Aims
The aims were to determine and compare the prevalence of possible psychiatric disorders among Bangladeshi adults before and during lockdown. It was hypothesized that prevalence of possible ...psychiatric disorders would increase during the lockdown. In Bangladesh, lockdown was implemented in response to the COVID-19 pandemic resulting in conditions where those prone to developing psychiatric disorders were more vulnerable in an environment where the mental healthcare infrastructure is already lacking. Although many studies outlined the devastating impact on mental health that the lockdown measures created, this unique study specifically uses a World Health Organization developed research instrument for a lower-middle-income country.
Methods
This was a cross-sectional, descriptive, comparative study with one stage design to determine possible psychiatric cases. Initially, 603 adults were randomly contacted using Facebook messenger & groups and email. Questionnaires including the validated Self Reporting Questionnaire (SRQ)-20 in Bangla, for screening psychopathology of the cases, and a structured questionnaire containing socio-demographic and other related variables, were inputted into Google Forms and hyperlinks were distributed. Eventually, 570 participants, from 18 to 77 years, with Internet access, who completed the questionnaires, were included in the study through purposive and consecutive sampling. The SRQ variables were divided into four categories: (1) depressive/anxious; (2) somatic symptoms; (3) reduced vital energy; and (4) depressive thoughts. Using IBM SPSS Statistics, paired sample t-tests were used during data analysis.
Results
The mean age of cases was 34.69 ± 13.02 years; male: female = 1.41:1. The prevalence of possible psychiatric disorders was 43.9% during lockdown compared to 23.3% before lockdown (t = 19.497, P = 0.000). Before lockdown, sex and employment status were significant factors for the SRQ positive cases. After lockdown, in the SRQ positive cases, sex, educational status, COVID-19 positive cases and death due to COVID-19 among family members were highly significant (p = 0.0001) factors. Somatic symptoms and depressive thoughts were approximately double in prevalence among the SRQ positive cases during lockdown compared to before lockdown.
Conclusion
There was a significant impact on mental health where a reduction in psychological and socioeconomic support occurred. These findings are in line with those in the literature where somatic symptoms have been identified as most commonly experienced during the pandemic. Increased depressive thoughts are associated with increased feelings of possible impending death and fear of an uncertain situation. Clearly, the mental health infrastructure of Bangladesh is in even greater need of rapid change to ensure resilience to the survivors of the lockdown.
Aims
Antipsychotic use is associated with cardiovascular and metabolic side-effects, which may contribute to increase mortality and morbidity in this patient group. This highlights the importance of ...physical health monitoring. We aimed to assess our compliance with the more stringent NICE guidelines, updated in September 2021.
Methods
Half of BEIS team's caseload was audited (n = 67) during October 2021 for compliance with NICE's monitoring guidelines for patients initiated on antipsychotic medication. These included initial and, if indicated, repeat monitoring of body mass index (BMI), pulse, blood pressure (BP), blood results, electrocardiogram, and adverse effects. Patients who were not on antipsychotics were excluded. 61% of patients were initiated on antipsychotics as inpatients, and 39% were outpatients. These patients have been started on antipsychotics within the last three years. Data were collected via electronic record systems. 80% compliance was set as the standard, in line with National Clinical Audit of Psychosis standards.
Results
In the first three months of antipsychotic initiation (61% as inpatients, 39% in the community) six out of nine parameters met standards (ranging from 2% to 100%), with BMI measurement (weekly), pulse and BP measurements and one month repeat haemoglobin A1C (HbA1c) failing. When only accounting for patients who were started on antipsychotics in outpatient settings (BEIS or crisis team), compliance was only met on two parameters.
Three months post initiation, when patients were mainly monitored in the community, only three of the nine parameters met compliance (lipids, HBA1c, and side-effects).
Conclusion
Adherence to the NICE standards for physical health monitoring in the community poses significant challenges. Possible barriers include reduced patient contact during the pandemic, lack of awareness of monitoring requirements, poor documentation (particularly of declined screening) and a lack of time and resources. There is also a possibility of unnecessarily stringent and impractical guidelines which are difficult to achieve in outpatient settings – such as weekly BMI. We plan to implement interventions including providing a checklist for medical and nursing staff and encouraging patients to monitor their own blood pressure and weight at home. We will reaudit the same parameters in 6 months’ time.
