Introduction Many studies have investigated whether there exist predictors of good response to antimanic drugs in bipolar disorder (BD). However, these factors predict response or only indicate ...benign illness course. Objectives To shed some light on the topic, we tested whether the response to antimanic drugs showed any variability beyond that expected by the effects of illness course and placebo. Methods We included all double-blind, placebo-controlled RCTs of oral pharmacotherapies targeting adult patients with acute bipolar mania from 1991 to 2020. The primary outcome was the variance of the improvement in manic symptoms in treated individuals compared to placebo. The effect size was the log variability ratio (logVR). We performed a random-effects meta-analysis, including assessments of heterogeneity, sensitivity/cumulative/subgroup analyses, and meta-regression. Results 42 RCTs (46 comparisons) from a total of 8,438 BD patients with acute mania (53.7% male, mean age=39.3; 5,563 treatment/2,875 control groups) were included in the analysis. Individuals in active treatment groups did not show variability in the response beyond that observed in individuals under placebo (VR=1; 95% C.I.=0.97,1.03; p-value=0.97). No heterogeneity was detected between the studies (I2=0%; tau2=0%; Q=29.21; df=45; p-value=0.97). Results were similar in the leave-one-out/cumulative/subgroup analyses. Meta-regression did not show influences by age, sample size, sex, severity of manic symptoms at baseline, or clinical features (rapid cycling, mixed or psychotic features). Conclusions This meta-analysis shows no evidence of differences in the individual response to treatments. These findings suggest that the average treatment effect is a reasonable assumption for the individual BD patient with acute mania. The presented article adds evidence to the equivalent results in schizophrenia-spectrum disorders, clinical high-risk state for psychosis, and major depressive disorder, not supporting classification in responders vs. non-responders. However, these findings should be balanced with results from other fields supporting such classification. Disclosure of InterestNone Declared
Introduction The Functioning Assessment Short Test (FAST) is a relatively specific test for bipolar disorders designed to assess the main functioning problems experienced by patients. Objectives FAST ...includes 24 items assessing impairment or disability in 6 domains of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time. It has already been translated into standardized versions in several languages. The aim of this study is to measure the validity and reliability of the Korean version of FAST (K-FAST). Methods A total of 209 bipolar disorder patients were recruited from 14 centers in Korea. K-FAST, Young Mania Rating Scale (YMRS), Bipolar Depression Rating Scale (BDRS), Global Assessment of Functioning (GAF) and the World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) were administered, and psychometric analysis of the K-FAST was conducted Results The internal consistency (Cronbach’s alpha) of the K-FAST was 0.95. Test-retest reliability analysis showed a strong correlation between the two measures assessed at a 1-week interval (ICC = 0.97; p < 0.001). The K-FAST exhibited significant correlations with GAF (r=-0.771), WHOQOL-BREF (r=-0.326), YMRS (r=0.509) and BDRS (r=0.598). A strong negative correlation with GAF pointed to a reasonable degree of concurrent validity. Although the exploratory factor analysis showed 4 factors, the confirmatory factor analysis of questionnaires had a good fit for a six factors model (CFI=0.925; TLI=0.912; RMSEA=0.078). Table. Model fit index of confirmatory factor analysis (n=209) Measure of fit 4-factor model 6-factor model Acceptable value χ2/df 2.832 2.267 <3 RMSEA (90% CI) 0.094(0.086-0.102) 0.078 (0.069-0.087) <0.08 CFI 0.887 0.925 >0.9 TLI 0.873 0.912 >0.9 χ2, chi-square; df, degrees of freedom; RMSEA, root mean square error of approximation; CFI, comparative fit index; TLI, Tucker-Lewis index. Conclusions The K-FAST has good psychometric properties, good internal consistency, and can be applicable and acceptable to the Korean context. Disclosure of InterestNone Declared
