Psychiatrike = Psychiatriki最新文献

Post-Traumatic Stress Disorder (PTSD) is connected with the experience of traumatic events and is significantly related to war and forced displacement. Refugee populations are characterized by a high degree of vulnerability for the development of PTSD, as they are confronted with stressors associated with all three distinct phases of migratory journey. The present article is an attempt to systematic review the therapeutic interventions based on the Cognitive Behavioral Approach and applied to refugees diagnosed with PTSD. For this reason, a review of the international literature was carried out through the electronic databases: Google Scholar, PubMed and Science Direct. Forty (40) studies were identified, of which 16 met the inclusion criteria. According to the results of the review, the most common interventions are Cognitive Behavioral Therapy (CBT), Narrative Exposure Therapy (NET) and Eye Movement Desensitization and Readaptation (EMDR). More specifically, CBT helps the individual to understand and reexamine the negative thoughts and feelings caused by the traumatic event, resulting in a reduction of symptoms and an improvement in quality of life. Following, NET supports that when a person talks about the traumatic events by placing them in a chronological continuity, they can gradually redefine the negative associations and responses related with the trauma. Finally, EMDR focuses on memory and how memories are stored in the brain. Its purpose is to reduce the intensity of the emotions associated with the traumatic event when it is recalled. All of those three approaches appear to have been studied and to yield reliable results. Other forms of therapeutic interventions are limited due to methodological issues as well as due to adopting standardized approaches that do not allow for an in depth understanding of trauma in refugee population. Further investigation of the long-term symptoms of trauma in refugees is suggested, in order to draw firm conclusions.

Sleep is an essential part of life, accounting for about one third of an individual's life expectancy and plays an important role in quality of life and professional performance. This study focuses specifically on primary school teachers, a group that often faces high levels of stress. Restorative sleep is vital for dealing with this stress, and when its quality is unsatisfactory, it can contribute to the development of burnout. The aim of the study was to assess the prevalence of poor sleep quality among state schoolteachers in Minas Gerais and to identify the factors associated with this condition. The cross-sectional study included 1,907 teachers who took part in a web survey. It included sociodemographic variables, work characteristics, lifestyle, and health conditions. The data was collected between October and December 2021, using validated instruments such as the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. The results showed that 39.1% of teachers reported poor or very poor sleep quality. The main variables associated with poor sleep quality included working more than 40 hours a week (OR = 1.618), low control over work (OR = 1.235), professional dissatisfaction (OR = 2.234), poor diet (OR = 3.240), smartphone dependence (OR = 2.265) and high fear of COVID-19 (OR =1.532). It was noted that mental health problems, such as anxiety (OR = 1.728), were also significantly related to sleep quality. In addition, although sleep quality varied with age, older teachers had fewer sleep problems. The study suggests that working conditions and psychosocial factors play a crucial role in sleep quality, highlighting the importance of interventions that consider the specific needs of teachers. The recommendations include carrying out regular psychological assessments and applying sleep hygiene practices in order to mitigate these problems and improve the quality of life of this group.

The current number of dementia cases in Europe stands at 7.7 million, a figure projected to double by 2050. Caregivers of individuals with dementia experience a heightened burden compared to those caring for other chronically ill individuals, increasing the risk of depression and stress disorders. This systematic literature review, following PRISMA guidelines, explores the prevalence of anxiety and depressive symptoms in dementia caregivers. Searches in academic databases, restricted to studies from the last 15 years, identified 85 articles with 16 meeting the inclusion criteria. Results indicate significant caregiver burden, diminished self-reported quality of life, and a propensity for clinical depression. Depression and anxiety symptoms were more pronounced among female caregivers. Caregiver depression correlated with increased emergency department utilization by dementia patients, with a surge in depressive symptoms reported during the COVID-19 pandemic. Caregiving for dementia patients was associated with burnout, adversely impacting caregiver quality of life. Depression and anxiety symptoms in caregivers correlated with substance use. Sociodemographic variables, including low socioeconomic status, high urbanization levels, and older age, were associated with caregiver depression. Caregivers of individuals with Alzheimer's disease reported higher anxiety, burden, and depression scores compared to those assisting individuals with other dementias, particularly when neuropsychiatric symptoms were evident. The identification of the factors that are linked to the mental burden of caregivers allows mental health professionals to enhance symptom detection and provide tailored support, ultimately alleviating caregiver burden and improving dementia care quality. Systematic professional assistance and training opportunities through health policies can effectively alleviate caregiver burden.

