To determine whether combinations of diagnosis and procedures codes can improve the detection of prosthetic hip and knee joint infections from administrative databases.

We performed a validation study of all readmissions from January 1, 2010, until December 31, 2016, following primary arthroplasty comparing the diagnosis and procedure codes obtained from an administrative database based upon the International Classification of Disease, Tenth Revision (ICD-10) to the reference standard of chart review.

Four tertiary-care hospitals in Toronto, Canada, from 2010 to 2016.

Individuals who had a primary arthroplasty were identified using procedure codes.

Chart review of readmissions identified the presence of a prosthetic joint infection and, if present, the surgical procedure performed.

Overall, 27,802 primary arthroplasties were performed. Among 8,844 readmissions over a median follow-up of 669 days (interquartile range, 256–1,249 days), a PJI was responsible for or present in 586 of 8,844 (6.6%). Diagnosis codes alone exhibited a sensitivity of 0.88 (95% CI, 0.85–0.92) and positive predictive value (PPV) of 0.78 (95% CI, 0.74–0.82) for detecting a PJI. Combining a PJI diagnosis code with procedure codes for an arthroplasty and the insertion of a peripherally inserted central catheter improved detection: sensitivity was 0.92 (95% CI, 0.88–0.94) and PPV was 0.78 (95% CI, 0.74–0.82). However, procedure codes were unable to identify the specific surgical approach to PJI treatment.

Compared to PJI diagnosis codes, combinations of diagnosis and procedure codes improve the detection of a PJI in administrative databases.

Fluoroquinolones (FQs) and extended-spectrum cephalosporins (ESCs) are associated with higher risk of Clostridioides difficile infection (CDI). Decreasing the unnecessary use of FQs and ESCs is a goal of antimicrobial stewardship. Understanding how prescribers perceive the risks and benefits of FQs and ESCs is needed.

We conducted interviews with clinicians from 4 hospitals. Interviews elicited respondent perceptions about the risk of ESCs, FQs, and CDI. Interviews were audio recorded, transcribed, and analyzed using a flexible coding approach.

Interviews were conducted with 64 respondents (38 physicians, 7 nurses, 6 advance practice providers, and 13 pharmacists). ESCs and FQs were perceived to have many benefits, including infrequent dosing, breadth of coverage, and greater patient adherence after hospital discharge. Prescribers stated that it was easy to make decisions about these drugs, so they were especially appealing to use in the context of time pressures. They described having difficulty discontinuing these drugs when prescribed by others due to inertia and fear. Prescribers were skeptical about targeting specific drugs as a stewardship approach and felt that the risk of a negative outcome from under treatment of a suspected bacterial infection was a higher priority than the prevention of CDI.

Prescribers in this study perceived many advantages to using ESCs and FQs, especially under conditions of time pressure and uncertainty. In making decisions about these drugs, prescribers balance risk and benefit, and they believed that the risk of CDI was acceptable in compared with the risk of undertreatment.

Low platelet MAO-B activity has been associated with various forms of impulsive behaviour and suicidality. The present study investigated the relationship between MAO-B activity in platelets and aspects of suicidality in depressed patients and controls.

In 87 patients with affective spectrum disorders (58% suffering from a Major Depressive Episode - MDE) the potential association between platelet MAO-B activity and suicidality was examined. 59 of the patients had committed suicide attempt recently (SA - “suicide attempters”), 28 patients were acutely depressed without having shown suicidal thoughts or suicidal behaviour in the past (NA - “non suicide attempters”).

SA and NA were comparable as to their diagnoses and general demographic and psychopathological parameters. MAO-B activity did not differ between SA and NA. No systematic correlations existed between MAO-B activity and any dimensions of suicidal behaviour or psychopathology. As a single finding only a weak positive association of higher MAO-B activity in SA with a fatal intention of the suicide attempt was observed.

Our findings do not support a consistent association of platelet MAO-B activity and suicidal behaviour in general, but specific facts of suicidality might be associated.

In the treatment of MDD, insufficient treatment outcome and the delayed onset of action still remain major problems.

Measuring plasma concentrations, i.e. TDM is a possible option to improve therapeutic outcomes.

The aim of this prospective and naturalistic study was to evaluate the economic and clinical benefit of TDM for depressed inpatients treated with citalopram.

Inpatients with MDD according to ICD-10 were included and treated with citalopram. Psychopathology was assessed by the 17-item Hamilton Depression (HAMD-17) rating scale in weekly intervals for five weeks. In parallel, serum concentrations of citalopram were measured.

55 patients were included (27f). 84% of the patients with citalopram plasma concentrations below 50 ng/ml (n = 36) were non-responders in week five. Among patients who achieved plasma concentrations ≥50 ng/ml (n = 19) on day 7, 47% became responder at week five (p = 0.025). Patients with plasma levels ≥50 ng/ml had a significantly shorter duration of hospitalization (49 ± 20) than patients below 50 ng/ml (72 ± 37; p = 0.033).

Our results show that citalopram plasma levels above 50 ng/ml are predictive for later treatment outcome and that TDM is cost effective due to reduced duration of hospitalization.

