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Recently, artificial intelligence-powered devices have been put forward as potentially powerful tools for the improvement of mental healthcare. An important question is how these devices impact the physician-patient interaction.
Aifred is an artificial intelligence-powered clinical decision support system (CDSS) for the treatment of major depression. Here, we explore the use of a simulation centre environment in evaluating the usability of Aifred, particularly its impact on the physician–patient interaction.
Twenty psychiatry and family medicine attending staff and residents were recruited to complete a 2.5-h study at a clinical interaction simulation centre with standardised patients. Each physician had the option of using the CDSS to inform their treatment choice in three 10-min clinical scenarios with standardised patients portraying mild, moderate and severe episodes of major depression. Feasibility and acceptability data were collected through self-report questionnaires, scenario observations, interviews and standardised patient feedback.
All 20 participants completed the study. Initial results indicate that the tool was acceptable to clinicians and feasible for use during clinical encounters. Clinicians indicated a willingness to use the tool in real clinical practice, a significant degree of trust in the system's predictions to assist with treatment selection, and reported that the tool helped increase patient understanding of and trust in treatment. The simulation environment allowed for the evaluation of the tool's impact on the physician–patient interaction.
The simulation centre allowed for direct observations of clinician use and impact of the tool on the clinician–patient interaction before clinical studies. It may therefore offer a useful and important environment in the early testing of new technological tools. The present results will inform further tool development and clinician training materials.
• To examine the clinical symptoms and functional capacity of the patients.
• To evaluate the cognitive dysfunctions and to see how they develop in 6 month.
• To examine the relationship between clinical and functional capacity and the cognitive dysfunctions of the chronic schizophrenia patients.
24 people with chronic schizophrenia were followed up 6 month along with a control group of 50 individuals free from schizophrenia. Patients were diagnosed using DSM-IV criteria, assessed with the PANSS, GAF, to evaluate psychiatric symptoms, respectively functionality. Rey Memory Test, Trail Making, Spatial Recognition Memory (SRM),Spatial Working Memory (SWM), Paired Associated Learning (PAL), Spatial Spam (SSP) and Stoking of Cambridge (SOC) from the CANTAB were applied to all patients at the start point of the study and after 6 month, in order to evaluate the cognitive functions.
The overall performance of chronic schizophrenia patients was significantly lower compared to healthy individuals on all cognitive tasks. the cognitive dysfunction is independent of age and intellectual level, but does correlate with global functioning and remain stable. CANTAB is a useful tool to detect and estimate the cognitive impairments.
The current study reveals that cognitive impairments are a central feature of schizophrenia and a major cause of poor functioning of the patients. the chronic schizophrenia patients perform worse on all investigated cognitive domains (memory, attention and executive function). the reviewed studies show different opinions about the development of these impairments. Further longitudinal studies are required in order to settle if they remain stable or progress in time.
Cognitive dysfunction represents an essentials feature of schizophrenia. Patients with schizophrenia have substantial memory deficits.
To examine memory deficits in first episode schizophrenia, characterise the nature of impairment and specify the relationships with the duration of untreated psychosis.
40 first episode schizophrenia patients admitted to the Second Psychiatric Clinic Cluj, Romania and 50 healthy controls were assessed with memory tests from CANTAB battery (Spatial Working Memory, Paired Associates Learning and Spatial Span) and with Rey Auditory Verbal Learning Test. The Positive and Negative Syndrome Scale (PANSS) was used to quantify symptom severity.
Statistical analysis: Results were analysed using SPSS 12 applying ANOVA, ANCOVA, chi square test and Pearson correlations. Duration of untreated psychosis was log10 transformed to reduce skew.
First episode schizophrenia patients scored significantly poorer then healthy subjects on all memory tests. Spatial working memory was impaired due to inadequate strategy use. Worse performance correlated with longer duration of untreated psychosis.
Impairments in memory are already present in first episode schizophrenia patients.
Purpose of our study was to evaluate the incidence of atherogenic profile, heart failure (HF) and if there is any correlation between these and cognitive impairment (CI) in patients with vascular dementia (VaD).
This was a retrospective study. We analyzed 35 patients with VaD and 25 age- and sex-matched healthy controls. NINDS-AIREN criteria and Hachinski's ischemic scale were used to identify VaD. Mini Mental State Examination was used to classify CI into mild, moderate and severe. Clinical and biochemical features were investigated by means of standardized tests. Echocardiography was done for evaluate ejection fraction (EF).
