To characterize associations between exposures within and outside the medical workplace with healthcare personnel (HCP) SARS-CoV-2 infection, including the effect of various forms of respiratory protection.

Case–control study.

We collected data from international participants via an online survey.

In total, 1,130 HCP (244 cases with laboratory-confirmed COVID-19, and 886 controls healthy throughout the pandemic) from 67 countries not meeting prespecified exclusion (ie, healthy but not working, missing workplace exposure data, COVID symptoms without lab confirmation) were included in this study.

Respondents were queried regarding workplace exposures, respiratory protection, and extra-occupational activities. Odds ratios for HCP infection were calculated using multivariable logistic regression and sensitivity analyses controlling for confounders and known biases.

HCP infection was associated with non–aerosol-generating contact with COVID-19 patients (adjusted OR, 1.4; 95% CI, 1.04–1.9; P = .03) and extra-occupational exposures including gatherings of ≥10 people, patronizing restaurants or bars, and public transportation (adjusted OR range, 3.1–16.2). Respirator use during aerosol-generating procedures (AGPs) was associated with lower odds of HCP infection (adjusted OR, 0.4; 95% CI, 0.2–0.8, P = .005), as was exposure to intensive care and dedicated COVID units, negative pressure rooms, and personal protective equipment (PPE) observers (adjusted OR range, 0.4–0.7).

COVID-19 transmission to HCP was associated with medical exposures currently considered lower-risk and multiple extra-occupational exposures, and exposures associated with proper use of appropriate PPE were protective. Closer scrutiny of infection control measures surrounding healthcare activities and medical settings considered lower risk, and continued awareness of the risks of public congregation, may reduce the incidence of HCP infection.

The Personal and Social Performance (PSP) scale is a reliable and valid instrument that utilizes objective parameters for assessment of social functioning in patients with schizophrenia. The aim of this study was to determine the validity and reliability of the French version of PSP in a population of French schizophrenic patients.

Patients with DSM-IV diagnoses of schizophrenia and schizoaffective disorder were recruited and assessed in a cross-sectional design using the PSP, GAF, SOFS, PANSS, CGI severity. Internal consistency for the PSP was obtained and convergent validity was assessed using correlations between PSP, GAF and PANSS factors. Inter-rater reliability was evaluated with intra class correlation coefficient (ICC).

147 in and out patients, at 5 French sites participated in this study. The Cronbach's alpha coefficient of the PSP was good (alpha=0.77). The PSP showed very good inter rater reliability (ICC = 0.90). Pearson correlation coefficient for association between PSP and GAF (r=0.85) and PSP and SOFS (r=- 0.78).are high proving good convergent validity for PSP. Pearson correlation coefficients are moderate when PSP is correlated with 4 of the five PANSS sub factors (r from -0.43 to -0.48). The anxious and depression factor (r=-0.17) showed low correlation with PSP. Spearman Rank correlation coefficient between PSP and CGI severity was r=-0.72.

Our results demonstrate that the PSP scale is a reliable and valid instrument for assessing social functioning of patients with schizophrenia during the course of treatment as well as in acute state.

Hallucinations are extremely distressing erroneous percepts accompanied by a powerful sense of reality. In schizophrenia, hallucinations were functionally explored in the verbal domain even if they may emerge outside the range of auditory. In the present study, we used advanced-Independent Component Analysis for fMRI-data-sets (ICA) to explore complex hallucinations and define potential rTMS targets beyond the conventional temporo-parietal junction.

16 adolescents with early-onset schizophrenia and suffering from refractory complex hallucinations were included. They all benefited from a 30-min. rest fMRI examination after which they were accurately interviewed about their psycho-sensory experiences during scanning. Using cortex-based ICA, BOLD signals related to the hallucinatory experience were extracted at the subject level and then submitted to a self-organizing-group ICA procedure to extract clusters at the group-level on the basis of a pure similarity matrix.

