Schizophrenia is highly comorbid with substance use disorders (SUD) but large epidemiological cohorts exploring the prevalence and prognostic significance of SUD are lacking.

To investigate the prevalence of SUD in patients with schizophrenia in Finland and Sweden, and the effect of these co-occurring disorders on risks of psychiatric hospitalization and mortality.

45,476 individuals with schizophrenia from two independent national cohort studies, aged <46 years at cohort entry, were followed during 22 (1996-2017, Finland) and 11 years (2006-2016, Sweden). We first assessed SUD prevalence (excluding smoking). Then we performed Cox regression on risk of psychiatric hospitalization and mortality in patients with schizohrenia and SUD compared with those without SUD.

The prevalence of SUD in specialized healthcare ranged from 26% (Finland) to 31% (Sweden). Multiple drug use and alcohol use disorders were the most prevalent SUD, followed by cannabis use disorders. Any SUD comorbidity, and particularly multiple drug use and alcohol use, were associated with 50% to 100% increases in hospitalization and mortality compared to individuals without SUD. Elevated mortality risks were observed especially for deaths due to suicide and other external causes. All results were similar across countries.

Co-occurring SUD, and particularly alcohol and multiple drug use, are associated with high rates of hospitalization and mortality in patients with schizophrenia. Preventive interventions should prioritize detection and tailored treatments for these co-morbidities, which often remain underdiagnosed and untreated.

ML: Genomi Solutions Ltd, Nursie Health Ltd, Sunovion, Orion Pharma, Janssen-Cilag, Finnish Medical Foundation, Emil Aaltonen Foundation. HT, EMR, AT: Eli Lilly, Janssen–Cilag. JT: Eli Lilly, Janssen-Cilag, Lundbeck, Otsuka.

To investigate the effect of Chinese herb Danshen-Dahuang on learning and memory ability in rats with Alzheimer disease (AD) induced by D-galactose and AlCl3 and its possible mechanisms.

The AD model was produced by injecting D-galactose and AlCl3 intraperitoneally for 90 days. Since the 20th day of D-galactose and AlCl3 intraperitoneal injection, the rats in Danshen-Dahuang group had been treated with Danshen-Dahuang extraction by intragastric administration for 70 days. Subsequently,learning and memory ability of the mice was evaluated by Morris water maze and hippocampal gene expression of APP, PS1 was tested by reverse transcription polymerase chain reaction (RT-PCR).

Rats intragastric administration with Danshen-Dahuang, mice had shorter latency (P< 0.05) and less error times (P< 0.05) in water maze test compared with those in AD model group. At the same time, Danshen-Dahuang down regulated the expression of APP, PS1 mRNA (P< 0.05) in hippocampus.

Danshen-Dahuang improves the learning and memory ability of AD rats, its mechanism may be related to the downregulated expression of APP, PS1 mRNA.

Perinatal depression is related to poorer outcomes for women and their children. Measurement indices that categorize perinatal depression as present or absent are commonly used in clinical practice and research efforts. Categorization minimizes the health effects of potentially different symptom clusters and may confound understanding of health outcomes.

The objective of this investigation is to explore the symptom clusters resulting from administering two commonly used depression screening instruments during pregnancy and postpartum.

(1) Identify the depressive symptom clusters for perinatal depression; (2) Test whether symptom clusters predict maternal and newborn outcomes, and if so, whether these differ from categorization analytics.

A secondary analysis was conducted on data from a longitudinal study of 139 women. They participated from their 3rd trimester of pregnancy through 8 months after birth and completed surveys at five times using the center for epidemiologic studies Depressed Mood Scale (CES-D) and the Edinburgh Postnatal Depression Survey (EPDS). Analysis procedures included cluster analysis and hierarchical regression.

Individual symptoms were reported by 2.9–31.7% of the sample. Separate clusters (CES-D = 4; EPDS = 2) were identified and, of these, two clusters were primary predictors of maternal and newborn outcomes. Results differed from that obtained with cut-score analytics.