Introduction Over a quarter of U.S. children have at least one immigrant parent. Mental health disparities in children need to be assessed to better identify disproportionate burdens and promote ...health equity. Objectives To assess the associations between race, ethnicity, and parent-child nativity, and mental health conditions in the U.S. Methods Data were from the 2016-2019 National Survey of Children’s Health (n=114,476 children aged 3-17 years), a nationwide, cross-sectional survey. Outcome variables included three mental health conditions (depression, anxiety, and behavior or conduct problems) reported by the parent/guardian. Additional measures included questions about healthcare access and use, demographics, and nine household challenge adverse childhood experiences (ACEs) used to quantify a total ACE score (0-9). Information on nativity was used to define immigrant generation (1st, 2nd, and 3rd+). Weighted logistic regression was used to assess the associations between race/ethnicity (Asian, Black, Hispanic, White, and Other), household generation, and outcome variables, among children who reported access to or utilized health services, adjusting for demographics. Multiple imputation was used to handle missing data. Results Asian, Black, Hispanic, and White 3rd+ generation children had increased odds of depression compared to their 1st generation counterparts, same as among White, 2nd generation children. Race/ethnicity was not associated with depression among 1st and 3rd+ generation children, but Asian, Black, and Hispanic children had lower odds of depression compared to White children among 2nd generation children. Asian, Black, Hispanic, and Other-race 3rd+ generation children had increased odds of anxiety compared to their 1st generation counterparts, with similar findings also observed for Black and Other-race 2nd generation children. Being racial/ethnic minorities was generally associated with decreased odds of anxiety among 1st and 2nd generation children compared to White children from the respective generations. Asian, Black, Hispanic, and Other-race 3rd+ generation children had increased odds of behavior/conduct problems compared to their 1st generation counterparts. The observed associations remained significant after adjusting for the modified ACE score. Conclusions We found significant differences in several mental health conditions in children by parent-child nativity, race, and ethnicity that could not be explained by demographics, childhood adversity, and healthcare access and use. Lower odds of mental health conditions among minority children could represent differences due to factors such as differential reporting, and higher odds of mental health conditions, including in third- and higher generation children, need further investigation to develop approaches to promote mental health equity. Disclosure of InterestNone Declared
Introduction Schizophrenia is a chronic severe mental disorder characterized by acute decompensation episodes that may lead to hospitalization. In Portugal a previous study found a total of 25,385 ...hospitalizations in an 8-year period, being one of the most burdensome serious mental disorders in Portugal.Rehospitalizations (hospitalization occurring after a previous discharge due to Schizophrenia) are one of the quality-of-care indicators of schizophrenia treatment. Objectives This project aims to describe and quantify hospitalization readmission rates in patients with schizophrenia in Portuguese public hospitals Methods A descriptive study was designed according to the RECORD guidelines, using a nationwide hospitalization administrative database that contains all hospitalizations registered in Portuguese mainland public hospitals. All episodes with discharges occurring between 2008 and 2015 with a primary diagnosis of Schizophrenia were selected according to the International Classification of Diseases version 9, Clinical Modification (ICD-9-CM) codes of diagnosis 295.xx. Readmission rates were estimated using a methodological approach developed by the authors that identified patients who have been rehospitalized in <=5; <=30; <=90 and <=365 days from a previous hospitalization episode during the study period. Individual patients were identified (crosschecking three variables: birthdate; sex and place of residence). The time between discharges was calculated using the difference between an index hospitalization and the next registered hospitalization from the same patient. Results A total of 14,279 patients were anonymously identified in order to calculate readmission rates per patient from a total of 25,385 hospitalization episodes. The mean hospitalization per patient ratio was 1.78. A total of 367 patients (2.6%) had a readmission in <=5 days after discharge. The readmission rate at <=30 days was 8.6% (n=1224); 14.1% (n=2013) at <= 90 days and 23.7% (n=3378) at <=365 days. Readmission rates were higher in male sex patients. Shorter periods of time between readmissions were increasingly frequent in male patients (3.1% vs. 1.6% of all male vs. all female patients in <=5days readmissions; 9.6% vs. 6.5% in <=30 days readmissions; 15.7% vs. 11.0% in <=90days readmissions and 25.3% vs. 20.4% in <=365days readmissions). Conclusions Rehospitalizations arise as one of the indicators of treatment failure and quality of care in patients with a diagnosis of schizophrenia. Our study is the first to measure and assess readmission rates in patients with Schizophrenia in Portuguese public hospitals at a nationwide level. Portugal presents lower 30-day readmission values when compared to other countries. The 30-day readmission rate in patients with Schizophrenia in Portuguese Public Hospitals is 8.6% and male patients have higher readmission rates when compared to female patients. Disclosure of InterestNone Declared
