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Revista Brasileira de Psiquiatria (Sao... Jun 2024This is the second part of the Brazilian S20 mental health report. The mental health working group is dedicated to leveraging scientific insights to foster innovation...
This is the second part of the Brazilian S20 mental health report. The mental health working group is dedicated to leveraging scientific insights to foster innovation and propose actionable recommendations for implementation in Brazil and participating countries. In addressing the heightened mental health challenges in a post-pandemic world, strategies should encompass several key elements. This second part of the S20 Brazilian Mental Health Report will delve into some of these elements, including: the impact of climate change on mental health, the influence of environmental factors on neurodevelopmental disorders, the intersection of serious mental illness and precision psychiatry, the co-occurrence of physical and mental disorders, advancements in biomarkers for mental disorders, the utilization of digital health in mental healthcare, the implementation of interventional psychiatry, and the design of innovative mental health systems integrating principles of innovation and human rights. Reassessing the treatment settings for psychiatric patients within general hospitals, where their mental health and physical needs are addressed should be prioritized in mental health policy. As the S20 countries prepare for the future, we need principles that stand to advance innovation, uphold human rights, and strive for the highest standards in mental health care.
PubMed: 38875470
DOI: 10.47626/1516-4446-2024-3707 -
Revista Brasileira de Psiquiatria (Sao... Jun 2024Panic disorder (PD) is a common disabling condition characterized by recurrent panic attacks. Emotional and behavioral impairments are associated with functional...
BACKGROUND
Panic disorder (PD) is a common disabling condition characterized by recurrent panic attacks. Emotional and behavioral impairments are associated with functional connectivity (FC) and network abnormalities. We used the whole brain FC, modular networks, and graph-theory analysis to investigate extensive network profiles in PD.
METHOD
The functional MRI data from 82 PD and 97 controls were included. Intrinsic FC between each pair of 160 regions, 6 intra-networks, and 15 inter-networks were analyzed. The topological properties were explored.
RESULTS
PD patients showed altered FCs within the right insula, between frontal cortex-posterior cingulate cortex (PCC), frontal cortex-cerebellum, and PCC-occipital cortex (corrected P values < 0.001). Lower connections within the Sensorimotor Network (SMN) and SMN-Occipital Network (OCN) were detected (P values < 0.05). Various decreased global and local network features were found in PD (P values < 0.05). In addition, significant correlations were found between PD symptoms and nodal efficiency (Ne) in the insula (r = -0.273, P = 0.016), and the FC of the intra-insula (r = -0.226, P = 0.041).
CONCLUSIONS
PD patients present with abnormal functional brain networks, especially the decreased FC and Ne within insula, suggesting that dysfunction of information integration plays an important role in PD.
PubMed: 38870426
DOI: 10.47626/1516-4446-2023-3520 -
PCN Reports : Psychiatry and Clinical... Mar 2024To date, only a few reports of anti-LGI1 encephalitis with isolated psychiatric symptoms in the initial phase have been reported. We present a relatively rare case of...
BACKGROUND
To date, only a few reports of anti-LGI1 encephalitis with isolated psychiatric symptoms in the initial phase have been reported. We present a relatively rare case of antileucine-rich glioma-inactivated 1 (LGI1) encephalitis that developed only psychiatric symptoms at the onset.
CASE PRESENTATION
The patient was a male in his 40s who developed anxiety and panic symptoms and was started on antidepressants after being diagnosed with panic disorder by a psychiatrist. He visited our hospital 2 months later presenting with hallucinations, delusions, mild cognitive decline, and faciobrachial dystonic seizures in the left upper extremity and face. Fluid-attenuated inversion recovery magnetic resonance imaging revealed swelling and hyperintensities in the right caudate nucleus and putamen. Cerebrospinal fluid analysis did not show increased protein levels or cell counts and revealed positive oligoclonal bands. Subsequently, positive results for anti-LGI1 antibodies were observed in the cerebrospinal fluid. Therefore, the patient was diagnosed with anti-LGI1 encephalitis.
CONCLUSION
This case highlights the need to consider anti-LGI1 encephalitis therapy in patients with acute-onset psychiatric symptoms.