Prevalence of atherogenic profile was increased in VaD compared with controls (72.2% vs 20%, p<0.001). High LDL cholesterol, triglicerides and low HDL cholesterol values were characteristic for VaD patients in the last 10 years. In present time we found low level for HDL cholesterol (34.1± 4.6 mg/dl vs 44.2± 5.8 mg/dl, p<0.001) and triglicerides (102.7± 7.5 mg/dl vs 154.2± 4.5 mg/dl, p<0.01) when compared with controls. 8 patients had mild CI, 2 of them had HF class II and 6 had class III NYHA, with EF in normal limits. 23 patients had moderate CI and low EF; 7 of them had HF class III and 16 had class IV NYHA. 4 patients with severe CI had very low EF and HF class IV NYHA. We found correlations between EF, triglicerides and CI.
The prevalence of atherogenic profile and heart failure were significantly higher in VaD and were correlated with cognitive impairment.
Schneider's first-rank symptoms have been connected to the diagnosis of Schizophrenia for decades. More recently, these types of symptoms have also been described in other types of psychosis, including affective psychosis. In general, current research focuses on the relationship between Schneider's first-rank symptoms and the subsequent clinical course, i.e. their role in the prognosis of the disorder.
To determine how the presence of Schneider's first-rank symptoms in psychosis can influence the evolution of the disorder.
We analyzed a group of subjects (N = 106) who had a first-episode psychosis between 1995-1998. This group was divided into two subgroups: one that presented Schneider's first-rank symptoms (N = 70) and another group (N = 36) without these symptoms. The groups were compared in terms of subsequent evolution. It is worth noting that this study only included subjects who were currently in active psychiatric follow-up in the outpatient service.
There are differences between the two groups in terms of clinical parameters (age, onset, educational level, employment and family status, clinical diagnosis) and disorder progression (number of admissions), but without any statistically significant differences in the first 10 years of evolution. The existence of transparency-influence symptoms in a first-episode psychosis correlates with an increase in the number of hospital admissions after 10 years of evolution.
The transparency-influence phenomena are correlated with an increase in the number of hospital admissions across the longitudinal evolution.
Sleep disturbance is common among patients with Parkinson's disease and occurs in approximately two thirds of patients.
The main objective of this study was to examine the prevalence of sleep disturbances in patients with Parkinson's disease in Romania.
To asses risk factors associated with excessive daytime sleepiness and nocturnal sleep disorders.
44 consecutive inpatients with Parkinson's disease (41% females) were included in a study of non-motor symptoms, including sleep disturbances. All participants responded to the Parkinson's Disease Sleep Scale (PDSS), where an overall score below 82 or a score below 5 on a sub-item indicate sleep disturbances. Factors associated with sleep were also investigated, with special emphasis on severity of Parkinson's disease, fatigue, mental health and restless legs syndrome (RLS).
The mean age was 67.8 years (range 35-74); the mean Hoehn and Yahr stage was 2.4 (SD 0.8), and the mean UPDRS part III was 22.6 (SD 11.5). Sleep disturbances were common among patients with Parkinson's disease. While only 17% of the sample had an overall score below 82 on the PDSS, 70% of the patients had a score below 5 on one item. There was no significant association between Parkinson's disease severity and any of the sleep items in the PDSS.
The current findings call for increased awareness of sleep problems in patients with Parkinson's disease, especially focusing on the association with mental health problems, fatigue and RLS.
The ability to recognize emotion is part of social cognition, a frequently analyzed parameter nowadays in the psychotic spectrum and also in other psychiatric disorders. The importance of this parameter is due to its facilitating role for psychotherapy and also by the role it plays for the social functioning of a person.
The evaluation of the relationship between emotion recognition and neurocognition in subjects with Bipolar Disorder.
The development of some specific intervention programs for subjects with Bipolar Disorder.
A group of subjects (n=34) with Affective Bipolar Disorder, according to ICD 10, was analyzed. The subjects had a clinical evolution between 5 and 10 years and they clinically presented psychotic symptoms. The parameters analyzed were: socio-demographical ones, neurocognition (attention, memory, executive function) and social cognition (emotion recognition ability).
