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At the start of the pandemic, it looked like the biggest COVID-related threat to democracy, in Eastern Europe and elsewhere, was executive aggrandizement. This focus, however, may lead us to overlook a bigger threat to Eastern European democracy. We argue that Eastern European democracies’ original sin of state capture has been exacerbated by the rise of conspiracy theories, whose stock has only increased with the addition of COVID misinformation. Eastern European voters struggle to differentiate between the true political conspiracy that enables private interests to control the state and conspiracies without empirical basis, such as COVID denialism, world government, or political correctness as a tyrannical plot. As a result, conspiracy theories enable the state capture camp to divide the reformist opposition and maintain their grip, while simultaneously claiming that they are governing competently and in line with European values. We use an original survey from Bulgaria and a GLOBSEC 2020 cross-national survey to explore this hypothesis. Finally, we draw some theoretical implications from the empirical evidence for assessing the nature of democratic backsliding in Eastern Europe. We call for more research on the conspiracy cleavage as a factor in explaining backsliding processes.
Although much of society believes that the sexual aggressor is unknown to the victim, this is not supported by the literature. In most cases, the rapist is a known, former or current intimate partner of the victim or even a family member.
189 persons accused of perpetrators of sexual crimes and who were subject to forensic psychiatric evaluation for the period from January 2010 to December 2019 in the territory of Central Northern Bulgaria were examined.
The current research uses sociological methods to gather information - interviews, observations, research of forensic and medical documents,
In the study group, 62% of the victims were known to the perpetrator of the sexual crime, 11% were part of the nuclear family and 8% were members of the extended family of the perpetrator.
J. Benton Heath introduced the topic. Essential security interests clauses have been invoked in a handful of cases, including several cases arising out of the Argentine debt crisis and the twin cases brought by Deutsche Bank and CC/Devas against India relating to satellite frequencies, with mixed outcomes and reasoning. In several treaties, these clauses also refer to public health measures, but there is little guidance on how such clauses should be interpreted or applied. Using a fictional but realistic scenario, the advocates and tribunal members—playing assigned roles—were asked to consider whether public health exceptions are self-judging, whether they deprive a tribunal of jurisdiction or go to the merits, and what showing is required for the clause to apply. The scenario also raised broader doctrinal questions about the nature of exceptions in investment treaties, their relationship with the treaty's primary obligations, and the interrelationship between security clauses and the customary international law defense of necessity.
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.
Dual or multiple earnership has been considered an important factor to prevent in-work poverty. The aim of this paper is to quantify the impact of second earnership on the risk of in-work poverty and the role of the tax-benefit system in moderating this risk. Our analysis refers to 2014 and employs EUROMOD, the tax-benefit microsimulation model for the European Union and the United Kingdom. In order to assess the role of second earners in preventing in-work poverty we simulate a counterfactual scenario where second earners become unemployed. Our results show that the effect of net replacement rates (i.e. the ratio of household income before and after the transition of second earners to unemployment) on the probability of in-work poverty is negative and statistically significant, but in relative terms it appears to be small compared to the effects of individual labour market characteristics, such as low pay and part-time employment.
One of relevant challenges of psychogeriatric assistance is recognition of depression and cognitive disturbances in elder patients because clinical similarity of their manifestations masks nature of syndrome.
To study of clinical severity and nosological belonging of depressive syndrome against the background of accompanying cerebrovascular pathology with availability of cognitive disorders in elder patients under treatment at the specialized department of affective states.
Total number of observations has constituted 55 persons (males - 24, females - 31, mean age 66,3 ± 5,8 years). Criteria of inclusion: age older than 60 years, complaints about memory disturbances and decreased background of mood as a basic cause of seeking psychiatric assistance. We excluded patients with mental disorders of psychotic register, presence of substance dependence syndrome, dementia.