Treatment-resistant schizophrenia affects approximately 30% of schizophrenia patients, and clozapine is the antipsychotic of choice for their treatment. Despite its effectiveness, clozapine is considerably under-prescribed for the aforementioned patients' group, probably due to its severe side effects. Measurement of plasma concentrations of clozapine and its active metabolite, norclozapine, in plasma could help clinicians to monitor compliance to treatment and reduce the possibility of severe side effects. Such measurements are currently not included in routine clinical practice, although clozapine plasma concentrations seem to be influenced by many different factors and do not usually reflect the prescribed dose. The aim of the present study was to measure clozapine and norclozapine plasma concentrations and their ratio in a group of early psychosis, treatment-resistant, schizophrenia patients and to investigate possible associations among the prescribed clozapine daily dose and socio- demographic variables. Thirty-eight patients were included in the study, and 342 blood samples were collected. Clozapine and norclozapine plasma concentration measurements were performed by UHPLC-MS/MS. Mixed-effects linear regression models were performed to associate blood clozapine and norclozapine levels and their ratio to clozapine dose. The median clozapine dose, clozapine, norclozapine plasma concentrations, and their ratio at first and last measurement were as follows: 400mg/day (IQR = 350mg/day to 500mg/day) and 425mg/day (IQR = 350mg/day to 600mg/day), 335 ng/ml (IQR = 191 ng/ml to 427 ng/ml) and 389 ng/ml (IQR = 276 ng/ml to 523 ng/ml), 129 ng/ml (IQR = 62 ng/ml to 218 ng/ml) and 135 ng/ml (IQR = 82 ng/ml to 209 ng/ml), 2.5 (IQR = 1.6 to 4.8) and 2.9 (IQR = 1.7 to 4.4). An increase of clozapine dose by 50mg/day was associated with higher blood clozapine and norclozapine levels but with lower clozapine/norclozapine ratio. Clozapine dose was positively associated with blood clozapine and norclozapine levels and negatively with the clozapine/norclozapine ratio.

In recent decades, a growing body of research has emphasized the unique nature of substance abuse among women, necessitating a gender-specific approach and thus individualized therapeutic interventions.The purpose of this study, based on the existential approach, was to examine whether symptoms of several behavioral addictions (shopping, sex, gambling and betting, eating) and alcohol use disorder correlate with death anxiety, lack of meaning in life, and levels of mental resilience in a convenience sample of women. A total of 3,176 women participated in this online study and completed a demographic characteristics questionnaire, the Shorter PROMIS Questionnaire (SPQ), the Meaning in Life Questionnaire (MLQ), the Connor-Davidson Resilience Scale (CD-RISC), and the Death Anxiety Scale (DAS).The results showed a significant negative correlation between the "Presence of meaning in life" subscale and all addiction symptoms subscales (shopping, p<0.001; sex, p<0.001; gambling and betting, p=0.006; food, p<0.001, and alcohol use, p<0.001). Conversely, the "Search for meaning in life" subscale showed a significant positive correlation with all addiction symptoms subscales (shopping, sex, gambling and betting, food, and alcohol use, p<0.001). Resilience emerged as a protective factor, showing significant negative correlations with symptoms of sex addiction (p<0.001), alcohol use disorder (p<0.001), shopping addiction (p<0.001), and food addiction (p<0.001) addiction, although the correlation coefficients were small (ranging from -0.07 to -0.21), indicating a weak or no correlation. Participants with higher death anxiety also showed more symptoms of gambling and betting addiction (p<0.001), shopping addiction (p<0.001), and food addiction (p<0.001). Women who were married and had a university degree showed fewer symptoms of sex addiction (â = - 0.079; p = 0.004 / â = - 0.118; p = 0.001), alcohol use disorder (â = -0.105; p = 0.011 / â = -0.158; p = 0.004), and gambling addiction (â = -0.055; p < 0.001 / â = -0.091; p < 0.001), while women aged 18-25 displayed significantly lower symptoms of shopping and food addiction. Marriage and higher levels of education emerged as protective factors against certain types of addictive behaviors. In conclusion, this research showed a meaningful relationship between the lack of meaning in life and death anxiety with the manifestation of behavioral addiction symptoms and alcohol use. Also, the presence of mental resilience may act as a protective factor against gambling and betting addiction, shopping addiction, and food addiction, but not against sex addiction and alcohol use disorder.

