Everywhere in the world, psychiatric clinics are modifying their practice in order to guarantee care and support to persons with mental health problems, but also to those who are not mentally ill and ...are suffering from the psychosocial consequences of the pandemic. ...Internet is spreading very rapidly a large amount of uncontrolled news. Most probably we will face an increase of mental health problems, behavioral disturbances, and substance-use disorders, as extreme stressors may exacerbate or induce psychiatric problems.
For the global population, one in three to six people appear adversely affected by depression, anxiety, insomnia, or suicidal ideas, the strongest predictor of these disorders being a history of ...mental health problems 2. Three articles of this collection listed advices and recommendations to protect and defend the rights of patients with severe mental disorders in the circumstances of a pandemic 7, to organize basic principles of mental healthcare during the COVID-19 pandemic 8, and to help the general population to reduce stress and cope with related aspects such as confinement and lockdown 9. 5 Wasserman D, Van der Gaag R, Wise J. The term “physical distancing” is recommended rather than “social distancing” during the COVID-19 pandemic for reducing feelings of rejection among people with mental health problems.
Impulsivity and compulsivity represent useful conceptualizations that involve dissociable cognitive functions, which are mediated by neuroanatomically and neurochemically distinct components of ...cortico-subcortical circuitry. The constructs were historically viewed as diametrically opposed, with impulsivity being associated with risk-seeking and compulsivity with harm-avoidance. However, they are increasingly recognized to be linked by shared neuropsychological mechanisms involving dysfunctional inhibition of thoughts and behaviors. In this article, we selectively review new developments in the investigation of the neurocognition of impulsivity and compulsivity in humans, in order to advance our understanding of the pathophysiology of impulsive, compulsive, and addictive disorders and indicate new directions for research.
Excessive physical exercise may evolve into physical exercise addiction, a recently identified entity with many yet unclear aspects, such as global prevalence and variability according to different ...types of physical exercise.
We systematically reviewed the current literature up to June 2018 to collect all studies screening exercise addiction with two of the most frequently used screening scales: the Exercise Addiction Inventory (EAI) and the Exercise Dependence Scale (EDS).
We detected forty-eight studies (20 using the EAI, 26 the EDS, and 2 both scales) reporting variable point prevalence of exercise addiction risk, depending on the target population and the investigated sport. The EAI identifies a higher proportion of people at risk for physical exercise addiction among endurance athletes (14,2%) followed by ball games (10,4%), fitness centre attendees (8,2%) and power disciplines (6,4%), while a frequency of 3,0% was reported in the general population. Studies using the EDS found discrepant results.
This systematic review suggests that sport disciplines are associated with different vulnerability for physical exercise addiction. Besides the different addictive potential of each sport, the heterogeneity of results may be also due to socio-demographic and cultural characteristics of the target populations. The EAI and the EDS identify different proportions of individuals at risk for exercise addiction both in general population and in specific sport categories. As the EAI screens a higher proportion of subjects at risk, especially in endurance disciplines, it could be more appropriate for early detection of at-risk subjects and/or disciplines.
Tailored prevention strategies for each discipline could help better preserving benefits of sports. More precision in research methods and the use of the most appropriate scale are required to allow a better comparability of prevalence among physical exercise disciplines and in general population.
•Exercise addiction is a recent, yet poorly understood entity with heterogeneous prevalence.•Endurance sports seem associated with the highest risk for exercise addiction.•The Exercise Addiction Inventory seems to screen a higher proportion of individuals at risk of physical exercise addiction.•A more rigorous selection of target populations and scales is encouraged to better understanding of exercise addiction.
Applying the concept of burnout to medical students before residency is relatively recent. Its estimated prevalence varies significantly between studies. Our objective was to estimate the prevalence ...of burnout in medical students worldwide.
We systematically searched Medline for English-language articles published between January 1, 2010 and December 31, 2017. We selected all the original studies about the prevalence of burnout in medical students before residency, using validated questionnaires for burnout. Statistical analyses were conducted using the OpenMetaAnalyst software.
Prevalence of current burnout was extracted from 24 studies encompassing 17,431 medical students. Among them, 8060 suffered from burnout and we estimated the prevalence to be 44.2% 33.4%–55.0%. The information about the prevalence of each subset of burnout dimensions was given in nine studies including 7588 students. Current prevalence was estimated to be 40.8% for ‘emotional exhaustion’ 32.8%–48.9%, 35.1% 27.2%–43.0% for ‘depersonalization’ and 27.4% 20.5%–34.3% for ‘personal accomplishment’. There is no significant gender difference in burnout. The prevalence of burnout is slightly different across countries with a higher prevalence in Oceania and the Middle East than in other continents.
The results of this meta-analysis suggest that one student out of two is suffering from burnout, even before residency. Again, our findings highlight the high level of distress in the medical population. These results should encourage the development of preventive strategies.
