Behçet’s disease, a rare autoimmune disorder, can present a challenging diagnostic puzzle, particularly when neuropsychiatric symptoms take the forefront. In this case study, we delve into the diagnostic process of a 43-year-old patient without prior psychiatric history, who initially presented with depressive and catatonic symptoms. The trajectory from psychiatric admission to a final diagnosis of Behçet’s disease with neuropsychiatric involvement underscores the importance of interdisciplinary collaboration and the consideration of rare diseases in psychiatric assessment. Clinical remission was achieved with immunosuppressive therapy.

Presentation of a clinical case of Behçet’s disease with neuropsychiatric manifestations.

Review of the patient’s clinical data in SOARIAN platform and research on UptoDate and Pubmed using the terms “Catatonia,” “Behçet disease,” “Neuro-Behçet,” and “Psychiatry.”

We present a clinical case of a 43-year-old patient, originally from India, not fluent in Portuguese or English, with no prior psychiatric history, who presented to the emergency department exhibiting mutism and was admitted to the psychiatry department with the diagnostic hypothesis of depressive episode with psychotic and catatonic symptoms. During hospitalization, severe vitamin deficiencies, gastrointestinal symptoms (vomiting, abdominal pain, and hematochezia), and gynecological symptoms (dyspareunia and vaginal discharge) were observed. From a psychiatric perspective, in addition to depressive and psychotic symptoms, atypical symptomatology incongruent with the initial diagnosis was identified, raising suspicion of an “organic” disease. There was an atypical fluctuation in symptoms, with periods of severe behavioral disorganization interspersed with periods of apathy and psychomotor retardation, significant alterations in attention and memory, and executive deficits. Additionally, there was a poor response to psychiatric medication and electroconvulsive therapy. A colonoscopy revealed ulcers at the ileocecal valve, and gynecological lesions suggestive of a vasculitic process were observed. Autoimmunity testing showed positivity for HLA B51/52. Given the neuropsychiatric, gastrointestinal, and gynecological manifestations, along with suggestive autoimmunity, the diagnosis of Behçet’s Disease with neurological involvement was established. Clinical remission was achieved only with immunosuppressive therapy. The case is enriched by the complex diagnostic journey, multiple complications encountered (including valproic acid-induced encephalopathy), and the challenges faced in treating neuropsychiatric manifestations.

This clinical case exemplifies the challenges in diagnosing a systemic disease with primary psychiatric presentation, as well as the therapeutic success resulting from multidisciplinary collaboration in a public hospital.

None Declared

People who are forced to leave home often experience emotional suffering and may be disproportionately subjected to risk factors for suicide. Although it is a grave concern for the global public health community, it has not been understood in Ethiopia.

This study aims to assess the prevalence and factors associated with suicidal ideation and attempts among war-affected internally displaced people in northwest Ethiopia, 2022.

From 23 May to 22 June 2022, a cross-sectional study design was conducted, and a sample of 765 participants was selected through simple random sampling. A structured interview was employed to collect data. Suicidal ideation and attempts were assessed using the Composite International Diagnostic Interview.

Out of 751 interviewed participants with a response rate of 98.2%, the magnitude of suicidal ideation and attempt was 22.4% (95% CI: 19.5%, 25.4%) and 6.7% (95% CI: 5.1%, 8.7%), respectively. People of female gender, having depression, family with a history of mental illness, and poor social support were significantly associated with both suicidal ideation and attempts. Furthermore, post-traumatic stress symptoms and the death of a family member were significantly associated with suicide ideation and attempt, respectively.

At least one in five of the displaced people in this population had experienced suicide ideation, and one in fifteen had attempted suicide. Therefore, strengthening early detection and intervention for individuals is recommended, especially for females with depression, post-traumatic stress symptoms, family with a history of mental illness, poor social support and the death of family members.

Missing data is a challenge that most researchers encounter. It is a concern that continues to be analyzed and addressed for solutions. Missing data occurs when there is no data stored for certain variables relating to participants. In health surveys, when participants answer in the form of “I don't know” or “I'd prefer not to answer”, these responses can, in many cases, be categorized as missing data responses from a participant in a specific category or question.