To determine the role of imaging measurements of emphysema and airway disease in determining chronic obstructive pulmonary disease (COPD) symptoms and exercise limitation in patients with COPD, ...particularly in patients with mild-to-moderate disease.
Participants (n = 116) with Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade U (unclassified) or grade I-IV COPD provided informed consent to an ethics board-approved HIPAA-compliant protocol and underwent spirometry and plethysmography, completed the St George's Respiratory Questionnaire (SGRQ), completed a 6-minute walk test for the 6-minute walk distance (6MWD), and underwent hyperpolarized helium 3 ((3)He) magnetic resonance (MR) imaging and computed tomography (CT). Emphysema was estimated by using the MR imaging apparent diffusion coefficient (ADC) and the relative area of the CT attenuation histogram with attenuation of -950 HU or less (RA950). Airway disease was measured by using the CT airway wall thickness of airways with an internal perimeter of 10 mm and total airway count. Ventilation defect percentage at (3)He MR imaging was used to measure ventilation. Multivariable regression models for the 6MWD and SGRQ symptom subscore were used to evaluate the relationships between physiologic and imaging measurements.
Multivariate modeling for the 6MWD in 80 patients with GOLD grade U-II COPD showed that ADC (β = 0.34, P = .04), diffusing capacity of the lung for carbon monoxide (β = 0.60, P = .0008), and residual volume/total lung capacity (β = -0.26, P = .02) were significant variables, while forced expiratory volume in 1 second (FEV1) and airway disease measurements were not. In 36 patients with GOLD grade III or IV disease, FEV1 (β = 0.48, P = .01) was the only significant contributor in a multivariate model for 6MWD. MR imaging emphysema measurements also made the greatest relative contribution to symptoms in patients with milder (GOLD grade U-II) COPD (ADC: β = 0.60, P = .005; RA950: β = -0.52, P = .02; FEV1: β = -0.45, P = .0002) and in grade III or IV disease (ADC: β = 0.95, P = .01; RA950: β = -0.62, P = .07; airway count: β = -0.49, P = .01).
In patients with mild-to-moderate COPD, MR imaging emphysema measurements played a dominant role in the expression of exercise limitation, while both CT and MR imaging measurements of emphysema explained symptoms.
Introduction
Patient acceptability with outpatient teleneurology has been reported within specific conditions, but less is known about acceptability across neurologic conditions. The study objective ...was to compare the acceptability of teleneurology between patients with various neurological conditions and determine what other factors influence acceptability.
Methods
This was a prospective study of Veterans who completed new outpatient teleneurology visits with the Department of Veterans Affairs National Teleneurology Program. Visits were conducted via video to home or video to the outpatient clinic. Patient acceptability was assessed via telephone interview two weeks post-visit. Acceptability was a summed score (3–21) of three 7-point Likert questions (higher = more acceptable). Clinical diagnosis categories were based on the neurologists’ ICD10 diagnosis code. Acceptability score was modeled using a censored Tobit model controlling for demographics, type of tele-visit, medical comorbidity, and ICD10 category.
Results
In FY 2021, 277 of 637 (43.5%) patients completed an interview with analyzable acceptability data. Of these 277, 70 (25.3%) had codes indicating headache, 46 (16.6%) movement disorder, 45 (16.2%) general symptoms, and 116 (41.9%) for all other categories. Mean patient acceptability was 18.3 (SD 3.2). There was no significant difference in scores between these groups. The only factor independently related to acceptability was medical comorbidity, with higher comorbidity associated with higher acceptability scores.
Discussion
Patients find their outpatient teleneurology experience highly acceptable independent of neurologic condition. Those with more comorbidity report higher acceptability. Use of teleneurology may be useful and acceptable across many outpatient neurologic conditions including for more medically complex patients.
To directly compare magnetic resonance (MR) imaging and computed tomography (CT) parametric response map (PRM) measurements of gas trapping and emphysema in ex-smokers both with and without chronic ...obstructive pulmonary disease (COPD).