Alterations of gut microbiota may play a role in Anorexia Nervosa (AN) through perturbations of the gut-brain axis. Some studies found differences in the gut microbiota of patients with AN compared ...to healthy controls, but results are heterogeneous. The aim of this work was to systematically review the existing studies comparing gut microbial composition in AN and healthy controls, and to perform a quantitative synthesis of the pooled clinical and microbiological data, when available.
A comprehensive literature search was performed to identify human studies investigating relationships between AN and gut microbiota. Microbiome datasets from studies were pooled and analysed focusing on alpha and beta-diversity and the relative abundance of microbial species in patients' gut microbiota compared to healthy controls.
Nine studies were eligible for the systematic review, of which 4 were included in the quantitative synthesis. Preserved alpha-diversity and decreased beta-diversity in AN emerged from the qualitative synthesis, while a slight increase of alpha-diversity (d < 0.4) and comparable beta-diversity were reported by the quantitative synthesis. Out of the 46 common species compared, three had a large combined effect size (d ≥ 0.9) to differentiate patients from controls, namely Alistipes, Parabacterioides and Roseburia. The latter was also correlated with BMI (ρ = 0.29).
The decrease of butyrate-producing species and the increase of mucine-degrading species may represent hallmarks of the gut microbiota alterations in AN, and therefore potentially interesting therapeutic targets. The heterogeneity of clinical and methodological characteristics hampers the generalizability of the results. Standardized research methods could improve comparability among studies to better identify the alterations of gut microbiota in AN.
•Gut dysbiosis may play a role in Anorexia Nervosa by altering the Gut-Brain Axis.•Nine studies explored the gut microbiota in Anorexia Nervosa and healthy controls.•An increase of intestinal mucine-degrading bacteria was found in gut microbiota of patients with Anorexia Nervosa.•A decrease of butyrate producing species was found in gut microbiota of patients with Anorexia Nervosa.•Great heterogeneity of methodologies limits comparability among studies.
The unpredictability and uncertainty of the COVID-19 pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the ...risk of mental health problems and exacerbate health inequalities. Preliminary findings suggest adverse mental health effects in previously healthy people and especially in people with pre-existing mental health disorders. Despite the heterogeneity of worldwide health systems, efforts have been made to adapt the delivery of mental health care to the demands of COVID-19. Mental health concerns have been addressed via the public mental health response and by adapting mental health services, mostly focusing on infection control, modifying access to diagnosis and treatment, ensuring continuity of care for mental health service users, and paying attention to new cases of mental ill health and populations at high risk of mental health problems. Sustainable adaptations of delivery systems for mental health care should be developed by experts, clinicians, and service users, and should be specifically designed to mitigate disparities in health-care provision. Thorough and continuous assessment of health and service-use outcomes in mental health clinical practice will be crucial for defining which practices should be further developed and which discontinued. For this Position Paper, an international group of clinicians, mental health experts, and users of mental health services has come together to reflect on the challenges for mental health that COVID-19 poses. The interconnectedness of the world made society vulnerable to this infection, but it also provides the infrastructure to address previous system failings by disseminating good practices that can result in sustained, efficient, and equitable delivery of mental health-care delivery. Thus, the COVID-19 pandemic could be an opportunity to improve mental health services.
Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly acknowledged as critical tools for enhancing patient-centred, value-based care. However, ...research is lacking on the impact of using standardized patient-reported indicators in acute psychiatric care. The aim of this study was to explore whether subjective well-being indicators (generic PROMs) are relevant for evaluating the quality of hospital care, distinct from measures of symptom improvement (disease-specific PROMs) and from PREMs.
Two hundred and forty-eight inpatients admitted to a psychiatric university hospital were included in the study between January and June 2021. Subjective well-being was assessed using standardized generic PROMs on well-being, symptom improvement was assessed using standardized disease-specific PROMs, and experience of care using PREMs. PROMs were completed at admission and discharge, PREMs were completed at discharge. Clinicians rated their experience of providing treatment using adapted PREMs items.
Change in subjective well-being (PROMs) at discharge was significantly (
< 0.001), but moderately (
= 28.5%), correlated to improvement in symptom outcomes, and weakly correlated to experience of care (PREMs) (
= 11.0%), the latter being weakly explained by symptom changes (
= 6.9%). Patients and clinicians assessed the experience of care differently.
This study supports the case for routinely measuring patients' subjective well-being to better capture the unmet needs of patients undergoing psychiatric hospital treatment, and the use of standardized patient-reported measures as key indicators of high quality of care across mental health services.
Studies of psychiatric disorders have traditionally focused on emotional symptoms such as depression, anxiety and hallucinations. However, poorly controlled cognitive deficits are equally prominent ...and severely compromise quality of life, including social and professional integration. Consequently, intensive efforts are being made to characterize the cellular and cerebral circuits underpinning cognitive function, define the nature and causes of cognitive impairment in psychiatric disorders and identify more effective treatments. Successful development will depend on rigorous validation in animal models as well as in patients, including measures of real-world cognitive functioning. This article critically discusses these issues, highlighting the challenges and opportunities for improving cognition in individuals suffering from psychiatric disorders.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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