PubMed: 38868479
DOI: 10.1002/pcn5.181 -
Frontiers in Psychiatry 2024The Royal Canadian Mounted Police (RCMP) Study includes longitudinal multimodal assessments of RCMP cadets from pre-training (i.e., starting the Cadet Training Program...
OBJECTIVE
The Royal Canadian Mounted Police (RCMP) Study includes longitudinal multimodal assessments of RCMP cadets from pre-training (i.e., starting the Cadet Training Program [CTP]) to post-deployment and for five years thereafter. The data allow for investigating the multidimensionality of volitional participation in digital health data collection frameworks within serial data collection platforms and the impact of participation inequalities by classifying cadets using the 90-9-1 rule. By classifying cadets as Lurkers, Contributors, and Superusers formally described by the 90-9-1 rule, where 90% of actors do not participate, 9% seldom contribute, and 1% contribute substantially allows for the assessing of relationships between participation inequalities in self-monitoring behaviors as well as whether mental health disorder symptoms at pre-training (i.e., starting the CTP) were associated with subsequent participation.
METHODS
Participants were asked to complete a Full Assessment prior to their training at CTP, as well as short daily surveys throughout their training. Participation frequency was described using a process where participants were rank ordered by the number of daily surveys completed and classified into one of three categories. Full assessment surveys completed prior to their training at CTP included screening tools for generalized anxiety disorder (GAD), major depressive disorder (MDD), posttraumatic stress disorder (PTSD), alcohol use disorder (AUD), and panic disorder (PD). The Kruskal-Wallis H test was used to assess differences in participation rates between mental health disorder symptom screening groups for each measure at pre-training, and Spearman's Rho was used to test for associations amongst self-reported Full Assessment screening tool responses and the number of daily surveys completed during CTP.
RESULTS
There were 18557 daily survey records collected from 772 participants. The rank-ordering of cadets by the number of daily surveys completed produced three categories in line with the 90-9-1 rule: Superusers who were the top 1% of cadets (=8) and produced 6.4% of all recordings; Contributors who were the next 9% of cadets (=68) and produced 49.2% of the recordings; and Lurkers who were the next 90% of cadets (=695) and produced 44.4% of daily survey recordings. Lurkers had the largest proportion of positive screens for self-reported mental health disorders at pre-training.
CONCLUSION
The creation of highly individualized, population-based mental health injury programs has been limited by an incomplete understanding of the causal relationships between protective factors and mental health. Disproportionate rates of disengagement from persons who screen positive for mental health disorders further compounds the difficulty in understanding the relationships between training programs and mental health. The current results suggest persons with mental health challenges may be less likely to engage in some forms of proactive mental health training. The current results also provide useful information about participation, adherence, and engagement that can be used to inform evidence-based paradigm shifts in health-related data collection in occupational populations.
PubMed: 38863607
DOI: 10.3389/fpsyt.2024.1297953 -
The South African Journal of Psychiatry... 2023There are a wide range of neuropsychiatric conditions associated with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). These mental...
BACKGROUND
There are a wide range of neuropsychiatric conditions associated with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). These mental disorders may be unrecognised yet their presence can significantly affect outcome.
AIM
This study aimed to determine psychiatric comorbidity associated with HIV and AIDS.
SETTING
The HIV clinic of a tertiary hospital in North-Eastern Nigeria.
METHODS
A cross-sectional descriptive study consecutively recruiting 328 adult persons living with HIV. The Mini International Neuropsychiatric Interview and a sociodemographic questionnaire were administered to the participants.
RESULTS
Two-thirds of the respondents were females. The mean age (±s.d.) was 42 years (±11.24). Majority of the participants had World Health Organization stage 1 HIV disease. The prevalence of psychiatry comorbidity among our respondents was 82.9%. Social phobia was the leading disorder (69.8%). Others were mixed depression anxiety disorder (49.4%) and post-traumatic stress disorder (36.6%). Current psychosis was 27.7%, while major depressive disorder was 12.2%. Psychiatric comorbidity was significantly associated with male gender, religion, ethnicity, marital status and being unemployed with < 0.01. Human immunodeficiency virus stage was related to panic disorder with < 0.01, while viral load was significantly associated with depressive disorder with = 0.001.