According to results of clinical-psychopathological investigation along with ICD-10 diagnostic criteria, nosological structure of revealed disorders has been represented by the following rubrics: organic affective disorder (F06.3) was diagnosed in 355 of patients; depressive disorders of rubric F3 were registered in 45% of patients, comorbid with organic asthenic disorder (F06.6) or with mild cognitive disorder (F06.7), in 15% of cases depression was leading syndrome within adjustment disorder also in combination with mild cognitive disorder, in 55 of cases depressive symptoms was regarded as secondary whereas predominating ones were cognitive and behavior disturbances within organic asthenic disorder (F06.6).
Thus, clinical assessment and nosological belonging of depressive syndrome combined with organic disorders in the elderly are an important factor mainly determining the choice of therapeutic strategy.
System of education is always in focus of public attention. However, according to heightening the educative standards and increase of study loading teachers begin increasingly to experience “burnout syndrome”. This is why it is not surprising that in most schools now teachers have no forces, no time to tackle the problems of schoolchildren of graduating classes. Youth remains confronting his or her experiences and have nobody to seek for help. I propose to introduce lessons of art-therapy because psychological assistance for adolescents in the period of preparation to exams allows them fuller realize possibilities of personality development. Similar lessons can increase the self-esteem, help to graduates in controlling their behavior. It is of importance because control above the behavior and emotions helps to people in decision making, in right choice making and responsibility bearing for subsequent results.
Art-therapy system possesses abilities to reproducibility and translation of some methods, techniques which application allows receipt of stable positive results. At the same time specific trait of technologies of such type is broad creative variation. Rational-technological components of pedagogical activity are inseparable from irrational-spontaneous, improvised, supposing estheticism, artistry, and certain theatricality of behavior, technique of presentation of his/her own personality.
Mood disorders in the elderly are a relevant clinical problem associated with high prevalence and frequent co-morbidity with chronic somatic diseases.
Study of clinical traits of depression in elder persons with somatic disorders.
The investigation was entered by 582 persons (women = 391 (67,1%), men = 191 (32,9%)), mean age of women has constituted 67,5 ± 5,8 years, men - 62,1 ± 3,8 years.
Criteria of inclusion
Age in women 55 years and higher, in men - 60 years and higher, clinical level of depression according to Beck Inventory more than 22 scores.
Affective disorders were represented by symptom complexes that masked depression and complicated diagnosis. Clinical symptoms in the kind of anhedonia and complaints about anergia dominated (73,6%), whereas depression, melancholy have moved behind and have constituted 26,4%. Psychopathologic disturbances presented against the background of lingering chronically flowing neurological and somatic diseases (cerebral atherosclerosis, brain blood circulation impairment, IHD, HI, respiratory organs’ diseases) in 73,6 %. High risk of emergence of depressive disorders was noticed in widows with low level of education, living in rural area and in persons with somatic diseases. In 32% of probands we have revealed depression that correlated with marital status and feeling of loneliness (p > 0,005). In persons with high level of depression and experiencing feeling of loneliness, risk of suicidal behavioral was higher 2,1 as much.
Study of affective disorders in the elderly allows assessing co-morbidity of somatic and mental disorders, developing tactic of psychotherapeutic and psychopharmacological assistance rendering.
The features of atypical neuroleptics influence on immune parameters and aspartate and alanine aminotransferases blood serum level of schizophrenics during 6-week therapy.
We examined 52 schizophrenics: 20 patients were treated by quetiapine, 12 - by olanzapine, 10 - by rispolept, 10 - by amisulpride. Scales PANSS and CGI was used at clinical examination. We defined the parameters of cellular, humoral immunity, serum levels of aminotransferases. Control group – 36 healthy people.
The data of favorable influence on positive, negative, general psychopathological symptoms of patients was observed.
Before therapy T-cell immunodeficiency with reduction of CD2+-, CD4+-, CD16+-cells was observed among schizophrenics (comparing to control). Authentically high aminotransferases levels in first point were observed in groups of patients treated by olanzapine and quetiapine.
During 6 weeks of quetiapine treatment indices of аHLA-DR+-cells quantity, CD16+-cells, IgA, IC level tend to those of control indices, the normalization of aminotransferases levels was observed.
