PErsonalized Treatment by Real-time assessment (PETRA): A web-application for personalized diaries in psychiatric care

Background: Smartphone self-monitoring through ecological momentary assessment (EMA) provides insights into the daily lives of people in psychiatric treatment and has the potential to improve their care. Currently, no clinical tools are available that help clients and clinicians with creating personalized EMA diaries and interpreting the gathered data. Integration of EMA in treatment is therefore difficult.Objective: To develop a web-based application for personalized EMA in routine psychiatric care, in close collaboration with all stakeholders (i.e., clients, clinicians, researchers, and software developers). Methods: We engaged 52 clients with mood, anxiety, and/or psychotic disorders and 45 clinicians (psychiatrists, psychologists, and psychiatric nurses) in interviews, focus groups, and usability sessions. We used human-centered design principles to determine important requirements for the web-app and designed high-fidelity prototypes that were continuously reevaluated and adapted. Results: The iterative development process resulted in PETRA (PErsonalized Treatment by Real-time Assessment), which is a scientifically grounded web-app for the integration of personalized EMA in clinical care. PETRA includes a decision aid to support clients and clinicians with constructing personalized EMA diaries, an EMA diary item repository, a text-message-based diary delivery system, and a feedback module for visualizing the gathered EMA data. PETRA is integrated in electronic health record (EHR) systems to ensure ease-of-use and sustainability, and adheres to privacy regulations.Conclusions: PETRA was built to fulfill the needs of clients and clinicians for a user-friendly and personalized EMA tool embedded in routine psychiatric care. PETRA is unique in this co-development process, its extensive yet user-friendly personalization options, its integration in EHR systems, its transdiagnostic focus, and its strong scientific foundation in the design of EMA diaries and feedback. The clinical effectiveness of integrating personalized diaries via PETRA into care awaits further research. As such, PETRA paves the way for a systematic investigation into the utility of personalized EMA for routine mental health care.

Pathomorphosis of Vascular Dementia with Psychotic Symptoms

Objective: To study the pathomorphosis of vascular dementia over the past 30 years. The study of the pathomorphosis of mental disorders makes significant adjustments to the criteria for diagnosis and nosography. Dementia has also undergone pathomorphosis over the years. Materials and Methods: The research was carried out in the Psychiatric Hospitalsin Azerbaijan. A retrospective analysis was carried out for the period 1990-1999, which were compared with a similar contingent during 2010-2020. Results: The number of hospitalized patients with vascular dementia has increased over the past 10 years, which means both an increase in the incidence of the disease and an increase in symptoms requiring psychiatric treatment. Conclusions: Pathomorphosis has also manifested itself in sex. Thus, the number of female patients has increased in the last 10 years. As a result of the disease, there is a positive trend, a decrease in mortality.

