Mood instability is an important problem but has received relatively little research attention. Natural language processing (NLP) is a novel method, which can used to automatically extract clinical data from electronic health records (EHRs).

To extract mood instability data from EHRs and investigate its impact on people with mental health disorders.

Data on mood instability were extracted using NLP from 27,704 adults receiving care from the South London and Maudsley NHS Foundation Trust (SLaM) for affective, personality or psychotic disorders. These data were used to investigate the association of mood instability with different mental disorders and with hospitalisation and treatment outcomes.

Mood instability was documented in 12.1% of people included in the study. It was most frequently documented in people with bipolar disorder (22.6%), but was also common in personality disorder (17.8%) and schizophrenia (15.5%). It was associated with a greater number of days spent in hospital (B coefficient 18.5, 95% CI 12.1–24.8), greater frequency of hospitalisation (incidence rate ratio 1.95, 1.75–2.17), and an increased likelihood of prescription of antipsychotics (2.03, 1.75–2.35).

Using NLP, it was possible to identify mood instability in a large number of people, which would otherwise not have been possible by manually reading clinical records. Mood instability occurs in a wide range of mental disorders. It is generally associated with poor clinical outcomes. These findings suggest that clinicians should screen for mood instability across all common mental health disorders. The data also highlight the utility of NLP for clinical research.

The authors have not supplied their declaration of competing interest.

The Coronavirus pandemic has originated unprecedented sanitary control measures that have conditioned people’s lifestyles and habits. Little is known about the impact of such measures, especially the most restrictive, on recent and growing phenomena such as exercise addiction, use of enhancement drugs, and Body Dysmorphic Disorder (BDD).

The objective was to investigate the above-mentioned phenomena during COVID-19 pandemic and how they relate.

The sample consisted of 3161 participants (65% women), from Portugal (11%), Italy (41%), Spain (16%), the UK (12%), Lithuania (12%), Japan (6%), and Hungary (4%). Mean age was 35.05 (SD = 12.10). Participants responded online to the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), and questions about use of enhancement drugs.

4.3% of the participants scored above the cut-off point of the EAI, with higher values registered in the UK and Spain. Exercise addiction was higher among men. Appearance anxiety and body satisfaction problems were found in participants of all participating countries, with 15.2% scoring over the cut-off point for BDD. Higher numbers of those at risk of BDD were found in Italy, Japan, and Portugal. About 29% reported the use of fitness supplements to make them look better, with 6.4% starting a new use during the lockdown. Change in supplements use and exercise are predicted by EAI scores. Change in mental health is predicted by AAI scores.

This study helps to shed light on how COVID-19 lookdown induced behavioral changes and how they affect physical and mental health-related aspects in different countries.

Burnout is prevalent in residents and coping is one of the important modifying factors.

This study aimed to investigate coping strategies, burnout, and their relationship among residents.

A cross-sectional descriptive study was conducted among residents from October 2019 to April 2020 in Thailand. The Brief COPE Inventory Thai version and The Maslach Burnout Inventory Thai version were used, and the associations between coping strategies and burnout were examined.

The number of 280 residents replied the questionnaire (response rate 41.5%). The most favored copings were self-distraction and acceptance and the least common were denial and substance use. Most residents had high level of emotional exhaustion (n = 113, 40.4%) and moderate level of reduced personal accomplishment (n = 99, 35.4%). However, low degree of depersonalization was reported predominantly (n = 164, 58.6%). The coping of venting, behavioral disengagement and self-blame independently predicted emotional exhaustion and depersonalization. Behavioral disengagement was the only predictor of burnout in all dimensions, whereas positive reframing is the only strategy that had independent and protective effect against burnout in all dimensions.Table 1

Multivariate analysis of factors associated with emotional exhaustion

A large number of residents had emotional exhaustion. Behavioral disengagement and positive reframing were the most influential coping strategies related to burnout. This study might inform residency training program of some specific approaches for burnout prevention.

None Declared

Melasma is a common disorder of acquired hyperpigmentation characterized by tan or brown macules and patches localized to photo-exposed areas of the face.

To study the psychological impact of melasma on Tunisian women.

We conducted a cross-sectional study on thirty patients with melasma who attended the dermatology department of the University Hospital in Sfax (Tunisia).