During olanzapine treatment the normalization of CD2+-, CD8+-cells was observed; we determined the increase of IgА and IgM in the process of normalization of IgG and IC level. Aminotransferases levels reduced up to control indices.
During rispolept treatment the normalization of lymphocytes, CD4+-, CD16+-cells, was observed; during amisulpride treatment the reduction of CD2+-, аHLA-DR+-lymphocytes the increase of IC level, the normalization of CD16+-cells quantity and the increase of aminotransferases levels was revealed.
Summary: Was observed priority data about render various effects on immune parameters of atypical neuroleptics; dynamics of aminotransferases level which depends on their initial level is revealed.
Major depressive disorder (MDD) is a global long-term condition and is the leading cause for disability in most countries. The objective of this study was to evaluate individual items of the PHQ-9 and SDS to show differences by treatment arm over the course of treatment.
The TRANSFORM-2 study (NCT02418585) was a Phase 3 short-term trial that evaluated efficacy and safety of flexible esketamine nasal spray (56 mg or 84 mg) doses in combination with newly initiated oral antidepressant (ESK+AD) vs oral AD + placebo nasal spray (AD+PBO) in patients with treatment resistant depression (TRD). The study population, men and women aged 18-64 years, who met the Diagnostic and Statistical Manual of Mental Disorders, Edition 5 diagnostic criteria for single-episode or recurrent MDD, but excluded subjects with suicidal ideation/intent to act within 6 months prior to study. Patient reported outcomes (PROs) were integrated to evaluate the patient perspective of treatment using instruments capturing concepts of importance. The 9-item Patient Health Questionnaire (PHQ-9) is a PRO instrument to assess self-reported depression symptoms, and the SDS a PRO instrument to assess function and disability. Individual items on each of these instruments represent a symptom or aspect of functioning. Respective items for PHQ-9 and SDS, are summed together to generate a total score: 0-27 for the PHQ-9 and 0-30 for SDS. Each total score reflects a single construct of depression severity for the PHQ-9 and functional disability for SDS. Change from baseline in SDS and PHQ-9 total scores at Day 28 were analyzed using a mixed-effects model using repeated measures based on observed case data. Generalized estimation equations of logistic regression models were used to estimate the likelihood of improvement by ≥ 1 point on the individual items of the PHQ-9 and SDS.
Full analysis set included 223 patients (ESK+AD: 114; AD+PBO: 109). Change in SDS total score from baseline to Day 28 numerically favored ESK+AD. The LS mean treatment difference (95% CI) was -4.0 (-6.28; -1.64). Change in PHQ-9 total score from baseline to Day 28 numerically favored treatment with ESK+AD. The LS mean difference (95%CI) was -2.4 (-4.18; -0.69). Most patients experienced improvement on all PHQ-9 items and more patients experienced greater improvement in the ESK+AD treatment arm compared to the AD+PBO arm (odds ratio range 1.367-2.767; favoring ESK+AD). Improvements were seen across all items of the Sheehan Disability Scale (odds ratio range from 1.994 – 3.378; favoring ESK+AD).
This study shows that while the magnitude of improvement varied on individual items, ESK+AD treatment leads to greater symptom improvement across the multiple symptoms included in the PHQ-9 and SDS compared to the AD+PBO. This assists interpretation of the total scores generated by these PRO measures since total scores on the two measures was not driven by a single item.
To assess health-related quality of life (HRQoL) and health status of patients with treatment resistant depression (TRD), treated with esketamine nasal spray+oral antidepressant (ESK+AD) vs oral antidepressant+placebo nasal spray (AD+PBO) using European Quality of Life Group-5-Dimension-5-Level (EQ-5D-5L). The EQ-5D-5L descriptive system consists of five domains relevant for patients with depression (mobility, self-care, usual activities, pain, anxiety/depression) and the EQ-Visual Analogue Scale (EQ-VAS).
