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The illusion of invulnerability has been linked to lower perceived risk and increased engagement in risky behaviors among youth. Therefore, it has been purported to influence young people’s poor adherence to public health measures aiming to contain the COVID-19 pandemic. Concomitantly, beliefs about the virus and mental health may also shape public health behaviours.
To investigate the role of beliefs, perceived invincibility and mental health status in explaining frequency of hand-washing and hours outside the house among youth in Greece
A total of 1.899 students, aged between 18-29 years old, were recruited from the main universities of the country. An online questionnaire entailing: (i) popular beliefs about COVID-19, (ii) the DASS-21, (iii) the Adolescent Invincibility Tool and (iv) queries about health behaviours, was distributed during the lockdown period.
Most participants reported washing their hands rarely/never within a day (78.6%) and spending 2-6 hours outside the house (68.1%). Handwashing was largely influenced by mental health [OR = 0.94, 95%CI= 0.91 – 0.98 for stress; OR = 0.96, 95%CI = 0.93-0.99 for anxiety and OR = 1.05, 95%CI= 1.02-1.08 for depression]; while hours outside the house by perceptions that the virus is out of control [OR=0.76, 95%CI = 0.61-0.95], manufactured [OR=1.21, 95%CI = 1.53, 95%CI =1.21 – 1.93] and airborne [OR= 0.78, 95%CI = 0.64-0.95].
Addressing stress and anxiety as well as health education interventions should be prioritized to foster young people’s adherence to public health measures amid the pandemic.
Multidisciplinary Design Optimization (MDO) is a method that has shown many promising results in the development of complex engineered products. To this date, research on MDO has been extensive, but at the same time, very few publications have addressed the aspect of how it can be taught to students and young professionals. In this light, this paper aims to present the experiences of the authors in respect to the development and management of an MDO course at Linköping University. First, this work will describe the authors' teaching approaches, and in particular, it will present the various educational activities that have been considered over the years as well as the lessons learnt. Secondly, this work will attempt to investigate how students perceive a set of common MDO concepts, and more specifically, it will present an analysis based on the results of two surveys that took place in 2016 and 2020, respectively. Given the above foundation, this paper will try to establish guidelines regarding the activities which are suitable for teaching each concept, while finally, it will also touch upon the challenges as well as the solutions for adjusting an MDO course to a distance learning mode.
Why do parties change candidate lists between elections? Although candidate list volatility is an important indicator of the responsiveness of electoral representation, it has received little attention in research. We offer a critical case study of party list volatility in Finland, using a candidate-centred open-list proportional (PR) electoral system with ideal conditions for ‘ultra-strategic’ party behaviour. Our explorative two-stage research design begins with party elite interviews, to extract factors that can affect list volatility, which in the following step are tested in a regression analysis of 564 party lists in parliamentary elections 1983–2019. Our results show that list formation is a complex phenomenon, where demand and supply factors interact in a contingent fashion. Following trends of voter dealignment, personalization and ‘electoral-professionalization’ of parties, volatility has increased over time. Electoral defeats and declining party membership increase volatility, but a member-driven mass-party heritage that limits party elites’ strategic capacity has a stabilizing effect.
Triple chronotherapy (defined as sleep deprivation for 36 hours, followed by 4 days of advancing the time of sleep, together with daily morning bright light therapy for 6 months) has demonstrated benefits for the rapid treatment of depressive symptoms in 4 small, controlled trials of in-patients. Our aims were to test the feasibility of recruitment and delivery of triple chronotherapy for out-patients with depression.
In a single blind trial, 82 participants were randomised to either triple chronotherapy or a control intervention. The primary outcome was Hamilton Depression Rating Scale 6 item (HAM-D6) at 1 week. Timings of observer ratings were baseline; 1 week; 2 weeks; 4 weeks; 8 weeks and 26 weeks after randomisation. Triple chronotherapy consisted of (a) Total sleep deprivation for 36 hours. On Day 1 patients were supported in a small group to stay awake at night with an occupational therapist, (b) Phase Advance of Sleep over 4 days. Phase Advance began after the first night of sleep deprivation, when they left the hospital at about 8am and were asked to go to bed earlier at about 5pm and rise at about 1am. Their sleep and wake up times were then shifted 2 hours later on each of the following three days until they attained their usual bedtime again at about 11pm.As a control for the triple chronotherapy, participants were given psychoeducation and written information on sleep hygiene. They were also given SomniLight amber light daily for 1 week in the morning.
