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Coronavirus pandemic (COVID-19) has caused a great psychological impact all over the world. With this research, we want to discover the incidence and associated risk factors for depressive symptoms among hospitalized patients. The objective is to investigate patients with criteria of a severe clinical picture and expressed systemic inflammatory response to SARS-CoV-2 coronavirus infection and if they develop mental disorders- depression, measured by Depression, anxiety and stress scale- DASS-21 scale. With this research, we also calculate the index of the immune-inflammatory response SII and test the hypothesis that people with higher SII will develop mental disorders more often. Demographic variables, comorbidities, COVID-19 severity criteria, and the intensity of the organism’s inflammatory response have also been examined. Psychiatric questionnaires were for the first time applied directly to patients with coronavirus infection during hospitalization.
To identify possible risk factors for depression and to investigate the association between disease severity and the occurrence of psychopathology among COVID-19 hospitalized patients.
The subjects are patients suffering from COVID-19, older than 18 years who were hospitalized in the respiratory center KB Dubrava. After an interview and informed consent, demographic data was taken and two psychological questionnaires had been applied. Variables: patient characteristics -demographic data, experience of vulnerability, information on whether they have been previously treated psychiatrically, symptoms of anxiety, depression, stress, somatic comorbidities Intensity of systemic inflammation Severity of COVID-19.
A total of 169 patients hospitalized were analyzed. The median age of the patients was 65. There were (62.1%) men and (37.9%) women. On admission, most patients had a severe (134, 79.3%) or critical (17, 10.1%) form of COVID-19. The median Charlson comorbidity index was 3 points. Arterial hypertension was present in 101 (59.8%), diabetes mellitus 42 (24.9%), hyperlipoproteinemia 30 (17.8%), obesity 61 (36.1%), malignant disease 17 (10.1%) patients. 11 (6.5%) smoked and 7 (4.1%) patients consumed alcohol. The median CRPa was 72.75 mg /L. Median SII was 1741. During hospitalization, the median DASS21 score for depression was 14, for anxiety 8, and for stress 6. Regarding depression, it was absent in 49 (29%), mild in 27 (16%), moderate in 47 (27.8%), severe in 18 (10.7%) and extremely severe in 28 (16.6%) patients during hospitalization.
Patients with symptoms of depression during hospitalization felt statistically significantly more likely to be in danger of life due to COVID-19, had a more pronounced intensity of symptoms of COVID-19 upon admission. Additionally, patients with higher DASS 21 scores for depression were significantly more likely to be female, had COPD and required oxygen supplementation at higher flows.
Depression and coronary artery disease (CAD) are often comorbid conditions. The presence of depression significantly interferes with the recovery after CAD therapy intervention, such as percutaneous coronary intervention (PCI), one of the most common medical procedures in developed countries. Brain derived neurotrophic factor (BDNF) has a major role in angiogenesis and neuromodulation. Its levels were previously shown to be reduced in patients with depression, and latest studies indicate similar in patients with CAD. However, the correlation of BDNF levels and depression after CAD treatment is unknown.
The aim of this preliminary study is to assess the changes in BDNF levels in patients with depressive symptoms during a six-month period upon PCI.
Antidepressant-free participants that underwent PCI with stent placement due to myocardial infarction or angina pectoris were enrolled in the study. Depressive symptoms were evaluated at baseline using the Beck’s Depression Inventory II (BDI-II) with a cut-off score ≥20 indicating moderate depression. Serum BDNF levels were measured from blood samples drawn a day after (baseline) and six-months upon a successful PCI without complications. The t-test for dependent samples was used with marked significant differences at p<0,05.
Altogether, 76 participants were included in the study, of which 25 finished a six-month follow-up. Participants with BDI-II≥20 at baseline had higher serum BDNF levels in the second measurement (M=23,12, SD=6,20; M=32,02, SD=12,26, respectively). No significant difference was found in serum BDNF levels in measurements between participants with and without depressive symptoms (t=0,33, p=0,74; t=-1,40, p=0,18, respectively). Statistically significant difference was found between serum BDNF in the first and second measurement in the overall sample (t=-2,28, p=0,03) and in participants with baseline moderate depressive symptoms (t=-2,46, p= 0,03), but not in those without (t=-0,59, p=0,57).
Serum BDNF levels in participants with baseline moderate depressive symptoms increased after a six-month period upon successful PCI treatment, whereas that trend was not observed in participants without depressive symptoms. This highlights the potential synergistic role of BDNF in comorbid depression and CAD.
