Clinical Practice and Epidemiology in Mental Health最新文献

Introduction: Mental health problems appear to be increasing in importance in Africa. Mental and substance use disorders were the leading cause of yearly lived with disability in Sub-Saharan Africa. Evidence from previous studies shows considerable variation in the prevalence of these disorders. The most acceptable explanation for this wide variation is likely to be the fact that socio cultural factors are major determinants of mental disorders. Therefore a mental disorder has to be understood in a specific setting to develop effective and tailored interventions.

Objective: The objective of this study was to determine the prevalence and associated factors of common mental disorders among adult residents in Silte Zone, southern Ethiopia.

Methods: Community based cross-sectional study was conducted in the study area. A total of 1178 adults were selected by using a three-stage systematic sampling technique. The Self-Reporting Questionnaire (SRQ-20) was used to determine the prevalence of common mental disorders. Data were analyzed by using SPSS version 20. Both bivariate and multiple logistic regression analyses were employed to identify factors associated with common mental disorders.

Results: The prevalence of common mental disorders among adults found to be 39.7%. Increased age (OR = 1.114; 95% CI = 1.095, 1.134), being female (OR = 9.421; 95% CI = 5.947, 14.926), poor social support (OR = 1.987; 95% CI = 1.358, 2.907) and having life threatening experience (OR = 2.162; 95% CI = 1.825, 2.562) were significantly associated with common mental disorders.

Conclusion: In the study, the magnitude of common mental disorders remains high in the study area. Increased age, being female, poor social support and having life-threatening experience were significantly associated with common mental disorders.

Background: There is a high incidence of alexithymia in people who report medically unexplained symptoms. There have been limited studies on the prevalence of alexithymia in patients with medically unexplained physical symptoms (MUPS) in various ethnic and cultural backgrounds.

Objective: This study aimed to estimate the prevalence of alexithymia in patients with MUPS and examine their socio-demographic data.

Methods: In this cross-sectional study, 196 patients with MUPS were recruited from tertiary care internal medicine and neuropsychiatry clinics during the first quarter of 2019. Patients completed a structured interview; socio-demographic and medical history data were collected. Somatic symptom severity was assessed using the Arabic version of the Patient Health Questionnaire (PHQ-15). Alexithymia was assessed using the Arabic version of the Toronto Alexithymia Scale.

Results: General fatigue was the most common complaint observed, followed by headache and dyspepsia. In addition, 73.5% of patients had a high Patient Health Questionnaire score, 17.9% had somatic symptoms of medium severity, while 8% and 0.5% had low and marginal somatic symptoms, respectively. Alexithymia was presented in 49.5%, 22.9% had no alexithymia, and 27.6% had borderline/intermediate alexithymia.A weak positive correlation (r<0.4) was found between somatic symptom severity and alexithymic psychopathology (r=0.277;p<0.05). Only the 'difficulty identifying feelings' dimension of alexithymic psychopathology was positively correlated with the severity of somatic symptoms (r=0.271;p<0.05).

Conclusion: Alexithymia is associated with the development of MUPS.

Aim: The aim of this study was to investigate the relationship between nutritional habits, lifestyle, anxiety, and coping strategies.

Background: Anxiety is an underestimated and often undiagnosed subclinical disorder that burdens the general public of modern societies and increases illness suscentibility.

Methods: The study group consisted of 693 individuals living in Peloponnese, Greece. A standardized questionnaire that consists of the dietary habits and lifestyle questionnaire, the trait Anxiety STAI-X-2 questionnaire and the brief-COPE questionnaire, was used. Principal components analysis identified the factors from the questionnaires, and stepwise multivariate regression analysis investigated their relationships.

Results: Weekly consumption of fruits, tomatoes, salads and lettuce, together with Εmotional/Ιnstrumental support, Denial/Behavioural disengagement, substance use and self-blame, was the most important predictors of anxiety scores. Positive reframing/Humour and Acceptance/Planning are also associated with the Positive STAI factor and decreased anxiety scores.

Conclusion: Healthy nutritional habits, comprised of consumption of salads and fruits, together with adaptive coping strategies, such as Positive reframing/Humour and Active problem solving, may provide the most profound improvement in the anxiety levels of a healthy population in Peloponnese, Greece.

Background: Obsessive-Compulsive Disorder (OCD) is a chronic neuropsychiatric disorder associated with unpleasant thoughts or mental images, making the patient repeat physical or mental behaviors to relieve discomfort. 40-60% of patients do not respond to Serotonin Reuptake Inhibitors, including fluvoxamine therapy.

Introduction: The aim of the study is to identify the predictors of fluvoxamine therapy in OCD patients by Bayesian Ordinal Quantile Regression Model.

Methods: This study was performed on 109 patients with OCD. Three methods, including Bayesian ordinal quantile, probit, and logistic regression models, were applied to identify predictors of response to fluvoxamine. The accuracy and weighted kappa were used to evaluate these models.

