Psychiatria Danubina最新文献

Introduction: Early onset anorexia nervosa accounts for 8% of anorexia cases worldwide. Very few studies on this subject exist, given the difficulty of obtaining a sufficiently significant sample. The aim of this study was to supplement the literature and investigate the clinical characteristics of early onset anorexia nervosa.

Subjects and methods: This is a monocentric retrospective study carried out on the records of patients aged 8 to 12 years with early onset anorexia nervosa, hospitalized in the child psychiatry unit at the Queen Fabiola University Children's Hospital, in Brussels, from 01/01/2000 to 01/07/2023. Descriptive statistics were then performed on the sample and compared with the data found in the literature.

Results: This study included 48 children aged 8 to 12 with early onset anorexia nervosa. In the sample, three children were diagnosed with autism spectrum disorder during hospitalization. The sample included 36 girls and 12 boys, with an average age of 11 years and 7 months. The patients had an average body mass index of 13.6 kg/m² on admission. A total of 87% of the parents had a history of psychiatric illness. A large majority of the children had underlying depressive and anxiety disorders. The duration of anorexia nervosa in these children was 13.5 months from diagnosis, with an average hospital stay of 5.4 months.

Conclusions: This study seems to show the difficulty for parents and caregivers in diagnosing this illness and the probable impact of genetics and maternal depression on the development of early onset anorexia nervosa.

Background: There is a broad appreciation that a diagnosis of depression (D) in the elderly is a strong risk factor for incident dementia, particularly Alzheimer's disease (AD). Indeed, the two disorders might constitute a dyad, although their causal relationship is uncertain, given the likely bidirectional and compounding effects of social withdrawal and loss of previous activities, and the manifestation of language disturbances, cognitive dysfunction, and social disruption that are typical of both conditions. We argue that language declines in D and AD share common patterns and biological underpinnings, and that D/AD patients might benefit from intensive language remediation training aiming to improve the functioning of neural networks that are linked to similar cognitive impairments.

Methods: A literature search in PubMed database included topics of language disturbances, cognitive impairments, and molecular brain imaging by positron emission tomography (PET) to identify common patterns in D and AD regarding language decline and its neurobiological underpinnings.

Results: Language disturbances show a particular commonality in the two disorders, manifesting in simplified language and particular speech markers (e.g., lexical and semantic repetitions, arguably due to ruminations in D and memory deficits in AD). PET can reveal abnormal protein deposits that are practically diagnostic of AD, but cerebrometabolic deficits to PET with the glucose tracer FDG show a certain commonality in D and AD. Typical findings of hypometabolism in the frontal lobes doubtless underlie the executive function deficits, where frontal hypometabolism in prodromal D increases with AD progression. This may reflect overlapping changes in noradrenaline and other neurotransmitter (e.g. serotonin) changes. Cerebrometabolic deficits associated with language dysfunction may inform targeted language remediation treatments in the D/AD progression.

Conclusions: Language remediation techniques targeting specific language disturbances might present an important complimentary treatment strategy along with an adjusted pharmacotherapy approach and standard psychosocial rehabilitation interventions. We see a need for investigations of language remediation informed by the overlapping pathologies and language disturbances in D and AD.

Although the end of the critical phase of the COVID-19 pandemic has been declared, its consequences are still observed in the general population and some categories of workers. HCWs have had to face the battle against this disease on the front lines. In our study, we evaluated the current state of the consequences of the pandemic on compassion fatigue, loneliness, empathy, anxiety, and hopelessness in a group of 71 HCWs from a rehabilitation center. This data, collected in the time of May-June 2024 (T2), was compared in the same sample in 2020 (T0) and 2023 (T1). The results highlighted increased burnout (P-Bonferroni: 0.005) and feelings of loneliness in T2 (P-Bonferroni: 0.005). Importantly, the results of the compassion satisfaction remained stable, providing reassurance about the resilience of HCWs. Secondary Trauma results decreased in T2, indicating less psychological pressure associated with COVID-19 pathology.

