughly studied. Results. Anxiety symptoms, in particular panic attacks and disorders, are widespread in primary care and occupy a significant part of the work process, especially at times of peak loads, natural disasters and situations of mass traumatism. Conclusions. Timely training and good preparation for recognition and adequate assessment of anxiety conditions in primary and emergency medical care significantly shorten the therapeutic route of patients. They receive competent help on time, and the cost of their treatment is significantly reduced. Discussion. Modern medical science, including psychiatric, offers advanced drug and non-drug methods for the treatment and prevention of anxiety conditions and disorders.

Lothar Kalinowsky and the arrival of electroshock to America

Includes appreciations of the work: Shock treatments, psychosurgery and other somatic treatments in psychiatry, by Lothar Kalinowsky and Paul Hoch, Editorial Cientifica Médica, Barcelona, ​​1953.

Hospital reform in Germany: Population-based calculation and simulation model for planning and impact assessment

Background: Due to the increasing shortage of specialists, disproportionately rising costs and inadequate quality of care, Germany is planning a fundamental hospital reform. The government commission has developed the central principles for this reform. The aim is to achieve a centralization of hospital services in oversupplied metropolitan areas by planning according to groups of services based on defined requirements for structural quality. The economic pressure to increase the number of cases shall be reduced through the introduction of a reserve payment and by dividing hospitals into levels - at least by transparent information for the general public. So far, however, there has been no generic model to determine the significance of specific care providers considering population needs (reachability), capacity of a hospital location, and the number and severity of treated patients. Methods: We developed a generic model to determine the significance of hospital location-related care and the need for the various groups of services. The model may also be used to assess reserve financing. For the model, the groups of services were divided into four categories according to degree of specialization and urgency with limits of reachability of 30, 45, 90 and 180 minutes. Gravity models were used to simulate the population-based significance of care providers for each group of services. In the basic model, the allocation of the significance was based exclusively on the reachability for the population living within the respective reachability corridor. In extended models, the historical number of cases and their case severity were also taken into account in order to account for current care capacities and existing choices of the population regarding, among other things, the quality of care. The model was implemented on the basis of nationwide data provided in accordance with § 21 data (of the German law for hospital remuneration). We then determined the effects of weighting the three influencing variables (i) population, (ii) number of cases and (iii) case severity on the significance of the hospital sites. Using the example of "endoprosthetics of the knee" (service group 14.2 in North Rhine-Westphalia) in the federal state of Saxony, the effect of concentration on the distribution of the reserve budgets and on the accessibility of the population was illustrated. The importance of care determined in this way is contrasted with a key value that reflects the need for hospitals in terms of securing care in rural areas. Results: From the approximately 16.5 million somatic treatment cases in 2021, 98.5% could be assigned to one of the 60 somatic groups of services according to North Rhine-Westphalia model. The simulation models show a differentiated picture for the various service groups. For the majority of service groups, a moderate concentration of services does not lead to relevant restrictions in terms of reachability. Exclusively considering the population to be cared for (basic model) would lead to significant shifts in the financing of running costs, which are, however, very well mitigated by considering the historic number and severity of cases (extended models). As an example, we show the effects for the service group "endoprosthetics of the knee" in the federal state of Saxony compared to the extrapolation at location level. Discussion: The empirically based simulation model proposed here takes into account reachability, patient preference and hospital capacity and offers a scientific way of comparing the regional significance of care providers as well as the necessity of hospital locations for each service group against the background of the state's obligation to provide care and to make economical use of resources. The simulation model is meant to support hospital planning (here: the allocation of groups of services) in the federal states and to guide rational planning. It is also suitable for the management of financial resources in the context of hospital reform. It also enables an impact analysis. The model is not intended to automate planning or otherwise make rigid specifications. The calculations should be regarded as exemplary. The weights of all parameters can be varied. However, the reachability thresholds and the parameterization of the simulation model should be defined jointly by federal and state governments in terms of a common set of objectives.