CONCLUSION
Majority of our HIV patients attending the clinic have undetected psychiatric morbidity. Clinicians need to be aware of the features of major psychiatric disorders and refer appropriately for improved overall outcome.
CONTRIBUTION
This study contributes to the body of work on unrecognised psychiatric comorbidity in people living with HIV and AIDS, especially in North-Eastern Nigeria, identifying issues which are relevant to clinical practice and buttressing the need for integration of mental healthcare services into HIV treatment and prevention services.
PubMed: 38860146
DOI: 10.4102/sajpsychiatry.v29i0.2022 -
Frontiers in Psychology 2024Understanding and acting upon risk is notably challenging, and navigating complexity with understandings developed for stable environments may inadvertently build a...
Understanding and acting upon risk is notably challenging, and navigating complexity with understandings developed for stable environments may inadvertently build a false sense of safety. Neglecting the potential for non-linear change or "black swan" events - highly impactful but uncommon occurrences - may lead to naive optimisation under assumed stability, exposing systems to extreme risks. For instance, loss aversion is seen as a cognitive bias in stable environments, but it can be an evolutionarily advantageous heuristic when complete destruction is possible. This paper advocates for better accounting of non-linear change in decision-making by leveraging insights from complex systems and psychological sciences, which help to identify blindspots in conventional decision-making and to develop risk mitigation plans that are interpreted contextually. In particular, we propose a framework using attractor landscapes to visualize and interpret complex system dynamics. In this context, attractors are states toward which systems naturally evolve, while tipping points - critical thresholds between attractors - can lead to profound, unexpected changes impacting a system's resilience and well-being. We present four generic attractor landscape types that provide a novel lens for viewing risks and opportunities, and serve as decision-making contexts. The main practical contribution is clarifying when to emphasize particular strategies - optimisation, risk mitigation, exploration, or stabilization - within this framework. Context-appropriate decision making should enhance system resilience and mitigate extreme risks.
PubMed: 38860037
DOI: 10.3389/fpsyg.2024.1346542 -
Journal of Clinical Medicine Research May 2024Attrition is an important problem in clinical practice and research. However, the predictors of dropping out from cognitive behavioral therapy (CBT) for panic disorder...
BACKGROUND
Attrition is an important problem in clinical practice and research. However, the predictors of dropping out from cognitive behavioral therapy (CBT) for panic disorder (PD) are not fully understood. In this study, we aimed to build a dropout prediction model for CBT for PD using machine learning (ML) algorithms.
METHODS
We treated 208 patients with PD applying group CBT. From baseline data, the prediction analysis was carried out using two ML algorithms, random forest and light gradient boosting machine. The baseline data included five personality dimensions in NEO Five Factor Index, depression subscale of Symptom Checklist-90 Revised, age, sex, and Panic Disorder Severity Scale.
RESULTS
Random forest identified dropout during CBT for PD showing that the accuracy of prediction was 88%. Light gradient boosting machine showed that the accuracy was 85%.
CONCLUSIONS
The ML algorithms could detect dropout after CBT for PD with relatively high accuracy. For the purpose of clinical decision-making, we could use this ML method. This study was conducted as a naturalistic study in a routine clinical setting. Therefore, our results in ML approach could be generalized to regular clinical settings.
PubMed: 38855785
DOI: 10.14740/jocmr5167 -
Neuropsychiatric Disease and Treatment 2024Despite the high prevalence of anxiety disorders in BD and its known impact on cognitive performance, the presence and severity of anxious symptoms is not systematically...
PURPOSE
Despite the high prevalence of anxiety disorders in BD and its known impact on cognitive performance, the presence and severity of anxious symptoms is not systematically evaluated in studies on cognition in BD. Our aim was to determine if attention and/or inhibition of cognitive interference in euthymic patients with type I Bipolar Disorder (BD-I) is affected by symptoms of anxiety.
