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There is increasing recognition of the mental health needs of elite athletes and sports professionals. The first of its kind, this important new book draws on lived experience from professional athletes bringing together the latest evidence-based research on severe mental illness recognition and management within elite sport. Each chapter focuses on a different sport with a case-study example to guide you through diagnosis and developing a biopsychosocial management plan, followed by self-assessment tools at the end of each case to help consolidate your learning. Each chapter has been co-authored by a mix of psychiatrists, sports medicine specialists and allied health care professionals to bring a diverse range of professional opinions and insights relating to optimising athlete mental health. Each chapter also features the unique perspective of a professional athlete from that sport, to gain insight from lived experience.
Absconding by patients from acute psychiatric wards is a high risk behavior profile in mental medical centers. Being admitted to an acute ward is a stressful event for the patient, accompanied by pathological psychiatric symptomatology, separation from family and familiar environment, adjustment to the environs of ward, the treatment process itself and the loss of autonomy over everyday life. Absconding by patients presents a legal, social and treatment challenge for caregivers. Absconding means abrupt stopping of medication and therapeutic processes, need for police and legal systems interference and worry for the family. Moreover, absconding disposes major safety issues for the patient and his surroundings.
This abstract summarizes prospective study in two mental health centers. Every absconding was mapped within 48 hours of occurrence. Mapping was carried out by a trained team member filling out a structured form.
Study goal: Collecting data and identifying absconders' characteristics, comparing absconders' data from the two centers, pointing out significant ward or hospital variables affecting absconding and comparing patient and staff apprehension of the event.
The study collected data of 143 absconding patients, 33% of whom were in confined hospitalization. Most of them were young, single and of low socioeconomic status. Most escaped in the evening shift. There were no significant differences in patient variables between the 2 hospitals. Previous hospitalizations was higher in one of the hospitals (t=2.568, p= .013). There were more staff members in one of the hospitals (t=4.016, p<.0001). There were no difference between the day and the absconding shift.
Fibromyalgia syndrome (FMS) is associated with depressive disorders.
to investigate characteristics of FMS in a cohort of young women with premenstrual syndrome (PMS).
30 young patients with PMS were included and compared with 26 women who attended a gynecological outpatient clinic. Assessment included demographics, clinical health assessment questionnaire (CLINHAQ), fibromyalgia impact questionnaire (FIQ), sleep and fatigue questionnaires, Sheehan disability scales, SF-36 assessment for QoL, visual analogue scale (VAS) and MINI questionnaires were completed. Each patient underwent a physical examination.
The FIQ score of the PMS group was 33.09±18.48 vs. 8.6±12.62 (p<0.001).. The global pain scale was 3.92±2.96 vs. 1.29±2.2 (p<0.005). A sleep questionnaire scored in the PMS group compared to 12.6±7.8 vs. 7.46±5.3 (p<0.01) in the controls. The tenderness was measured by the number of tender point as defined in the ACR criteria of the FMS 3.13±4.36 v. 0.46±1.1 in the PMS groups compared to the controls (p<0.005), five PMS patients and none in the controls had clinical established FMS. Psychiatric comorbidity was significantly more common in the PMS group affecting 16 of the 30 PMS patients compared to only 3 of the 26 controls (χ2(1)=10.85) (p<0.005).
In this study group of patients PMS we detected higher levels of tenderness, higher psychiatric comorbidity, higher disabilities and lower QoL. All of these correlated with have a lower pain threshold.
Fibromyalgia syndrome (FMS) is characterized by widespread pain and diffuse tenderness. FMS is more prevalent in females rather than males, and among patients with major depression disorder (MDD).
to obtain better conception of linkage between depression, gender and FMS.
42 male and 42 age matched females, and age matched male and female healthy controls were evaluated for coexisting FMS. Each patient completed a questionnaire characterizing sleep quality, Sheehan Disability Scale (SDS) and SF-36 scale, Hamilton Depression rating scales (HDRS) and the CGI-S.
Disease parameters were worse for men as compared to women;
CGI-S: 5.4±1, vs. 4.0±1 (t=6.634, p<0.001), HDRS: 23.9±6 vs. 20.8±6 (t=2.304, p=0.024), respectively. Yet, FMS was more prevalent among depressed females. The SF-36, SDS and sleep quality scores were similar between males and females. A one way analysis of variance with gender and MDD revealed that both gender and disease were found to be significant contributing factors for the number of tender points (F=21.131, p<.0001; F=65.232, p<.0001, respectively). A one way analysis of covariance for tender points with CGI-S and HDRS as covariates revealed that gender was a significant factor regardless of depression severity. CGI-S and Hamilton scores correlated with tender points count in females but not in males.
Female gender is a risk factor for FMS in depressed population. Depression is associated with FMS among women but not among men. Among females, depression severity is significantly correlated to FMS severity. FMS is correlated to sleep quality and to QoL among depressed patients.
There is a shortage of psychiatrists worldwide. Within Europe, psychiatric trainees can move between countries, which increases the problem in some countries and alleviates it in others. However, little is known about the reasons psychiatric trainees move to another country.