While shared clinical decision-making (SDM) is the preferred approach to decision-making in mental health care, its implementation in everyday clinical practice is still insufficient. The European Psychiatric Association undertook a study aiming to gather data on the clinical decision-making style preferences of psychiatrists working in Europe.
We conducted a cross-sectional online survey involving a sample of 751 psychiatrists and psychiatry specialist trainees from 38 European countries in 2021, using the Clinical Decision-Making Style – Staff questionnaire and a set of questions regarding clinicians’ expertise, training, and practice.
SDM was the preferred decision-making style across all European regions ([central and eastern Europe, CEE], northern and western Europe [NWE], and southern Europe [SE]), with an average of 73% of clinical decisions being rated as SDM. However, we found significant differences in non-SDM decision-making styles: participants working in NWE countries more often prefer shared and active decision-making styles rather than passive styles when compared to other European regions, especially to the CEE. Additionally, psychiatry specialist trainees (compared to psychiatrists), those working mainly with outpatients (compared to those working mainly with inpatients) and those working in community mental health services/public services (compared to mixed and private settings) have a significantly lower preference for passive decision-making style.
The preferences for SDM styles among European psychiatrists are generally similar. However, the identified differences in the preferences for non-SDM styles across the regions call for more dialogue and educational efforts to harmonize practice across Europe.
Depressive symptoms are common in individuals with tinnitus, however, the mechanisms of their interaction are not fully understood. There is neurobiological evidence that might help understanding the interplay between tinnitus and depression which, in turn, helps in making the right choice for treating both conditions.
This case report describes a 70-year old female patient that presented with tinnitus and depressive symptoms lasting for the past 5 years.
The patient showed limited treatment results with different antidepressants. The otorhinolaryngologist ruled out any possible somatic causes of her tinnitus. Tinnitus was causing her sleep disturbances, which worsened her everyday functioning that was already quite poor even further.
After being administered with 30 rounds of TMS, her symptoms either completely resolved or at least reached a level that was adequate for her to start functioning normally on a day-to-day basis.
TMS is a technique that provides non-invasive cortical stimulation, more specifically, when used for depression treatment it stimulates the left dorsolateral prefrontal cortex, a brain region synaptically connected to the limbic system involved in mood regulation that is proven to be hypoactive in depression. The limbic system is where tinnitus-related brain networks and regions involved in the pathophysiology of depression overlap. Further research is needed to deepen the understanding of this topic.
During the ongoing COVID-19 pandemic, two regions in Croatia, Zagreb and Petrinja in the Sisak-Moslavina County experienced strong earthquakes, on the March 22nd 2020 and on the 29th of December 2020. Both earthquakes, but especially the later one resulted on severe damage of the regions and caused severe disruptions in (mental) health service delivery. In these circumstances, the RECOVER-E project (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE), which was ongoing in Croatia from 2018-2022 aimed to implement flexible assertive community treatment as the new health care service for persons with severe mental illness (SMI). Since the pandemic and earthquakes have significantly influenced the life circumstances of all RECOVER-E project participants with SMI, we wanted further to examine the impact of health care delivery on mental health and the response to stress caused by a pandemic and earthquake in the patients with SMI involved in the project, in the first and second wave of the COVID-19 pandemics. Additionally, using case series, we will demonstrate the community mental health teams’ contributions in managing SMI after a double disaster in providing feasible, comprehensive, and accessible mental health services.1
There is no clinical difference between depressive episodes in bipolar disorder compared to major depressive disorder, which is why bipolar disorder remains unrecognized. Correctly distinguishing these disorders is of great importance because the therapeutic approach differs significantly. According to previous research, zinc, albumin, C reactive protein (CRP), and interleukin-6(IL-6) seem to play a role in differentiating these two types of depressive episodes.
To determine zinc, albumin, CRP and IL-6 serum concentrations in patients with major depressive disorder and depressive episode of bipolar disorder.
Research involved 60 participants. Participants signed informed consent prior to inclusion in the study. Sociodemographic data have been collected using a previously structured questionnaire. The severity of depressive symptoms has been measured by the Montgomery Asberg Depression Rating Scale (MADRS) and the Hamilton Depression Scale (HAM-D-17). Blood samples were obtained from each study participant’s brachial vein, to determine zinc, albumin, C reactive protein and interleukin-6 serum concentrations.
Statistically significant difference was found in zinc serum levels between the two analysed groups. In the overall sample, there is a significant positive correlation between the results on the rating scales and the serum level of CRP.
