The extent to which structural gender inequality contributes to macro-level differences in postpartum depression (PPD) remains largely unknown.

To examine the association of structural gender inequalities with national-level prevalence estimates of PPD symptoms.

Meta-analytically derived national-level estimates for the prevalence of PPD symptoms – based on the Edinburgh Postnatal Depression Scale (EPDS) – were combined with economic (e.g., income inequality), health (e.g., infant mortality rate), sociodemographic (e.g., urban population), and structural gender inequality variables (e.g., abortion policies) for 40 countries (276 primary studies). Data came from a prior meta-analysis on PPD prevalence and international agencies (e.g., UNICEF). Meta-regression techniques and traditional p-value based stepwise procedures, complemented with a Bayesian model averaging approach, were used for a robust selection of variables associated with national-level PPD symptom prevalence. Sensitivity analyses excluded primary studies with small sample sizes or countries lacking evidence for psychometric properties of the EPDS.

Income inequality (β = 0.04, 95% CI = 0.02 to 0.07) and abortion policies (β = 0.02, 95% CI = 0.00 to 0.03) were the only variables included in the final, adjusted model, accounting for 60.7% of the variance in PPD symptoms across countries. Gradual liberalizations of abortion policies were associated with a 2% decrease in national-level PPD symptom prevalence. Results were robust to sensitivity analyses.

Structural gender inequalities might be social determinants of PPD, as the liberalization of abortion policies seem to impact women’s perinatal mental health on a population level. More research on structural gender inequality is needed to guide policy and practice.

No significant relationships.

No significant relationships.

The COVID-19 pandemic can be seen as mental trauma. The concept of baseline beliefs helps to explain the extent to which mental trauma affects individuals.

The study aimed to investigate baseline beliefs in humanities students in Russian universities and analyse the relationship between baseline beliefs and emotional reactions.

Data collection was carried out between May and July 2020 using a Google form that we developed. A total of 92 humanities students participated in the study. The WAS-37 was used to examine baseline beliefs, and the DASS-21 was used to determine depression, anxiety, and stress levels.

We found that the mean values of the scales “Benevolence in the World” (M = 34.8±6.5), “Self-image” (M = 27.2±4.4), “Luck” (M = 32.7±5.7) and “Controlling beliefs” (M = 27.9±4.0) were above the normative mean values for the Russian population and only the values of the scale “Justice” (M = 20.8±3.8) were below these. All components of baseline beliefs had negative associations with depression, anxiety, and stress; only “Benevolence in the World” was associated exclusively with anxiety (rs = -0.223, p < 0.05), and “Justice” with depression (rs = -0.223, p < 0.05).

In a pandemic, the world around them is perceived by humanities students as less fair. Trust in the world, beliefs about the fairness of the world and a positive self-image are correlated with a more favourable emotional state. By this, we support the view that individuals’ implicit beliefs (baseline beliefs) are related to the severity of the traumatic event.

No significant relationships.

Clinical relapses in schizophrenia remain a frequent event. Long-acting injectable (LAI) antipsychotics enhance adherence, but low blood levels can sometimes be observed despite an adequate posology. Nonetheless, the evaluation of this parameter is uncommon in clinical practice.

To explore the potential advantages of therapeutic drug monitoring (TDM) of LAIs as a predictor of relapse in clinically stable outpatients with schizophrenia.

44 individuals who had reached the pharmacokinetic steady state of LAI treatment (paliperidone, olanzapine, aripiprazole) underwent an anamnestic and psychopathological assessment. LAI blood levels were measured using liquid chromatography-mass spectrometry and classified as “in range” or “under range” according to the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) guideline values. Individuals who relapsed during the one-year follow-up were compared to non-relapsers (Fisher’s exact test, χ2 or Mann-Whitney U). An exploratory binary logistic regression tested the role of other possible relevant predictors of relapse.

No differences were observed in baseline use of mood stabilisers (p=0.211), antidepressants (p=0.530), or prescribed LAI (p=0.563). Other comparisons are presented in the table: among these variables, in-range LAI levels were the only significant predictor of relapse (F=5.95, p=0.015; OR 0.04, 95%CI 0.02-0.56).

