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During the initial surge of the COVID-19 pandemic in the spring and summer of 2020, paediatric heart centres were forced to rapidly alter the way patient care was provided to minimise interruption to patient care as well as exposure to the virus. In this survey-based descriptive study, we characterise changes that occurred within paediatric cardiology practices across the United States and described provider experience and attitudes towards these changes during the pandemic. Common changes that were implemented included decreased numbers of procedures, limiting visitors and shifting towards telemedicine encounters. The information obtained from this survey may be useful in guiding and standardising responses to future public health crises.
Pharmaceutical treatment and psychotherapy constitute the most common treatment methods for depression and anxiety. Physical training has been shown to have comparable effect to cognitive behavioral therapy in treatment of mild to moderate depression and anxiety. Physically active individuals also show lower risks to develop depression and relapse in depression.
The objectives are to evaluate how physical activity can affect depressive and anxiety symptoms, by examining biomarkers in the blood and from the gut and also by measuring cognitive functions. Hopefully, this can lead to new treatment strategies for patients with depression and anxiety.
102 patients are randomized to two groups and undergo 12 weeks intervention as add-on to standard outpatient psychiatric treatment. The first group will participate in physical training three times per week and the other group will receive relaxation therapy on a weekly basis. Daily activity intensity will be measured before and at the last week of intervention with an accelerometer. Blood and faeces sample collection, symptom grading by clinician together with self-rating scales and cognitive screening will be performed at baseline, week 12 and one year of follow-up. The cognitive screenings are performed digitally in cooperation with Mindmore.
The RCT is currently recruiting patients at the Department of Psychiatry of Örebro University Hospital.
The project aims to be holistic in its approach, combining the defining clinical psychiatric symptoms in patients who have both depression and anxiety with the finding and evaluation of new biomarkers from blood and gut to improve cognitive functions.
Visual and auditory signs of patient functioning have long been used for clinical diagnosis, treatment selection, and prognosis. Direct measurement and quantification of these signals can aim to improve the consistency, sensitivity, and scalability of clinical assessment. Currently, we investigate if machine learning-based computer vision (CV), semantic, and acoustic analysis can capture clinical features from free speech responses to a brief interview 1 month post-trauma that accurately classify major depressive disorder (MDD) and posttraumatic stress disorder (PTSD).
N = 81 patients admitted to an emergency department (ED) of a Level-1 Trauma Unit following a life-threatening traumatic event participated in an open-ended qualitative interview with a para-professional about their experience 1 month following admission. A deep neural network was utilized to extract facial features of emotion and their intensity, movement parameters, speech prosody, and natural language content. These features were utilized as inputs to classify PTSD and MDD cross-sectionally.
Both video- and audio-based markers contributed to good discriminatory classification accuracy. The algorithm discriminates PTSD status at 1 month after ED admission with an AUC of 0.90 (weighted average precision = 0.83, recall = 0.84, and f1-score = 0.83) as well as depression status at 1 month after ED admission with an AUC of 0.86 (weighted average precision = 0.83, recall = 0.82, and f1-score = 0.82).
Direct clinical observation during post-trauma free speech using deep learning identifies digital markers that can be utilized to classify MDD and PTSD status.
In recent years the courts have become more involved in the psychiatric services in Israel. Data reveal a gradual increase in the rate of court ordered hospitalizations according to Section 15 of the Law for the Treatment of the Mentally Ill. This paper examines the implications of this trend while focusing on the issues of security and safety in psychiatric hospitals. The work presents highlights from extensive British experience with this issue, while focusing on the implications on forensic psychiatry in Israel. The development of the hierarchy of security in the British psychiatric services beginning with the early 1970's, with the establishment of the Butler Committee that determined a hierarchy of three levels of security for the treatment of patients and culminating with the establishment of principles for the operation of medium security units in Britain (Read Committee, 1991) is reviewed. Forensic psychiatric services in Britain are based on these developments.
