The 2019 coronavirus epidemic (CoViD-19) in Italy originated in Lombardy, on February 21, 2020. Crowding has been defined as a worldwide problem and causes reduced quality of care. It is due and identified by three orders of factors: those at the access (input); those related to the patient’s process (throughput); and those at the exit from the ED (output).

We evaluated all the population who went to ED for mental disorder. Due to the high level of care needed and the simultaneous exposure to risk factors, an excessive duration of ED process can be counterproductive.

We evaluated all patients accessing our ED for mental disorder from February 22 to May 1, 2020 and during the same period of the previous year.

We enrolled 345 patients. The Crowding input factors are lower in the pandemic period: reduced attenders (142 vs 203) and reduced average waiting times (40 min vs 54 min). The Crowding throughput factors have instead worsened: LOS (length of stay) for both visit rooms (383 vs 271 min) and holding area (1735 min vs 797 min). The Crowding output factors also worsened: the percentage of access block is higher during the pandemic (100% vs 20%). The Total Access Block Time is significantly higher in the CoViD period for both the visit rooms (3.239 vs 649 min) and the holding area (590 vs 185 min).

The pandemic period presented a worsened crowding for these patients due to the Access Block.

The 2019 coronavirus epidemic (CoViD-19) in Italy originated in Lombardy, on February 21, 2020. The Fondazione IRCCS Policlinico San Matteo di Pavia has been involved in the management of the outbreak since its beginning. ED’ psychiatric population is considered fragile, at risk of under triage.

We evaluated all the population who went to the ED for mental disorder to assess the severity of cases evaluated as exit code and rate of hospitalization.

We evaluated all patients accessing our ED for mental disorder from February 22 to May 1, 2020 and during the same period of the previous year.

We enrolled 345 patients. There was a severe reduction in the total number of accesses for mental disorder: 142 in the CoViD period and 203 in 2019. The vital parameters, age (mean about 40 years) and sex were overlapping without statistically significant differences. The priority codes for the medical examination were not different. CoViD pandemic patients have higher discharge severity codes (yellow and red) more frequently than in the reference period (9.9% vs 5.9%) and more frequently need hospitalization (25.3% vs 18.6%).

The epidemic has led to a reduction of accesses for mental disorder. Patients had more frequent hospitalization needs and more severe exit codes. the data may be due to the fact that during the pandemic only the most serious patients access the E.D., but also to the fact that a pandemic has contributed to destabilizing this class of fragile patients.

The 2019 coronavirus epidemic (CoViD-19) in Italy originated in Lombardy, on February 21, 2020. Crowding has been defined as a worldwide problem as cause of reduced quality of care and patient satisfaction. It is due and identified by three orders of factors: those at the access (input); those related to the patient’s process (throughput); and those at the exit from the ED (output).

We evaluated all the population who went to ED for intossication and substance abuse. Due to the high level of care needed by these, an excessive duration of LOS (length of Stay) can be counterproductive.

We evaluated all patients accessing our ED for intossication and substance abuse from February 22 to May 1, 2020 and during the same period of the previous year.

We enrolled 142 patients. The Crowding input factors are lower in the pandemic period: reduced attenders (41 vs 101) and reduced average waiting times (59 min vs 86 min). The Crowding throughput factors have instead worsened: LOS for both the visit rooms (810 vs 544 min) and the holding area (1205 min vs 947 min). The Crowding output factors also worsened: the percentage of access block is higher during the pandemic (10% vs 5%). The Total Access Block Time is significantly higher in the CoViD period for the holding area (1053 vs 930 min).

The pandemic period presented a worsened crowding for these patients due to the Access Block.

During the 1st wave of CoViD-19 pandemic there was a drastic reduction in total number of accesses, with more serious cases and a exorbitant increase in crowding, due to access block.

evaluate population who went to ED for (1) mental disorders requesting a psychiatric visit and for (2) intossication and substance abuse, between the first and second wave of the coronavirus pandemic

We enrolled all patients who went at our ED from May 1 to October 20, 2020 and during the same period of 2019. We analized: vital parameters, age, sex, exit severity codes, hospitalization rate, Crowding input factors (number of access, waiting time, priority time to doc), Crowding throughput factors (LOS: Length Of ED Stay), Crowding output factors (percentage of access block; Total Access Block Time).