TDM of LAIs may optimise the clinical management of schizophrenia by highlighting a suboptimal dosage and a consequent higher relapse risk. Large-scale, drug-specific assessments are needed to confirm these findings.

No significant relationships.

Cognitive function may be impaired in COVID-19 patients, especially in executive functions such as phonemic fluency. Among risk factors, inflammation during hospitalization is related with worse cognitive performance in the long term. On the other side, it has been shown that cognitive reserve (CR) protects against cognitive impairment associated with brain damage, psychiatric disorders and neurodegenerative diseases.

Our aim is to study the protective role of cognitive reserve in phonemic fluency to inflammation after SARS-CoV-2 infection.

We enrolled a cohort of 102 severe SARS-CoV-2 survivors after Intensive Care Unit (ICU) discharge and 58 agreed to participate in this 6-month follow-up study. Patients with previously known cognitive impairment were excluded. Demographic, clinical and laboratory data were collected. To assess the phonemic fluency, we used the Controlled Oral Word Association Test (COWAT) controlling the effects of age and education. Inflammation was recorded according to the number of days with high CRP. ANCOVA analyses were used to test the effect of interaction between medical variables and cognitive reserve on phonemic fluency.

The COVID-19 inflammation interacted with CR in phonemic fluency (F= 6.47, p= 0.01), with worse performance in patients with low CR (mean 16.7 (10.2-23.3)) than those with high CR (mean 37.7 (34.3-41.2)) in function of number of days with high PCR during ICU stay.

The role of the cognitive reserve is important to reduce the cognitive impairment related with COVID-19 inflammation in post-ICU patients.

No significant relationships.

Esketamine nasal spray has been developed to treat adults with treatment resistant depression. On Dec.2019, EMA granted a market access approval in this indication.

ESKALE is a descriptive study of treatment resistant depression patients treated with esketamine in France.

Observational retrospective study. 157 patients are included in 3 cohorts depending on their treatment initiation date. This abstract presents the second interim results of patients treated with esketamine and whom data collection ranges from Oct.2019 and Sept.2021.

66.7% of patients were females. Average age was 49 years old with 26 patients > 65 years old. Duration of the current depressive episode was 26.0 months (mean). 48.8% of patient have > 1 suicide attempt during whole life. At esketamine initiation, 78.2% patients were clinically perceived to have severe depression with a MADRS score of 32.4 (median) and a PHQ9 score of 19.5 (median). For the overall sample, esketamine was prescribed in median as a 3rd line and for 40.5% of patients after neurostimulation. The majority of the patient started esketamine at 28 mg or 56 mg and increased the dose to 84 mg. After 4 months of treatment, clinical benefits are the following: decrease of MADRS total score -16.5 points (median) corresponding to 58% of responders and a PHQ9 total score decrease of -8.6 points (median). No new safety signal detected.

This second interim analysis describes patients’ profiles and clinical evolution over a longer period and a broader population than the first interim analysis. The conditions of use are consistent with the ones approved by health authorities.

I (Marie-Alix Codet) works as a full employee at Janssen Cilag

The association between low birth weight and attention problems in childhood has been replicated many times (e.g. Momany, Kamradt, & Nikolas, 2018). However birth weight is unlikely the aetiological start-point of this association, as birth weight is itself the product of many prenatal factors e.g. gestational complications, maternal toxin exposure during pregnancy and basic demographics.

We explore (1) which prenatal factors best predict attention problems in two independant population-based cohorts of children (2) which associations, if any, are moderated by sex and (3) we report accuracy statistics of our prenatal prediction algorithm for attention problems.

Participants were children aged 9 from ABCD study from the United States (N > 9,000) and the Growing Up in Ireland (GUI) study from Ireland (N > 6,000). Selected variables included familial pscyhiatric history, maternal smoking during gestation, prescription and non-prescription drug-use during gestation and a variety of gestational complications. All interactions with sex were also included. We used 5-fold cross-validation and elastic net regression (glmnet) to identify the optimal predictors of attention problems (measured by CBCL and SDQ).