A statistical significant correlation exists between the subjects ability to recognize ‘Joy’ and ‘Love’ (Spearman R = 0.403, p < 0.05). This shows a connection between these two emotions. Also there is a significant correlation between neurocognition and performance in emotion recognition (Spearman R = −0.504 and Spearman R = −0.421, p < 0.05).
Subjects with Bipolar Disorder show a lowered ability to be attentive, a decreased speed for processing information and a reduced performance in executive functions that are correlated with difficulties in recognizing emotions.
Children's beliefs regarding mental disorders depend on their age, but also on their education and contact with this field.
The study aims to explore children's knowledge and views on mental disorders, focusing on the definition and causes of mental illness and the way they perceive people with mental disorders.
Material and method
A sample of 41 children aged 12-14 was analyzed. They completed a questionnaire designed by the authors including demographic data (age, gender), yes/no questions and open-ended questions about mental disorders. Data were analyzed quantitatively and qualitatively.
Most of the children described mental disorder in terms of thinking or behavioural disturbances, like 'not thinking clearly”, 'acting differently or abnormally” or 'a problem affecting the brain”. When asked to give examples of mental disorders, Alzheimer's Disease and Schizophrenia were the most frequently mentioned. The subjects believed that mental disorders can be caused by trauma, stress, environmental factors or family conflicts. Some of them thought that they are congenital or hereditary. 66% of the children do not know any person having a mental disorder. The ones who had contact with someone suffering from a mental illness were more informed about the subject. 69% of them thought that persons with mental disorders are dangerous and 7% that they are contagious.
Many children have little or no information about mental disorders, leading to false beliefs and stigma. Thus, education in this field and mental health promotion need to start at a young age.
Depression and apathy are among the most common psychiatric and behavioral disorders associated with Parkinson’s disease (PD). This two psychiatric disorders are major determinants of quality of life for patients with Parkinson’s disease.
The main objective of this study was to establish the prevalence and demographic and clinical correlates of depression and apathy in a sample of inpatients with Parkinson’s disease.
To identify depression and apathy in a group of patients diagnosed with Parkinson’s disease and to allow appropriate treatment to improve their quality of life.
A number of 44 inpatients with Parkinson’s disease were investigated with the Starkstein’s Apathy Scale (AS), the 17-item Hamilton Depression Rating Scale (HDRS-17), the Hoehn and Yahr staging (HY), the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Mini -Mental State Examination (MMSE).
Apathy coexisted with depression in 34.1% of PD patients, compared with depression without apathy in 4.6%, and apathy without depression in 22.7%. Apathy was associated with higher UPDRS score, lower MMSE score and earlier HY stages. Depression was correlated with more advanced HY stages and younger age of patients with Parkinson’s disease.
Apathy and depression are common in patients with Parkinson’s disease. Therefore these two conditions should be screened and considered in the management of patients with Parkinson’s disease.
The recurrence of episodes of mania and/or depression is a feature of bipolar affective disorder and it interferes with neurocognitive performance.
Identifying specific domains of cognitive dysfunction for manic episodes in bipolar affective disorder.
Improving life quality of bipolar patients with cognitive deficits.
60 bipolar (HAMD score >= 17, manic/hippomanic: YMRS score >= 12, euthymic: 6 month of remission, HAMD score < = 8, YMRS score < = 6) patients (DSM IV TR). The cognitive battery included standardized test of IQ, attention, working memory, visual memory, verbal memory and executive functioning. Demographic data, data about family history, psychiatric history, past/current treatment, history of psychosis, duration of illness, age of onset were collected. We analyzed statistically these data and identified specific domains of cognitive dysfunction for manic episode.
Stable and lasting cognitive impairments involving executive functioning (working memory, executive control, verbal fluency, mental manipulation and cognitive flexibility), verbal learning and memory and attention are evident across all phases of illness. Sustained attention (vigilance) is impaired in bipolar patients regardless of whether they are studied during periods of mania or depression. Performances on task that tapes domains of verbal learning and memory, and sustained attention were particularly impaired in manic patients.
There are persistent cognitive deficits over the course of bipolar affective disorder and specific cognitive impairment of each phase of the illness, like mania. This study identified several important risk factors that may moderate these cognitive deficits in manic patients.
Ischemic stroke can lead to heart injury via dysfunction of the autonomic nervous system. QT intervals on electrocardiography (ECG) are susceptible to autonomic influences and their prolongation was associated with increased mortality after stroke.
