•Physicians may be psycologically affected in the battle against the Covid19 pandemics•The mental wellbeing of healthcare workers need to be taken into consideration•Women, young and less experienced ...people are in the high-risk group•The excessive workload and inadequate logistic support may increase the perception of risk
To investigate anxiety, stress, and depression levels of physicians during the Covid-19 outbreak and explored associated factors in both clinical and general site.
An online survey is conducted to asses psychological responses of healthcare workers and related factors during Covid-19 outbreak. It is consisted of three subsections covering the following areas: 1) sociodemographic data 2) information on individuals` working condition 3) Depression Anxiety and Stress Scale-21 (DAS-21).
Of all 442 participants, 286 (64.7%) had symptoms of depression, 224 (51.6%) anxiety, and 182 (41.2%) stress. Being female, young, and single, having less work experience, working in frontline were associated with higher scores, whereas having a child was associated with lower scores in each subscale. Factors found to be associated with higher DAS-21 total scores in frontline workers were as follows: increased weekly working hours, increased number of Covid-19 patients cared for, lower level of support from peers and supervisors, lower logistic support, and lower feelings of competence during Covid-19 related tasks.
Our findings highlight the factors which need to be taken into consideration to protect the mental wellbeing of doctors while fighting with a disaster that has major impacts on society worldwide.
Extracellular Genomic Materials (EGMs) are the nucleic acids secreted or released from all types of cells by endogenous or exogenous stimuli through varying mechanisms into the extracellular region ...and inevitably to all biological fluids. EGMs could be found as free, protein-bound, and/ or with vesicles. EGMs can potentially have immunophenotypic and/or genotypic characteristics of a cell of origin, travel to distant organs, and interact with the new microenvironment. To achieve all, EGMs might bi-directionally transit through varying membranes, including the blood-brain barrier. Such ability provides the transfer of any information related to the pathophysiological changes in psychiatric disorders in the brain to the other distant organ systems or vice versa. In this article, many aspects of EGMs have been elegantly reviewed, including their potential in diagnosis as biomarkers, application in treatment modalities, and functional effects in the pathophysiology of psychiatric disorders. The psychiatric disorders were studied under subgroups of Schizophrenia spectrum disorders, bipolar disorder, depressive disorders, and an autism spectrum disorders. EGMs provide a robust and promising tool in clinics for prognosis and diagnosis. The successful application of EGMs into treatment modalities might further provide encouraging outcomes for researchers and clinicians in psychiatric disorders.
Objectives: Schizophrenia is a common mental health condition associated with significant morbidity and excess early mortality. Treatment-resistant schizophrenia (TRS) occurs in about one in three ...patients diagnosed with schizophrenia. The aim of this study was to identify attitudes of a nationally representative sample of psychiatrists towards pharmacotherapy of patients with TRS, the potential factors related to their choice of various regimens, and to investigate the clinical outcomes of different methods employed.
Methods: Psychiatrists were contacted through national e-groups and various psychiatry conventions. They provided information about their professional and demographic characteristics. They were asked to describe clinical and demographic characteristics of an adult patient with TRS under their care for at least 3 months. They reported on the medication change they made and the effect of this intervention on the positive symptoms and functioning of the patient.
Results: Among the 207 patients reported on, only 28.7% were on monotherapy for TRS immediately before the change in medication. With the change made in treatment regime, 40.1% were switched to a different antipsychotic agent as monotherapy, 40.6% received combination therapy with two or more antipsychotic agents, 1.4% received high-dose antipsychotics, and 4.8% had augmentation with antidepressants or mood stabilizers. 13.1% psychiatrists employed more than one method. Of the whole sample, 48.3% were put on clozapine either as monotherapy or with other medications. The monotherapy and combination groups were compared in terms of characteristics of patients and prescribers, which revealed no significant difference (p > .05). There was also no difference found on the outcome variables of two groups (p > .05).
Conclusions: Although polypharmacy was found to be a common practice, there seemed to be a comparably good ratio of clozapine utilization and of attempts of switching to monotherapy among the prescribers. There were no significant patient- or prescriber-related factors in relation to preference of treatment regimens, which need further investigation on larger samples.
Background: Deep Brain Stimulation (DBS) is the only modality proven to be effective on selective stimulation of the deep brain structures. It was previously reported that, by using DBS, stimulation ...of nucleus accumbens (NA), a region that plays a pivotal role in the pathogenesis of substance addiction, is effective for the treatment of substance addiction.
Objective: The purpose of the current study was to observe how the morphine-conditioned place preference changed in rats by stimulating NA with a non-invasive method, focused ultrasound (US) and to detect whether there would be any tissue damage caused by US waves.
Methods: We used low-intensity focused ultrasound (LIFU), a noninvasive modality, in a place conditioning model to stimulate NA in rats.