Results: Our result showed that rs3780413 (mean=-0.69, sd=0.39) and cleaning dimension (mean=-0.61, sd=0.20) had reverse effects on response to fluvoxamine therapy in Bayesian ordinal probit and logistic regression models. In the 75^th quantile regression model, marital status (mean=1.62, sd=0.47) and family history (mean=1.33, sd=0.61) had a direct effect, and cleaning (mean=-1.10, sd=0.37) and somatic (mean=-0.58, sd=0.27) dimensions had reverse effects on response to fluvoxamine therapy.

Conclusion: Response to fluvoxamine is a multifactorial problem and can be different in the levels of socio-demographic, genetic, and clinical predictors. Marital status, familial history, cleaning, and somatic dimensions are associated with response to fluvoxamine therapy.

Background: Physical activity in the elderly is recommended by international guidelines to protect against cognitive decline and functional impairment.

Objective: This Randomized Controlled Trial (RCT) was set up to verify whether medium-intensity physical activity in elderly people living in the community is effective in improving cognitive performance.

Design: RCT with parallel and balanced large groups.

Setting: Academic university hospital and Olympic gyms.

Subjects: People aged 65 years old and older of both genders living at home holding a medical certificate for suitability in non-competitive physical activity.

Methods: Participants were randomized to a 12-week, 3 sessions per week moderate physical activity program or to a control condition focused on cultural and recreational activities in groups of the same size and timing as the active intervention group. The active phase integrated a mixture of aerobic and anaerobic exercises, including drills of "life movements", strength and balance. The primary outcome was: any change in Addenbrooke's Cognitive Examination Revised (ACE-R) and its subscales.

Results: At the end of the trial, 52 people completed the active intervention, and 53 people completed the control condition. People in the active intervention improved on the ACE-R (ANOVA: F(1;102)=4.32, p=0.040), and also showed better performances on the memory (F(1;102)=5.40 p=0.022) and visual-space skills subscales of the ACE-R (F(1;102)=4.09 p=0.046).

Conclusion: A moderate-intensity exercise administered for a relatively short period of 12 weeks is capable of improving cognitive performance in a sample of elderly people who live independently in their homes.Clinical Trials Registration No: NCT03858114.

Background: Depression and cardiovascular disorders are significant determinants of health that affect the quality of life and life expectations. Despite the high importance of depression screening among Coronary Artery Disease (CAD) patients, the time being to assess and treat it remains controversial.

Objectives: This study aims to assess the prevalence estimates and severity of depressive symptoms and determine the risk factors associated with developing such symptoms among CAD patients after ten days of Percutaneous Coronary Intervention (PCI).

Methods: All patients who underwent elective PCI between October 5, 2019, and Mid-March 2020 and diagnosed with CAD were included in this cross-sectional study. CAD was defined as intra-luminal stenosis of ≥ 50% in one or more of the coronary arteries. Depressive symptoms were screened after ten days of the PCI utilizing the patient health questionnaire-9 (PHQ-9) tool. A linear regression model was used to assess the adjusted effects of independent variables on PHQ-9 scores. Electronic medical records, clinical charts, and PCI and echocardiogram reports were reviewed.

Results: Out of 385 CAD patients, a total of 335 were included in this study, with a response rate of 87%. The participants' mean (±SD) age was 57.5±10.7 years, 75.2% were males, 43% were current smokers, and 73.7% had below bachelor's education. The prevalence estimates of patients with moderate to severe depressive symptoms (PHQ-9 ≥10) was 34%, mild depression 45.1%, and normal 20.9%. Female gender, low educational level and diabetes mellitus were found to be the significant independent predictors of depression among our cohort with (t(333) = 3.68, p<0.001); (t(333) = 5.13, p<0.001); and (t(333) = 2.79, p=0.042), respectively.

Conclusion: This study suggests a high prevalence of depressive symptoms among CAD patients after ten days of PCI. Approximately one out of three patients with CAD have significant symptoms of depression, which is an alarming finding for clinicians. Moreover, this study demonstrates a lack of sufficient depression recognition and management in similar study settings. Integration of mental health assessment and treatment among patients with CAD as soon as after PCI is recommended for optimal and effective treatment and to obtain the best outcomes.

Even if the use of distance learning and E-learning has a long tradition all over the world and both have been used to keep in contact with students and to provide lessons, support and learning materials, there is an open debate on the balance between advantages and disadvantages in the use of distance learning. This debate is even more central in their use to support students with Learning Disabilities (LDs), an overarching group of neurodevelopmental disorders that affect more than 5% of students. The current COVID-19 outbreak caused school closures and the massive use of E-learning all over the world and it put higher attention on the debate of the effects of E-learning. This paper aims to review papers that investigated the positive and negative effects of the use of Distance Learning and E-learning in students with LDs. We conducted a literature review on the relationship between Distance Learning, E-learning and Learning Disabilities, via Scopus, Eric and Google Scholar electronic database, according to Prisma Guidelines. The findings are summarized using a narrative, but systematic, approach. According to the data resulting from the papers, we also discuss issues to be analyzed in future research and in the use of E-learning during the current pandemic of COVID-19.