The COVID-19 pandemic emerged suddenly, profoundly impacting the lives of us all, including mental health workers (MHW). This unprecedented crisis introduced significant challenges for MHW, exposing them to increased risks of psychological distress. This systematic review aims to evaluate the psychopathological effects of the COVID-19 pandemic on MHW. Additionally, it seeks to explore factors-social, regional, occupational, and others-influencing these effects. A systematic search was conducted across PubMed, PsycINFO, and Embase databases following PRISMA guidelines. A total of 2621 citations were screened, with 29 studies meeting the inclusion criteria for analysis. Our review focused exclusively on studies utilizing validated measurement tools to ensure reliability. Our findings revealed a high prevalence of anxiety, depression, stress, trauma-related disorders, and burnout among mental health nurses and other MHW during the COVID-19 pandemic, with significant variations based on regional, occupational, gender, and other demographic factors. Depressive symptoms ranged from 16.8% to 52.2%, and anxiety levels varied from 9.7% to 63% among MHW. Interestingly, MHW exhibited lower rates of depression and anxiety compared to other healthcare workers and the general population, possibly indicating higher resilience. Factors such as younger age, female gender, profession, work setting, fear of COVID-19, and workload were associated with increased psychological distress. Our review also underscores the need for more systematically accurate trauma research, particularly in how trauma is defined and assessed during global crises. While the consistency in study findings highlights the considerable effect of the pandemic, we observed differences that suggest the influence of multiple interacting factors. The lack of longitudinal studies and comparative data limits the ability to determine changes over time and differences with other groups. The COVID-19 pandemic significantly affected the mental health of those responsible for caring for the mental health of others, with considerable variations influenced by multiple interacting factors. Our findings highlight the critical need for protective protocols and psychological support systems to mitigate adverse effects on MHW during global crises. The variance in impact across different countries, in relation to local, political, cultural, and other factors, provides a foundation for future research.

To the Editors, We recently published evidence-based guidelines for the role of exercise in the prevention of dementia.1 The guidelines combined an umbrella review and expert consensus, and has important implications for psychiatry. Evidence from published studies was evaluated using the GRADE assessment. We found scarce and relatively low-quality evidence in the literature, particularly for the primary prevention of dementia. Our GRADE-informed evidence synthesis yielded the following conclusions: For Primary prevention of dementia: Physical activity may be considered for the primary prevention of dementia. In people without dementia or MCI, exercise may be no better than health education for the primary prevention of dementia and MCI.

Quality of evidence: Very low for physical activity; very low for exercise. For Secondary prevention of dementia: In people with MCI there is continued uncertainty about the role of physical activity and exercise in slowing the conversion to dementia.

Quality of evidence: Very low for physical activity; very low for exercise. For Tertiary prevention of dementia: In people with moderate dementia, physical activity/exercise could be considered for maintaining cognition and exercise could be considered for stabilizing disability compared to usual care.

Quality of evidence: Exercise: very low for cognitive outcomes; low for disability. Following a consensus process, we recommended physical activity/exercise for all three purposes, namely primary, secondary, and tertiary prevention (improve cognition and reduce disability) of dementia. The recommendation of exercise was largely contingent on its positive effects on mental health,2,3 in conjunction with the extensive body of evidence linking mental disorder with dementia.4 The guidelines highlight the need for further research on multidisciplinary interventions for both the primary and secondary prevention of dementia. A question remains whether the positive effect of physical activity on mood/behaviour applies to the MCI group, as it does to the dementia group. More research is required in people with established dementia and in less common forms of dementia. The guidelines also make an implicit research recommendation in support of heurism, in the sense that they integrate the evidence-based expectation that exercise is likely to be beneficial both for mental and physical health. Indeed, employing heurism may be inherently necessary in prevention research.5 Overall, these guidelines offer an evidence-based insight into the effectiveness of physical activity/exercise for the prevention (primary, secondary, and tertiary) of dementia. Importantly, they necessitate the inclusion of mental health in a multi-component approach. In doing so, they emphasize the necessity of mental health promotion and mental illness prevention in the prevention and management of dementia.