Participants in the triple chronotherapy group were able to stay awake for the planned thirty-six hours and 89.9% adhered to the plan of phase advance of their sleep over the following 4 days. We achieved our recruitment target with 60 participants having completed the trial within 13 months. There were no reported adverse side effects. We explored outcomes and found a significant difference between the groups for the HAM-D6 at week 1, 8 and 26. Response (> 50% reduction in symptoms) was achieved by 52% in the triple chronotherapy group compared to 18% in the control group at week 1. This gradually increased to 70% achieving response in the triple chronotherapy group at week 26 compared to 22% in the control group.
Triple chronotherapy produced a significant and rapid benefit after 1 week in out-patients with depression that was sustained at 26 weeks. Further cost-effective trials with a larger clinical sample size are required.
The linear stability of a liquid film falling down an inclined flexible plane under the influence of gravity is investigated using analytical and computational techniques. A general model for the flexible substrate is used leading to a modified Orr–Sommerfeld problem addressed numerically using a Chebyshev tau decomposition. Asymptotic limits of long waves and small Reynolds numbers are addressed analytically and linked to the computations. For long waves, the flexibility has a destabilising effect, where the critical Reynolds number decreases with decreasing stiffness, even destabilising Stokes flow for sufficiently small stiffness. To pursue this further, a Stokes flow approximation was considered, which confirmed the long-wave results, but also revealed a short wave instability not captured by the long-wave expansions. Increasing the surface tension has little effect on these instabilities and so they were characterised as wall modes. Wider exploration revealed mode switching in the dispersion relation, with the wall and surface mode swapping characteristics for higher wavenumbers. The zero-Reynolds-number results demonstrate that the long-wave limit is not sufficient to determine instabilities so the numerical solution for arbitrary wavenumbers was sought. A Chebyshev tau spectral method was implemented and verified against analytical solutions. Short wave wall instabilities persist at larger Reynolds numbers and destabilisation of all Reynolds numbers is achievable by increasing the wall flexibility, however increasing the stiffness reverts back to the rigid wall limit. An energy decomposition analysis is presented and used to identify the salient instability mechanisms and link them to their physical origin.
The notion of “Ich-Störungen” (self-disorders) depicts a major aspect of Kurt Schneider's concept of first rank symptoms of schizophrenia. Terms such as “passivity phenomena”, “delusions of alien control” and “ego pathology” have been used to characterise these phenomena once postulated to be pathognomonic for schizophrenia. The present review focuses on clinical studies examining the symptoms’ diagnostic and nosological implications.
We conducted a semi-structured literature review. 374 references were obtained using the key words “ego disorder/(psycho)pathology”, “thought insertion”, “alien control”, “passivity symptoms/phenomena/experiences”, “first rank symptoms”, “schneiderian” and “self disorders”. We distinguished two major fields of research:
(1) neurobiological and neuropsychological studies based on phenomenological or neurocognitive paradigms;
(2) studies on diagnosis and nosology (including assessment instruments and factor analyses), outcome and prognostic value.
Of the studies on the second field, 83 have clinical relevance and are reviewed here.
Several specific instruments with sound foundations in psychopathology have been developed for the assessment of self-disorders; however, they have rarely been included in research. Factor analyses have consistently shown a highly loaded factor consisting of self-disorders, in some studies distinct from other first-rank symptoms. There is contradictory data on outcome and prognosis.
Self-disorders remain ill-defined and inconsistently included into diagnostic criteria, and therefore lack nosological significance. Their clinical relevance has been insufficiently studied, although they have been consistently shown to form a highly specific factor within the schizophrenia symptom spectrum. The present review stresses the need for a global definition of self-disorders on the basis of phenomenology.
The high comorbidity of depression in patients with diabetes mellitus type 2 has been established.
The association between Obsessive Compulsive Disorder (OCD) and diabetes mellitus type 2 is poorly understood.
The aim of the present study was to assess the degree in which diabetes mellitus type 2 is accompanied by OCD.
131 diabetic patients, 55 female and 76 male were randomly enrolled and during the first assessment was administered in all participants the Zung Self Rating Scale (ZUNG) and the Maudsley O-C Inventory Questionnaire (MOCI). After one year, while an intensive effort to improve the patients’ metabolic profile was performed, the diabetic patients that were initially uncontrolled (n = 31) were re-evaluated by the same psychometric tools. From those 31 patients 10 had managed to control their metabolic profile.