This method highlighted auditory, visual and multisensory hyper-active clusters after decomposition by random-effect sog-ICA (ǀZǀ=2.2; p< 0.01). The increased BOLD-signal measured in association sensory areas during hallucinations was concomitant of the de-engagement of the “resting-state” network in hallucinating subjects.

Data-driven analysis methods for rest-fMRI-data allowed evidencing the neural correlates of complex hallucinations in adolescents with schizophrenia. Despite inter-individual variability, sog-ICA clearly demonstrates that the hallucinatory experience emerges from increased activity within modality-dependent associative sensory cortices and can be fused in cross-modal areas. These brain regions constitute good candidates to guide dimensional treatment of hallucinations like rTMS.

Metabolic syndrome - a significant risk factor for cardiovascular morbidity and mortality - is twice as prevalent among psychiatric patients (21-63%) as general populations (20-24%). Although there is an inherent illness-associated metabolic risk, medications do contribute. Atypicals vary in metabolic risk from high (clozapine, olanzapine), moderate (risperidone, quetiapine) to low (aripiprazole, ziprasidone) (ADA, 2004). Few studies have comprehensively measured cardiovascular risk or directly compared antipsychotics. Limited controlled data show that antipsychotic-induced metabolic abnormalities may be reversible, rationalizing the switch to a lower-risk agent (DeNayer, 2004). Non-HDL-cholesterol encompasses all atherogenic cholesterols and provides a marker of CV risk: an increase of 29ng/dL in diabetics is associated with 50% increased risk (Jiang, 2004). Non-HDL-cholesterol is independently associated with increased risk of non-fatal myocardial infarction and angina.

This study will provide cross-European data from 13 countries on MS rates in schizophrenia and will assess antipsychotic metabolic profiles and benefits of antipsychotic switching.

In this ongoing, 16-week, open-label, European multicentre study, 258 schizophrenia patients treated for ≥3 months with olanzapine, risperidone or quetiapine and who have MS will be randomized to switch to aripiprazole (Week 1: 5mg/day; Week 2: 10mg/day; flexible 10-30mg/day after Week 2) or continue with previous antipsychotic. the primary objective is to demonstrate superiority of aripiprazole versus atypicals on mean percentage change of fasting non-HDL-cholesterol from baseline to Week 16.

This study will provide the first direct and comprehensive comparison of metabolic risk with various atypicals in Europe and should impact the future management of schizophrenia.

Partial or non-adherence to medication is high amongst patients with schizophrenia. Rates of non-adherence of up to 72% have being reported depending on the method used and the patient population. Adherence is essential for optimal long-term patient outcomes in schizophrenia and failure to adhere to medication can have a major impact on the course of illness and treatment outcomes.

The objective of the EMEA (Europe, Middle east and Africa) ADHES survey was to collect psychiatrist's perceptions of the assessment, reasons and management of partial and non-adherence to medication.

The aim of this poster is to present psychiatrist's perceptions collected in the EMEA ADHES survey.

The survey was devised to ascertain psychiatrists’ preferred methods of assessing adherence, their perceptions of the level of adherence, reasons for non-adherence and on strategies to improve adherence.

Psychiatrists estimated that during the previous month more than half of their patients (53%) were partially or non-adherent. They estimated that as few as a third of patients who deteriorated after stopping medication was able to attribute this to their non-adherence. 76% of psychiatrists assessed adherence most frequently by asking their patient explicitly. Use of long-acting treatment was the preferred choice to address adherence problems for 62% of respondents.

This EMEA-wide survey illustrates that while respondents recognised the relevance and importance of partial and non-adherence to medication, there remains a need for more proactive management of treatment adherence of patients with schizophrenia to reduce the frequency and consequences of relapse.

The effect of minor orthopaedic day surgery (MiODS) on patient's mood.

A prospective population-based cohort study of 148 consecutive patients with age above 18 and less than 65, an American Society of Anaesthesiology (ASA) score of 1, and the requirement of General Anaesthesia (GA) were included. The Medical Outcomes Study-Short Form 36 (SF-36), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were used pre- and postoperatively.