Legal problems of use of compulsory psychiatric treatment in Russia and Belarus

The subject of the research is the problems of legislative regulation of compulsory psychiatric measures in the criminal legislation of the Republic of Belarus and the Russian Federation.The purpose of the article is to confirm or refute the hypothesis that there are defects in legislative regulation that prevent the effective use of compulsory psychiatric treatment. They are not eliminated in the Criminal Codes of the Russian Federation and the Republic of Belarus. Research methodology. On the basis of a system-integrated approach on an interdisciplinary basis, a scientific analysis of special legal and forensic psychiatric scientific literature and interpretation of the criminal legislation of the Republic of Belarus and the Russian Federation were carried out.Main results. An analysis of the Criminal Codes of the Republic of Belarus and the Russian Federation showed that compulsory psychiatric treatment is an independent institution of criminal law, which is regulated in sufficient detail in the national criminal legislation. The article includes a comparative legal analysis of the norms of the criminal legislation of both states (Chapter 14 of the Criminal Code of the Republic of Belarus and Chapter 15 of the Criminal Code of the Russian Federation) that regulate psychiatric coercive measures applied to persons with mental disorders who have committed illegal acts. Based on the results of the study, a number of problems were identified in the legislative regulation of psychiatric compulsory measures in the criminal codes of both states, the authors propose directions for further improvement of the current criminal legislation.Conclusions. The Criminal Codes of the Republic of Belarus and the Russian Federation contain only general criteria for choosing the type of psychiatric measures of a coercive nature, in the most general form, the procedure for their change and termination is provided, they need editorial clarification of their purpose. There is no legislative definition of the concepts of “coercive security measures and treatment” (Chapter 14 of the Criminal Code of the Republic of Belarus) and “compulsory measures of a medical nature” (Chapter 15 of the Criminal Code of the Russian Federation), etc., which causes serious difficulties in law enforcement practice and indicates the need to continue work to improve the current criminal legislation.The terminology used “coercive and security measures and treatment” (Chapter 14 of the Criminal Code of the Republic of Belarus) and “coercive measures of a medical nature” (Chapter 15 of the Criminal Code of the Russian Federation) does not reflect the specifics of these measures, which in their essence and content are exclusively psychiatric measures. The identified problems of legislative regulation of psychiatric compulsory measures in the criminal legislation of both states require their further resolution, and based on the interdisciplinary medico-legal nature of the problems involved, with the obligatory involvement of forensic psychiatrists in their solution.

Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults

Background Individuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown. Methods The study is based on Finnish administrative register data on all individuals born 1986–1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16–21 in 2002–2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income. Results An educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and lowest probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34–0.43, and after 0.29, 95% CI 0.25–0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18–0.26, and after 0.18, 95% CI 0.14–0.22). The largest differences were observed in inpatient care. Conclusions The results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment. The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed.

Mental health of Turkish medical students during the COVID-19 pandemic

Background: The coronavirus disease emerged in 2019, spread in Turkey as all over the world rapidly. In this process, young people began to experience some mental problems due to the fear of contagion, as well as some changes in their lifestyles. Aims: In this study it is aimed to investigate anxiety and depression levels of medical school students and the factors associated with these mental problems. Method: The forms were sent over the internet to the officials responsible for medical education at universities in various regions of Turkey. A total of 2,778 medical faculty students were included in the study. Students were asked to fill out the sociodemographic data form, the Patient Health Questionnaire – 9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) Test. Results: Students’ 67.3% were female and 31.7% were male. About 90.2% of the students in the PHQ-9 scale had depressive symptoms in the major depressive disorder (MDD) dimension, and 44.5% in the GAD-7 scale had moderate/severe anxiety symptoms. Gender, being a preclinical student, history of psychiatric treatment in the past, currently receiving psychiatric treatment, death of someone due to pandemic, economic and health situation, perception of mental health were found associated with MDD and Moderate/Severe Anxiety symptoms. Students with Anxiety and MDD reported significantly more anxiety about contamination and negative beliefs about precautions’ sufficiency. Conclusions: It was determined that medical school students in our country showed anxiety and depression at a remarkable level during the pandemic. Examining the underlying causes of these high rates will be beneficial in terms of taking precautions during the long-term pandemic. In literature, there are a limited number of studies on this subject in our country, we believe that our study will be useful in future studies to determine the underlying causes of mental illnesses and what can be done to help students.

Phenomenology of the COVID-19 Pandemic Experience in Patients Suffering from Chronic Schizophrenia—A Qualitative Analysis

Many studies have shown that the COVID-19 pandemic can have a great influence on mental health. However, there is still not enough research to fully understand how people suffering from schizophrenia experience crisis situations such as a pandemic. This qualitative study aims to explore this subject. Ten outpatients suffering from schizophrenia were interviewed in a semi-structured format using an interview designed by the authors for the purpose of this study. The interviews were transcribed, and a conventional qualitative content analysis was conducted. The general themes identified in the content analysis were organized into four categories: first reactions to information about the pandemic; subjective assessment of the pandemic’s impact on patients’ mental health; patients’ attitudes towards the temporary limitations and lockdowns; psychiatric treatment and psychotherapy during the pandemic. A variety of different experiences were observed, but the general conclusion arising from the study suggests that the majority of the interviewed patients coped quite well with the pandemic and that the observed reactions were similar to the reactions of other groups described in the literature. The study also confirmed the importance of the continuity of psychiatric care for patients with schizophrenia.