Survey of psychiatric trainees in 33 European countries, exploring how frequently psychiatric trainees have migrated or want to migrate, their reasons to stay and leave the country, and the countries where they come from and where they move to. A 61-item self-report questionnaire was developed, covering questions about their demographics, experiences of short-term mobility (from 3 months up to 1 year), experiences of long-term migration (of more than 1 year) and their attitudes towards migration.
A total of 2281 psychiatric trainees in Europe participated in the survey, of which 72.0% have ‘ever’ considered to move to a different country in their future, 53.5% were considering it ‘now’, at the time of the survey, and 13.3% had already moved country. For these immigrant trainees, academic was the main reason they gave to move from their country of origin. For all trainees, the overall main reason for which they would leave was financial (34.4%), especially in those with lower (<500€) incomes (58.1%), whereas in those with higher (>2500€) incomes, personal reasons were paramount (44.5%).
A high number of psychiatric trainees considered moving to another country, and their motivation largely reflects the substantial salary differences. These findings suggest tackling financial conditions and academic opportunities.
Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease that has a wide variety of physical manifestations, including neuropsychiatric features. Bipolar disorder (BD) is a chronic, episodic illness, that may present as depression or as mania. The objective of this study was to investigate the association between SLE and BD using big data analysis methods.
Patients with SLE were compared with age- and sex-matched controls regarding the prevalence of BD in a cross-sectional study. Chi-square and t-tests were used for univariate analysis and a logistic regression model was used for multivariate analysis, adjusting for confounders. The study was performed utilizing the chronic disease registry of Clalit Health Services medical database.
The study included 5018 SLE patients and 25,090 matched controls. BD was found in a higher prevalence among SLE patients compared to controls (0.62% vs. 0.26%, respectively, P < 0.001). BD patients had a greater prevalence of smokers compared to non-BD patients (62.5% vs 23.5%, respectively, P < 0.001). In a multivariate analysis, smoking and SLE were both found to be significantly associated with BD.
SLE was found to be independently associated with BD. These findings may imply that an autoimmune process affecting the central nervous system among SLE patients facilitates the expression of concomitant BD.
This work analyses the viscous flow and elastic deformation created by the forced axial motion of a rigid cylinder within an elastic liquid-filled tube. The examined configuration is relevant to various minimally invasive medical procedures in which slender devices are inserted into fluid-filled biological vessels, such as vascular interventions, interventional radiology, endoscopies and laparoscopies. By applying the lubrication approximation, thin shell elastic model, as well as scaling analysis and regular and singular asymptotic schemes, the problem is examined for small and large deformation limits (relative to the gap between the cylinder and the tube). At the limit of large deformations, forced insertion of the cylinder is shown to involve three distinct regimes and time scales: (i) initial shear dominant regime, (ii) intermediate regime of dominant fluidic pressure and a propagating viscous-peeling front, (iii) late-time quasi-steady flow regime of the fully peeled tube. A uniform solution for all regimes is presented for a suddenly applied constant force, showing initial deceleration and then acceleration of the inserted cylinder. For the case of forced extraction of the cylinder from the tube, the negative gauge pressure reduces the gap between the cylinder and the tube, increasing viscous resistance or creating friction due to contact of the tube and cylinder. Matched asymptotic schemes are used to calculate the dynamics of the near-contact and contact limits. We find that the cylinder exits the tube in a finite time for sufficiently small or large forces. However, for an intermediate range of forces, the radial contact creates a steady locking of the cylinder inside the tube.
Despite extensive research, symptom structure of posttraumatic stress disorder (PTSD) is highly debated. The network approach to psychopathology offers a novel method for understanding and conceptualizing PTSD. However, extant studies have mainly used small samples and self-report measures among sub-clinical populations, while also overlooking co-morbid depressive symptoms.
PTSD symptom network topology was estimated in a sample of 1489 treatment-seeking veteran patients based on a clinician-rated PTSD measure. Next, clinician-rated depressive symptoms were incorporated into the network to assess their influence on PTSD network structure. The PTSD-symptom network was then contrasted with the network of 306 trauma-exposed (TE) treatment-seeking patients not meeting full criteria for PTSD to assess corresponding network differences. Finally, a directed acyclic graph (DAG) was computed to estimate potential directionality among symptoms, including depressive symptoms and daily functioning.
The PTSD symptom network evidenced robust reliability. Flashbacks and getting emotionally upset by trauma reminders emerged as the most central nodes in the PTSD network, regardless of the inclusion of depressive symptoms. Distinct clustering emerged for PTSD and depressive symptoms within the comorbidity network. DAG analysis suggested a key triggering role for re-experiencing symptoms. Network topology in the PTSD sample was significantly distinct from that of the TE sample.
Flashbacks and psychological reactions to trauma reminders, along with their strong connections to other re-experiencing symptoms, have a pivotal role in the clinical presentation of combat-related PTSD among veterans. Depressive and posttraumatic symptoms constitute two separate diagnostic entities, but with meaningful between-disorder connections, suggesting two mutually-influential systems.