Results: At the initial stage of our study, we used morphine to induce place preference. As expected, morphine administration caused significant place preference. After the place preference was obtained by morphine, we divided the rats into two groups. One group received LIFU waves to NA and the other group received only sham, that is, no stimulation with US waves. Rats in both groups were continued to receive morphine. Then, we investigated whether LIFU and sham will reduce morphine-induced place preference or not. We observed that morphine-induced place preference had an ongoing raise in the sham group while no raise was detected in the ultrasound group. Although LIFU prevented the rats from the raise, it did not cause a significant reduction of morphine preference.
Conclusion: We state that there is a need for future studies to investigate the effects of low-intensity focused ultrasound as an alternative treatment modality in addiction.
Behavioural, cognitive, and pharmacological interventions can all be effective for insomnia. However, because of inadequate resources, medications are more frequently used worldwide. We aimed to ...estimate the comparative effectiveness of pharmacological treatments for the acute and long-term treatment of adults with insomnia disorder.
In this systematic review and network meta-analysis, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Embase, PsycINFO, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, and websites of regulatory agencies from database inception to Nov 25, 2021, to identify published and unpublished randomised controlled trials. We included studies comparing pharmacological treatments or placebo as monotherapy for the treatment of adults (≥18 year) with insomnia disorder. We assessed the certainty of evidence using the confidence in network meta-analysis (CINeMA) framework. Primary outcomes were efficacy (ie, quality of sleep measured by any self-rated scale), treatment discontinuation for any reason and due to side-effects specifically, and safety (ie, number of patients with at least one adverse event) both for acute and long-term treatment. We estimated summary standardised mean differences (SMDs) and odds ratios (ORs) using pairwise and network meta-analysis with random effects. This study is registered with Open Science Framework, https://doi.org/10.17605/OSF.IO/PU4QJ.
We included 170 trials (36 interventions and 47 950 participants) in the systematic review and 154 double-blind, randomised controlled trials (30 interventions and 44 089 participants) were eligible for the network meta-analysis. In terms of acute treatment, benzodiazepines, doxylamine, eszopiclone, lemborexant, seltorexant, zolpidem, and zopiclone were more efficacious than placebo (SMD range: 0·36-0·83 CINeMA estimates of certainty: high to moderate). Benzodiazepines, eszopiclone, zolpidem, and zopiclone were more efficacious than melatonin, ramelteon, and zaleplon (SMD 0·27-0·71 moderate to very low). Intermediate-acting benzodiazepines, long-acting benzodiazepines, and eszopiclone had fewer discontinuations due to any cause than ramelteon (OR 0·72 95% CI 0·52-0·99; moderate, 0·70 0·51-0·95; moderate and 0·71 0·52-0·98; moderate, respectively). Zopiclone and zolpidem caused more dropouts due to adverse events than did placebo (zopiclone: OR 2·00 95% CI 1·28-3·13; very low; zolpidem: 1·79 1·25-2·50; moderate); and zopiclone caused more dropouts than did eszopiclone (OR 1·82 95% CI 1·01-3·33; low), daridorexant (3·45 1·41-8·33; low), and suvorexant (3·13 1·47-6·67; low). For the number of individuals with side-effects at study endpoint, benzodiazepines, eszopiclone, zolpidem, and zopiclone were worse than placebo, doxepin, seltorexant, and zaleplon (OR range 1·27-2·78 high to very low). For long-term treatment, eszopiclone and lemborexant were more effective than placebo (eszopiclone: SMD 0·63 95% CI 0·36-0·90; very low; lemborexant: 0·41 0·04-0·78; very low) and eszopiclone was more effective than ramelteon (0.63 0·16-1·10; very low) and zolpidem (0·60 0·00-1·20; very low). Compared with ramelteon, eszopiclone and zolpidem had a lower rate of all-cause discontinuations (eszopiclone: OR 0·43 95% CI 0·20-0·93; very low; zolpidem: 0·43 0·19-0·95; very low); however, zolpidem was associated with a higher number of dropouts due to side-effects than placebo (OR 2·00 95% CI 1·11-3·70; very low).
Overall, eszopiclone and lemborexant had a favorable profile, but eszopiclone might cause substantial adverse events and safety data on lemborexant were inconclusive. Doxepin, seltorexant, and zaleplon were well tolerated, but data on efficacy and other important outcomes were scarce and do not allow firm conclusions. Many licensed drugs (including benzodiazepines, daridorexant, suvorexant, and trazodone) can be effective in the acute treatment of insomnia but are associated with poor tolerability, or information about long-term effects is not available. Melatonin, ramelteon, and non-licensed drugs did not show overall material benefits. These results should serve evidence-based clinical practice.
UK National Institute for Health Research Oxford Health Biomedical Research Centre.
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