The mean physical component score of SF-36 before surgery was 45.3 (SD = ±10.1) and 8 weeks following surgery was 44.9 (SD = ±11.04) [n = 148, p = 0.51, 95%CI = (-1.03 -1.52)]. For the measurement of the changes in mood using BDI, BAI and SF-36, latent construct modelling was employed to increase validity. The covariance between mood pre- and post-operatively (cov = 69.44) corresponded to a correlation coefficient, r = 0.88 indicating that patients suffering a greater number of mood symptoms before surgery continue to have a greater number of symptoms following surgery. When the latent mood constructs were permitted to have different means the model fitted well with χ2 (df = 1) = 0.86 for which p = 0.77, thus the null hypothesis that MiODS has no effect on patient mood was rejected.

MiODS affects patient mood which deteriorates at 8 weeks post-operatively regardless of the pre-operative patient mood state. More importantly patients suffering a greater number of mood symptoms before MiODS continue to have a greater number of symptoms following surgery.

To assess weight gain in adolescents treated with antipsychotic drugs for early onset schizophrenia (EOS).

One-year follow-up of 13 consecutive adolescents (10 male, 3 females, age range: 11-16) treated with atypical antipsychotics for early onset schizophrenia (according to DSM-IV criterias). The main outcome measure is sex- and age-adjusted Z scores of Body Mass Index (BMI).

BMI, sex- and age-adjusted BMI percentiles and BMI Z scores are significantly increased in schizophrenic adolescents after prescription of atypical antipsychotics (p= 0.025).

Despite the limited number of children included, this pilot study confirms a significant link between prescription of risperidone in early onset schizophrenia and increase of adjusted BMIZ scores. Clinicians and caregivers are to be aware of potential metabolic adverse effects of these medications. These findings suggest a regular health monitoring in adolescents treated with atypical antipsychotics, before and along the prescription.

Partial or non-adherence to medication is high amongst patients with schizophrenia. Many and often overlapping factors are considered to impact on treatment adherence, including: patient-related (lack of insight, psychotic, negative or cognitive symptoms), treatment-related (adverse effects, insufficient efficacy), environmental (living situation, negative attitudes of relatives/friends), and physician-related (patient-healthcare professionals relationship) factors.

The objective of the ADHES EMEA (Europe, Middle East and Africa) survey was to collect psychiatrist's perceptions of the assessment, reasons and management of partial and non-adherence to medication.

To present psychiatrist's opinion through EMEA of potential reasons for partial or non-adherence

The ADHES survey comprised 20 questions and was conducted in 36 countries across EMEA (over 4500 psychiatrists treating patients with schizophrenia).

Across EMEA 37% of psychiatrists viewed lack of insight as the most important reason for their patients stopping medication. 23% of psychiatrists viewed patient's feeling better and thinking it unnecessary to take medication as the most important reason for their patients stopping medication. 7% or less of psychiatrists viewed undesirable side effects, insufficient efficacy, cognitive impairment or drug/alcohol abuse as the most important reasons for their patients stopping medication.

In this survey, psychiatrists estimated that patient’s lack of insight and subjective improvement could constitute the main factors explaining poor adherence. Other factors (i.e., side effects, substance abuse) were regarded as less important. Strategies aimed at raising awareness of maintaining treatment, are warranted within EMEA, with the aim of improving clinical outcomes.

Rates of non-adherence of up to 72% have being reported, in schizophrenia, depending on the method used and the patient population. Rates of approximately 59% over 1 year have been reported for individuals with a first episode. Patients who stop medication are almost five times more likely to experience relapse than adherent patients. Failure to adhere to medication can have a major impact on the course of illness and treatment outcomes.

The EMEA (Europe, Middle East and Africa) ADHES schizophrenia survey was a survey of psychiatrists across the region, treating patients with schizophrenia, designed to canvas their perceptions of assessment, potential reasons and management for partial or non-adherence to medication amongst their patients.

To present methodology and demographics of the EMEA ADHES survey in schizophrenia.