MOCI and the sub-scale of slowness are statistically related with the diabetic profile (controlled-uncontrolled), with uncontrolled patients scoring significantly higher on the overall MOCI score and the factor of slowness of MOCI scale (p = 0.028). Regarding the association between the values of Glycosylated Haemoglobin (HbA1c) and the scores of MOCI it was found that they were significantly positively correlated in overall scores (p = 0,028) and in the subscale of slowness (p = 0,028). The analysis revealed a positive association between depression (p = 0.004) and obsessive compulsive disorder symptomatology (p < 0.001) and thepatient’s metabolic profile.
Diabetes mellitus type 2 is associated with obsessive compulsive disorder symptomatology and depression. Improvements in glycaemic control were found to decrease the severity of the symptoms.
In the context of psychiatric reformation, the long-term mentally ill have moved from institutionalized care to outpatient-based mental health services and community-based rehabilitation settings.
Quality of Life (QoL) constitutes a critical outcome of mental health programs and services and is a multidimensional subjective construct.
Exploring the perceived QoL of long-term psychiatric residents and, identifying possible associations between sociodemographic variables, psychiatric history, cognitive function (MMSE), physical comorbidity and type of residential care.
104 patients residing for over six months, to community based rehabilitation settings subjected to the PHPO (5 sheltered apartments, 7 hostels, 2 boarding houses) were encountered. QoL of participants was assessed using the self-fulfilling, 36 item Short-Form Health Survey (SF-36) at a given point of time.
The majority of the residents expressed good levels of satisfaction in all subscales of the SF-36, with mean values of Physical Component Summary (PCS): 34.90 ± 13.92 (range: 0–50) and Mental Component Summary (MCS): 67.89 ± 20.09 (range: 25-100). Statistical significant differences were recorded concerning the PCS and age (p = 0.000), MMSE scores (p = 0.000), educational level (p = 0.017), marital status (p = 0.049) and type of residential home (p = 0.012). MCS was statistically significant associated with age (p = 0.032), MMSE scores (p = 0.007), socioeconomic status (p = 0.008) and type of residential home, too (p = 0.040). No differences were found concerning psychiatric diagnosis or physical comorbidity.
Community care models provide subjective positive life satisfactions to the majority of the chronically mentally ill. Thus, besides the care giver's management, independent variables play an important role to perceived QoL.
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.
Treatment of schizophrenia with antipsychotic drugs is frequently sub-optimal. One reason for this may be heterogeneity between patients with schizophrenia. The objectives of this study were to identify patient, disease and treatment attributes that are important for physicians in choosing an antipsychotic drug, and to identify empirically subgroups of patients who may respond differentially to antipsychotic drugs. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients with schizophrenia. Information on 39 variables was collected. Multiple component analysis was used to identify dimensions that explained the variance between patients. Three axes, accounting for 99% of the variance, were associated with disease severity (64%), socioeconomic status (27%) and patient autonomy (8%). These dimensions discriminated between six discrete patient subgroups, identified using ascending hierarchical classification analysis. The six subgroups differed regarding educational level, illness severity, autonomy, symptom presentation, addictive behaviors, comorbidities and cardiometabolic risk factors. Subgroup 1 patients had moderately severe physician-rated disease and addictive behaviours (23.2%); Subgroup 2 patients were well-integrated and autonomous with mild to moderate disease (6.7%); Subgroup 3 patients were less well-integrated with mild to moderate disease, living alone (11.2%); Subgroup 4 patients were women with low education levels (5.4%), Subgroup 5 patients were young men with severe disease (36.8%); and Subgroup 6 patients were poorly-integrated with moderately severe disease, needing caregiver support (16.7%). The presence of these subgroups, which require confirmation and extension regarding potentially identifiable biological markers, may help individualizing treatment in patients with schizophrenia.
Schizophrenia and bipolar disorder are both associated with increased levels of serum lipids compared to healthy controls. However, it is not clear whether patients with schizophrenia differ from bipolar patients in terms of serum lipid concentrations and hyperlipidemia rates.
The serum lipid levels of 160 patients with schizophrenia and 41 patients with bipolar disorder (manic episode), consecutively admitted in an acute psychiatric ward during a 2-year period, were assessed.
There was no significant difference in serum cholesterol, high-density lipoproteins, low-density lipoproteins or triglycerides levels between the two groups of patients, after controlling for age. A considerable rate of schizophrenia patients demonstrated high cholesterol levels (>200mg/dl; 45.6%), whereas 15.6% of them had elevated triglyceride levels (>150 mg/dl). In bipolar patients, the rates for both
hypercholesterolemia and hypertriglyceridemia were 29.3%. The above rates did not differ significantly between the two groups of patients.