Predicting symptom response and quality of life to the low FODMAP diet in irritable bowel syndrome: a 6-month longitudinal study

The low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet is recommended as a first line therapeutic management strategy for irritable bowel syndrome (IBS)(1). The low FODMAP diet is supported by meta-analytical evidence(2), and demonstrates acceptability and effectiveness for improving symptoms and quality of life (QoL) in 50-75% of individuals with IBS. However, a subset of individuals (25-50%) do not respond to the diet(3). The identification of individual-level predictors of treatment response across all three phases of the low FODMAP diet is currently lacking. The study aims were to assess psychological predictors of symptom and QoL response to the low FODMAP diet in patients with IBS. Adults with IBS underwent a three-phase low FODMAP diet, guided by individualised dietetic education. Predictor variables included levels of depressive, anxiety, and extraintestinal somatic symptoms, stress, treatment beliefs and expectations, behavioural avoidance, and illness perceptions. Symptom severity and QoL were the main outcomes. Questionnaires assessing psychological predictors, symptoms and QoL were administered at five points: pre-dietitian (week 0), post-dietitian, end of elimination (week 5), end of reintroduction (week 13), and end of personalisation (week 25) phases. Latent class growth analysis was used to identify classes of response trajectories for symptoms. Linear mixed models were used to test the effect of baseline psychological scores on symptoms and QoL over time. Cross lagged panel models determined the directional predictive relationship between psychological predictors and symptom severity. 112 participants (89% F) median age 30 ± 17 years were included. There were three classes of symptom response trajectories, including ‘non-improvers’ (21.3% of participants) with high initial symptom severity and minimal improvement, ‘improvers’ (22.5% of participants) with low initial symptom severity and significant improvement, and an ‘intermediate’ group (56.2% of participants) with moderate initial symptom severity and significant improvement. Higher treatment beliefs predicted a stronger initial symptom response (effect on linear slope p = 0.036). Lower gut-specific anxiety, as well as higher levels of personal and treatment control at baseline predicted a stronger reduction in IBS symptom severity and improved QoL from week 0 to week 25. Participants with higher levels of baseline psychological symptoms and negative illness perceptions (i.e., lower emotional representations) predicted a stronger initial and later QoL response (effect on linear (p = 0.006) and quadratic (p = 0.049) slopes). Increased cyclical time beliefs predicted poorer initial and later QoL response (effect on linear (p = 0.015) and quadratic (p = 0.029) slopes). Individuals experiencing lower to mid-range symptom severity at baseline had greater improvement with the low FODMAP diet. Lower anxiety, positive illness views and higher treatment beliefs predict better QoL and symptom response. Personalised strategies are crucial for optimising low FODMAP diet effectiveness in IBS.

The Effectiveness of High-frequency Repetitive Transcranial Magnetic Stimulation in Persistent Somatic symptoms Disorder: A Case report study

IntroductionBackground:Somatic symptoms disorders are usually comorbid with depressive disorders despite that there is little evidence for effective treatment for it. Repetitive transcranial magnetic stimulation (rTMS) have been approved by FDA for mildly resistance depression. From this point we hypothesized that rTMS delivered over the prefrontal cortex (PFC) may be useful in somatic symptoms disorder. Therefore, in our case report we want to shed light on the potential effectiveness of rTMS in somatic symptoms disorder.Objectivescase reportMethodscase reportResultsCase Report: A 65-year-old Omani female with multiple medical comorbidities on multiple medications. She presented complaining of multiple somatic complains in the last 2 years after visiting multiple clinics and underwent several specialists’ examinations, investigations and procedure for somatic treatments, all of them where normal.Then patient was seen by different psychiatric clinic multiple anti-depressant and adjuvant anti-psychotic medication were try, patient still not improve.Patient get admitted to hospital for observation and management. Initially she was preoccupying by her somatic complain kept on Fluoxetine and Olanzapine along with that topiramate was added, but still with minimal improvement. Then rTMS was added to her management plan following Intermittent theta burst (iTBS) rTMS protocol. After complete all sessions of rTMS patient was recovering from her all symptoms, no complain report from her.ConclusionsConclusion: our case highlights the important of investigated more thoroughly in rTMS as treatment option for Persistent Somatic symptoms Disorder.Disclosure of InterestNone Declared

The Effectiveness of High-frequency Repetitive Transcranial Magnetic Stimulation in Persistent Somatic symptoms Disorder: A Case report study