The EMEA ADHES survey comprised 20 questions and was conducted in 36 countries across EMEA. In addition to recording the gender, age and practice setting of the respondents, questions related directly to the issue of partial-/non-adherence in patients with schizophrenia.

The survey was conducted amongst psychiatrists (including neurologists with psychiatric background in Germany) from January - March 2010. Results were obtained from 4722 respondents. Psychiatrists perceived that during the previous month more than half of their patients (53%) were partially or non-adherent across all EMEA regions

The EMEA ADHES schizophrenia survey is a large and geographically broad survey providing insight on psychiatrists’ perceptions of the assessment, causes and management of partial and non-adherence to medication.

La dopamine a un rôle important dans la physiopathologie de la schizophrénie. L’hypothèse d’une « attribution aberrante de saillance » dans la schizophrénie pourrait expliquer les symptômes positifs et négatifs de la schizophrénie [1]. Les processus de récompense composent la saillance motivationnelle, dans laquelle la dopamine est impliquée [2]. Ce travail a pour objectif de faire une méta-analyse des études d’activation cérébrale en IRM fonctionnelles, comparant les patients schizophrènes aux sujets sains lors des tâches de récompense.

Nous avons réalisé une recherche Pubmed, utilisant les mots clés : “schizophren* OR psychosis,” “fMRI OR PET,” “salienc* OR reward”. Au total, 171 études ont été sélectionnées, dont 12 comparant spécifiquement les patients schizophrènes et témoins durant les tâches de récompense. Elles comprenaient 480 sujets et 82 foci d’activation pour l’anticipation de récompense (30 foci), la réception de la récompense (14 foci) et l’erreur de prédiction (38 foci). La méthode utilisée est une estimation de la probabilité d’activation, réalisée à l’aide d’un algorithme implémenté sur le logiciel GingerALE Version 2.3.3 [3]. Nous avons utilisé un algorithme d’inférence par Cluster (p = 0,05) avec un p non corrigé pour le seuil de formation du cluster de 0,001.

Les patients schizophrènes montraient par rapport aux patients témoins un défaut d’activation dans l’aire tegmentale ventrale, le striatum ventral bilatéral, l’hippocampe, et le cortex cingulaire antérieur, lors de l’anticipation, la réception de récompense, et lors de l’erreur de prédiction.

Les patients schizophrènes montrent par rapport aux patients témoins un défaut d’activation dans les régions méso-limbiques impliquées dans les processus de récompense [4]. Cependant, le nombre de patient, notamment pour le contraste « réception de récompense » est encore faible.

Partial/non-adherence to medication is common amongst patients with schizophrenia. Nurses play an important role in assessing and managing mental health problems and are often involved in helping patients manage and adhere to their medication. As such, the perception of nurses regarding the burden and potential causes of non-adherence is vital in addressing the adherence problem.

The ADHES nurses survey collected opinions of nurses across the EMEA (Europe, Middle East and Africa) region.

To ascertain nurses' perceptions of assessment, potential causes and management of partial/non-adherence to medication in patients with schizophrenia.

The survey was conducted from January-March 2010 in 29 countries across EMEA, comprising 14 questions addressing the issue of partial/non-adherence and the use of long-acting injectable (LAI) antipsychotic medication in patients with schizophrenia.

Results were obtained from 4120 respondents. Nurses estimated high levels of partial/non-adherence (mean 54%) amongst patients with schizophrenia and 85% believed improving medication adherence would have a huge/sizable impact on patient outcomes. 93% believed that continuous medication with an LAI would have long-term benefits for patients with schizophrenia, and that many patients (mean 40%) would prefer LAI medication.

Nurses recognize the issue of partial/non-adherence to medication in patients with schizophrenia. Most nurses believe patients are well informed about LAI antipsychotics, however, approximately a third of nurses believe patients to be poorly informed. There is a need to address the problem of partial/non-adherence in clinical practice with a multidisciplinary approach to avoid suboptimal treatment outcomes in patients with schizophrenia.