We confirmed an association between serum levels of CRP and the severity of the illness. Regardless, these are preliminary results of the research. Sufficient final conclusion cannot yet be drawn because it is being limited by the sample size and further investigation is needed.
The COVID-19 pandemic caused an unprecedented worldwide crisis affecting several sectors, including health, social care, economy and society at large. The World Health Organisation has emphasized that mental health care should be considered as one of the core sectors within the overall COVID-19 health response. By March 2020, recommendations for the organization of mental health services across Europe have been developed by several national and international mental health professional associations.
The European Psychiatric Association (EPA) surveyed a large European sample of psychiatrists, namely the “EPA Ambassadors”, on their clinical experience of the impact of COVID-19 pandemic on the treatment of psychiatric patients during the month of April 2020 in order to: a) identify and report the views and experiences of European psychiatrists; and b) represent and share these results with mental health policy makers at European level. Based on the recommendations issued by national psychiatric associations and on the results of our survey, we identified important organisational aspects of mental health care during the peak of the first wave of the COVID-19.
While most of the recommendations followed the same principles, significant differences between countries emerged in service delivery, mainly relating to referrals to outpatients and for inpatient admission, assessments and treatment for people with mental disorders. Compared to previous months, the mean number of patients treated by psychiatrists in outpatient settings halved in April 2020. In the same period, the number of mentally ill patients tested for, or developing, COVID-19 was low. In most of countries, traditional face-to-face visits were replaced by online remote consultations.
Based on our findings we recommend: 1) to implement professional guidelines into practice and harmonize psychiatric clinical practice across Europe; 2) to monitor the treatment outcomes of patients with COVID-19 and pre-existing mental disorders; 3) to keep psychiatric services active by using all available options (for example telepsychiatry); 4) to increase communication and cooperation between different health care providers.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Electroconvulsive therapy (ECT) has been considered a treatment option for the treatment resistance, mania, depression, suicidality and schizophrenia. It has been still controversial due to the lack of controlled clinical trials and unknown biological basis but also because of the negative image from the history of the treatment.
Specifics of the clinical judgement on when and for which patients’ indications, ECT was a treatment choice.
Aim of the study was to evaluate indications for the ECT treatment in the hospitalized psychiatric patients at the psychiatric department.
For all the patient cases in the last 7 years at the department (n = 326), data was analyzed regarding age, gender, number of hospitalizations, age of first episode, diagnose, previous treatment, leading indication for ECT and outcome after the ECT, regarding following treatment.
The leading indication for ECT was psychosis and/or pharmacological treatment resistance, followed by suicidality. Patients with psychosis were younger than patients with other diagnoses when receiving ECT treatment. Regarding the results, indications for ECT had been partially differentiated from expected guidelines. Outcomes after the ECT were favorable in terms of better controlling the symptoms, lowering exacerbation frequency and intensity and partially, functioning.
Studies on ECT indications and outcome could provide further insight on efficacy of the treatment, and possible improvements in clinical assessment on eligible patients who could benefit from the ECT treatment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Previous studies suggested that patients with schizophrenia had an increased prevalence of antibodies against toxoplasma gondii (TG) and that those seropositive patients had higher symptom severity. However, there is no data on the relationship between treatment-resistant schizophrenia (TRS) and TG seroprevalence.
To determine the association between TRS and TG seropositivity, and to further investigate the relationship between TG seropositivity and different clinical features of schizophrenia.
In this cross-sectional study, we included 210 male inpatients with schizophrenia. TG seropositivity was determined by ELFA assay. Treatment-resistance was defined as a failure of at least 2 adequate anti-psychotic trials. Data were analyzed using χ2 test or Mann–Whitney test.
The rate of TG seropositivity in the entire sample was 52.3%, whereas 47.6% of patients met the definition for treatment-resistance. Seropositive patients had twice the rate of treatment–resistance compared to seronegative patients (63.6% vs. 30.0%, P < 0.0001). Moreover, in the seropositive group, the patients were older (47.6 ± 12.2 vs. 39.81 ± 12.01 years, P < 0.0001), had higher number of previous hospitalizations (13.9 ± 11.7 vs. 9.6 ± 8.5, P = 0.0073), and increased Calgary depression scale for schizophrenia (CDSS) total score (7.8 ± 4.5 vs. 6.3 ± 3.8, P = 0.012). There were no differences between the groups in the age of disease onset, smoking, positive and negative syndrome scale (PANSS) total, positive and negative scores, and the life-time history of suicide attempts.
Our results support the hypothesis that TG seropositivity might contribute to treatment-resistance in schizophrenia, at least in male patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
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