We examine the current status of mental health facilities in Israel, and the relevance of the British experience to the Israeli situation. In our opinion, a safe appropriate environment is a necessary condition for an appropriate treatment setting. As is in several European countries we are suggesting the establishment of medium security forensic psychiatry departments within a mental health facility that will enable concentration and classification of court ordered admissions as well as systemic flexibility and capacity for better treatment, commensurate with patient needs.
Neuropsychiatric symptoms and behavioral disturbances in dementia (BPSD) are key symptoms of AD, adds to cognitive decline and causes an increased caregivers burden. Antipsychotics provide a limited treatment option and acetylcholineesterase inhibitors (AchEI) also show beneficial effects in treatment of BPSD.
To compare treatment effects between AchEI (galantamine, GAL) and antipsychotics (risperidone, RIS) in patients with BPSD.
Open randomized trial in 100 patients (mean 78.7years, 67% females) using the NeuroPsychiatric Inventory score (NPI)>10 on patients (73% mild to moderate AD and 27% other dementias, treated with GAL (n=50) or RIS (n=50) for 12 weeks. Neuropsychiatric symptoms (NPI, CMAI, FAST), caregivers stress (PGWB), cognition (MMSE) and severity (CIBIC) were assessed at baseline and 12 weeks.
91 patients completed the trial. Safety and tolerability were good. 58% were APOEɛ4 carriers. At baseline MMSE was 20.1±4.6, and NPI 51.0±25.8. After 12 weeks NPI total scores had improved significantly (GAL: 16.6±16.1, RIS: 16.2±16.2).
In both groups there were statistically significant improvements after 12 weeks. In several of the NPI-domains galantamine and risperidone were equally effective. RIS showed a significant treatment advantage in the NPI-domains irritation (p=0.02), agitation (p=0.02) and a trend in aberrant motor behaviour (p=0.08). GAL showed a ppositive trend in apathy/indifference (p=0.09), night time behaviour (p=0.07) and appetite (p=0.06). GAL improved MMSE scores with 2.8 p (p< 0.001) and RIS with 1 p (p< 0.07).
This indicates that GAL could be beneficial in the treatment of neuropsychiatric and behavioural symptoms underlying AD unless aggressive symptoms are prominent.
Anxiety and depression are often interlinked as demonstrated by clinical, epidemiological, psychopharmacological and even genetic studies. However, robust biochemical and electrophysiological evidence for linkage or separation of mood and anxiety disorders is scarce. Brain stem auditory evoked potentials (BASEP) can easily and non-invasivly be measured in psychiatric patients and reflect neurophysiological processes in the brain stem. The aim of the present study was to evaluate BASEP in drug-free patients suffering from panic disorder or major depression and to compare these to healthy controls. Patients (n = 26; panic = 16, depression = 10) were diagnosed according to Diagnostic and Statistical Manual (DSM)-III-R criteria assessed by the Hamilton Anxiety and Hamilton Depression Scales, and all underwent 3 weeks of medications washout. All subjects (n = 36) completed the study. N3 latency was decreased in the patient group (P < 0.05), N3-5 interval was lengthened (P < 0.05), the N3 latency correlated with anxiety scores and depression scores correlated with the N3 and N5 latency periods. In conclusion, our small sample demonstrated shared electrophysiological variables in panic disorder and depression, further supporting the concept of spectrum disorder.
Individuals grieving a suicide death (suicide survivors) may be at risk for psychiatric complications and suicidal behaviors. Support groups may provide valuable resource for survivors, who often do not seek out mental health treatment. Social support and self regulation which are at the nature of the support groups can facilitate growth from crisis.
Objectives & aims
The objective of the present study was to investigate the effectiveness of support groups for suicide survivors. The specific aims were to assess the relationship between group participation and stress related growth and to assess the role of self regulation and social support as mediating variables.
74 suicide survivors belonged to one of two groups: 32 survivors who participate in a support group, compared with 42 survivors who did not participate. All participants completed questionnaires covering of self regulation, social support and stress related growth.
Survivors who participated in a support group showed better recovery from stress than those who didn’t participate. The effect was stronger in survivors who lost their offspring. A hierarchical regression indicates that time past from the event as well as self regulation and social support explained more than 33% of the variance of stress related growth.