Examination of depression symptom clusters as related to health outcomes during childbearing has significance for clinical practice and research, particularly for women who would not score as depressed on established screening instruments.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The use of mobile apps aimed at supporting patients with a mental illness is rapidly increasing.

The presented results explore psychiatrists’ concerns about mobile apps for patients with a mental illness. These results are part of a larger study that examines psychiatrists’ attitudes regarding the use and development of mobile apps.

In the qualitative exploratory study, semi-structured interviews were conducted with 18 psychiatrists in Czech Republic, Austria, and Slovakia. Psychiatrists were recruited via snowball sampling. The interviews were digitally recorded, transcribed verbatim, translated into English, and content analyzed using deductive and inductive category development.

There were mixed feelings regarding mobile apps for patients with mental illness. While psychiatrists emphasized certain benefits (e.g. increasing patients’ treatment motivation and engagement), several concerns were also expressed, especially by psychiatrists who were generally unfamiliar with mobile apps. They feared being replaced; were afraid that patients would act as their own doctors, thereby damaging their health; stressed that mobile apps could not respond or be tailored to an individual the same way psychiatrists could tailor treatment to a patient.

The psychiatrists who were more likely to have concerns about mental health apps were those who were generally unfamiliar with the apps and/or thought the apps aim to replace, rather than support, face-to-face treatment. Thus, clinicians and patients should be familiarized with the use of such mobile apps and educated on how they could support the face-to-face treatment.

The suicide attempt is a real challenge for the clinician who works at the emergency department in order to identify and propose an adequate care.

To estimate the prevalence of the suicide attempts, to describe the sociodemographic and clinical characteristics and to identify the predictors of recurrence.

Our cross-sectional study was conducted at the medical emergency department of the university hospital of Mahdia and lasted for 12 months. Data were collected using a questionnaire of 51 items exploring the general and clinical characteristics and providing information of the treatment.

Among the 513 consultants, 90 had attempted suicide (17,5%). We found an average age of 26 years old, a sex-ratio (M/F) of 0,3, a secondary education level (53,3%), an unemployment and a single status (38,9% and 75,6%). The presence of psychiatric personal history and/or suicide attempts was found in 31,1% and 33,3% of cases. Suicide attempts were taken place in all cases at home, between 18 and midnight (43,3%), without premeditation (82,2%), in the presence of triggering factor (95,6%), during the last 3 months of the year (34,4%). In 70,2% of cases, the type of the suicide attempts was a drug intoxication. 67,8% of the suicide attempters regretted and criticized their acts.

A good assessment of the suicide risk determines the type of intervention that should be established and allows an adequate care.

The authors have not supplied their declaration of competing interest.

Internet addiction disorder (IAD) is defined as one of the commonest disorder in children and adolescents affecting 40 percent of them. Although it does not cause mental disorders it is known that IAD is commonly related with attention deficit and hyperactivity disorder (ADHD). The best approach to asses attention is recording of event related potentials (ERPs) especially late response like P300. There are growing evidence regarding assessment of attention in IAD with different questionnaires but less is known about evidence received with more valid measurements like P300.

The aim of our study was to measure attention parameters in IAD subjects by using the most valid test–latency and amplitude of P300. We have examined 70 children with IAD aged 5-18 years. Children were divided into two groups: Group 1 (40 children) was matched as a study group including children with IAD and group 2 controls (30 children) without IAD and without ADHD.

IAD was assessed by Young IAD scale. Children with Young scale less than 20 and with IQ less than 85 were excluded from the study. Recording of P300 was done by international protocol using oddball paradigm method. Statistical analysis was done by SSPS 26.

In study group increase in P300 latency was found (mean range 350-375 msc) while amplitude was normal (p <0.05). In controls both parameters were within normal range.

IAD could be related with attention disorders causing poor attention span. This evidence is very important as they affect internet addicted children and adolescents’ social well being.

No significant relationships.

