Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.

To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.

Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.

Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.

AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.

An accurate estimate of the average number of hand hygiene opportunities per patient hour (HHO rate) is required to implement group electronic hand hygiene monitoring systems (GEHHMSs). We sought to identify predictors of HHOs to validate and implement a GEHHMS across a network of critical care units.

Multicenter, observational study (10 hospitals) followed by quality improvement intervention involving 24 critical care units across 12 hospitals in Ontario, Canada.

Critical care patient beds were randomized to receive 1 hour of continuous direct observation to determine the HHO rate. A Poisson regression model determined unit-level predictors of HHOs. Estimates of average HHO rates across different types of critical care units were derived and used to implement and evaluate use of GEHHMS.

During 2,812 hours of observation, we identified 25,417 HHOs. There was significant variability in HHO rate across critical care units. Time of day, day of the week, unit acuity, patient acuity, patient population and use of transmission-based precautions were significantly associated with HHO rate. Using unit-specific estimates of average HHO rate, aggregate HH adherence was 30.0% (1,084,329 of 3,614,908) at baseline with GEHHMS and improved to 38.5% (740,660 of 1,921,656) within 2 months of continuous feedback to units (P < .0001).

Unit-specific estimates based on known predictors of HHO rate enabled broad implementation of GEHHMS. Further longitudinal quality improvement efforts using this system are required to assess the impact of GEHHMS on both HH adherence and clinical outcomes within critically ill patient populations.

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.

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.

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.