The questionnaire included socio-demographic and clinical data. We used four measurement scales:

– MELASQOL questionnaire;

– Rosenberg Self-Esteem Scale;

– Hospital Anxiety and Depression Scale;

– Body Image Questionnaire.

The mean age was 34.6 years. The majority was living in urban areas (90%), was married (56.7%) and had a profession (80%).

Sixty percent of patients were anxious and 16.7% were depressed. Both self-esteem and body image were respectively altered in 43.3% and 36.6%. The average score of MELASQOL was 31.77%. It was higher in single woman (36.8 vs. 28.4), younger than 40 years old (31.5 vs. 21.7), having a low socioeconomic status (45.2 vs. 29) and working in private sector (40 vs. 24).

The quality of life was more damaged in patients with disease duration less than five years (P = 0.024).

Anxious patients had higher MELASQOL scores than non-anxious (38.17 vs. 22.17; P = 0.008), as well as depressed patients (49 vs. 28.32; P = 0.009).

High MELASQOL scores were correlated with low self-esteem (P = 0.05) and altered body image (P = 0.04).

Although benign, melasma causes an important psychological impact such as anxiety, depression, low self-esteem and poor body image. These effects should be considered in the care plan.

The authors have not supplied their declaration of competing interest.

Stigma toward mental illness is an international phenomena and it has negative consequences on the patients and their families. Studies on public attitudes toward people with mental illness (PWMI) in the Arab world initially reported less prevalence of stigma compared to other societies; however, follow up studies showed that stigma was influenced by specific socio-cultural factors.

This study aims to examine public attitudes toward people with mental illness in Oman and the impact of socio-demographic factors.

This is a cross-sectional survey conducted among the general public in Oman. The attitude was measured via the Attitude toward Mental Illness (AMI) questionnaire. Various demographic factors were examined including age, place of residence, occupation and previous encounter with PWMI. The data were collected using online research methods.

A total of 601 subjects participated in this study, (M: 41.4%, F: 58.6%). 48% of the participants were aged 15–30 years while 46% were aged 31–45 years. The majority of the participants were employed and 10% were students. After adjusting for all other variables, subjects aged (15–30years) had less positive attitude compared to those aged (46–60 years) (P = 0.06). Socio-demographic factors such as gender, occupation and previous contact were correlated with the endorsement of positive attitudes toward PWMI.

This study illustrated that public attitudes toward PWMI in Oman is generally sub-optimal. The observed attitudes were strongly influenced by age, gender, occupation and previous exposure to PWMI. Future studies with robust methodology are recommended to scrutinize the present findings.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Academic procrastination is a specific sub-type of procrastination, assessing the tendency to delay academic tasks in connection with the preparation of courses or exams.

To determine the impact of academic procrastination on studies and academic performances and identify associated factors.

We conducted a cross-sectional descriptive study in students from three different universities: a medical school, a law school and an engineering school. Socio-demographic, clinical and academic data were collected. Procrastination was assessed using the Academic Procrastination Scale. We further administered the Short Version of the impulsive behaviour scale, the Satisfaction with Life Scale, the Perfectionism scale, and the one item Self-esteem Scale.

Our sample consisted of 1019 students. The mean age was 22 ± 2.25 years, and 62% were females. About one third of study participants used tobacco or alcohol, and 10% used drugs (cannabis or others). We found a significant positive correlation between procrastination and academic failure (r=0.22 p= 0.00) and a negative correlation with academic success (r= -0.27 p=0.00). Multivariate regression analysis showed the following risk factors for academic procrastination: alcohol consumption (ORa= 1.74 [1.14; 2.67]), study field (with reference to medicine: law ORa= 1.50 [1.02; 2.19], engineering studies ORa= 2.01 [1.34; 3.02]), and impulsivity (ORa= 2.11 [1.55; 2.86]).

Academic procrastination has a negative impact on academic achievement and performance. This impact appears to differ depending on the field of study. It also seems closely related to impulsiveness and alcohol use. Our findings might contribute to find new ways of helping students to improve academic performance.

No significant relationships.

People with severe mental illness (SMI) die prematurely, mostly due to preventable causes.

To examine multimorbidity and mortality in people living with SMI using linked administrative datasets.

Analysis of linked electronically captured routine hospital administrative data from Northern Ireland (2010–2021). We derived sex-specific age-standardised rates for seven chronic life-limiting physical conditions (chronic kidney disease, malignant neoplasms, diabetes mellitus, chronic obstructive pulmonary disease, chronic heart failure, myocardial infarction, and stroke) and used logistic regression to examine the relationship between SMI, socio-demographic indicators, and comorbid conditions; survival models quantified the relationship between all-cause mortality and SMI.