The results are shown in table 1

We would like to thank all employees of the IRCCS Policlinico San Matteo Foundation for their extraordinary efforts during the pandemic.

The intravenous (IV) is one of the main parenteral routes for drug administration. Rapid onset of action, precise titration, patient-specific dosing and bypass of liver metabolism are a few of its advantages, while hypersensitivity reactions, adverse effects, infection risk and a higher overall cost some of its most debated downsides. Unlike other areas of Medicine, IV has been significantly under-utilized in Psychiatry.

This systematic review analyzed the evidence for effectiveness and safety behind the use of IV medication used for the management of acute disturbance.

APA PsycINFO, MEDLINE, and EMBASE databases were searched for eligible studies. Studies were included if they used IV medication to treat acute disturbance, in English language, had participants aged >18. The quality of the included studies was assessed using the National Institutes of Health quality checklist.

17 studies were deemed eligible. Data analysis was limited to narrative synthesis since primary outcome measures varied significantly between each study. Findings showed strong evidence for efficacy and safety of dexmedetomidine, droperidol, midazolam, and olanzapine. These medications displayed a short time to sedation, reduction in agitation levels, or large percentage of patients adequately sedated with a low number of adverse events. Results did not provide enough evidence for the use of IV ketamine, haloperidol, diazepam, lorazepam, and promethazine.

This review supports dexmedetomidine, droperidol, midazolam, and olanzapine as safe and efficacious options for managing acute disturbance via the intravenous route, particularly in special clinical settings where trained staff, optimal monitoring, resuscitation equipment and ventilators are all at hand.

Stigma has been associated with various groups, based on certain attributes or characteristics, such as; Race or health status is a complex and dynamic process, a universal phenomenon that is part of all social groups and is maintained by its functions related to the establishment of one’s own identity and the facilitation of socialization processes. Many societies throughout history have identified people with a mental health problem as part of a minority group considered inferior to the rest. What has made this population an object of social stigma. With the beginning of community psychiatry, and with the need to integrate people with a serious mental disorder into it, it becomes even more valuable to be able to assess the social stigma towards mental illness in the community.

The goal is to examine community attitudes towards people with mental illness.

Cross-sectional study of 228 people through an anonymous online survey. Sociodemographic variables and questionnaires were collected, such as the Community Attitudes Questionnaire towards people with Mental Illness (CAMI).

65% of respondents are women and 35% men. 74% have university studies. 18% do not agree that mental illness is an illness like any other. 1% believe that not all people can develop a mental illness. 7% of those surveyed are afraid that people with mental illness reside in their neighborhood and 14% believe that they are more dangerous people than the general population.

Given the results obtained, we observe that the stigma towards people with mental illness is still present in society.

Lebanon is a medium-income country in the Eastern Mediterranean which has seen a surge in interest in mental health following years of stagnation. The mental health needs of the country for severe psychiatric disorders are underserved.

The aim of our study is to describe community mental healthcare services in Lebanon and to address local opportunities and challenges.

A review of the literature using local resources along with expert opinion was undertaken to synthesize the evidence.

Political instability, chronic underfunding and widespread stigma have contributed to maintaining a traditional model of private clinics affiliated with inpatient and long-stay psychiatric units. A number of initiatives have been launched to cater for patients with psychotic disorders and to offer partial hospitalization for others with mood-related conditions. In parallel, the Ministry of Public Health, with international funding, has been instrumental in efforts to standardize care at a national level, particularly for early detection and treatment in primary care. The priorities of the national mental health programme are consistent with the global trend in shifting services to the community. Hurdles remain, in line with those facing countries with similar socio-demographics and resources. These include limited third-party coverage of mental health, absence of training opportunities in multidisciplinary community settings and some clinicians’ reluctance to update their ways of working.

Development of a local workforce dedicated to providing a patient-centred approach in the least restrictive settings, is essential for consolidating community care in Lebanon. This would be reinforced by (overdue) legislation and implementation of a mental health law.

The antipsychotic dosage of Chinese schizophrenia patients has rarely been studied, although nonstandard dosage has impact on prognosis.

To describe the dosage of antipsychotics in China routine practice.

