European Journal of Psychiatry最新文献

Background and objectives

This paper reviews Australia's take-up of digital mental health interventions, including some specific reference to their application in relation to employment. Use of these interventions in Australia was already significant. Under COVID-19 they have exploded. The Australian experience offers useful lessons for European and other countries, and these are summarised.

Methods

This paper presents a narrative review of key texts, resources, policies and reports, from government and other sources. It also presents data reflecting the take-up of digital mental health services and the employment of people with a mental illness in Australia.

Results

We present data showing the explosion in uptake of digital mental health services. There is very limited evidence about the impact of these services in improving employment outcomes for people with a mental illness in Australia. The Government has moved to make them a permanent feature of mental health care, in addition to traditional face-to-face care.

Conclusion

Key lessons emerge from the Australian experience, including the need for target clarity; the importance of blending digital services into broader frameworks of mental health care; the need for quality and safety standards to be developed and applied to digital services; and the need for better evaluation of the outcomes of digital interventions in the workplace.

The digital mental health genie is out of the bottle. New capacity for evaluation of the outcomes of digital mental health services is vital to ensure value and quality of such investments.

Background and objectives

The stigma attached to mental disorders remains a public health challenge, represents an important barrier to healthcare and widens existing social inequalities.

This study aimed to characterize the association between perceived stigma and mental disorders. The two main objectives were to estimate the association between perceived stigma and 12-month anxiety and mood disorders, and to assess the factors associated with perceived stigma among persons with these mental disorders.

Methods

A nationally representative sample of the Portuguese population was used. Participants were Portuguese-speaking adults, aged 18 or above and residing in permanent dwellings in the country's mainland. The survey was administered by trained lay interviewers using a computer assisted personal interview (CAPI) on a face-to-face setting.

Results

The results showed a two-fold increase in the likelihood of experiencing stigma among individuals with 12-month anxiety and mood disorders, slightly higher in the latter, when compared with individuals without. Among the sub-sample with these mental disorders, participants retired (or others), with psychiatric comorbidity and with co-occurrence of psychiatric and physical disorders had higher odds of reporting perceived stigma.

Conclusions

The findings of this study highlight the need to consider stigma as a public health priority in Portugal and to develop policies to create awareness and promote the social inclusion of persons with mental disorders.

Heterogeneity of depression in older adults is a challenge for the development of person-centered treatment. To address this, we studied glutamate and glutathione metabolism enzymes in blood cells in 53 older adult patients with depression and 20 controls. Patients with depression had decreased platelet glutathione-S-transferase and erythrocyte glutathione reductase. The biochemical and clinical data contributed to three clinical clusters that are not linked to the onset of depression or its duration but were related to anxiety, cerebrovascular and cardiovascular comorbidities, including parkinsonian features such as tremor, akathisia, and rigidity. These findings could aid person-centered diagnosis and outcomes and timely successful treatment(s) of depression in older adults.

Background and objectives

Sleep and circadian disturbances have been widely studied in patients with bipolar disorder. However, there is no clear evidence about the role of peripheral biomarkers of the circadian cycle in this population. This systematic review aims to identify potential endocrine blood biomarkers of circadian rhythms and study their relationship with sleep problems in these patients.

Methods

An electronic search was performed of PubMed and PsycINFO databases. It included articles about the topic from 1991 through 2021. The search strategy was: ("peripheral biomarkers" OR "biological markers" OR biomarker OR cortisol OR melatonin OR orexin OR hypocretin) AND (blood OR serum OR plasma) AND (“sleep-wake” OR "circadian rhythm" OR sleep OR insomnia) AND "bipolar."

Results

After excluding duplicates, 92 records were obtained. Only 5 studies met the inclusion criteria (n=499; bipolar disorder=125; unipolar depression=148; schizophrenia=80; controls=146). The endocrine parameters analyzed were: cortisol (3 studies), melatonin (1 study), and orexin-A (1 study). Overall, no significant associations were detected between these biomarkers and sleep disturbances, assessed with subjective (psychometric evaluation) and/or objective (polysomnography) measures.

Conclusion

This review highlights the lack of studies exploring the role of endocrine biomarkers related to circadian function in the pathophysiology of sleep disturbances in bipolar disorder.

Background and Objectives

Spectral-domain optical coherence tomography (SD-OCT) findings in substance use disorders have been investigated in recent years. In this study, we compared the retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL), the inner plexiform layer (IPL), and the choroid thickness (CT) of OUD and control groups before and after buprenorphine/naloxone maintenance treatment (BN-MT).

Methods

The OUD group consisted of 46 male subjects and the control group consisted of 49 male subjects. Patients with chronic opioid use and opioid positivity in their urine during the initial SD-OCT application were included in the study. At the end of the fourth week of BN-MT, SD-OCT was repeated and BN positivity was detected in the urine of the patients at this time.

Results

There was a significant difference between OUD and control groups in terms of nasal superior and CT values of both eyes (p<0.05) before BN use. The values of RNFL sectors and CT of both eyes before and after BN-MT differed significantly (p<0.05); CT increased and RNFL sectors decreased. After BN-MT, psychometric scales differed significantly in favor of the patients (p<0.05). The SD-OCT values of the OUD group after BN-MT were compared with the control group: the right IPL (p=0.003), the left IPL (p=0.023), the right N (p=0.001) and the left N (p<0.001) values were significantly lower in the OUD group.