We aimed to study QT intervals in patients with ischemic stroke in chronic phase with and without cognitive impairment.
ECGs were recorded in 50 patients with ischemic stroke. QT interval corrected for heart rate (QTc), QT dispersion (QTd), and QT interval variability (QTIV) were measured. The QTVI was calculated as the logarithm of the ratio between the variances of the normalized QT and RR intervals. Using Mini Mental State Examination and Hachinski's ischemic scale we identified vascular dementia (VaD) in 17 patients. Twenty age-matched healthy subjects were examined for comparison.
We identified QTc, QTd prolongation in patients with ischemic stroke. Comparing patients with ischemic stroke vs. VaD, QTc (412 ±75.2 ms vs 456± 115 ms, p<0.01) and QTd (64±14ms vs 154±69 ms, p<0.0001) were more prolonged in VaD. QTVI were generally increased in ischemic stroke patients compared with healthy subjects (p<0.05) but the differences with high statistical significance level were found in VaD patients (p<0.001). We found correlation between QTd, QTVI, hypertension, diabetes, arrhythmia and cognitive impairment.
Prolongation of QT intervals and increased QTVI occurs frequently after ischemic stroke but most significant changes were found in patients with cognitive impairment. Early detection of cognitive impairment in stroke patients provides better prevention of possible dementia.
Stigma and discrimination are associated with psychiatric disorders throughout the world. Several surveys have shown that the general population has limited knowledge about mental illness and holds unfavorable attitudes toward people with mental disorders and that physicians and medical students endorse this stereotypical views and negative attitudes.
The objective of this study was to determine the attitudes of medical students towards mental illness by comparing those who have had contact with mental patients and those who have not and to evaluate the impact of an educational intervention designed to reduce stigma.
A case vignette and two dependent measures (social distance and dangerousness scale) were used to assess the attitude of medical students toward mental illness. An educational program was developed to change attitudes towards mental illness and was conducted on 140 medical students from University of Medicine and Pharmacy ‘Iuliu Hatieganu’, Cluj-Napoca, Romania (70 from first year and 70 from sixth year) using a pre- and post-questionnaire study design. A similar study without the educational program was conducted on 140 medical students as controls.
The final year students who had knowledge and contact with patients were less stigmatizing toward mentally ill patients. After the programs statistically significant change in attitude toward mental illness were observed. No significant change was observed in the control group.
The education of medical students and their attitudes toward people with mental illness play a crucial role and may represent a further step in creating clinical practices with an antistigma orientation.
Current research shows that subjects with disorders belonging to the schizophrenia spectrum have a poor social functioning. There are several factors that can influence social functioning, social cognition being one of them.
Assessing the ability to identify emotions and its role in the social functioning of subjects with a schizophrenia spectrum diagnosis.
Increasing the social functioning of subjects with a schizophrenia spectrum diagnosis.
We evaluated 31 subjects who were at their first admission to the Timisoara psychiatric clinic and who met the diagnostic criteria for a schizophrenia spectrum disorder (a diagnosis of F20, F22 or F25 according to ICD 10). The following parameters were monitored: sociodemographic (gender, age of onset, educational level, marital and professional status), theory of mind (Reading the Mind in the Eyes Test) and social functioning (GAF Scale). The subjects were evaluated during periods of remission. The acquired data was statistically processed.
The results of the sociodemographic parameters analysis were similar to those in international literature. Most subjects showed a lack of theory of mind (a mean score of 18, standard deviation 5.84). All subjects experienced a decrease in social functioning (a mean score of 64.7 on the GAF Scale). There is a direct correlation between the ability to identify emotions and social functioning (Spearman R = 0.386, P < 0.05).
A decreased ability to identify emotions is directly correlated with decreased social functioning in subjects with schizophrenia spectrum disorders.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Oncology-related illnesses have become quite frequent in our lives. Lately, medical progress in the field of oncology has led to an increase in the survival rates of people diagnosed with cancer. The minimisation of disturbances in the lives of these people is done by each on their own, by using defence mechanisms and coping skills.
To identify the coping and defence mechanisms of subjects diagnosed with cancer compared with non-clinical subjects.
To increase quality of life of subjects diagnosed with cancer through psychotherapy interventions.