This was a retrospective cohort study using de-identified data from a Chinese mental health hospital. The included patients were adults (≥18 years) with at least one diagnosis of schizophrenia (ICD-10: F20) and one prescription of any antipsychotic between 2014 and 2019. Date of first identified antipsychotic prescription was defined as index date, patients were followed up until last prescription of antipsychotics, end of 2019, or discontinuation (>60 days without antipsychotic prescription), whichever was earliest. Dosage was summarized using defined daily dose (DDD), calculated by cumulative average daily dose (CAD) with a unit of DDDs/day, i.e., total DDDs of all antipsychotics in follow-up period divided by total days of follow-up. CAD was categorized into low (<0.5 DDDs/day), moderate (0.5-1.5 DDDs/day), and high (>1.5 DDDs/day) groups.

13554 patients were included with an average follow-up of 269.9 days. Median CAD was 0.8 DDDs/day (IQR=0.5-1.3), patients with hospitalization during follow-up and used multiple antipsychotics at the same time had larger median CAD, 1.0 DDDs/day and 1.2 DDDs/days, respectively. There were 3245 (23.9%), 7627 (56.3%), and 2682 (19.8%) patients in low, moderate, and high groups, respectively. The median CAD of high dosage group was 2.5 DDDs/day (IQR=1.9-10.5).

CAD of most Chinese schizophrenia patients was low or moderate. Association between CAD and hospitalization and multiple concurrent antipsychotics merit further research.

The improvement perceived by the patients is a subjective measure of the psychic state, while the clinical evaluation corresponds to an objective evaluation of the psychopathological improvement performed by a psychiatrist. It is therefore relevant to evaluate whether these parameters evolve in a common way after patients have undergone an intervention in Day Hospital focusing on first psychotic episodes.

Study the relationship between subjective improvement and clinical evaluation.

This is a prospective study, which includes consecutive patients admitted to the Day Hospital during 2018. Their objective clinical improvement was assessed by means of the PANSS and GAF scales at admission and discharge. Subjective clinical improvement was assessed using an anonymous Likert scale with a score between 1 and 7. Sociodemographic data and other satisfaction parameters were also collected. A statistical analysis was performed using Pearson’s correlation.

A total of 73 patients were included. The perception of improvement on the part of the patients is very high presenting average values close to the maximum in almost all the evaluated items. The correlation between subjective improvement and PANSS variation presented a Pearson value 0.008; p = .957 and with the GAF variation presented a Pearson correlation of -0.066; p = .578 which indicates that there is no significant correlation between the variables.

Clinical evaluation and subjective perception of improvement are independent parameters.

Recently, the seasonal pattern of bipolar disorder has been accepted, with the clinical, diagnostic, treatment and prognostic consequences that this entails. It is interesting to study its epidemiological characteristics, such as the influence of gender on this pattern.

To study the influence of gender in the Seasonal Pattern of Bipolar Disorder.

A systematic review was carried out by means of a bibliographic search in Ovid MEDLINE of articles published in the last ten years (2010-2020), using the following keywords: bipolar disorder, seasonal pattern and gender: Those studies carried out in patients who presented a seasonal pattern were selected, and the influence of gender on this was studied.

The initial search showed a total of 92 articles, of which 7 met the inclusion criteria. It was found that, indeed, gender influences both the clinical characteristics and the course, management and prognosis of the seasonality of bipolar disorder.

The diagnosis of the Seasonal Pattern in Bipolar Disorder continues to be an important challenge. Women more frequently present PE, associated with manic, depressive or mixed episodes, while men in depressive episodes. Men are more frequently associated with Bipolar Disorder type II and depressive episodes, and women with rapid cycling and eating disorders. Male manic episodes are associated with psychotic symptoms, and with greater severity in admissions. Women have a higher risk of Seasonal Pattern than men, with the clinical and prognostic repercussions that this entails.

Challenged by the lack of collaboration between treatment sectors in psychiatric care in Germany, a legal basis for the implementation of Stationsäquivalente Behandlung (StäB), a programme for crisis resolution and home treatment (CRHT), was formed in 2017. It offers intensive care to patients with severe mental illness in their own living environments, carried out by a team of diverse professionals.

The present analysis is the first to evaluate the CRHT-program that has been established in the greater Munich area in 2018.