Epidemiological data on non-suicidal self-injury (NSSI) in the context of eating disorders (ED) are limited, with estimates varying widely across studies and reviews being primarily narrative. Self-injurious behaviour is present in various psychiatric disorders of adolescents and young adults, including eating disorders. A study conducted on the general population of adolescents showed that 30% of females and 24% of 16-year-old males with an eating disorder had engaged in acts of self-harm compared with 8.3% of females and 4.0% of males without an eating disorder. In particular, self-harm behaviours, including Non-Suicidal Self-Injury (NSSI), suicide attempts (SA), and suicidal ideations (SI), are common among individuals with Anorexia Nervosa (AN) and Bulimia Nervosa (BN). Presence of eating disorders and self-injurious behaviours in the same individual is associated with more severe psychopathology increasing the risk of more severe depressive and anxiety symptoms and suicide attempts.

Response rate to treatment is generally not as high as expected in psychiatric disorders. The lack of clinical improvement under a well-conducted treatment, that complies with guidelines, may be the consequence of genetic abnormalities that impact the metabolizing pathways of the drug. Genetic polymorphism of metabolizing enzymes is frequent in the population and has been proven to have a clinical impact. It may also be the consequence of environmental or organic factors that interact with the pharmacokinetic pathways (absorption, distribution, metabolizing, excretion) of the drug. These intrinsic and extrinsic factors will lead to inter- and intraindividual fluctuations in plasma drug concentrations. Therapeutic drug monitoring permits to measure plasma drug concentrations in order to adapt psychopharmacotherapy individually. In some cases, it can be coupled to pharmacogenetic testings. This review presents recent literature and guidelines on the subject. Eventually, there is a focus made on the French-speaking part of Belgium where neither therapeutic drug monitoring, nor pharmacogenetics testing, are used frequently in clinical practice. Some challenges are to be addressed to implement these techniques in Belgium.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in communication, social interactions, and repetitive behaviors. Applied Behavior Analysis (ABA) is a prominent intervention aimed at modifying problem behaviors in individuals with ASD. ABA focuses on analyzing environmental contingencies and using operant conditioning to promote functional behaviors. Despite its widespread use, the effectiveness of ABA remains debated, with mixed scientific evidence. Some studies highlight its benefits, while others point out biases and limitations. Further research, including randomized controlled trials, is needed to determine the most effective interventions for ASD, considering the diverse needs of individuals and the potential biases in current studies.

Introduction: Schizophrenia is a complex psychiatric disorder characterized by heterogeneous symptom trajectories that significantly impact patient outcomes. We believe that the study of the trajectories of Schizophrenia is useful in assessing treatment options and outcomes. While the Positive and Negative Syndrome scale is usually used on one occasion to measure symptoms at a single time, if measured repeatedly , the PANSS is also useful in measuring trajectories. In order to illustrate and promote this serial use, we have reviewed papers which describe the delineation of Trajectories of Symptoms in Schizophrenia based on PANSS scores. This review integrates findings from longitudinal studies focusing on the trajectories of positive symptoms, negative symptoms, the relation between positive and negative symptoms and cognition, soft neurological signs, and treatment response in schizophrenia.

Methods: Studies were identified from the PUBMED database .Studies included in this review employed diverse methodologies such as trajectory analyses, longitudinal assessments, and clinical trials. Data were extracted from a range of patient cohorts, including those with first-episode psychosis and chronic schizophrenia.

Results: Longitudinal studies consistently demonstrate variability in the trajectories of positive symptoms, with most patients experiencing early stable remission, though a subgroup exhibits persistent or fluctuating symptomatology. Negative symptoms, on the other hand, often show poor improvement over time, correlating with impaired social and neurocognitive functioning. Cognitive deficits also vary, with some domains showing improvement while others, such as logical memory, deteriorate in certain patient subgroups. The relationship between positive and negative symptom trajectories highlights their complex relationship, influencing overall functioning and treatment outcomes. Antipsychotic medications demonstrate varied responses across patient cohorts, with distinct trajectory patterns observed based on medication type and patient-specific factors such as co-morbid substance abuse and duration of untreated psychosis.