Background: The rates of tobacco use, including cigarette and waterpipe smoking, are surging in the Eastern Mediterranean region. The use of these products causes nicotine dependence that makes even short-term tobacco abstinence difficult due to aversive symptoms. During the daytime fasting of the month of "Ramadan", people accept significant disruption in regular activities, including tobacco smoking. Thus, daytime during Ramadan (before sunset) is likely associated with abstinence symptoms emerging among tobacco smokers. We assessed this hypothesis by measuring tobacco/nicotine abstinence symptoms and craving among smokers of cigarettes or waterpipes during Ramadan.

Methods: A cross-sectional survey-based study was conducted on a convenience sample of adults. Participants were assessed for general information about tobacco smoking, dependence, and nicotine desire or craving, and withdrawal symptoms using the Minnesota Nicotine Withdrawal Scale (MNWS) and the Tiffany-Drobes Questionnaire on Smoking Urges.

Results: The study sample included 632 exclusive cigarette smokers and 161 exclusive waterpipe tobacco smokers. After fasting and abstaining from tobacco during the day, approximately 75% of cigarette smokers and 20% of waterpipe smokers reported smoking within the first 30 minutes. In addition, 10% of cigarette smokers and 30% of waterpipe smokers reported smoking within the first 60 minutes. Regarding smoking urge, no significant difference was found between cigarette and waterpipe smokers. For nicotine craving and withdrawal, significant differences between cigarette and waterpipe smokers were found when comparing mean scores for each of the following items: (i) urge to smoke, (ii) craving nicotine, (iii) hunger, (iv) desire for sweets, and (v) depression/feeling blue (P-values < 0.05).

Conclusion: This study provided evidence from the month of Ramadan that waterpipe smoking is associated with abstinence-induced smoking urge and withdrawal symptoms that are comparable to cigarette smoking. More interdisciplinary research must be focused on developing interventions to reduce tobacco smoking, including waterpipe.

Background: Divorce rates have increased during the last decade, leading to a greater focus of marital scholars on the importance of understanding couple-maintaining strategies within marital life. Distresses in couples are attributable to difficulties controlling felt, experienced, and expressed emotions; thus, emotion dysregulation is a core stressor in couples with maladaptive responses.

Objective: The aim of the study was to evaluate the effect of Dialectical Behaviour Therapy (DBT) on outpatient couples to treat emotion dysregulation.

Methods: We recruited 20 couples with marital distress in which partners presented emotion dysregulation. We offered the couples the opportunity to join a couple DBT group at their convenience and based on the immediate availability of treatment slots. We measured the treatment efficacy using psychometric tools (the Difficulties in Emotion Regulation Scale (DERS) and the Dyadic Adjustment Ccale (DAS) at baseline and after DBT therapy.

Results: Both male and female partners presented significant improvements in marital adjustment DAS and emotion regulation scores. Female partners showed significantly greater amplitude changes in both scales. Female partners showed significant improvement in most DERS subscales (except the GOALS subscale); on the other hand, male partners showed significant improvements in impulse, awareness, strategies, and clarity subscales. We found significant improvements in most DAS subscales in both sexes; only affectional expression remained unchanged before and after therapy.

Conclusion: DBT for couples is an effective approach to treat emotion dysregulation.

Background: Potential interactions between mood disorders and microcytic anaemias have been suggested by case reports, surveys of haematological parameters in psychiatric populations, and surveys of psychiatric morbidity in thalassaemic carriers.

Objectives: a) To review published studies.b) To study the prevalence of microcytic anaemia in a sample of Sardinian outpatients with recurrent mood disorders.c) To check whether mood disorders and microcytic anaemia co-segregate within families.

Methods: We extracted data on blood count and serum iron concentrations from the records of patients admitted between January 1st, 2001 and December 31st, 2016, to our clinic for mood disorders. Moreover, we studied siblings of subjects with both major mood disorders (according to Research Diagnostic Criteria) and heterozygous thalassaemia (according to Mean Corpuscular Volume, serum iron, and haemoglobin A₂ concentrations). Siblings affected with a major mood disorder were examined for haematological concordance with the proband (reduced MCV and/or increased HbA₂ in case of heterozygous β-thalassaemia, or presence of gene deletions in case of α-thalassaemia).

Results: Microcytic anaemia was highly prevalent (81/337 = 24.0%) among outpatients with mood disorders. Starting from 30 probands with heterozygous ß-thalassaemia, concordance for reduced MCV and/or increased HbA₂ was found in 78% (35/45) of affected siblings. Starting from 3 probands with heterozygous α-thalassaemia, only one of the 5 affected siblings carried four α-globin functional genes.

Conclusion: Based on the review of the literature, the high prevalence of microcytic anaemia in outpatients, and the concordance between affected siblings, we can conclude that a role of heterozygous thalassaemias is highly probable. Future studies are required to establish the relevance of heterozygous thalassaemias and evaluate the magnitude of the effect, possibly using a molecular diagnosis also in the case of heterozygous β-thalassaemia.