Introduction Recent scientific evidence confirms that employability is extremely important in mental health care. Employment promotes a healthy lifestyle and unemployment leads to a global ...deterioration in health. This principle is transversal to all areas of health, applying equally to people with mental illness, including serious mental illness such as schizophrenia and bipolar affective disorder. Objectives Highlight the importance of employability in the treatment and rehabilitation process of people with mental illness. Methods PubMed database searched using the terms “supported employment” and “mental health” and “policies”. Results Parallel to conventional psychiatric treatments, employment generates self-confidence, promotes social responsibility, a sense of belonging and, consequently, integration in the community. From an economic point of view, it brings financial autonomy to the sick person, allowing the financing of their own accommodation, the payment of proposed treatments and the enjoyment of structures and leisure activities that until then would be impossible. It is also known that patients who are employed are less likely to resort to psychiatric emergency services and have a lower rate of readmissions to psychiatric hospitals, reflecting a better ability to manage the disease. Overall, employability increases the sick person’s quality of life, not only being an effective short-term treatment, but also one of the only interventions that reduce dependence on the health system in the long term. Conclusions The treatment plan should aim for more than the suppression of symptoms. Knowing that employment generates positive outcomes, gets that as fundamental parameter for the treatment and for the rehabilitation of the person with mental illness, and it must therefore become essential that mental health services help patients to find satisfactory jobs and that protect your needs. Thus, mental health policies should defend a new mental health treatment paradigm and emphasize employment as an imperative measure in the treatment and psychosocial rehabilitation of the sick person, including supported employment as an essential part of treatment. Disclosure of InterestNone Declared
Introduction Eye movement desensitization and reprocessing (EMDR) is a psychotherapeutic approach that has been shown to be effective in the treatment of post-traumatic stress disorder (PTSD). The ...technique is known to facilitate the reprocessing of maladaptive memories thought to be at the heart of this pathology. Strong evidence shows that traumatic events can contribute to the onset of serious mental disorders and can worsen their prognosis. Therefore, research on EMDR therapy has increased beyond PTSD and several studies have analyzed the effect of this therapy in other mental health conditions such as psychosis, bipolar disorder, depression, anxiety disorders, substance use disorders and chronic pain. Objectives The objective of this systematic review is to summarize the most important results of available studies conducted in this area. Methods We performed a systematic literature search among PubMed, ScienceDirect and Scopus. Studies included work published up to 2021 The search was performed automatically by title in each database and included the keywords “EMDR”, “Eye Movement Desensitization and Reprocessing” excluding those focusing on trauma and PTSD Results Studies are still sparse in these comorbid conditions, but available evidence suggests that EMDR therapy improves trauma-associated symptoms and has a minor effect on primary disorders by achieving partial symptomatic improvement. A positive effect has been reported in many pathological situations, including addictions, somatoform disorders, sexual dysfunctions, eating disorders, adult personality disorders, mood disorders, severe stress reaction, anxiety disorders, pain, neurodegenerative disorders, mental disorders of childhood and adolescence and sleep. Conclusions Despite a generally positive view of EMDR as an alternative treatment option, more methodologically rigorous studies are needed. Disclosure of InterestNone Declared