Analysis was based on 929,412 hospital patients aged 20 years and above, of whom 10,965 (1.3%) recorded a diagnosis of SMI. Higher likelihoods of an SMI diagnosis were associated with living in socially deprived circumstances, urbanicity. SMI patients were more likely to have more comorbid physical conditions than non-SMI patients, and younger at referral to hospital for each condition, than non-SMI patients. Finally, in fully adjusted models, SMI patients had a twofold excess all-cause mortality.

Multiple morbidities associated with SMI can drive excess mortality. While SMI patients are younger at referral to treatment for these life-limiting conditions, their relatively premature death suggests that these conditions are also quite advanced. There is a need for a more aggressive approach to improving the physical health of this population.

Weakness in grammar understanding is key future of specific language impairment (SLI) in children. There has been a considerable amount of work on the language abilities of children with SLI, but we still know relatively little about their other cognitive abilities –in particular their non-linguistic cognitive strengths and weaknesses.

The aim of this research was to examine the hypothesis that Russian-speaking children at the age of 4 with deficit in executive abilities have a risk for emerging weakness in grammar understanding at the age of 6.

One hundred and twenty-five children at the age of 4 were assessed with the NEPSY to reveal children with different level of executive abilities. We have revealed 21 children with deficit in executive abilities. The control group included 21 children with typical level of executive abilities. The children from experimental and control group were matched for IQ and gender. In the framework of longitudinal research, children at the age of 6 from both groups were assessed by Grammar Understanding Test from Luria's neuropsychological assessment technique.

Two-way ANOVAs with repeated measures revealed significant differences between groups for scores in the Grammar Understanding Test. Children from experimental group had weakness in grammar understanding.

We have revealed that children at the age of 4 with weakness in executive abilities have a risk for emerging weakness in grammar understanding at the age of 6. In view of the obtained results, it can be assumed that executive abilities have influence on the development of grammar understanding in preschool children.

The author has not supplied his/her declaration of competing interest.

The PHQ-9 has been recommended as the best available screening and case-finding instrument for primary care based on its brevity, and ability to inform the clinicians on both depression severity and diagnostic criteria.

Our study evaluated the reliability and the validity of the Tunisian version of the PHQ-9 in detecting major depression in general population.

We undertook a cross-sectional and analytical study. A total of 134 participants, representative of the Tunisian general population, were enrolled. The PHQ-9 was validated against the HAD reference standard. The types of validity determined for the PHQ-9 in this study were: translation validity, internal reliability and criterion validity.

Test-Retest reliability was determined by intraclass correlation. This scale is stable over 2 weeks (ICC = 0.97). The Tunisian version of the PHQ-9 was found to have good internal reliability (Cronbach's alpha = 0.84). As for criterion validity of the PHQ-9, the Pearson's correlation coefficient between the PHQ-9 and HAD was 0.94 and the Spearman's correlation coefficient was 0.81. This indicated a positive association of good strength between the two instruments. A cut-off score of 10 or higher on the PHQ-9 had a sensitivity of 86.2 and a specificity of 83.8. The VPP was 0.6 and the VPN was 0.9.

The Tunisan version of the PHQ-9 has several potential advantages. It was found to be a valid and reliable casefinding instrument for detecting depression in general population.

The authors have not supplied their declaration of competing interest.

Severe behavioural problems (SBPs) in childhood are highly prevalent, impair functioning, and predict negative outcomes later in life. Over the last decade, clinical practice guidelines for SBPs have been developed across Europe to facilitate the translation of scientific evidence into clinical practice. This study outlines the results of an investigation into academic experts’ perspectives on the current prevalence, implementation, and utility of clinical guidelines for SBPs in children aged 6–12 across Europe.

An online semi-structured questionnaire was completed by 28 psychiatry and psychology experts from 23 countries.

Experts indicated that approximately two thirds of the included European countries use at least an unofficial clinical document such as textbooks, while nearly half possess official guidelines for SBPs. Experts believed that, although useful for practice, guidelines’ benefits would be maximised if they included more specific recommendations and were implemented more conscientiously. Similarly, experts suggested that unofficial clinical documents offer a wide range of treatment options to individualise treatment from. However, they stressed the need for more consistent, evidence-based clinical practices, by means of developing national and European clinical guidelines for SBPs.