IntroductionBackground:Somatic symptoms disorders are usually comorbid with depressive disorders despite that there is little evidence for effective treatment for it. Repetitive transcranial magnetic stimulation (rTMS) have been approved by FDA for mildly resistance depression. From this point we hypothesized that rTMS delivered over the prefrontal cortex (PFC) may be useful in somatic symptoms disorder. Therefore, in our case report we want to shed light on the potential effectiveness of rTMS in somatic symptoms disorder.Objectivescase reportMethodscase reportResultsCase Report: A 65-year-old Omani female with multiple medical comorbidities on multiple medications. She presented complaining of multiple somatic complains in the last 2 years after visiting multiple clinics and underwent several specialists’ examinations, investigations and procedure for somatic treatments, all of them where normal.Then patient was seen by different psychiatric clinic multiple anti-depressant and adjuvant anti-psychotic medication were try, patient still not improve.Patient get admitted to hospital for observation and management. Initially she was preoccupying by her somatic complain kept on Fluoxetine and Olanzapine along with that topiramate was added, but still with minimal improvement. Then rTMS was added to her management plan following Intermittent theta burst (iTBS) rTMS protocol. After complete all sessions of rTMS patient was recovering from her all symptoms, no complain report from her.ConclusionsConclusion: our case highlights the important of investigated more thoroughly in rTMS as treatment option for Persistent Somatic symptoms Disorder.Disclosure of InterestNone Declared

Association of somatic comorbidity and treatment adherence in patients with psychotic disorder

BackgroundIncreased risk for somatic comorbidity in individuals with schizophrenia has been well established. In addition, psychiatric patients with somatic illnesses are more likely to have more psychiatric readmissions. Increased burden of treatment related to chronic somatic comorbidities may be associated with lower adherence to psychiatric medication. MethodsCross-sectional study of 275 patients with schizophrenia spectrum disorder. A general practitioner performed a complete physical health checkup for all participants, including a complete medical examination and laboratory tests. Patients’ adherence, attitudes, insight, and side-effects were evaluated using the Attitudes toward Neuroleptic Treatment Scale. Overall symptomatology was measured using the Brief Psychiatric Rating Scale. Regression analysis was used to investigate interactions and associations among health beliefs, disease burden, and treatment adherence. Separate regression models were utilized to account for the complexity of health behavior and treatment adherence pathways. ResultsPatients’ somatic comorbidity and health behavior were not associated with adherence or attitudes toward antipsychotic treatment. High dose of antipsychotics and obesity were related to the need for medical interventions, while a healthy diet reduced the risk. Higher BPRS score and older age were associated with having somatic symptoms. Somatic comorbidities had no negative effects on treatment adherence or attitudes. ConclusionThis study focuses on exploring possible associations between health beliefs and treatment adherence pathways in patients with psychotic disorders. Contrary to our hypotheses, we found no evidence to support our health belief and diseases burden models and their associations.

General practitioners’ experiences of providing somatic care for patients with severe mental illness: a qualitative study

BackgroundPatients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI is frequently disjointed, as they engage with diverse healthcare providers. Despite this fragmentation, primary care, particularly general practitioners (GPs), assumes a pivotal role in the care of SMI patients. Our study aimed to delve into the first-hand experiences of GPs in delivering somatic care to SMI patients, concentrating on the challenges they encounter and the strategies they employ to navigate these difficulties.MethodsWe conducted in-depth interviews with fifteen GPs, utilizing a semi-structured interview guide, supplemented by ethnographic observations during clinical consultations in general practice. Through inductive coding, interview transcripts and observational field notes were systematically analysed using interpretative phenomenological analysis (IPA). The findings were then deliberated upon within the author group.ResultsGPs revealed that managing the chronic somatic care of SMI patients posed significant challenges. These challenges encompassed the multifaceted needs of patients, their behavior tied to symptoms, a lack of care continuity, and overarching time constraints. To tackle these challenges, the GPs had devised various strategies. However, all participants underscored the critical importance of having adequate time to properly prepare for, conduct, and follow up on consultations.ConclusionThe GPs’ interactions with SMI patients brought numerous challenges, although treating these patients were concurrently acknowledged as vital and fulfilling. The findings suggest that increased allocated time in general practice consultations for patients with SMI is important to support the somatic treatment requirements of this patient group.