The eight-item Patient Health Questionnaire (PHQ-8) is an essential tool in healthcare and clinical settings to assess an individual's mental health, specifically related to symptoms of depression. The items are scored on a scale from 0 to 3 with the total score obtained by summing the scores for each item. Higher PHQ-8 scores indicate the presence of depressive symptoms.

We used empirical data from a previous study on depression symptoms in patients with coronary heart disease to study the effect of considering the answers “I do not know” and “I prefer not to answer” as missing values when estimating the percentage of depression using PHQ-8. Moreover, we studied the effect of the complete case analysis and multiple imputation on parameter estimates and confidence intervals. The outcome of this study aims to shed light on the development of missing data procedural knowledge and provide methodological support for public health decision-making when data with missing values are collected.

Furthermore, this study aims to prevent the exclusion of missing data rather than to generate data.

A simulation study with 1000 replicates was performed. Four common statistical machine learning methods for handling missing values were included in this study. These are K-Nearest Neighbor (KNN), K-Means, Classification and Regression Trees (CART), and Random Forest (RF) imputations. Five clusters were used for KNN and K-mean. Likewise, five multiple imputations were used for the CART and RF methods. The simulation was based on publicly available data with available PHQ-8 data for 1096 subjects. In the simulation study and for each replication, multivariate missing values were generated using the missing-at-random (MAR) assumption with 10%, 20%, 30%, 40%, and 50% proportions of missingness. The percent of depression was calculated using the PHQ-8 questionnaire and a comparison was made between estimated actual depression, complete-case analysis, KNN, Kmean, RF, and CART, respectively.

The Median age of the subjects was 69 (interquartile range: 61–67) and more males (72.9%) than females were included in the data. The estimated actual depression was 16.8, whereas the estimated percentage of depression varies between 6.9–13.5, 16.2–16.7, 16.3–16.7, 16.6–16.7 and 16.7–16.8 for the complete case, KNN, Kmean, RF and CART respectively.

The results of this simulation study show that missing PHQ-8 data are best handled by applying multiple imputations based on CART or RF. However, using K-Means or KNN leads to a good estimate of the true percentage of depression. Furthermore, the results of this simulation study show that complete-case analysis leads to biased estimates of the true percentage of depression. Nevertheless, further investigation is needed to address the problem of missing PHQ-8 data under the assumption of missing not at random.

The evidence for the association between vitamin-D deficiency and depression, although equivocal, has been established in several populations in different countries and supported by meta-analytical studies1. Much of the evidence for this comes from Western countries2. Similarly, the evidence for the benefits of supplementation, although shown, also comes from similar populations and is equivocal3. Need for data from different populations and for randomized controlled trials to establish causality is stressed by most researchers. This study aims for presentation reviews of the association between vitamin-D and depression in the GCC, using the publicly available data of Our World in Data.

The statistical analysis used median prevalence depressive disorders data (from 1990–2019) in the GCC countries (both sex and age-standardized (%)), which was downloaded from Our World in Data and was last updated on August 28, 2022. Vitamin D deficiency data were collected through a literature review search using PubMed and Google Scholar. A linear regression model was performed with the median prevalence of depressive disorders data as an outcome. The prevalence of vitamin-D deficiency, population median age and the interaction term between prevalence of vitamin-D deficiency and population median age were used as predictors. The effects of prevalence of depressive disorders both sex age standardized (AS) percentage (%) were estimated with 95% confidence interval (95% CI) using bootstrap covariance matrix estimator. Fitted model's likelihood ratio chi-square (LR χ2) test with corresponding p-value was computed and reported.

A positive association was observed between the median prevalence of depressive disorders and the prevalence of vitamin-D deficiency, adjusted for population median age, were observed (LR χ2 p-value = 0.005) and adjusted R2 = 0.706.

Prevalence of depressive disorders was associated with prevalence of vitamin D deficiency among the population of GCC countries. Future randomized control trials on Vitamin D supplementation are needed to confirm these observations.

In most populations, the prevalence of depression is more significant in women than in men. Nonetheless, the degree of gender disparity varies significantly across countries. The aim of this study is to consider the role of gender inequality in explaining these differences in the Gulf Cooperation Council (GCC) countries.

Data on the ecological prevalence of depression (males versus females) from 1990–2019 from the GCC countries were downloaded from Our World in Data and included in the statistical analysis. A mixed-effects linear model was used to examine the association between males and females, i.e. females regress on males. Year and country variables were used as random effect variables.