This study offers a preliminary insight into the current successes and challenges perceived by experts around Europe associated with guidelines and documents for SBPs, acting as a stepping stone for future systematic, in-depth investigations of guidelines. Additionally, it establishes experts’ consensus for the need to develop official guidelines better tailored to clinical practice, creating a momentum for a transition towards European clinical guidelines for this population.

Urban living has consistently been associated with higher risk of developing schizophrenia when compared to rural living. Exposure to green space has been associated with better mental health outcomes and, more recently, childhood exposure to green space has been linked with lower rates of schizophrenia. The reasons for these findings remain unknown, although lower levels of pollution and psychological factors may play a role.

We aim to review the literature regarding exposure to green space and its relationship with the risk of developing schizophrenia.

We performed an updated review in the PubMed database using the terms “green space” and “schizophrenia”. The included articles were selected by title and abstract.

Growing up surrounded by non-urban environments is associated with lower schizophrenia rates. Upbringing in urban areas is associated with higher schizophrenia rates when compared with non-built-up areas. Schizophrenia risk seems to decrease with vegetation density in a dose-response relationship for urban and agricultural areas. Risk of schizophrenia has been found to be associated additively with green space exposure and genetic liability. No evidence for gene-environment interaction has been reported so far in this regard.

Exposure to green space during childhood appears to lower the risk of developing schizophrenia later in life and can be a preventive strategy. Further research in this area is needed.

Paraneoplastic syndromes (PS) result from indirect effects of neoplasms. In 50% of the cases the symptoms precede the diagnosis and run independently. PS may involve the peripheral or central nervous system, resulting in symptoms from sensory neuropathies to several neuropsychiatric manifestations.

To review the psychiatric manifestations of paraneoplastic syndromes affecting the nervous system.

Selective literature review via PubMed search, using the keywords “paraneoplastic syndromes”, “endrocrine paraneoplastic syndromes”, “neuropsychiatric manifestations”, “limbic encephalitis”.

The prevalence of PS varies with the type of cancer (<1% for breast and ovarian cancers; 3-5% for small cell lung cancer; 20% for thymomas). The general mechanisms behind PS are related to the production of substances by the tumor that directly or indirectly cause distant symptoms, the depletion of substances or the host response to the tumor. Frequently there are autoimmune phenomena involved, with the production of antineuronal antibodies that recognise various antigens at the nervous system. Paraneoplastic neurological disorders include limbic encephalits that can present subacutely with symptoms of depression, irritability, hallucinations, cognitive impairment associated with sleep alterations, confusion and seizures. Others include psoclonus-myoclonus ataxia syndrome, neuromyotonia and cramp fasciculation syndrome. Metabolic and endocrine paraneoplastic syndromes (hypercortisolism, carcinoid tumors, pancreatic cancer) can result from the production of cytokines and hormones by the tumor and produce mood disorders, confusional states and psychosis.

PS can be related to various neuropsychiatric manifestations affecting consciousness, cognition, mood and perception. The recognition of this association can alert for the possibility of a cancer diagnosis specially when facing a patient with unusual clinical presentation.

No significant relationships.

Delivery of information about his/her disease and its treatment to a schizophrenic patient is essential but no consensus exists concerning to what extent and how to deliver the information.

To study the therapeutic impact of internet mediated knowledge an internet site was built particularly for the use of schizophrenic patients and contained information about pharmacotherapy, symptoms management and patients’ rights.

The patients enrolled in the study were randomly divided into 4 groups. Each of the three study groups was given a task to study different topic (pharmacological treatment, symptoms management or patients’ rights) by means of the internet site. The forth group was a control one. Based on analysis of the questionnaires filled out by the patients before and two weeks after the information delivery we have analyzed whether the site is user friendly, emotional responses of the patients, extent of information catching, satisfaction change and contribution to pharmacotherapy.

Patients diagnosed as suffering from schizophrenia and being hospitalized more than once.

28 patients were enrolled, among them 25 being hospitalized. In the study groups, satisfaction from the therapy has improved after browsing the site. Compliance to pharmacotherapy has improved in the groups that had learned about pharmacotherapy and symptoms management. Compliance did not improve in the group instructed on the patients’ rights and in the control group.