Management of HIV/AIDS “worried well” people is among the most complex and challenging psychiatric problems in HIV care.

To provide an overview of HIV/AIDS “worried well”.

Literature review based on PubMed/Medline, using the keywords “HIV” and “worried well”.

The HIV/AIDS “worried well” are those individuals who are intensely worried about being infected with HIV, despite overwhelming evidence to the contrary. Indeed, they will rapidly return with the renewed conviction that the physician has “got it wrong” or “missed something”. So, they tend to over-utilize health care services. Seven HIV/AIDS “worried well” sub-groups have been identified: those with past sex or drug use history; those with relationship problems; the partners/spouse of those at risk; couples in individual or family life transitions; past history of psychological problems; misunderstanding of health education material; and pseudo and factitious AIDS. These patients have several striking consistencies in their presenting phenomenology and background features and usually have psychiatric problems associated. The authors will analyze all these aspects. Currently there are no guidelines to deal with this clinical condition, however cognitive-behavioral therapy along with selective serotonin reuptake inhibitors has been an effective approach. It is also important to ensure follow-up discussion to these patients, especially where unresolved life issues may cause future vulnerability in absence of intervention.

Patients may express their concerns about HIV infection by several ways, directly or indirectly, and psychiatrists need to be aware of this reality, which causes much suffering as well as severe monetary loss.

The authors have not supplied their declaration of competing interest.

Lewy Bodie Dementia (LBD) is the second more common progressive dementia caused by the deposition of proteins at the neocortical level, producing motor and psychotic symptoms (parkinsonism and visual hallucinations) which typically get worse with antipsychotics.

Find the best antipsychotic treatment in a real patient with LBD balancing control of motor and psychotic symptoms.

A clinical trial about a real case based on an updated bibliographical review. Received a 70 years old man with more than ten years LBD diagnosis, treated with clozapine (25mg / 12h). According to his wife (principal keeper), it stills a paranoid speech with fluctuant delusional ideas conditioned by visual hallucinations, predominantly in the evening, with no amelioration in four years clozapine treatment, adding a progressive parkinsonism impairment despite neurological drugs (carbidopa:levodopa). Doing a bibliographical review, we found a 2019 article (with 3 Systematic review/Metanalysis and 3 Clinical Practice Guidance, including in NICE), where point olanzapine 5mg well effective but worse tolerated and light up quetiapine as choice that should be considered (no doses specified).

One month later of therapeutic trial following the review in our clinical case, changing clozapine for quetiapine (50mg / 12h), we found an improvement of motor control and a reduction of psychotic manifestation that allows a less disruptive behavior in our patient, also objectified by his principal keeper.

While bibliography doesn’t point a specific dose drug guide for antipsychotic treatment in LBD, in our clinical trial we detected a better control of symptoms using low dose quetiapine, nevertheless more studies are needed.

Zolpidem is a nonbenzodiazepine, which acts as a sedative- hypnotic that binds to GABA (A) receptors at the same location as benzodiazepines and increases GABA effects in the central nervous system (Kovacic et al. Oxidative medicine and cellular longevity 2009, 2(1), 52–57). Literature shows that behavioral changes including amnesia, hallucinations, and other neurocognitive effects are some of the known side effects (Edinoff et al. Health psychology research 2021, 9(1), 24927). We present a case about Ms. A, a female in her sixties with a history of major depressive disorder with psychotic symptoms who was brought into the hospital by the EMS under police custody after stabbing her granddaughter with a knife. During the evaluation she was dissociating with impaired memory of the circumstances of her presentation. Collateral information about Ms. A revealed that she had no history of being violent, or any history of psychoactive substance use. Ms. A’s home psychiatric medications consisted of Sertraline 100mg, Bupropion 150 mg, Zolpidem 5mg.

To better understand the potential risks with prescribing zolpidem in patient with insomnia.

In depth literature review about zolpidem. In addition, observation of Ms. A in the emergency with a full medical workup including but not limited to urine drug screen, brain imaging, lumbar puncture, etc.