Strongest predictors of attention problems in the U.S. cohort included male sex, number of drugs used during pregnancy, number of family members with a history of mental illness, and number of gestational complications. Sex interacted with several of these risks. Protective factors included being a twin/triplet, being Asian, having higher household income and higher parental education level.

Several risk factors for childhood attention problems were identified across both cohorts, supporting their generalizabilty. Other findings were cohort-specific.

No significant relationships.

Mothers of terminally ill children experience chronic stress that can lead to physical and emotional exhaustion. A better understanding of their experiences, resources, and vulnerabilities can help plan psychological interventions.

The research is aimed to study mothers’ appraisals of their life situation related to the child’s terminal illness and their coping strategies.

Participants: 21 women (aged 26-49) whose children were patients at the hospice. Women answered a set of open-ended questions and completed questionnaires: “Appraisal Criteria of the Difficulty of a Life Situation”, “Types of Orientations in Difficult Situation”, “Ways of Coping Checklist”. Data were analyzed with Pearson’s r.

Planned coping was associated with evaluations of opportunity (r=0.78) and threat to the future (r=0.61). Despite the deteriorating health status of most of the children, women reported a high degree of subjective control. This might be related to outside help. Participants stated that helping by the family, doctors, and psychologists was essential. Unexpectedly, the “need for a quick and active response” score correlates with that for the coping strategy “fantasizing” (r=0.62). This can be explained by the depletion of resources; deprivation of sleep and active rest is often observed. An important feature is that half of the participants report high self-blame.

We suggest that self-blame, an analysis of opportunities, and probable future scenarios are important psychotherapy targets for mothers of terminally ill children. The consequences of threat appraisal are twofold: admitting the threat can be painful, but it also mobilizes one’s energy. Funding: The study was funded by RFBR, project number 20-013-00838.

No significant relationships.

Many different causes of catatonia are well-documented in medicine. Modern understanding of catatonia has evolved in the last 100 years with the suggestion that there is a root cause in neuroinflammation. This is a case report of a young woman who presented to the emergency department with altered mental status, found to have catatonia responsive to lorazepam, with the underlying etiology being a diagnosis of multiple sclerosis.

A case-based approach is used to support the following learning objectives: - Review the diagnostic criteria for catatonia - Distinguish between simple and malignant catatonia - Review the Bush-Francis Scale - Review available treatment

Mother brings 24-year-old woman into the hospital for altered mental status and changes in behavior including staring spells, periods of withdrawal, refusal to eat, lack of purposeful movement, apraxia, and mutism that worsened 24 hours prior to presentation.

The patient was afebile with negative covid-19 test. Recent diagnosis of Bell’s palsy treated with antivirals and oral steroird, which terminated just prior to presentation. Additionally, patient had outpatient treatment for vertigo. Lumbar puncture was negative for an infectious process. MRI revealed multiple stable white matter lesions in the periventricular, pontine, and subcortical regions, some oriented perpendicular to the corpus callosum.

This case of a 24-year-old woman with catatonia brought an opportunity to retrospectively review a case in detail in order to feature learning objectives that review very important considerations in the evaluation, differential diagnosis, symptom tracking, and treatment of catatonia. The future of research in catatonia is bright and diverse.

No significant relationships.

No significant relationships.

Resilience has been described as an individual’s ability to adjust or adapt to significant adverse or traumatic circumstances.

The aims of this study were to assess the resilience of caregivers of patients with mental disorders and to identify its associated factors.

We conducted a descriptive and analytical cross-sectional study among caregivers of patients followed in the outpatient psychiatry department at the university hospital of Sfax(Tunisia), during septembre 2021. Resilience was assessed using Connor–Davidson Resilience Scale(CD‑RISC).The total scores range from zero to 100. The cut-off scores for this questionnaire is 50, with higher score indicating higher resilience.