Qualitative and quantitative data were collected within the framework of a mixed-methods-analysis. Records of all patients (N=139) included in the CRHT over a thirteen-month period (’18–’19) were examined regarding sociodemographic, clinical parameters, and treatment data. A focus group with StäB-employees (N=8) and individual interviews with patients (N=10) were conducted, then transcribed, and analysed using thematic analysis.

139 patients (74% female) were treated in 164 cases for 38 days on average. Main diagnoses were schizophrenic diseases (43%) and mood disorders (35%), with patients ranging from markedly to severely ill (mean CGI-S: 5.8). 9.4% were in postpartum. Qualitative analysis is still in progress. Preliminary results demonstrate positive responses to individual treatment and environmental integration, whereas frequently changing contacts and the logistical effort were seen critically.

Work is still in progress. We expect StäB to be an adequate alternative to inpatient treatment for women in puerperium and a new opportunity for patients who need intensive treatment but refuse hospitalisation.

Adverse childhood experiences (ACEs) are shown to be risk factors for developing anxiety later in life. However, one’s family relationship acts as a protective factor between ACEs and anxiety.

The present study examines the interaction between ACEs and family relationship and their effect on generalized anxiety (GA) amongst the youth population in Hong Kong.

Participants aged 15-24 were recruited from a population-based epidemiological study in Hong Kong. GA in the past two weeks was assessed using GAD-7, while ACEs were measured using the childhood section of Composite International Diagnostic Interview screening scales (CIDI-SC), encompassing parental psychopathology, physical, emotional, sexual abuse, and neglect before age 17. Family relationship was measured by the Brief Family Relationship Scale (BFRS). Linear regression and a two-way ANCOVA were conducted to examine the association between ACEs, family relationship and GA, while adjusted for age and gender.

633 (70.7%) out of 895 participants had any ACEs. ACEs significantly predicted GAD-7 scores (Β=1.272, t(891)=4.115, p<.001). Two-way ANCOVA reported a significant interaction effect of ACEs and family relationship on GA (F(1, 889)=4.398, p=.036), namely those who had any ACEs and poorer family relationship scored higher in GAD-7 (p<.001), whereas there was no difference in family relationship for those without ACEs on GA (p=.501).

ACEs increases the vulnerability to GA later in life. However, its effect on anxiety decreases when one has a better family relationship. This suggests a possible moderating role of family relationship in developing GA among younger people.

People with schizophrenia experience higher levels of stigma compared with other diseases. The analysis of social media content is a tool of great importance to understand the public opinion toward a particular topic.

The aim of this study is to analyse the content of social media on schizophrenia and the most prevalent sentiments towards this disorder.

Tweets were retrieved using Twitter’s Application Programming Interface and the keyword “schizophrenia”. Parameters were set to allow the retrieval of recent and popular tweets on the topic and no restrictions were made in terms of geolocation. Analysis of 8 basic emotions (anger, anticipation, disgust, fear, joy, sadness, surprise, and trust) was conducted automatically using a lexicon-based approach and the NRC Word-Emotion Association Lexicon.

Tweets on schizophrenia were heterogeneous. The most prevalent sentiments on the topic were mainly negative, namely anger, fear, sadness and disgust. Qualitative analyses of the most retweeted posts added insight into the nature of the public dialogue on schizophrenia.

Analyses of social media content can add value to the research on stigma toward psychiatric disorders. This tool is of growing importance in many fields and further research in mental health can help the development of public health strategies in order to decrease the stigma towards psychiatric disorders.

Workplace violence (WPV) is a worldwide health problem with major individual and societal consequences. Previously identified predictors of WPV include working in psychiatry and work stress.

To investigate WPV trends during Norwegian doctors’ careers and assess individual long-term predictors in a longitudinal study.

Two nationwide medical student cohorts (n=1052) who graduated 6 years apart were surveyed at graduation (T1, 1993/94 and 1999) and 4 (T2), 10 (T3), 15 (T4) and 20 (T5) years after graduation (Figure 1). WPV was measured as multiple threats or acts of violence experienced at least twice. Individual predictors were obtained at T1 and work-related factors at T2–T5. WPV was analysed using repeated measures (Generalized Estimating Equations).