Ms.A medical workup was positive for a urinalysis revealing asymptomatic bacteriuria and she was treated empirically with cefdinir. Her medication regimen consisted of Bupropion 150 mg and Sertraline 100m, both daily. Zolpidem was discontinued and changed to Clonazepam 0.5mg for insomnia. She was also started on Olanzapine 5mg in the AM and 10mg in the PM. Her mental status was noted to have improved after discontinuation of Zolpidem. Patient received one dose in the hospital but after two days since discontinuation her mental status improved. Upon literature review previous reports have been published citing cases of patients on Zolpidem physically acting out while sleeping in a parasomnia-like behavior, with no recollection of memories upon awakening. (Inagaki et al. Primary care companion to the Journal of clinical psychiatry 2010, 12(6)). There are case reports of Zolpidem associated homicide (Paradis et al.The primary care companion for CNS disorders 2012, 14(4).

One limitation of our study is the patient was noted to have a sudden change in behavior with altered mental status which may be attributed to an underlying asymptomatic bacteriuria. It should be noted that this may have been an incidental finding. This does not exclude the possibility of Zolpidem as the primary cause of the change of her altered mental status or further exacerbating the change in her mental status. Though Zolpidem can be therapeutic and safe, we as clinicians have to be aware of the potential side effects of Zolpidem when prescribing medications.

None Declared

Suicide has emerged as one of the most important causes of death in the age group 15–34 and ranks as the second cause of death after traffic accidents and other injuries in the age group 15–19. In Europe, more than 13,000 young men and women aged 15–24 die by suicide each year. Therefore, identifying risk factors for suicidal behavior has become a priority, and suicide prevention in the young population is a major area of interest for public health professionals, stakeholders and researchers.

To actively screen for a range of unhealthy behaviors used as cut-offs in the Romanian SEYLE (Saving and Empowering Young Lives in Europe) sample, and to assess their significance as risk factors for suicidal behavior.

1143 9th grade pupils aged between 14 and 16 from 16 high schools in two counties in North-Western Romania were randomized in the SEYLE protocol. They were screened for suicidal ideation and behavior, depression, anxiety and a number of risk-taking behaviors: non-suicidal self injury, unhealthy eating behavior, sensation seeking & delinquent behavior, substance abuse, increased exposure to media, limited social relationships, bullying, and truancy.

Suicidal behavior in adolescents is commonly associated with anxiety and a number of risk-taking behaviors, which may be used as warning signs while actively screening for suicide risk in adolescent populations. Although a high number of at-risk pupils were identified at baseline, no completed or attempted suicides were recorded in the assessed sample at 3-months follow-up.

Sleep is a basic physiological need for the health and well being. Aging brings many changes in sleep holding the advance in age, multiple comorbidities and changes in lifestyle.

Describe the quantity and quality of sleep in the elderly.

Prospective and descriptive study involving 40 people aged over 65. The sleep evaluation was done over a period of four weeks with a sleep diary (daily self-assessment tool of sleep and wakefulness).

In our study, we found an average of hours of sleep in elderly subjects 8 to 9 hours per day. The sleep time was in 60% of cases before 10 pm and the wake-up time was in 52% cases at or before 6 am. The sleep latency did not exceed 30 min in 68% of cases. Sixty pourcent subjects have had nocturnal awakening for more than an hour. Sleep quality was considered poor by 55% of sujets and disturbance was attributed significantly to somatic diseases.

Sleep disorders in the elderly are common. The effective treatment must take account of psychological, psychosocial and somatic factors specific to age.

The objectives of this study were to explore the impact of a communication course for doctors on family satisfaction and anxiety in an Australasian ICU and to elucidate the determinants of family satisfaction and anxiety.

Prospective observational study. Pre- and post-study design.

One hundred and three consecutive family members of patients staying in the ICU for more than 48 hours were identified. Eighty-six subjects were evaluated and analysed.