A significant part computer game players and internet users show clinical features of abuse and addiction (loss of control, withdrawal symptoms, tolerance, continuation of game play even with increasing negative consequence in social and academic life). Similar mechanisms are suggested to underlie the pathogenesis and maintenance of internet and computer game addiction and substance-related addictions.

Neuroscientific research on internet and computer game addiction is sparse, yet emerging. To review previous studies is the objective of the present project.

We aim to identify common findings regarding the neurophysiological processes underlying internet and computer game addiction. This could be helpful for establishing a sound model for these emerging disorders.

Neuroscientific studies on internet and computer game addiction were systematically searched in “Pubmed”, “Google scholar” and “PsychInfo”. Titles were examined first to screen potential articles, followed by abstracts, and then manuscripts were downloaded. The reference sections of downloaded manuscripts were examined for additional references not located in the searches.

Neuroscientific research on internet and computer game addiction is mainly located in the Asian area, probably due to a higher regional prevalence. Methodologies range from ERP, resting state EEG, resting state fMRI, VBM to PET, investigating very different concepts of addiction, including impulsivity, craving, reward processing and cue-reactivity.

Addicted internet and computer game users are overall suggested to have altered brain mechanisms similar to individuals with substance addictions. However, a sound model on the neurophysiologic alterations has not been established yet.

En psychiatrie, la contention médicale reste une pratique courante qui peut s’avérer traumatisante pour le patient. Elle doit toujours être associée à une sédation. Nous avons voulu réaliser un état des lieux de cette prise en charge médicamenteuse dans notre établissement.

Pendant 1 mois (janvier 2015), nous avons ciblé les patients sous énoxaparine sodique en préventif grâce au logiciel de prescription (Pharma®). Pour chaque patient, nous avons vérifié qu’il s’agissait bien d’une contention physique. Puis, une analyse des traitements prescrits était réalisée (médicaments, associations, posologies…).

Quatorze patients ont été inclus dans l’étude (8 hommes et 6 femmes, âge moyen : 33 ans). En moyenne, les patients ont été contenus 4 jours [1–10], l’énoxaparine sodique a été initié 24 h [0–72] après le début de la contention et administré pendant 2 jours [0–6]. Les patients ont reçu entre 0 et 3 antipsychotiques différents (cyamémazine, lévomépromazine et halopéridol) indiqués dans les états psychotiques aigus dont le plus prescrit était le cyamémazine (10/14 patients) à une posologie moyenne de 50 mg à j1, 115 mg à j2 et j3. Concernant les benzodiazépines, les patients ont reçu en moyenne une seule benzodiazépine et principalement le lorazépam (7/14) à une posologie de 4 mg à j1, 5,5 mg à j2 et j3 ou le diazépam (4/14) à une posologie de 7,5 mg à j1, 22,5 mg à j2 et 27,5 mg à j3.

Les patients contenus reçoivent donc peu de psychotropes, à posologies faibles par rapport aux doses habituelles en psychiatrie (exemple : cyamémazine jusqu’à 600 mg). Un groupe de travail sur la contention en psychiatrie est actuellement en cours dans l’établissement afin d’émettre des recommandations sur les modalités de prescription des psychotropes pour éviter une contention physique durable.

Joint hypermobility syndrome (JHS) has repeatedly been associated with anxiety and anxiety disorders, fibromyalgia, irritable bowel syndrome and temporomandibular joint disorder. However, the neural underpinnings of these associations still remain unclear. This study explored brain responses to facial visual stimuli with emotional cues using fMRI techniques in general population with different ranges of hypermobility.

Fifty-one non-clinical volunteers (33 women) completed state and trait anxiety questionnaire measures, were assessed with a clinical examination for hypermobility (Beighton system) and performed an emotional face processing paradigm during functional neuroimaging.

Trait anxiety scores did significantly correlate with both state anxiety and hypermobility scores. BOLD signals of the hippocampus did positively correlate with hypermobility scores for the crying faces versus neutral faces contrast in ROI analyses. No results were found for any of the other studied ROIs. Additionally, hypermobility scores were also associated with other key affective processing areas (i.e. the middle and anterior cingulate gyrus, fusiform gyrus, parahippocampal region, orbitofrontal cortex and cerebellum) in the whole brain analysis.

Hypermobility scores are associated with trait anxiety and higher brain responses to emotional faces in emotion processing brain areas (including hippocampus) described to be linked to anxiety and somatic symptoms. These findings increase our understanding of emotion processing in people bearing this heritable variant of collagen and the mechanisms through which vulnerability to anxiety and somatic symptoms arises in this population.

A proinflammatory state in a subgroup of depressed patients has been reported repeatedly (e.g. increased interleukin-6 and tumour necrosis factor-alpha). COX-2 inhibitors down-regulate increased inflammatory markers and are therefore investigated as an add-on therapy in depression. Proinflammatory cytokines and/or kynurenine metabolites may predict the outcome of treatment with COX-2 inhibitors.