Our sample included 34 family caregivers. The mean age was 47.47 years (SD=12.4 years)and the sex ratio (M/F) was 1.42. They were the parents of patients in 35.3% of cases. The mean duration of providing care to patients was 8.62 years. The mean resilience score of caregivers was 42.85 and 26.5% of them were resilients. The Caregivers with low socioeconomic level (p=0.004), a history of chronic illness (p=0.0001), a long duration of providing care (p=0.001), a stressful events (0.002) and those victims of agressive behaviors committed by patients (p=0.0001) were more likely to have a low resilience score.

Our results stated that three out four cargivers have low level of resilience. Interventions targeting stress related to social events and burden of care, and violence committed by patients in their family environment should be integrated to increase the caregivers’resilience.

No significant relationships.

Mutism is the inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output. Mutism is a common manifestation of psychiatric, neurological, and drug-related illnesses. Psychiatric disorders associated with mutism include schizophrenia, affective disorders, conversion reactions, dissociative states, and dementias. Neurological disorders causing mutism affect the basal ganglia, frontal lobes, or the limbic system.

Outline the importance of setting a differential diagnosis of mutism in the Emergency Room.

Review of scientific literature based on a relevant clinical case.

Male, 58 years old. He has lived in a residence for 3 months due to voluntary refusal to ingest. Diagnosed with paranoid personality disorder. He is refered to the Emergency Service due to sudden mutism. During this day, he has been stable and suitable with a good functionality. For 3 hours he is mutist, oppositional attitude and stiff limbs, refusing to obey simple orders. Hyperalert and hyperproxia. Not staring. After ruling out organic pathology: normal blood tests, negative urine toxins and cranial CT without alterations, he was admitted to Psychiatry for observation and, finally, he was diagnosed with Psychotic Disorder NOS.

Mutism most often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. The most common disorder of behavior occurring with mutism is catatonia. The differential diagnosis of mutism is complex. In some cases the diagnosis will be clarified only by careful observation and after a neurological evaluation. Published studies show neurological disorders presenting with mutism can be misdiagnosed as psychiatric.

No significant relationships.

Kleptomania is characterized by recurrent failure to resist the impulse to steal items of little value despite the ego-dystonic impulse and awareness of the wrongfulness of the act. Its prevalence is considered to be 0.6–0.8% in the general population and it is mostly comorbid with other psychiatric disorders. Kleptomania is a disabling disorder since patients suffer from emotional distress and impaired functioning.

Although there is no cure, treatment may help prevent Kleptomania worsening and its negative consequences. We propose a review of the therapeutic approach to this disease.

Non-systematic literature review.

No effective treatment is available for Kleptomania. Better efficacy can be achieved by combining psychotherapy with pharmacotherapy. Different treatment interventions can be selected based on clinical similarities to other disorders, co-occurring conditions or behavioral core features. Patients with significant mood symptoms may benefit from mood stabilizers or antidepressants. For patients with shoplift cravings and/or family history of substance use disorders, Naltrexone may reduce symptoms. Stimulants may be useful for Kleptomania bassociated with Attention Deficit Hyperactivity Disorder impulsivity. Benzodiazepines are effective in tension relief when used as adjuvants, at the beginning of treatment. Electroconvulsive therapy should be reserved for patients with treatment-resistant symptoms and comorbid depression. Cognitive-behavioral therapy has replaced Psychoanalytic and Psychodynamic psychotherapies.

Treatment helps decrease disruption to the person’s life, preventing the intense shame, legal, social, family, and occupational repercussions of Kleptomania. Although pharmaceutical and psychosocial interventions are available, we still lack specific treatments for Kleptomania.

No significant relationships.

At Kiskunhalas Semmelweis Hospital, a special mobile container hospital was set up to care for patients infected with SARS-CoV-2 during the first wave of the pandemic.

We aimed to create a proactive integrated mental health protection system for the frontline healthcare workers that provides an opportunity for psychophysiological monitoring of stress and crisis during shifts, as well as providing staff with more lasting methods of coping with difficulties.