Conclusion: Understanding the longitudinal trajectories of symptoms in schizophrenia is crucial for optimizing therapeutic strategies and improving patient outcomes. Personalised interventions tailored to individual symptom profiles and early clinical responses are recommended to enhance treatment efficacy and promote recovery. The PANSS scale can be used to delineate Trajectories of various symptom Groups in Schizophrenia.

Cognitive reserve (CR) is essential in reducing natural cognitive decline. Identified in neurodegenerative pathologies, it also increasingly plays a role in the development of the symptomatic processes of numerous psychiatric pathologies. CR could help identify subgroups of elderly patients affected by primary psychosis and mood disorders and evaluate their correlation with diagnostic and therapeutic trajectories. Our observational study assessed the correlation between cognitive reserve and cognitive and psychopathological trajectories in a group of elderly inpatients in health residential centers. After two years of observation, the results indicate a correlation between cognitive reserve levels and psychopathological and cognitive trajectories. No significant variations or correlations were observed between another investigation factor, aberrant salience, and the symptoms in the above trajectories.

Background: The literature consistently highlights the significant burden faced by healthcare professionals, often describing caregivers as "invisible patients." Resilience is a critical factor in their well-being and quality of life. This study aimed to examine the presence of variables such as resilience and burden in caregivers, along with factors like age, gender, education, and work commitment, to understand the correlations among these independent and clinical variables.

Methods: The sample consisted of 126 carers aged 18-30 years old (M: 26.15; SD: 3.21) with a 77.8% of the sample being female. The variables included the socio-demographic (age, sex, education, hours/days of speech per week and years of service) and clinical status, therefore burden (time dependence, development, physical, social and emotional burden) and resilience (self-perception, planned future, social competence, structured style, family cohesion and social resources).

Results: Regarding the correlational analyses involving socio-demographic variables and resilience, only a few significant correlations were found. However, significant positive correlations were identified between socio-demographic variables and burden, specifically with age, hours and days of work per week, and years of service. Conversely, education showed a significant negative correlation with burden, highlighting its protective role. Significant correlations between resilience and burden variables were generally positive, except for self-perception and developmental burden. Multivariate linear regression analyses revealed numerous dependencies, with predictors such as age, sex, education, hours/days of work per week, and years of service influencing the dependent variables related to burden and resilience.

Conclusions: This study examined fundamental socio-demographic, occupational, and psychological variables in the lives of caregivers. It highlights not only the presence of factors that negatively impact caregivers' quality of life but also important relationships between personal variables, resilience, and burden risk. Therefore, it is crucial to consider the findings of this study, along with existing literature, to design interventions aimed at reducing burdens and improving the quality of life for caregivers.

Introduction: The characteristics of the working environment significantly influence the mental well-being of workers, and the presence of unfavorable conditions in the workplace can have a negative impact on mental health. Healthcare professionals are particularly exposed to the risk of burnout and the development of psychiatric, and particularly affective, symptoms. This paper aims to describe the activity of a psychological support service dedicated to work-related stress at the General Hospital of Perugia, Italy.

Subjects and methods: In June 2022, a free and anonymous psychological service dedicated to healthcare professionals was established at the Perugia General Hospital. The main objectives of the service were to promote overall well-being of workers, to provide psychological support, and to address professionals towards specific pathways to care.

Results: The activity of the service consisted of clinical consultations with psychiatrists and psychologists who also administered psychometric tools to better characterize the overall clinical picture. After the clinical evaluation process, healthcare professionals who accessed the service were addressed to specific pathways of care, when needed. The data collection carried out from June 2022 to April 2024 showed a total number of 139 accesses to the Service, with a majority of requests from women (80%) and mainly belonging to nursing staff (53%).

Conclusions: Preliminary data from the psychological service dedicated to healthcare professionals confirms the high prevalence of work-related stress, especially in specific settings. In the near future, psychological support services are expected to identify work-related stress situations as soon possible, possibly contributing to the reduction of stigma and to the built of healthier working environments.