Nineteen subjects diagnosed with cancer who were receiving chemotherapy were recruited to the study. For comparison, a control group of non-clinical participants were also recruited. Participants were included into the study according to particular inclusion/exclusion criteria. The evaluation was conducted during 2014 and consisted of the analysis of the following parameters: socio-demographic data, clinical data, defence mechanisms (DSQ-60) and coping mechanisms (COPE scale).
The group of subjects diagnosed with cancer demonstrated the presence of defence mechanisms of the following type: passive aggressiveness, projection and coping mechanisms that were characterised by an emphasis on social support. The control group had defence mechanisms of the following types: repression, denial and coping mechanisms that focused on emotions.
There are differences in defence and coping mechanisms between subjects with cancer compared to the non-clinical group. It may be that defence and coping mechanisms can be optimized through psychotherapy interventions to increase quality of life.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The aim of this study is to conduct an extended surface and cross-section characterization of a denture base acrylic resin subjected to 500, 650, and 750 W microwave irradiation for 2, 3, and 5 min to assess its morphological modifications. A commercial heat-cured powder was polymerized according to the manufacturer’s specifications and distributed into 20 circular samples. A stainless-steel wire was partially embedded in half of the discs, in order to investigate the metal–polymer interface. High-resolution scanning electron microscopy (SEM) imaging, white light interferometry, roughness measurements and Fourier transform infrared spectrometry were employed for morphological and structural evaluation of the irradiated polymer. Superficial adaptation was discovered after 5 min exposure at 500 W, 650 W, and 750 W, revealing significant roughness correction for 750 W. SEM characterization revealed the inner alteration of the resin for the 750 W protocol and a metal–polymer gap developed regardless of the irradiation conditions. The considerable temperature fluctuations that the samples were subject to during the experiments did not essentially change the poly(methyl-methacrylate) bond structure.
A major difficulty hampering the accuracy of UV/optical star formation rate tracers is the effect of interstellar dust, absorbing and scattering light produced by both young and old stellar populations (SPs). Although empirically calibrated corrections or energy balance SED fitting are often used for fast de-reddening of galaxy stellar emission, eventually only radiative transfer calculations can provide self-consistent predictions of galaxy model spectra, taking into account important factors such as galaxy inclination, different morphological components, non-local heating of the dust and scattered radiation. In addition, dust radiative transfer can be used to determine the fraction of monochromatic dust emission powered by either young or old SPs. This calculation needs to take into account the different response of the dust grains to the UV and optical radiation field, depending on the grain size and composition. We determined the dust heating fractions, on both global and local scales, for a high-resolution galaxy model by using our 3D ray-tracing dust radiative transfer code “DART-Ray”. We show the results obtained using this method and discuss the consequences for star formation rate indicators.
DART-Ray is a 3D ray-tracing dust radiative transfer (RT) code that can be used to derive stellar and dust emission maps of galaxy models and simulations with arbitrary geometries. In addition to the previously published RT algorithm, we have now included in DART-Ray the possibility of calculating the stocastically heated dust emission from each volume element within a galaxy. To show the capabilities of the code, we performed a high-resolution (26 pc) RT calculation for a galaxy N-body+SPH simulation. The simulated galaxy we considered is characterized by a nuclear disc and a flocculent spiral structure. We analysed the derived galaxy maps for the global and local effects of dust on the galaxy attenuation as well as the contribution of scattered radiation to the predicted observed emission. In addition, by performing an additional RT calculation including only the stellar volume emissivity due to young stellar populations (SPs), we derived the contribution to the total dust emission powered by young and old SPs. Full details of this work will be presented in a forthcoming publication.
The current report describes the installation and the preliminary commissioning of the Material Science Powder Diffraction (MSPD) beamline at the Spanish synchrotron ALBA-CELLS. The beamline is fully dedicated to powder diffraction techniques and consists of two experimental stations positioned in series: a High Pressure/Microdiffraction station and a High Resolution/High Throughput powder diffraction station.
A heuristic greedy algorithm is developed for efficiently tiling spatially dense redshift surveys. In its first application to the Galaxy and MassAssembly (GAMA) redshift survey we find it rapidly improves the spatial uniformity of our data, and naturally corrects for any spatial bias introduced by the 2dF multi-object spectrograph. We make conservative predictions for the final state of the GAMA redshift survey after our final allocation of time, and can be confident that even if worse than typical weather affects our observations, all of our main survey requirements will be met.