Introduction One of the most important functions of sleep may be the promotion of brain development. The non-REM and REM sleep sequences show the succession of cerebral processing phenomena that ...underlie memory consolidation. The negative consequences of sleep loss on neural and behavioral plasticity has been examined. On the other hand, sleep disruption can be a crucial symptom to develop depression disorders. Recent literature suggests that maintenance insomnia may be a risk factor for dementia. It would be important to elucidate which factors may increase the risk of developing dementia and aggravating its progression. Objectives The aim of this scoping review is to point out the increased risk of developing dementia related to insomnia and depression. Methods Relevant literature was searched with PUBMED as electronic database. We used and combined the following MeSH terms: depression, insomnia, cognitive impairment and dementia. We chose sixteen recent studies from 2009 to 2021. Four of them were ruled out because the methodology and conclusions were not enough evident. Results We underlined an interesting research which was carried out with Chinese population in 2021. A total of 256 patients with insomnia disorder were diagnosed by neurologists, 45 of whom were diagnosed with amnesic mild cognitive impairment (aMCI) and 45 participants with intact cognition were chosen as controls matched for age and education. A case-control study was conducted to compare sleep structure between aMCI and control patients with insomnia disorder. An American prospective research in 2016 founded a statistically significant association with a higher MCI/dementia risk in women with either short (≤6 hours/night) or long (≥8 hours/night) sleep duration (vs.7 hours/night). The relationships between depression, cognitive function, serum brain-derived neurotrophic factor (BDNF) and volumetric MRI measurements in older adults were investigated. A total of 4352 individuals aged 65 years or older (mean age 72 years) participated in this Japanese study. Conclusions According to these researches, we emphasize the importance of detecting sleep disturbances as potential risk factors for MCI and dementia. All of them provide evidences that future studies should investigate dementia prevention among elderly individuals through the management of insomnia. At that point we have to consider personalized medicine and machine learning techniques for sleep and cognitive or mood symptoms. Disclosure of InterestNone Declared
Introduction Family caregivers can be a valuable source of knowledge and help in treating persons with mental illness during a psychiatric hospitalization and in ensuring a continuity of service ...between family caregivers and professionals after the discharge form a psychiatric hospital. Therefore, a family care model has been developed in order to provide professional staff members in psychiatric wards guidelines for how to collaborate with family caregivers during each stage of the hospitalization of their family member with mental illness. Objectives To examine the impact of implementing the Family Care model in psychiatric hospitals in Israel on the family caregivers and on the continuity of care between the hospitalization and the community. Methods A comparative study was conducted implementing an AB design with an intervention and control groups. Seventy five persons participated in the control group and 93 in the intervention group. Questionnaires were delivered to family caregivers during the hospitalization and after the discharge from hospitalization, about the quality of collaboration of the family caregivers with the professionals during the hospitalization, about the family caregivers health and mental health, about their knowledge and ability to handle situations related to the family member with SMI and about the continuity of services between the hospitalization and the community Results The findings indicate that in the intervention group comparing to the control group there was: A lower level of anxiety of the family caregivers after the discharge of their family member from the psychiatric hospital, a higher level of evaluation of the caregivers’ knowledge how to respond to the needs of the family members with mental illness, a higher level of evaluation of the quality of collaboration between the caregivers and the professional staff during the psychiatric hospitalization and a more frequent contact a between the persons with mental illness and the mental health services as well as a greater compliance with treatment after the discharge from the psychiatric hospital. Conclusions The Family-Centered care model expands the traditional boundaries of the definition of the patient in psychiatric hospitals to include the family caregivers. This model could help prevent the development of problems for the family caregivers and it could help improve the continuation of services in the community. Therefore, the findings support the implementation of this model in psychiatric hospitals. Disclosure of InterestNone Declared
Introduction
Cannabis use is associated with mental illness among men and women, especially induction or exacerbation of psychosis, anxiety, and depression. Although safety and efficacy of cannabis ...in most medical conditions have not been established, use of medical cannabis is growing exponentially. In particular, albeit sex-related differences in the activity of the endocannabinoid system in animals and humans, differential effects of cannabis on men and women have rarely been sought.