Support groups for suicide survivors are a helpful intervention tool and can serve as a powerful form of primary and secondary prevention. Social support as well as self disclosure to other survivors can facilitate growth from crisis and diminish feelings of guilt, shame and other psychiatric complications.
The study of near fatal suicide attempters may provide insight into the minds of persons who die by suicide. Such attempts are characterized by high suicide intent, together with high medical lethality. The ability to fully understand the specific psychological profiles associated with severe of suicide intent can provide insights for suicide prevention.
Objectives & aims
The objective of the present study was to investigate the relationship of suicide intent to lethality among medically serious suicide attempters. Our aim was to examine specific psychological variables related to the subjective and objective components within suicide intent.
102 suicide attempters belonged to one of two groups: 35 subjects who made medically serious suicide attempts were compared with 67 non- medically serious suicide attempters. All were interviewed and completed questionnaires covering mental pain, communication difficulties, and seriousness of the suicide intent.
The objective component of the suicide intent scale (SIS) was highly correlated the lethality, as well as to communication difficulties, such as self disclosure while the subjective component of the SIS was related to mental pain variables such as depression and hopelessness. A significant interaction between mental pain and communication difficulties was found to predict severity of the objective suicide intent.
The suicidal person whom suffers from depression and hopelessness and cannot signal his pain to others because of communication difficulties can be a risk for a serious suicide attempt - which is more planned, with more precautions against discovery and without communication before or during the attempts.
Patients with schizophrenia display significant working memory and executive deficits. In patients with obsessive-compulsive disorder (OCD), several studies suggest that working memory dysfunction may be one of the causes of compulsive checking behaviors. Hence, this study aimed at assessing whether patients with schizophrenia were impaired on an image comparison task used to measure checking behaviors, and whether the origin and profile of impairment on this task was different between schizophrenia and OCD.
Eye movement recordings were used to assess the checking behavior of 24 patients with schizophrenia and 24 control participants who had to decide whether two images were different or identical. The verbal and visuo-spatial components of participants’ working memory were measured using the reading span and backward location span tests.
Compared to controls, patients with schizophrenia had reduced working memory spans and showed excessive checking behavior when comparing the two images. However, the intensity of their checking behavior was not significantly related to their working memory deficits.
Several recent studies demonstrated that the excessive checking behaviors displayed by patients with OCD were related to working memory dysfunction. The absence of a relationship between the excessive checking behavior of patients with schizophrenia and their working memory deficits suggests that checking behaviors do not have the same origin in the two disorders.
The long-term associations between posttraumatic stress disorder (PTSD) and suicidal ideation (SI) among ex-prisoners of war (ex-POWs) has recently been exemplified. Several studies have revealed the toll of war captivity on secondary traumatization’ (ST) of ex-POWs’ wives. However, a question remains regarding the possible SI among ex-POWs’ wives.
Understanding of SI phenomena among wives of severely traumatized ex-POWs in a longitudinal dyadic designed study.
Assessment of SI among ex-POWs’ wives and the longitudinal associations with their husbands’ PTSD. We also aim to assess the moderating role of the couple's dyadic adjustment in these associations.
A sample of 233 Israeli couples (142 ex-POWs couples and a comparison group of 91 veteran couples) completed self-report measures at two time points: T1 30 (2003-4) and T2 37 (2010) years after the ‘Yom Kipur’ 1973 war.
Surprisingly, no significant differences were found between ex-POWs wives and veterans’ wives, with and without husbands’ PTSD, in SI at T1 and T2. Only among ex-POW couples, an increase in the husband's level of PTSD and SI was related to a more moderate increase in their wives’ SI between T1 and T2. Interestingly, the more a wife reported positive dyadic adjustment, the more moderate the increase in her SI between T1 to T2, regardless of the study group.
Suicidal ideation among ex-POWs’ wives is closely related to their husbands’ PTSD and is moderated by their perception of marital adjustment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Efforts to reduce Clostridioides difficile infection (CDI) have targeted transmission from patients with symptomatic C. difficile. However, many patients with the C. difficile organism are carriers without symptoms who may serve as reservoirs for spread of infection and may be at risk for progression to symptomatic C. difficile. To estimate the prevalence of C. difficile carriage and determine the risk and speed of progression to symptomatic C. difficile among carriers, we established a pilot screening program in a large urban hospital.