A working model of dance movement therapy and its application for psychological assistance hotlines

Psychological hotlines are widely used, convenient, and effective means to help people overcome their stress reactions. In this article, we focused on integrating somatic and mental-micro interventions into the psychological assistance hotline process. In addition to verbal communication, dance movement therapy based on the body-mind interaction can help clients re-establish their connection with psychological resources, such as creativity and resilience in addition to verbal communication. Based on the basic steps and core points of the SAFER-R model, we explored how embodied movement elements can be applied to the hotline setting for body-mind micro-interventions. Furthermore, we proposed the CREATE model and explained how it can be used to intervene and realise the basic functions of psychological hot line service through four case vignettes. Through this article, we added new perspectives and options for the provision of psychological support during public health events, and we enriched the working methods of psychological hotline assistance.

Trend and geo-availability of somatic therapies for treatment resistant depression in the US

BackgroundHaving failed at least two pharmacotherapies, treatment-resistant depression (TRD) constitutes a major burden to healthcare in the US and globally, affecting close to a third of people diagnosed with depression in the US. Several studies have demonstrated the higher economic burden associated with TRD. This study sought to investigate changes in the availability of TRD somatic treatment options (Electroconvulsive therapy [ECT], Ketamine infusion therapy (KIT), and Transcranial Magnetic Stimulation [TMS]) in the US between 2014 and 2020 and the geographic variations in availability of TRD treatment options in the US as of 2020. MethodThis study is a cross-sectional study of US mental health facilities providing TRD treatment options between 2014 and 2020. We used the 2014 to 2020 National Mental Health Services Survey (N-MHSS) data from the Substance Abuse and Mental Health Service Administration (SAMHSA). We estimated service availability per 100,000 US adults, both nationally and regionally, and computed a random-effect logistic regression to calculate the changes in the availability of the services over the study period. ResultOverall, availability of any one of ECT, KIT, or TMS in US mental health facilities declined between 2014 and 2019 (0.23 vs. 0.18 per 100,000 US adults) but increased to 0.24 in 2020. While availability of ECT consistently declined between 2014 and 2020, ketamine and TMS reportedly became available only in 2020. North Dakota, Wyoming, and Utah had the highest availability per 100,000 US adults (0.86, 0.67, and 0.65) while Nevada, Oregon and Georgia had the lowest availability (0.04, 0.06, and 0.06) regionally. ConclusionThe US had less than one mental health facility offering somatic treatment options for TRD per 100,000 US adults as of 2020. Also, the observed increase in the availability of somatic treatment options for TRD across the US between 2014 and 2020 did not reflect the increasing need for more treatment options for the treatment of TRD.

Germline mutations in patients with metastatic prostate cancer: A prospective cohort study in South Korea (KCSG GU20-19).

193 Background: Several clinical guidelines recommend screening for hereditary prostate cancer in high-risk groups for metastatic prostate cancer. However, despite the recent increase in the diagnosis of prostate cancer in Korea, genetic testing for hereditary prostate cancer is not being performed, making it impossible to know the frequency of hereditary prostate cancer. This study aimed to determine the prevalence of germline mutations in unselected Korean patients with metastatic prostate cancer. Methods: Between July 2021 and December 2022, metastatic prostate cancer patients were enrolled prospectively, without any specific selection based on age or family history. Germline mutation analysis was performed on DNA from blood via next generation sequencing using SOLIDaccuTestTM DNA HRD (NgeneBio, Korea). Results: A total of 301 patients were enrolled and the prevalence of germline mutation was analyzed. At diagnosis, the median age was 67 (46-91 years old), and the median PSA was 150 ng/mL (3.07-5000). 250 patients had a Gleason score of 8 or higher. 36 patients (12.0 %) carried a pathogenic (14/301, 4.6 %)/likely pathogenic (22/301, 7.3 %) variant in a germline mutation. Of these patients, 11 patients (3.65 %) had BRCA2 mutations. ATM (6/301, 1.99 %) was the second most frequently mutated gene, followed by FH (4/301, 1.33 %), FANCA, FANCD2, MRE11, SLFN11, SMO (0.66 % of each, 2/301), BLM, CHEK2, ERBB3, MAP2K1, and VHL (0.33 % of each, 1/301). Further analysis will be conducted to evaluate the impact of germline mutations on somatic mutation results, treatment patterns, and clinical outcomes. Conclusions: The prevalence of pathogenic germline mutations among unselected Korean patients with metastatic prostate cancer was 12.0 %. Germline mutation prevalence in this cohort was comparable to previous reported results. This study provides the framework for the development of preventive and treatment strategies based on hereditary genetic factors for prostate cancer in the Korean population. [Table: see text]