From the ascending branch of the second wave, every two weeks on the workers’ rest day, mental helpers initiated a phone call to each employee participating in the program. If it was necessary, we provided psychological counseling, crisis intervention, brief psychotherapy, and psychopharmacotherapy. In addition, self-operated psychophysiological screening devices were used at the frontline work site, which provided an opportunity for continuous telemedicine monitoring.

In our department, three psychologists and three psychiatrists kept in touch with an average of 150 frontline workers per month. Interventions were needed for a total of over 24% in December and January, over 17% in February and March, almost 9% in April, and only 4% in May. Helpers rated an average of two-thirds of these cases as moderate. They faced severe stress 2-3 times a month in sum, and for 2-3 workers needed medication.

Without a mental support system, self-report-based data suggest that nearly half of responders working at the frontline reached the threshold of clinically significant mental syndromes (Greenberg et al, 2021). Using our mental health support system, one-fifth of the workers needed intervention.

No significant relationships.

No significant relationships.

Increasing educational attainment (EA) could decrease the occurrence of depression. We investigated the relationship between EA and depressive symptoms in older individuals across four European regions.

1) examine association between EA and depressive symptoms 2) determine, if there is an upper limit to this association 3) explore regional and demographic differences within this relationship across Europe

We studied 108 315 Europeans (54 % women, median age 63 years old) in Europe assessing EA and depressive symptoms. Logistic regression estimated the association between EA and depressive symptoms, adjusting for sociodemographic and health-related factors; testing for sex/age/region and education interactions.

Higher EA was associated with lower odds of depressive symptoms, independent of sociodemographic and health-related factors. A threshold of the lowest odds of depressive symptoms was detected at the first stage of tertiary education (OR 0.60; 95% CI 0.55-0.65; p<0.001; relative to no education). Central and Eastern Europe showed the strongest association (OR for high vs. low education 0.37; 95% CI 0.33-0.40; p<0.001) and Scandinavia the weakest (OR for high vs. low education 0.69; 95% CI 0.60-0.80; p<0.001). The association was strongest amongst younger individuals. There was a sex and education interaction only within Central and Eastern Europe.

Level of EA is reflected in later-life depressive symptoms, suggesting that supporting individuals in achieving EA, and considering those with lower EA at increased risk for depression, could lead to decreased burden of depression across the life-course. Further educational support in Central and Eastern Europe may decrease the higher burden of depressive symptoms in women.

No significant relationships.

Recently, several antidepressants, mood stabilizers, and antipsychotics have been suggested to have favorable effects in the treatment of COVID-19.

The aim of this systematic review was to collect evidence from preclinical and clinical studies concerning the scientific evidence for the repurposing of psychotropic drugs in COVID-19 treatment.

Two independent authors searched PubMed-MEDLINE, Scopus, PsycInfo, Clinical Trial Registration Site US (ClinicalTrials.gov) databases, and reviewed the reference lists of articles for eligible articles published up to May 31st, 2021. All preclinical and clinical studies on the effect of any psychotropic drug on Sars-CoV-2 or patients with COVID-19 were included. The Newcastle-Ottawa scale was used for the quality assessment of clinical studies. This systematic review adheres to the PRISMA guidelines.

22 studies were included in the synthesis: 9 clinical studies, 9 preclinical studies, and 4 computational studies. The use of antidepressants, both SSRI and non-SSRI, was associated with a reduced risk of severe complications of COVID-19. Several antipsychotics showed an increased risk for both Sars-CoV-2 infection and severe complications during COVID-19.

The current evidence supports a potential anti-SARS-CoV-2 role for several antidepressants, while the evidence on mood stabilizers or antipsychotics remains controversial. Drug repurposing proved highly successful in response to the current pandemic and psychotropic medications are widely used in clinical practice with well-known safety and tolerability profiles, showing antiviral, immunomodulatory, and anti-inflammatory properties, being perfect candidates for possible treatment of COVID-19. Further research will deliver optimized and specific therapeutic tools that will increase the preparedness of health systems for possible future epidemics.

No significant relationships.