Data from TRANSFORM-2 (NCT02418585), a randomized, double-blind short-term study were analyzed. Patients (18-64 years inclusive) with TRD were included. Patient reported health status change using EQ-5D-5L and EQ-VAS was measured from baseline to end of 4-week induction phase (endpoint). Each domain of EQ-5D-5L included 5 levels of perceived problems (L1: no problems; L5: extreme problems).
Full analysis set included 223 patients (ESK+AD: 114; AD+PBO: 109). At endpoint, mean (SD) change in health status index was 0.288 (0.2317) for ESK+AD group and 0.231 (0.2506) for AD+PBO group with higher score reflecting higher levels of functioning. At endpoint, percentage of patients reporting problems (grouped L2-L5 responses for each dimension) in ESK+AD vs AD+PBO group: mobility (13.5% vs 25.7%), self-care (16.2% vs 30.5%), usual activities (55.0% vs 71.4%), pain (38.7% vs 52.4%), and anxiety/depression (71.2% vs 78.1%). Mean (SD) change in EQ-VAS score at endpoint was 29.1 (26.32) for ESK+AD and 20.9 (26.60) for AD+PBO group.
Greater improvement in HRQoL and health status using EQ-5D-5L and EQ-VAS was observed among patients with TRD treated with ESK+AD vs AD+PBO.
This study was sponsored by Janssen Research and Development, LLC.
Major depressive disorder (MDD) has been ranked among the top causes worldwide of years lived with disability. In this study we assessed meaningful change for the PHQ-9 and the SDS and determined the meaningful change threshold (MCT) using anchor-based methods, which could be used to compare meaningful differences in patients within different treatment arms.
TRANSFORM-1 (NCT02417064) and -2 (NCT0241858) were Phase 3 trials that evaluated the efficacy and safety of fixed and flexible doses of esketamine nasal spray (56 mg or 84 mg) in combination with newly initiated oral antidepressant (ESK+AD) vs oral antidepressant + placebo nasal spray (AD+PBO) in TRD patients. Patient Reported Outcomes (PROs) were integrated into these trials to evaluate the patient perspective of treatment using instruments capturing concepts of importance to patients. The 9-item Patient Health Questionnaire (PHQ-9) is a PRO instrument used to assess self-reported depression symptoms and the Sheehan Disability Scale (SDS) is a PRO for self-reported function and disability. Blinded trial data (combined treatment groups) from TRANSFORM-1 was used for the anchor-based analysis. The Clinical Global Impression - Severity (CGI-S) was used as an anchor and patients were classified into response groups depending on their level of change over the course of the study. Patients were classified among all possible change categories (15 levels, ranging from -7 to 7 where negative change scores indicate improvement). Cumulative Distribution Function (CDF) curves of change from baseline to day 28 were generated using unblinded data from TRANSFORM-2 to visualize the range of responses demonstrated in the respective treatment groups for the PHQ-9 and SDS. MCT values were used to as thresholds to evaluate percentage of responders in each treatment group.
In anchor-based analyses using TRANSFORM-1 combined treatment groups, the correlation between change on the CGI-S and change on the PHQ-9 at Day 28 was high (> 0.60) with anchor-based MCTs ranging from 5 to 8 points. The magnitude of change (standardized effect size estimate within-subject change) for patients improving was exceptionally high (> 0.80). Similar results were observed on the SDS: high correlation of CGI-S and SDS at Day 28 (0.75), moderate SES (0.66), with suggested MCT ranging from 3 to 7 with an MCT value of 5 pts. CDF curves from TRANSFORM-2 showed clear separation between the ESK+AD vs AD+PBO across a number of responder definitions inclusive of those identified with the anchor-based analyses.
The current study is the first to derive an MCT on the PHQ-9 and SDS in TRD to measure meaningful change from the perspective of the patient using regulatory-preferred psychometric anchor-based methodology. These analyses assist with interpretation of meaningfulness of esketamine phase 3 clinical trial results from the patient perspective.