Objectives
To characterize patterns of use and adverse effects experienced by men and women using medical cannabis.
Methods
Data from the Israeli national database of patients licensed to use medical cannabis in Israel from January 2014 to December 2021 was analyzed. The database includes indications for cannabis use, monthly cannabis quantities, Tetrahydrocannabinol (THC) and Cannabidiol (CBD) concentrations, and reports of adverse effects. Comparative statistics were used to evaluate the sex related differences.
Results
161,644 persons (62% men) were issued a license to use medical cannabis during the study period. Men are significantly younger than women (50.5±19.1 vs. 56.5±18.4). The leading indications among both men and women are chronic pain (58% of men, 57% of women), symptoms related to oncological disease and chemotherapy treatment (21% of men, 24% of women) and post-traumatic stress disorder (9% of men, 6% of women). Men consume significantly higher monthly quantities at the beginning of treatment compared to women (31.6 gram vs. 29.3 gram) with a higher THC concentration (13.9% vs. 11.6%) and lower CBD concentration (5.3% vs. 6.7%). Over two years of use, there is an increase among both men and women in the amount and THC concentration, and a decrease in the CBD concentration. The differences between men and women remain significant throughout the whole period. Data on adverse effects are available for 28,629 men and 17,204 women (28.6% of men, 28.0% of women). Women report significantly more physical adverse effects (RR 1.48 95%CI 1.39-1.57), anxiety (RR 1.45 95%CI 1.35-1.56), depression (RR 1.36 95%CI 0.95-1.96) and derealization (RR 3.44 95%CI 2.42-4.89).
Conclusions
Although the prevalence of medical conditions for which medical cannabis is indicated are similar for both genders, approximately 60% more men consume medical cannabis. While consuming lower cannabis amount and THC concentration, women report more physical and psychiatric adverse effects than men. Understanding the differences in usage patterns and adverse effects between men and women will enable more accurate policy determinations and more effective and safer treatment strategies.
Disclosure of Interest
None Declared
Introduction
Sexual and gender minority (SGM) college students endorsed higher psychological distress and worsened mental health outcomes than their cisgender heterosexual peers. Such disparity is ...exacerbated during the COVID-19 pandemic, during which SGM youth may be sent home to unaccepting environments or presented with fewer healthcare options. The “Black lives matter (BLM)” and “Anti-Asian Hate” also exposed college students disproportionally to more witnessed discrimination and poorer social cohesion, which in turn, might negatively affect the mental health outcomes.
Objectives
The present study aims to explore the mental health outcome profile within SGM college students by (1) identify mental health disparities across different sexual and gender identities and (2) evaluating the impacts of discrimination, social cohesion and other factors on mental health outcomes of college students with different sexual and gender identities.
Methods
The study utilizes the 2020-2021 Healthy Minds Study data with 139,470 college students across 60 U.S. campuses. Multivariable regression models are built with minority status to predict mental health outcome (depression, anxiety, and suicidal ideation).
Results
SGM students reported higher symptoms of depression, anxiety, and suicidal ideation. Besides, SGM individuals having experienced or witnessed discrimination or hostile behaviors due to their race/ethnicity also showed worse mental health outcomes. Noted, perceived stronger social cohesion is a protective factor for lower depression (OR: 0.59; 95%CI: 0.45, 0.78) and anxiety (OR: 0.69; 95%CI: 0.51, 0.93) symptoms in SGM, while perceived weaker social cohesion is a risk factor for depression (OR: 1.37; 95%CI: 1.14, 1.64) and anxiety symptoms (OR:1.32; 95%CI:1.09-1.59) in cisgender heterosexual individuals.
Conclusions
These findings acknowledge the negative impact of discrimination on mental health, highlight the importance of recognizing social cohesion affect differently in SGM and their peers, and enhance the understanding of differential impact of social cohesion to inform public policy and early intervention in vulnerable populations during COVID-19 pandemic.
Disclosure of Interest
None Declared