Maintaining remission, preventing from future episodes, better treatment adherence and improving the quality of life are main aims of long-term treatment in bipolar disorders (BD). In recent years, new generation long-acting injectable (LAI) antipsychotics have been frequently used in maintenance treatment for bipolar disorders.

We aimed to review socio-demographic and clinical characteristics of bipolar patients taking LAI treatment for maintenance treatment.

Clinical records of 44 bipolar patients who are on LAI treatment and followed in Mazhar Osman Mood Clinic (MOMC) of Selcuk University Medical Faculty were evaluated.

Nearly half of the patients were male (n:24, 54%). 43,2% of the patients were married. The mean age was 36.6±11.9 years and the mean duration of education was 11.5±3.9 years. All of the patients were diagnosed with bipolar 1 disorder. Most of the patients (65.9%) was on aripiprazole LAI while remaining was receiving paliperidone LAI for maintenance treatment. Ten of the patients discontinued the treatment due to the side effects and extrapyramidal side effects was the most common side effect. Relapse was observed in 25% of the patients and there was no difference between aripiprazole and paliperidone in terms of relapse rate.

LAI new generation antipsychotics are taking place in long-term treatment of bipolar disorder via improving treatment adherence. Side effect profile of aripiprazole and paliperidone are different. However, we could not find any difference between two drugs in terms of side effects and relapse rates. Small sample size and shorter duration of follow-up should be considered as limitations.

No significant relationships.

Clozapine is highly effective in patients with treatment-resistant schizophrenia but, to ensure optimal clinical response it is important to optimize its use and this depends on adequate pharmacological monitoring.

Evaluate the therapeutic response rate according to clozapine plasma concentration.

It was a cross-sectional, retrospective and analytical study, carried out over a period of six months, in the F and A psychiatry departments of the Razi hospital in Tunis, including patients followed for treatment-resistant schizophrenia and receiving clozapine. We evaluated the response to clozapine using the Brief Psychiatric Rating Scale (BPRS).

The average age was 37.7 ± 9.4. The mean age of introduction of clozapine was 31 years and the mean time to its introduction was 9.3 years. Clozapine was administered as a single drug in 85% of cases. The mean dose of clozapine was 373 mg/day. The mean of clozapine plasma concentration was 386.5 ng/ml with a minimum of 89 ng/ml and a maximum of 913 ng/ml. The clinical response rate to clozapine was 25% with a BPRS good response threshold value of less than 35. Patients with clozapine levels above the conventional cut-off of 350 ng/ml (n=34) had a response rate of 34.6%. A response rate of 37% was observed in the group of patients with a clozapine plasma concentration interval of 200-350 ng/ml. There was no statistically significant difference in therapeutic response (p=0186)

Our study revealed a therapeutic response variation according to plasma clozapine concentration and showed the existence of a non-negligible and effective response rate.

No significant relationships.

The social media platform Reddit is a contemporary context where we have an opportunity to identify problems experienced by people regarding different aspects of life. The platform is virtually anonymous which might make users discuss their problems more freely. Reddit is divided in subreddits where different subjects are discussed and the discussions are controlled by creators and moderators. I have identified a quite active subreddit targeted towards recovering addicts of benzodiazepines; r/benzorecovery.

* To analyze strategies of recovery in user narrative * To identify techniques commonly used and the how they are described * To construct metadata in order to assess how frequent the discussion of a different techniques are

Technically, what is done in this study, is adding mark-up metadata to different discussion. A rudimentary form of analysis suitable with a larger digital corpus where content metadata is added (Gilliland Swetland 2000). The metadata is constructed through a hermeneutical method in which the researcher analyses the subreddit.

Answering question like: Example: DIY-tapering; different ways to limit drug use by using less. 1) how common are discussion of taperings in relation to other subjects? 2) Is tapering commonly discussed together with other subjects and techniques?

Using a method of categorization and metadata mark-up we could gain a good understanding of the problems among recovering benzodiazepine addicts. We will also have the possibility to identify concepts that addicts themselves discuss and relate these to professional concepts thus creating better possibilities of communication between professionals and clients.

No significant relationships.