The prevalence of multiple threats and acts of violence declined at T2–T5 (p<0.001). Adjusted predictors of threats were male gender (odds ratio, OR 2.76, [95% confidence interval] 1.73–4.40; p<0.001), vulnerability traits (OR 0.90, [0.82–0.99]; p=0.031), older cohort (OR 1.63,[1.04–2.58], p=0.035) and working in psychiatry (OR 7.50, [4.42–12.71]; p<0.001). Adjusted predictors of acts were male gender (OR 3.37, [1.45–7.84]; p=0.005), older cohort (OR 6.08, [1.68–21.97]; p=0.006) and working in psychiatry (OR 12.34, [5.40–28.23]; p<0.001).

Higher rates of multiple threats and acts of violence were observed during early medical careers, with men at higher risk. Low levels of vulnerability traits (neuroticism) predicted independently the experience of violent threats. A cohort effect indicated a reduction in WPV (both threats and acts) in the younger cohort.

Medical students are exposed to many stressors which may contribute to the onset of Burnout Syndrome (BS). It consists of a triad of emotional exhaustion, cynicism and low professional efficacy. As a result, BS may reduce academic performance, quality of life and damage future professional life.

Estimate the prevalence and recognize associated factors of BS among medical students from two different medical schools form the same Brazilian Public University with different teaching models: School 1, with a traditional model, and School 2, with Problem-Based Learning model.

A cross-sectional study was performed with randomly selected students between April and June 2019. A structured questionnaire on socio-demographic characteristics and the educational process in addition to The Maslach Burnout Inventory/Student Survey (MBI-SS) were used. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis.

Study included 213 students, with an average age of 23±3.77, 50,2% were male and 62,5% belong to School 1. Among this sample, 21,6% of the students fit tridimensional criteria for BS. Burnout levels were higher in those people who rarely get emotional support they need in the course (OR=3,98, CI 95%, 1,75-9,06), who considered abandoning the course (OR= 2,88, CI 95% 1,29-6,43) and who consider their academic performance regular or weak (OR= 12,1, CI 95%, 4-36,5).

Results suggest a high prevalence of BS with factors associated with the psychosocial and educational sphere of medical students. In our research, the teaching model was not a factor associated with BS.

Common Mental Disorders (CMD) are minor manifestations of depressive, anxious or somatoform symptoms, which do not fit the diagnostic criteria of the International Code of Diseases (ICD). In medical students, this panorama can generate even more repercussions given the complexity of the medical education process.

Estimate the prevalence and recognize associated factors of CMD among medical at the Federal University of Sergipe, Brazil.

A cross-sectional study was performed with randomly selected students between April and June 2019. The Self Report Questionnaire (SRQ-20) were used, along with a questionnaire about socioeconomic and demographic characteristics, personal aspects and educational process, prepared by the authors and previously tested in a pilot study. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis.

The study included 80 students, equivalent to 22.59% of the total population of the studied Campus. There was an age average of 23.2 years (± 4.12), mostly female (52.5%) and single individuals (35%). The prevalence of CMD was 50% and an association was observed with the following factors: feeling of dissatisfaction with the course (p = 0.034); consider their own academic performance poor or regular (p = 0.12); lack of physical activity (p = 0.043); being anxious when not using a cell phone (p = 0.007); and the retraction pattern in the face of conflict situations in their interpersonal relationships (p = 0.025).

Results suggest a high prevalence of CDM, associated mainly with the personal perspective about the educational process and personal habits.

The field of psychiatry extends from diagnosis to treatment, including prevention and various cognitive behavioral and emotional disorders.

To study the activity of Mahdia’s psychiatric department in order to improve its outcomes.

This study was retrospective based on reporting data of the inpatients during 3 years (2016-2018) and then analyzing them.

This study involved 395 patients with an average age 36.6 years. The sex ratio M/F was 1.58. The prevalence of the disorders was more marked with the low socio-economic level, school failure and unemployment. 37% had a family psychiatry history and schizophrenia was the most common. 75.5% had a personal psychiatric history and 16.8% had a history of suicide attempt. Schizophrenia (28%), Bipolar Disorder (22.1%) and Depression (14.7%) were the main conditions. The majority 79.2% had irregular medical follow-up, 44% had poor therapeutic adherence. The majority 86.6% were hospitalized without consent. The most common reason was aggression and the average length of stay was 19.47 days. The mean duration of parenteral therapy was 4.38 days. Electro-convulsive therapy was indicated for only 16 patients. Typical antipsychotics were the most prescribed 37.4%. The exit treatment was monotherapy in 14.3% and polytherapy in 83.4%. The exit destination was home in 98% and the obligation follow-up was only indicated in 2.8% (11patients).