Prospective cohort study.
An 800-bed, tertiary-care, academic medical center in the Bronx, New York.
A sample of admitted adults without diarrhea, with oversampling of nursing facility patients.
Perirectal swabs were tested by polymerase chain reaction for C. difficile within 24 hours of admission, and patients were followed for progression to symptomatic C. difficile. Development of symptomatic C. difficile was compared among C. difficile carriers and noncarriers using a Cox proportional hazards model.
Of the 220 subjects, 21 (9.6%) were C. difficile carriers, including 10.2% of the nursing facility residents and 7.7% of the community residents (P = .60). Among the 21 C. difficile carriers, 8 (38.1%) progressed to symptomatic C. difficile, but only 4 (2.0%) of the 199 noncarriers progressed to symptomatic C. difficile (hazard ratio, 23.9; 95% CI, 7.2–79.6; P < .0001).
Asymptomatic carriage of C. difficile is prevalent among admitted patients and confers a significant risk of progression to symptomatic CDI. Screening for asymptomatic carriers may represent an opportunity to reduce CDI.
This study aimed to investigate the prevalence of and risk factors for Eustachian tube dysfunction leading to middle-ear pathology in patients on chronic mechanical ventilation via tracheostomy tube.
A total of 40 patients on chronic ventilation were included in a prospective cohort study. Middle-ear status was determined by tympanometry. Tympanograms were categorised as types A, B or C; types B and C were defined as middle-ear pathology.
In all, 57 ears of 40 patients were examined. Disease was found in at least 1 ear in 26 out of 40 patients. Middle-ear pathology was found in 25 out of 34 patients who were tube fed (via nasogastric tube or percutaneous endoscopic gastrostomy) vs 1 patient out of the 6 fed orally (p = 0.014), and in 23 out of 31 with conscious or cognitive impairment vs 3 out of 9 cognitively intact patients (p = 0.044).
Middle-ear pathology is common in patients on chronic mechanical ventilation via tracheostomy tube. The highest prevalence was in those with impaired consciousness or cognition, and oral feeding appeared protective.
Cytomegalovirus (CMV) infection remains the leading cause of congenital virus infection in developed countries. Measuring the national prevalence of this infection, especially among women of childbearing age, is of great value to estimate the risk of congenital CMV infection, as well as to identify risk groups that should be targeted for behavioural interventions and/or vaccination once a CMV vaccine finally becomes available. In order to fulfil these objectives, a seroprevalence survey was conducted in 2010, using a nationally representative, population-based sample of 2536 people aged between 15 and 49 years, living in metropolitan France and attending private microbiological laboratories for blood testing. All blood samples were analysed in the same laboratory and screened for CMV-specific IgG using an enzyme-linked immunoassay technique (Elisa PKS Medac Enzyme immunoassay). The overall point estimate of CMV infection seroprevalence for individuals aged 15–49 years was 41.9%. The estimates were higher in women than in men (respectively 45.6% and 39.3%), and people born in a non-Western country were more likely to be CMV seropositive than those born in France or in another Western country (93.7% vs. 37.7%). Our results showed that a substantial percentage of women of childbearing age in France are CMV seronegative and therefore at risk of primary CMV infection during pregnancy. Educational measures and future vaccine are key issues to prevent infection in pregnant women and congenital CMV disease.
The ‘holographic’ technique for accurately measuring the surface figure of large reflector antennas, described by Bennet et al, (1976) and Scott and Ryle (1977), has many advantages over older conventional survey methods. These include high speed, low cost, and the absence of any need for additional complex mechanical or optical survey devices. In essence, the technique consists of measuring the complex far-field response of the antenna at a single frequency using a terrestrial, satellite-borne or celestial radiation source of small angular diameter. This two-dimensional pattern is then Fourier-transformed to yield the complex illumination function across the antenna aperture. Antenna surface deviations are manifested as phase fluctuations in this function. In practice, a second antenna is needed to provide a phase reference.