PATIENTS AND METHODS
Eighty-seven euthymic BD-I patients were included. Patients with comorbidities other than Generalized Anxiety Disorder (GAD) or Panic Disorder (PD) were excluded. State anxiety was measured with the Brief Inventory of Anxious Responses and Situations (ISRA-B). Subjective cognitive performance was evaluated with the COBRA scale, attention with the Digit-Span Forward task and inhibition of cognitive interference was assessed with the StroopTest interference score. Multiple linear regression models were used to test if anxious symptoms were associated with attention or inhibition of cognitive interference, considering other known contributors for cognitive impairment.
RESULTS
Attention was unaffected by anxiety symptoms, but the overall regression for inhibition of cognitive interference was significant: years of schooling (β=1.12, p = 0.001), cognitive complaints (β=0.44, p = 0.008), and anxiety (β=-0.21, p = 0.017) explained 15% of the interference score of the Stroop test (R2 = 0.15).
CONCLUSION
Beyond residual affective symptoms, anxious symptoms seem to affect inhibition of cognitive interference. We recommend routine testing of anxiety when considering cognitive evaluations, especially when screening for cognitive deficits.
PubMed: 38855382
DOI: 10.2147/NDT.S457186 -
Cureus May 2024This case report delves into the rare occurrence of hyperventilation syndrome (HVS) with hypocalcemia in an 18-year-old female diagnosed with autism spectrum disorder...
This case report delves into the rare occurrence of hyperventilation syndrome (HVS) with hypocalcemia in an 18-year-old female diagnosed with autism spectrum disorder (ASD). The rare occurrence highlights the importance of recognizing the potential association between HVS, hypocalcemia, and ASD, emphasizing the need for comprehensive evaluation and management strategies in individuals with ASD presenting with unusual symptoms. Despite ongoing psychotherapeutic treatment, the patient's clinical examination revealed ASD-related communication anomalies. Treatment with Escitalopram resolved panic attacks but left residual anxiety. During an emergency room visit for menstrual-related abdominal pain, a hyperventilation crisis ensued, leading to respiratory alkalosis and hypocalcemia. Swift intervention, including closed mask ventilation and electrolyte infusion, successfully alleviated symptoms. Follow-up assessments indicated normal thyroid function and vitamin D levels. The case highlights the necessity for clinicians to consider electrolyte imbalances in anxiety attacks among ASD patients, emphasizing the importance of timely management for patient safety. The intricate interplay between hyperventilation syndrome, anxiety, and hypocalcemia in ASD patients is explored, offering valuable insights for the nuanced understanding and comprehensive assessment of such cases.
PubMed: 38832161
DOI: 10.7759/cureus.59639 -
Journal of Family Medicine and Primary... Apr 2024Medical undergraduates, being away from their institutes due to the lockdown, are at a greater risk of being affected by the negative news, which may easily instill fear...
CONTEXT
Medical undergraduates, being away from their institutes due to the lockdown, are at a greater risk of being affected by the negative news, which may easily instill fear and panic among them. Therefore, the present study was planned with the objective to study the effects of media exposure on the psychological health of undergraduate medical students at a tertiary health institute.
AIM
To assess the psychological effects of social media/media use and coping mechanisms adopted during the COVID-19 pandemic.
SETTINGS AND DESIGN
Tertiary care teaching Institute and Cross-sectional study.
MATERIAL AND METHODS
It is a cross-sectional observational study performed among (under graduate) UG students, which was assessed using a pre-tested questionnaire including the pre-validated DASS-21 scale.
STATISTICAL ANALYSIS
Data collected was entered in MS Excel. Descriptive statistics and correlation of the study variables were analyzed while controlling for demographics using Epi-info software version 7.2.2.
RESULTS
It was observed that around one-fifth of the participants have moderate depression, followed by mild 10.97%; one-fifth of the participants have moderate levels of anxiety 20.41% followed by extremely severe anxiety 13.27% and about two-thirds of the study participants having no stress 64.29% followed by mild stress 14.80% and moderate stress 9.69%.
CONCLUSION
There was a significant psychological impact of the use of social media among young populations, particularly anxiety, stress, and depression with exposure to negative news and reports on social media platforms.
PubMed: 38827727
DOI: 10.4103/jfmpc.jfmpc_1355_23