This study is at the heart of psychiatric news with many questions around these coercive practices at legal and ethical level, particularly respect for freedom, legitimacy of these measures, patients’ safety and the quality of the treatments.

Belarus is undergoing legislative shifts towards community-based mental health care. Responding effectively to support this process requires an understanding of the experiences and challenges facing families caring for a relative affected by mental illness.

To identify how caring for a person with severe mental illness impacts on family carers, and what carers identify as their support needs.

Semi-structured interviews were undertaken with 17 caregivers of people affected by severe mental illness (diagnosis of F06.8, F20, F25, F7, and/or F 84) in Belarus between March - June 2019.

Care-giving for a family member was usually undertaken on a full time basis with no option for respite. Whilst caring did, in cases, strengthen family solidarity, it also resulted in intensive stress and burnout, financial pressures, and high levels of family tension, exacerbated when the person living with mental illness was perceived as a potential safety risk. High levels of societal stigma meant that care-givers commonly felt unable to discuss their circumstances, travel in public spaces, or participate in community activities. Stigma also deterred carers from seeking professional support. Priorities for support amongst carers included better information, public awareness raising and sensitization, advocacy to support patient integration into social and economic life, peer support and respite for family carers, and an increase in mental health specialists.

Caregiving affected family carers on multiple levels with predominantly negative consequences. Priorities identified by carers need to be considered and acted upon if community-based care is to become an effective option.

It has been recently proposed that diagnoses traditionally framed in axis II of the DSM and diseases related to the elderly are progressively replacing serious mental illness in acute inpatient wards.

To study the clinical and sociodemographic characteristics of the patients in an acute psychiatric unit, and to compare them between a ten-year period.

Observational, descriptive, and retrospective study that analyzes the data recorded in the discharge reports from the acute ward of the Hospital Provincial de Castellón.

Among the studied patients, we found statistically significant differences regarding gender, age, readmission rate, and stay duration between the two periods. In the most recent one (2017-18), more women and elderly have entered, with shorter stays and fewer readmissions. In both periods, the most prevalent psychiatric diagnoses are by far serious mental illness (bipolar disorder, schizophrenia). By grouping the diagnoses into five broad categories (serious mental illness, dementias, personality disorders, drug misuse, and others), we found significant differences in their distribution. Lately, more personality disorders and dementias were admitted as the main diagnosis, while serious mental illness and substance use disorders increased their prevalence as accessory diagnoses.

The research carried out allows us to conclude that the clinical and sociodemographic profile of patients admitted to an acute unit is changing. It would be advisable to investigate the causes that motivate it and modify the devices to adapt to this new reality.

The prevalence of mental health issues amongst domestic and foreign students in Slovakian medical schools and any differences between them is currently unknown.

The goals of this paper are to determine the prevalence and extent of mental health issues among medical students at Pavol Jozef Šafárik University (UPJŠ) in Kosice, Slovakia and to determine if there is a difference between domestic and foreign students’ mental health at UPJŠ.

A combined questionnaire utilizing well-known sources was distributed to UPJŠ medical students to self-assess their levels of anxiety, depression and hedonic capacity (Zung, 1965; Zung, 1971; Snaith et al., 1995). Two-tailed T-tests and regression statistical analyses were applied to determine the significance of the data and any differences.

27% (n=319) and 25% (n=300) responses were collected from domestic and foreign UPJŠ medical students, respectively. 57% of domestic and 74% of foreign students screened positive for either anxiety, depression, or a combination. The 17% increased rate of anxiety and/or depression amongst foreign students when compared to domestic students was statistically significant (P<0.001). The differences between the two groups regarding hedonic tone were not statistically significant.

The prevalence of mental health issues amongst domestic and foreign UPJŠ medical students is much higher than the worldwide average. The higher rate of anxiety and depression observed in foreign UPJŠ medical students when compared to domestic students may be due to a reduced social support system as well as studying in a foreign country. These data suggest special support may be necessary for medical students studying abroad.