Diabetes mellitus (DM) is associated with chronic complications and comorbidities. Psychopathology and personality changes (PCh) are also found in DM. Some authors suggest organic PCh. The aim of our study was to access DM associated PCh and their relations with DM complications, glycemic control (GC) and family history for DM (FH).
Material and methods
We examined 47 patients with DM type 2 (64.65 ± 9.78 years old; 14 males, 33 females; 24 with and 23 without FH, 20 with good, 15 with poor and 12 with very poor GC). All of them underwent somatic and neurological examinations. Blood count and biochemistry, urine analysis, brain computer tomography, electroneurography, electrocardiography and neuropsychological battery were applied. PCh were accessed by Minnesota Multiphasic Personality Inventory.
The most frequent PCh were hypochondriasis (Hs, 77%), hysteria (Xy, 74%) and schizoidia (Se; 77%); hypomania was low in 60%; 30% showed low psychasthenia and 49% low psychopatia. High paranoia had 23% and low–15%. Poor GC was associated with cognitive impairment (CI) and high Hs, Xy and Se. Patients with high Hs, Xy and Se showed more frequent diabetic complications (retinopathy, polyneuropathy and nephropathy), comorbidities and CI than those without, even after correction for age, therapy and DM duration. FH was risk factor for PCh.
Patients with DM show specific PCh. High scoring on Hs, Xy and Se scales are associated with poor GC, chronic DM complications, comorbidities and CI. FH is risk factor for PCh.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Schizophrenia is associated with working memory (WM), executive dysfunction and access visual WM dysfunctions among patients with paranoid schizophrenia (PSz).
Material and methods
We examined 89 patients (41.35 ± 11.52 years old, 65 males, 24 females, 15 with basic, 52 with middle and 22 with high formal education) with PSz (65% with prevalence of positive and 31 of negative syndromes) by Benton visual retention test (BVRT, var.A and E).
The average number of correct performed items was 3.12 ± 1.1.83, the average errors, 13.04 ± 3.70 (6.51 ± 3.05 at left and 5.35 ± 2.30 at right visual field (VF)). Females had more corrects (P = 0.0256). Education is associated with less errors and more corrects. Patients with prevalence of negative syndromes showed more errors at left VF than those with positive, although the total number of errors and corrects were similar. Ageing was not directly associated with total number of corrects and errors. Twenty-three percent of our patients had addictions, 52% had omissions, 96% distortions (average 4.12 ± 2.31), 78% perseverations, 79% rotations, 83% misplacements and 61% size errors. Horizontal displacements were obtained from 42%.
Visual WM dysfunction is frequent among patients with PSz. Female sex and high education are associated with better test performances. Negative syndromes are related with high number of errors at left VF, but not with total numbers of corrects and errors. We suggest horizontal displacement as specific error among patients with PSz.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Morgellons disease is a delusional disorder that leads to the belief that one has parasites or foreign material moving in, or coming out of, the skin. The name was coined in 2002 by Mary Leitao; a mother who rejected the medical diagnosis of her son's delusional parasitosis. She revived it from a letter written by a physician in the mid-1600s.
In this case report, we aim to describe the clinical characteristics and manifestation of morgellon disease in 26 years man.
Results and discussion
Bulgarian athlete of 26 years stopped to be actively involved with the sport after a severe contusion to the right knee during the race. Had a joint surgery in the Netherlands and of course when that will not be able to compete more professional sports began to use cannabinoids daily. After three months patient went to dermatologist because of skin rashes and intense itching, crawling sensation on and under the skin. The patient reported that pull out threads from his skin. Dermatologist Initiated treatment with antibiotic creams and corticosteroids. The symptoms persist and the patient has consulted a psychiatrist regarding appeared complaints of fatigue, poor concentration and increased anxiety. Psychiatrist based on clinical and medical history was diagnosed morgellon disease. We started treatment with risperidone in increasing doses up to 2 mg/day. After a month the patient has a significant reduction of symptoms.
Morgellons disease is a little-known disorder that is often associated with non-specific skin, nerve, and psychiatric symptoms.
Disclosure of interest
The authors have not supplied their declaration of competing interest.