Participants provided written informed consent to a protocol that was approved by a local research ethics board and Health Canada and was compliant with the HIPAA (Institutional Review Board Reg. #00000940). The prospectively planned study was performed from March 2014 to December 2014 and included 58 ex-smokers (mean age, 73 years ± 9) with (n = 32; mean age, 74 years ± 7) and without (n = 26; mean age, 70 years ± 11) COPD. MR imaging (at functional residual capacity plus 1 L), CT (at full inspiration and expiration), and spirometry or plethysmography were performed during a 2-hour visit to generate ventilation defect percent (VDP), apparent diffusion coefficient (ADC), and PRM gas trapping and emphysema measurements. The relationships between pulmonary function and imaging measurements were determined with analysis of variance (ANOVA), Holm-Bonferroni corrected Pearson correlations, multivariate regression modeling, and the spatial overlap coefficient (SOC).
VDP, ADC, and PRM gas trapping and emphysema (ANOVA, P < .001) measurements were significantly different in healthy ex-smokers than they were in ex-smokers with COPD. In all ex-smokers, VDP was correlated with PRM gas trapping (r = 0.58, P < .001) and with PRM emphysema (r = 0.68, P < .001). VDP was also significantly correlated with PRM in ex-smokers with COPD (gas trapping: r = 0.47 and P = .03; emphysema: r = 0.62 and P < .001) but not in healthy ex-smokers. In a multivariate model that predicted PRM gas trapping, the forced expiratory volume in 1 second normalized to the forced vital capacity (standardized coefficients βS = -0.69, P = .001) and airway wall area percent (βS = -0.22, P = .02) were significant predictors. PRM emphysema was predicted by the diffusing capacity for carbon monoxide (βS = -0.29, P = .03) and VDP (βS = 0.41, P = .001). Helium 3 ADC values were significantly elevated in PRM gas-trapping regions (P < .001). The spatial relationship for ventilation defects was significantly greater with PRM gas trapping than with PRM emphysema in patients with mild (for gas trapping, SOC = 36% ± 28; for emphysema, SOC = 1% ± 2; P = .001) and moderate (for gas trapping, SOC = 34% ± 28; for emphysema, SOC = 7% ± 15; P = .006) COPD. For severe COPD, the spatial relationship for ventilation defects with PRM emphysema (SOC = 64% ± 30) was significantly greater than that for PRM gas trapping (SOC = 36% ± 18; P = .01).
In all ex-smokers, ADC values were significantly elevated in regions of PRM gas trapping, and VDP was quantitatively and spatially related to both PRM gas trapping and PRM emphysema. In patients with mild to moderate COPD, VDP was related to PRM gas trapping, whereas in patients with severe COPD, VDP correlated with both PRM gas trapping and PRM emphysema.
Hyperpolarized (3)He magnetic resonance imaging (MRI) ventilation abnormalities are visible in ex-smokers without airflow limitation, but the clinical relevance of this is not well-understood. Our ...objective was to phenotype healthy ex-smokers with normal and abnormally elevated ventilation defect percent (VDP).
Sixty ex-smokers without airflow limitation provided written informed consent to (3)He MRI, computed tomography (CT), and pulmonary function tests in a single visit. (3)He MRI VDP and apparent diffusion coefficients (ADCs) were measured for whole-lung and each lung lobe as were CT measurements of emphysema (relative area RA with attenuation ≤-950 HU, RA950) and airway morphology (wall area percent WA%, lumen area LA and LA normalized to body surface area LA/BSA).
In 42 ex-smokers, there was abnormally elevated VDP and no significant differences for pulmonary function, RA950, or airway measurements compared to 18 ex-smokers with normal VDP. Ex-smokers with abnormally elevated VDP reported significantly greater (3)He ADC in the apical lung (right upper lobe RUL, P = .02; right middle lobe RML, P = .04; and left upper lobe LUL, P = .009). Whole lung (r = 0.40, P = .001) and lobar VDP (RUL, r = 0.32, P = .01; RML, r = 0.46, P = .002; right lower lobe RLL, r = 0.38, P = .003; LUL, r = 0.35, P = .006; and left lower lobe, r = 0.37, P = .004) correlated with regional (3)He ADC. Although whole-lung VDP and CT airway morphology measurements were not correlated, regional VDP was correlated with RUL LA (r = -0.37, P = .004), LA/BSA (r = -0.42, P = .0008), RLL WA% (r = 0.28, P = .03), LA (r = -0.28, P = .03), and LA/BSA (r = -0.37, P = .004).
Abnormally elevated VDP in ex-smokers without airflow limitation was coincident with very mild emphysema detected using MRI and regional airway remodeling detected using CT representing a subclinical obstructive lung disease phenotype.
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