Ten-point Likert scale (FS-ICU Questionnaire) used to measure satisfaction. Hospital Anxiety and Depression Scale was used to measure anxiety. Study performed over a 12-week period (9 weeks pre- and 3 weeks post-course) in a 34-bed intensive care unit before and after a communication course for junior medical officers.

Fifty-six subjects were approached for the purpose of this study. Forty-three family members were included, 40 of patients who survived, and 3 whose relative died in ICU. Overall family satisfaction was high (mean scores 9.44 ± 0.91). Post-course, 47 subjects were approached for the purpose of this study and 43 family members consented to participate. Overall family satisfaction was high (mean scores 9.84 ± 0.97). There was a statistically significant difference in the frequency of doctors’ communication before and after the course (P < 0.01) and anxiety levels (P = 0.0001)

The majority of families are happy with their care in the ICU. A communication course aimed at junior medical officers was effective in improving satisfaction and reducing anxiety among family members.

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

Some previous studies have demonstrated an early effect of caffeine administration on subjective state, but none of them has explored its existence after the administration of decaffeinate coffee, nor the possible differences according to the gender. The aim of the present work was to investigate, using a realistic design (non-research settings and naturalistic administration of the drug), the early effects (10-30 min post-consumption) of a single low-moderate dose of caffeine (100 mg) and decaffeinate coffee on sleepiness and subjective activation.

A random double-blind informed placebo controlled procedure was applied to a group of 688 healthy undergraduate volunteers (238 men) mean age 22.03 ± 2.21 years. Measures were recorded in two experimental sessions: morning 11:00-13:00h or afternoon 16:00-18:00h, in three moments before (30, 20 and 10 min.) averaged as a stable baseline, and three after (10, 20 and 30 min.) consumption.

Caffeine administration induces fewer somnolence (F= 159.776, p<0.0001) and greater activation (F= 43.516, p<0.0001) in all post-consumption records, while the decaffeinated drink only induced arousing effects in the 10 min. post-consumption record. Caffeine effects were greater in men and the decaffeinated beverage produced greater effect in women (sleepiness: F= 14.893, p<0.0001; activation: F= 4.229, p=0.038).

Future works should study more accurately the early effect of caffeine and decaffeinate coffee and the influence of gender, using other parameters which have proven to be sensitive to their administration, as well as several caffeine doses.

To evaluate the long-term safety and efficacy of adjunctive aripiprazole (ARI) to lithium (LI) or valproate (VAL) in delaying time to relapse in bipolar I disorder.

Bipolar I disorder subjects with a current manic or mixed episode received LI or VAL for at least 2 weeks; inadequate responders (YMRS score ≥ 16 and ≤35% decrease from baseline at 2 weeks) received adjunctive ARI. Subjects maintaining mood stability (YMRS and MADRS ≤ 12 for 12 consecutive weeks) were randomised 1:1 to double-blind ARI (10 to 30 mg/day) or placebo (PBO) plus LI or VAL. Relapse was monitored up to 52 weeks.

337 subjects were randomised to continuation of mood stabiliser plus adjunctive ARI or PBO; 61.3% and 52.7%, respectively, completed the study. Adjunctive ARI significantly delayed the time to any relapse, hazard ratio = 0.544 (95% CI: 0.33, 0.89, log-rank p = 0.014). Overall relapse rates at 52 weeks were 14.9% and 25.4% in ARI vs PBO subjects. A superior reduction in CGI-BP Mania Severity of Illness from baseline at 52 weeks was also observed (0.3 vs. 0.0, respectively, p = 0.01). Adverse events generally were as expected per known drug and illness profiles with no significant difference in mean change in body weight between adjunctive PBO (0.60 kg) and adjunctive ARI (1.07 kg) (p = 0.49 Week 52, LOCF).

Continuation of aripiprazole treatment increased time to relapse to any mood episode compared with placebo plus LI/VAL over 1 year, indicating a long-term benefit in continuing adjunctive aripiprazole to a mood stabiliser after sustained remission is achieved.