Persons with mental health disorders are vulnerable, with demanding care needs. This cross-sectional study aimed to report on their vaccination coverage against COVID-19 and common vaccine-preventable diseases. The study was conducted from September to November 2022 at the psychiatric outpatient settings of Venizeleion General Hospital of Heraklion, Crete, Greece, and the Mental Health Center of Heraklion. Information was collected via personal medical interview and prescription data. The study population included 361 participants, with a mean age of 49.8±14.3 years, 59.0% women. The most common diagnoses were recurrent depressive disorder (24.1%), schizophrenia (22.7%), anxiety disorder (21.3%), and bipolar disorder (15.7%). Vaccination coverage against seasonal influenza for 2020, 2021, and 2022 was 43.2%, 39.8%, and 40.7%, respectively. Pneumococcal vaccination included the conjugate (28.8%) and polysaccharide (7.7%) vaccines. Vaccination against Tetanus, Diphtheria, Pertussis (TDP) accounted for 11.0%, Hepatitis B for 5.8%, and Herpes Zoster for 27.1%. COVID-19 vaccination, with at least one booster dose, reached a high 73.6%. Patients with severe mental illness, 139 out of 361, were less likely to have contracted COVID-19 (50/139, 35.9%) than those without (108/222, 46.6%), (p=0.018). Coverage with polysaccharide vaccine, TDP, and Hepatitis B, was very low. Patients annually vaccinated for influenza in the last three consecutive years were most likely to be fully vaccinated for pneumococcal disease and for COVID-19 (with at least one booster dose). Future research and clinical practice should focus on identifying patients at risk of not receiving preventive services, such as vaccines.

The negative consequences of the COVID-19 pandemic and the subsequent restrictive measures on the mental health and well-being of the population and psychiatric patients have been widely recognized. Patients' treatment attendance and engagement with mental health services had been negatively affected by the pandemic, whereas patients were less likely to receive timely outpatient care. The pandemic also impacted the use of inpatient services. The aim of the present study was to explore the variability of attendance and admissions to a general hospital psychiatric ward over a 12-month interval after the onset of the pandemic (March 2020), compared to the respective 12-month pre-pandemic interval. A retrospective, observational pre/post study was performed, involving a general hospital psychiatric ward in Corfu, Northwest Greece, which serves an insular catchment area of approximately 100,000 inhabitants. For data analysis, c- and u-charts of statistical process control charts were employed, using monthly data (March 2019 to February 2021). Overall, a significant decline in attendance rates was observed, mostly accounted for by a 26.5% reduction in voluntary attendance rates (1516 patients prior vs. 1114 patients after the onset of the pandemic). The involuntary commitment of patients did not differ between the two periods (106 prior vs. 100 after the onset of the pandemic). Admission rates did not change significantly between the two periods. Diagnoses that exhibited significant variance in examinations between the two study periods were mood disorders and personality disorders, whereas there was no significant variation in the number of admissions across different diagnoses. Length of hospital stay increased significantly by 13.2% over the first year of the pandemic, from 25.57 days (Md= 13, IQR= 22) during the pre-COVID-19 period to 28.95 days (Md= 22, IQR= 28) during the COVID-19 period. Patients with schizophrenia and related disorders (Mean= 34.25 days, SD= 43.19) and mood disorders (Mean= 26.26, SD= 33.48) had prolonged hospital stays compared to other diagnoses. These findings highlight significant shifts in psychiatric care delivery during the pandemic and underscore the need for targeted interventions to address the evolving demands on mental health services during public health crises.