Conclusion

This is the first study to show the SD-OCT findings of patients with OUD before and after BN-MT. The findings of this study may indicate possible effects of chronic opioid use in patients and/or possible effects of exogenous opioid or BN present in the body during SD-OCT applications. However, based on our findings, it is not possible to distinguish between the two possible outcomes. The fact that the use of BN acting through opioid receptors has different effects from exogenous opioids may be due to different receptor profiles.

Background and objectives

Early detection of psychiatric disorders in general hospital settings could facilitate a systematic assessment of anxiety and depression, and lessen their non-detection, misdiagnoses and subsequent negative impacts. We built a new short screening tool with simple Yes/No questions on anxiety and depression and examined its diagnostic capacity and acceptability.

Methods

Our cross-sectional study included 608 patients examined in an emergency department at a Parisian general hospital. Their depressive and anxiety symptoms were assessed with the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder 7 (GAD-7). Participants also completed the ‘GHU-checklist’, a list of 17 words evoking moods or feelings. Sensitivity and specificity of the checklist were determined using receiver operating characteristic (ROC) analysis.

Results

22.7% of participants had depressive symptoms as measured by the PHQ-9, while 25.4% suffered from moderate or severe anxiety. Most participants perceived positively the GHU-checklist, which had a sensitivity of 81.5% in distinguishing patients with depressive symptoms. Sensitivity was 86.0% for moderate anxiety and 94.7% for severe anxiety. The specificity ranged from 64.3% to 71.1%.

Conclusions

A short 17-words checklist is able to ultra-rapidly screen for depressive and anxiety symptoms in non-psychiatric medical settings, and was perceived positively by patients. Its systematic use could facilitate a rapid and systematic assessment of these symptoms, especially in crowded and under-staffed settings such as the emergency department.

Background and objectives

To explore the discriminatory ability of a decision tree model based on cognitive testing data for the differential diagnosis of schizophrenia.

Methods

This study enrolled 82 patients with schizophrenia and 82 patients with affective disorders. The cognitive function of the two groups of participants was assessed based on learning, symbol coding, digital span, trail making, and category fluency tests. The logistic regression model in the sklearn package in Python was applied to discriminate and analyse the data for all 11 variables in the MATRICS Consensus Cognitive Battery (MCCB).

Results

The recognition rate for schizophrenia and affective disorder using all 11 variables of the MCCB was 82%.

Conclusion

The logistics model based on cognitive data distinguished patients with schizophrenia from those with affective disorder.

Background and Objectives

The number of people living with dementia is increasing globally, particularly in middle-income countries like Turkey. To reduce risk of dementia, the implementation of lifestyle changes targeting modifiable risk factors are important. This study aimed to translate and validate the Turkish version of the Motivation to Change Lifestyle for Dementia Risk Reduction (T-MOCHAD-10).

Methods

Cross-sectional psychometric study design was used. After translation and back translation, we assessed face and content validity. For construct validation and reliability assessment, we conducted a survey with 601 individuals aged 40 and above using a socio-demographic form and the T-MOCHAD-10. We used Exploratory Principal Axis Factoring with Oblimin rotation to explore the factor structure. We then confirmed the factor structure using fit indices. Reliability was established using test-re-test, Cronbach's alpha coefficient, item-total and item-subdimensions correlations, ceiling and floor effects, and the Hotelling's T-squared test.

Results

The T-MOCHAD-10 showed adequate face and content validity (Kendall W=0.09, p=0.60). As in the original scale, a two-factor solution was obtained. All fit indices were ≥0.95, and RMSEA was 0.06. A Cronbach's alpha of 0.79 was obtained and no significant differences were found between test and re-test measures (p>0.05). We found no evidence of ceiling or floor effects, nor response bias (Hotelling's T-squared=4683.80, p<0.001).

Conclusion

T-MOCHAD-10 is a short measurement tool which provides valid and reliable scores concerning the motivation to change lifestyle for reducing dementia risk among Turkish individuals aged 40 and over.

Background and objectives

The elderly physician population is increasing worldwide. Data on how doctors have aged are scarce. The purpose of this study is to evaluate subjective successful aging (SSA) and its correlations with resilience, happiness, and optimism in a sample of older physicians.

Methods

A cross-sectional study was carried out with physicians over 65, through face-to-face interviews. All the volunteers answered the following: Self-rate successful aging; CD-RISC 10; Subjective Happiness Scale; LOT-R; SF-36; and a socio-demographic questionnaire.

Results

The mean of self-rate successful aging in SSA was 8.65 (92.3% over or equal to 7), and significant and positive correlations were found between resilience (r = 0.33) and happiness (r = 0.68). No correlation was found between age subset (young-old x old) or physical limitations and evaluation of SSA.

Conclusion

Physicians evaluated aging as successful regardless of health and limitations. SSA had a positive correlation with resilience and happiness.