To prove or disapprove the hypothesis of a better therapy response in the group of add-on celecoxib to sertraline, particularly in patients with a more pronounced proinflammatory state at baseline. The aim is to find a biological predictor (cytokines and/or kynurenine metabolites) for treatment outcome.

This is a dual-center, randomized, double-blind, placebo-controlled, parallel group phase IIa study. It investigates the mean change in clinical outcome and in serum cytokine and kynurenine levels from baseline to endpoint (week 6) in patients with major depression (HAMD-17 ≥ 22) treated with sertraline plus celecoxib versus sertraline plus placebo for six weeks. 51 depressed patients of both gender, aged between 18 and 60 years without any recent inflammatory disease were enrolled. The study comprises six study visits (6x ratings, 3x blood collections) during six weeks of treatment and a follow-up visit 10 weeks after baseline. Cytokines were measured by Enzyme-linked Immunosorbent Assay (ELISA), kynurenine and its metabolites by High Performance Liquid Chromatography (HPLC).

The study was completed quite recently and the results are in progress.

Transcranial direct current stimulation (tDCS) is currently discussed as a therapeutic intervention in various psychiatric disorders. Based on the report about the effectiveness of tDCS in a patient with catatonic schizophrenia, we applied bilateral prefrontal tDCS in a patient with corpus callosum aplasia (CCA) and severe catatonia instead of maintenance electroconvulsive therapy (ECT).

To investigate whether tDCS can replace ECT in a largely treatment-resistant patient.

The 41 year-old male patient showed severe catatonic symptoms since adolescence and was treated by weekly ECT for almost 6 years. Due to cardiac complications and increasing cognitive deficits caused by long-term ECT and weekly anesthesia, tDCS was suggested. The anode was positioned over the left dorsolateral prefrontal cortex (DLPFC), the cathode over the right DLPFC. 2mA tDCS was delivered for 2x 20 minutes (90 minutes break in between), three times a week for the first two weeks, thereafter once to twice weekly. Concomitant medication (clozapine 600 mg/d, aripiprazole 10 mg/d, pirenzepine 50 mg/d, lorazepam 3 mg/d) was continued.

So far, more than 20 double sessions of tDCS were applied. ECT was needed once after a period of hospitalisation for 10 days due to pneumonia. Since then the patient has solely received tDCS for more than 13 weeks. Catatonic symptoms resolved further under tDCS compared to ECT (Bush-Francis Catatonia Rating Scale: 27/69 points during ECT, 5/69 during tDCS).

tDCS in combination with neuroleptic treatment could be an alternative to ECT in organic catatonia. Further studies are needed to support our hypothesis.

A proinflammatory state in a subgroup of depressed patients has been reported repeatedly, for example an increase in interleukin-6 and tumour necrosis factor-a is well documented. Treatment with COX-2 inhibitors down-regulate increased inflammatory markers. Therefore an adjunctive treatment of depression with COX-2 in combination with an antidepressant might lead to a better clinical outcome.

To prove or disapprove the hypothesis of a better clinical outcome in the group with add-on celecoxib to sertraline in terms of improvement of HamD-17 and MADRS scores from baseline to endpoint.

This is a dual-center, randomized, double-blind, placebo-controlled, parallel group phase IIa study to investigate the mean change in clinical outcome and in serum expression of inflammation markers from baseline to endpoint (week 6) in patients with major depression (HAMD-17 ≥ 22) treated with celecoxib in combination with sertraline compared to sertraline combined with placebo. 51 depressed patients of both gender, aged between 18 and 60 without any recent inflammatory related disease were enrolled. The study comprises six study visits (6x ratings including HAMD-17 and MADRS, 3x blood collections) during six weeks of treatment and a follow-up visit 10 weeks after baseline.

The study was completed quite recently and the results are in progress.

Recent studies have shown that psychopathological rating by the Hamilton Depression Rating scale (HAMD) is well established and highly predictive for later response. in this study we aimed to find out if Clinical Global Impression (CGI) scale is suitable to guide antidepressive treatment under naturalistic conditions.

Inpatients with a major depressive disorder and treatment with citalopram were included and rated using in parallel the HAMD scale and the CGI scale weekly at baseline to day 35. According to CGI the sample has been divided in “CGI improver” (CGI = 2–4) and “CGI non-improver” (CGI = 5–6). Response was defined as HAMD sum score reduction by at least 50%.

55 patients were included. A HAMD score reduction of ≥24% on day 14 was highly predictive (p = 0.016) for both response and non-response on day 35. Among patients who improved on CGI scale at week two 33% became responder at week five vs 44% when improvement on HAMD scale was achieved. HAMD sum scores correlated well on the CGI scale (53–74%, p = 0.000). Patients who were “improved” according to CGI scale on day 14 exhibited less reduction on the HAMD scale on day 35 than patients who were “improved” according to HAMD (35% vs 46%, respectively). CGI rating on day 14 predicted response on day 35 with only 44% specificity (p = 0.255).

Our findings revealed that the CGI rating scale is not predictive for later response on day 35.