Impact of the COVID-19 Pandemic on Mental Well-Being. A Nationwide Online Survey Covering Three Pandemic Waves in Poland

The COVID-19 pandemic has a significant impact on human life. This study aims to assess the prevalence of depressive and anxiety symptoms, and the assessment of the quality of life in different stages of the COVID-19 pandemic based on an online nationwide survey. The study was based on a voluntary, anonymous, and authors' own questionnaire. The first section assesses sociodemographic status. Then, standardized psychometric tools were used such as the Beck Depression Inventory (BDI), the Generalized Anxiety Disorder Assessment (GAD-7), and the Manchester Short Assessment of Quality of Life (MANSA). The study was conducted in three stages corresponding to the waves of the COVID-19 pandemic in Poland. The survey involved 5,790 respondents; 2,457, 1,626, and 1,707 for the first, second, and third pandemic wave, respectively. It was found that anxiety and depressive symptoms increased as the pandemic progressed. There was no significant effect on the subjective quality-of-life assessment. Moreover, there was a gradual decrease in anxiety about being infected with COVID-19 as well as reduced adherence to the Minister of Health's recommendations. As the COVID-19 pandemic progressed, depressive and anxiety symptoms increased among Poles. Women, singles, and people with prior psychiatric treatment are more likely to develop the aforementioned symptoms.

Prevalence, predictors, and treatment of eating disorders in children: a national study

Background Although the prevalence rates of preadolescent eating disorders (EDs) are on the rise, considerably less is known about the correlates and treatment of EDs in this age group. Clarifying the epidemiology of EDs in preadolescent children is a necessary first step to understand the nature and scope of this problem in this age group. Methods Analysis of data collected in the ABCD Study release 2.0.1. The ABCD cohort was a population-based sample that consisted of 11 721 children ages 9–10 years. Measures included reports of a lifetime and current mental disorders determined using a diagnostic interview for DSM-5 disorders, sociodemographic factors, and psychiatric treatment utilization. Results The lifetime prevalence of EDs was 0.95%. Being Black, multiracial, having unmarried parents, and family economic insecurity were significant predictors for developing an ED. Among psychiatric conditions, the major depressive disorder was most robustly associated with EDs in both cross-sectional and temporal analyses. Only 47.40% of children who had a lifetime ED received some type of psychiatric treatment. EDs were not a significant predictor of psychiatric treatment utilization after accounting for sex, sexual orientation, parent marital status, economic insecurity, and all other psychiatric diagnoses. Conclusions Despite increasing prevalence rates of preadolescent EDs, the current findings suggest that the majority of children with these disorders remain untreated. Devoting increased attention and resources to reaching families of children with EDs with the least means for receiving care, and screening for EDs in children with depression, may be important steps for reducing this unmet need.

Severe Anxiety Post-COVID-19 Infection

COVID-19 infection is linked to increased risk of neuropsychiatric symptoms such as psychosis and suicidal ideation/behavior. After further review of the literature, there is not a large body of data on anxiety following COVID-19 infection. Most literature found is related to fear/anxiety of contracting and dying from COVID-19. We illustrate a case of a 27-year-old male with no previous psychiatric treatment history or symptomology, who developed severe anxiety with intrusive thoughts of self-harm via firearm after COVID-19 infection. Given the severe nature of the anxiety and intrusive thoughts, the patient feared for his safety and sought acute inpatient admission. The patient was effectively treated with group therapy and psychotropic medications and was able to be discharged in a timely manner with outpatient psychiatric follow-up. Much is still unknown of COVID-19. With this case report, we discuss a potential relationship between anxiety and COVID-19 infection.