Acutely hospitalized patients with schizophrenia and bipolar disorder did not differ in serum lipid concentrations and hyperlipidemia rates.
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.
Twenty-two patients with major depressive disorder, 11 of them with melancholic features, and 11 controls were investigated with CANTAB subtests focusing in visual memory/learning and executive functions. Melancholic patients performed worse than the other groups in all tasks and manifested a significant impairment in set shifting. The results are discussed in association with prefrontal dysfunction.
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.
Zolpidem is a GABA (A) agonist, which is indicated for the short-term management of insomnia. Recent research provide evidence suggesting that zolpidem produces spatial working memory (WM) deficits and dependence; however, the underlying mechanisms of these effects are unknown. Since the auditory N400 component of event-related potentials (ERPS) is considered as an index of memory use of context processing, the present study focused on N400 waveform of ERPs elicited during a WM task in a case suffering from zolpidem dependence. The patterns of N400 waveform of this case were compared to the patterns obtained from healthy controls. This comparison revealed that zolpidem dependence is accompanied by reduced amplitudes located at posterior brain areas and diffuse prolongation of N400. These findings may indicate that zolpidem dependence manifests alterations with regard to the memory use of context processing, involving or affecting a wide-ranging network of the brain's structures.
Postnatal depression is a serious disorder affecting 10–20% of postpartum women. It has a negative impact on the whole family system and on the child's development.
It is important to identify possible risk factors for PND, due to its frequency and severity. It has been hypothesized that the hormonal fluctuatios of the immediate postpartum period could be a risk factor for the appearance of PND.
This study aimed at inquiring the possible correlation of hormonal parameters in the 1st week postpartum with the appearance of PND.
95 postpartum women were recruited, in the process of validating the Greek EPDS. Of them, 40 consented to give blood on the second postpartum day, so that the plasma levels of TSH, T4, T3, FSH, LH, Progesterone, Estradiol, Prolactin and Cortisol were measured. 81/95 women consented to be reassessed at 8 weeks postpartum, and 10/81 were diagnosed with depression, major or minor. Plasma levels of the hormones were correlated with the diagnosis of PND and with the EPDS.
Women who suffered from PND did not differ from the non-PND subjects in the levels of all measured hormones. There was a statistically significant negative correlation of the levels of prolactin with the EPDS on the second postpartum day (p < 0.001, correlation coefficient -0.56).
Our study failed to show a definite correlation of the hormonal levels in the immediate postpartum period with PND. In other studies the role of hormones in the appearance of PND remains as well questionable.
Schizophrenia is a frequent psychiatric disorder whose prevalence appears to be relatively stable across different patient groups. However, attitudes to care and resources devoted to mental health care may differ between countries. The objective of this analysis was to compare sociodemographic and psychopathological features of patients, antipsychotic treatment and frequency of hospitalisation between four European countries (Germany, Greece, Italy and Spain) collected as part of a large survey of the characteristics of patients with schizophrenia. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients. Information on 39 variables was collected. A number of between-country differences were observed which tended to distinguish Germany on the one hand, from the Mediterranean countries, and Greece in particular, on the other. While demographic features and clinical features were essentially similar, more patients in Germany were considered to have severe disease by their psychiatrist (59.0% versus 35.9% in Greece) and to be hospitalised (49.3% versus 15.0%). 46.7% of German patients were living alone compared to less than 20% in the Mediterranean countries and 50.2% were living with their family (versus over70% elsewhere). Smoking and addictive behaviours were more frequently reported for patients in Spain. With regard to empirically derived patient subgroups, Subgroup 2, corresponding to well-integrated and autonomous patients with mild to moderate disease severity was most highly represented in Greece (23.6% of patients compared to less than 10% elsewhere) elsewhere, Subgroup 6 (poorly-integrated patients with moderately severe disease who require caregiver support) was under-represented in Germany (4.5% versus over 17% elsewhere). Patterns of treatment were essentially similar, although quetiapine was more frequently prescribed and paliperidone less frequently prescribed in Germany than elsewhere. Reasons for treatment choice were comparable between countries, primarily related to good tolerability and control of positive symptoms. The differences observed may be attributed to differences in mental health care resource provision, socio-cultural or educational differences or to resource issues.