The prevalence of depression in the GCC countries shows a gender-specific pattern with a higher prevalence in females than in males 1.218 (95% CI: 1.149–1.285), p-value < 0.001. Higher levels of depression between men and women were observed in Kuwait and Saudi Arabia compared with the other four countries. The lowest depression prevalence was observed in the United Arab Emirates.

The pattern of depression in the GCC countries is based on gender. However, the association between global measures of gender inequality and the gender gap in depression may depend on how the level of depression is measured. More research is needed to investigate the mechanisms that underlie the gendered nature of depression prevalence.

To identify if COVID-19 has changed the experience for patients under the care of Crisis Resolution Home Treatment teams (HTT).

To identify if COVID-19 altered the response for HTT patients in the context of Personality Disorder (PD).

To provide useful demographic and experiential information about patients using HTT with PD during crisis.

Data regarding the demographics of patients with personality disorders under the care of the Croydon crisis home treatment team were collected retrospectively for two, predetermined time windows. The first window was pre-COVID-19 (26/03/2019–25/03/2020) and the second window was during COVID-19 (26/03/2020–25/03/2021). The demographics of patients with personality disorder referred to the team during these two time periods included were compared.

More patients with personality disorder were referred to the Croydon HTT during COVID-19 (n = 82) when compared with the window before (n = 58). The proportion of referred patients with Emotionally Unstable Personality Disorder (EUPD) was constant before and during COVID-19. The average length of stay reduced from 22.6 days before COVID-19 to 18.7 days during COVID-19. The proportion of rejected referrals to the HTT of patients with personality disorder increased during COVID-19. Finally, the proportion of BAME (Black, Asian, Minority Ethnicity) referrals of patients with personality disorder increased during COVID when compared with before, with this finding not being replicated in any other ethnic group.

Increased numbers of referrals may indicate worsening mental health in the community. This may have been compounded by an inability of community mental health teams and inpatient services to meet such an increase in demand for services. An overall reduction in inpatient admissions during COVID-19 supports this idea. There was a relatively larger drop in duration of admission for patient with personality disorder during COVID-19, when compared with all patients. This may be due to staff feeling unable to offer quick management for patients with personality disorder. Subsequently, staff may have selectively discharged such patients earlier. The rate of rejected referrals to the Croydon HTT was consistently higher than the acceptances both pre- and post- COVID-19. Therefore, HTT clinicians may feel unable to adequately treat PD.

In conclusion, the number of referrals to the HTT increased during COVID-19, however, with a reduced average duration of stay with HTT for patients. The rejection rates for personality disorder patients were consistently higher than for other patient groups, both before and during COVID-19. Additionally, the proportion of patients with personality disorder from BAME backgrounds increased during COVID-19.

Depression disorder is a major public health problem and a serious medical illness which negatively affects people's daily life. The WHO's International Classification of Diseases (ICD–10) defines this set of disorders ranging from mild to moderate to severe. Estimated annual percentage change (EAPC) is a useful statistic that is used to measure trends in rates over time-period.

The aim of this study was to compute the drift in depression prevalence disorder using the EAPC of the prevalence of depression disorder between 1990 to 2019 with corresponding 95% confidence intervals (95% CI) across the GCC countries.

Prevalence of depression disorder data for the GCC countries were downloaded from “Our World in Data” https://ourworldindata.org/mental-health#depression. We computed the drift of depression over 30 years between the 6 GCC countries using the statistical software R.

The greatest decrease was seen for Bahrain which is (–5.2%) followed by Qatar (–3.2%) and United Arab Emirates (–3%). However, the largest increase was observed for Saudi Arabia (2.7%), followed by Kuwait (1.1%) and Oman (0.7%). The reduction in the prevalence of depression disorder seen in Bahrain, Qatar and United Arab Emirates shows a significant achievement in mental health diagnosis, prevention, and treatment.

However, further studies are required to better understand the drifts in the GCC countries. Furthermore, governmental funding for academic and research mental health programs is highly recommended.

Although the losses associated with aging activate additional psychological resilience resources, dependency settings, which often require admission to Residential Care Facilities (RCF's), need adequate care so that the person can maintain his/her dignity and quality of life. The activation of mechanisms for regulating losses and the preservation of the identity and autonomy of the person respecting his/her decision-making capacity are central for the preservation of the well-being of people with dependence. Portuguese RCF's are mainly based on care models that are opposed to the models of attention centered on the person, which value the person's potential and decision-making capacity. The COVID-19 pandemic has tested RCF's, highlighting their weaknesses and limitations.

This study aimed to identify ways to improve the provision of care in RCF's during the pandemic.

This is a qualitative study, with data collection through an online questionnaire. Participants were invited to indicate strategies to improve the provision of care to elderly residents in RCF's. The study included 198 RCF ́s workers during the COVID-19 pandemic. Content analysis of the collected data was performed.

Preliminary results on the ongoing study: The results indicate that the strategies that RCF´s workers consider most necessary are at the level of human resources, also highlighting the need for greater proximity, affection and attention to residents, the personalization of care and the valorization of the resident person and his/her opinions. These are considered by the participants as central strategies for the quality of care and satisfaction of RCF ́s workers.

The needs identified are in line with the guiding principles of Person-Centered Care. The use of reminiscence as a strategy for valuing the person and his/her identity, as well as the promotion of self-determination, evaluating and allowing the person to make decisions may be central to meeting the needs identified at the level of care. The necessary transition from RCF's in Portugal to paradigms of centered care is thus reinforced by the results of this study.

Treatment of childhood central nervous system (CNS) tumors can lead to sensorineural hearing loss (SNHL), with prior research indicating associations between SNHL and cognitive difficulties. Infants (0-3 years) treated for CNS tumors are at particular risk for neurocognitive deficits due to increased vulnerability of the developing brain and missed developmental opportunities secondary to prolonged treatment. This study expands upon existing research by examining the association between treatment-related SNHL and later neurocognitive outcomes among infants.

Serial audiology and neurocognitive assessments were conducted as part of a prospective, multisite, longitudinal trial (SJYC07). Children with newly diagnosed CNS tumors were treated with chemotherapy, with or without focal proton or photon radiation therapy (RT). SNHL was dichotomized based on hearing in the better ear as present versus not present (Chang grade ≥1a vs. <1a). Neurocognitive assessments included intellectual functioning (IQ), and parent ratings of executive functioning and behavioral functioning. Demographic and clinical variables investigated included: sex, age at diagnosis (years), treatment type (chemotherapy only vs. chemotherapy + RT), risk group (low vs. intermediate vs. high), and socioeconomic status (SES, continuous). Logistic regression models were used to identify factors associated with SNHL. Change point longitudinal models were used to examine the effect of each covariate individually and the potential impact of SNHL on trajectories of neurocognitive outcomes.

Of 135 patients (median age at diagnosis= 1.5 years), 67% had mild-to-severe SNHL as defined by Chang grade ≥1a at last follow-up. SNHL occurred early after treatment with a 1-year cumulative incidence 63.0% ±4.3%. SNHL was associated with age at diagnosis (p <.001) but not sex, treatment exposure or study risk arm (p >.10). At pretreatment baseline, IQ was associated with age at diagnosis (older age= higher IQ) and SES (higher SES= higher IQ) with a change in the trajectory of IQ after SNHL (stable prior to SNHL and declined 1.46 points/year after SNHL), which was impacted by tumor location (patients with supratentorial tumors stable prior to SNHL and declined 2.84 points/year after SNHL; whereas, patients with infratentorial tumors increased 1.93 points/year prior to SNHL and were stable after SNHL). At pre-treatment baseline, adaptive functioning was associated with age at diagnosis (older age= higher skills) with a change in adaptive functioning after SNHL that varied by age. There was a change in trajectory of attention problems (stable before SNHL and worsening 1.39 points/year after SNHL). SNHL was not associated with parent report of emerging executive functioning.

Children with brain tumors experience SNHL and cognitive difficulties early in treatment that can worsen over time. Younger age at diagnosis is associated with greater risk for SNHL and cognitive difficulties. Analyses of the time course between the emergence of SNHL and cognitive late effects suggests even mild SNHL is associated with a clinically signficant decline in IQ and attention problems. These findings have notable implications with respect to refining monitoring guidelines, informing modifications to treatment, advocating for interventions, and helping educate parents, teachers, and providers about the significant impact of mild SNHL.