The European Journal of Psychiatry

Mental Health of Chinese Peacekeepers in Liberia

Background and Objectives: As part of UN peacekeeping operations in Liberia, China has sent a dozen of batches of peacekeeping force to Liberia for medical, engineering and transporting purposes from 2003 to 2012. This study aimed to explore the mental health of Chinese peacekeepers under the influence of stressful and traumatic events in Liberia. Methods: A total of 440 Chinese peacekeepers were selected by cluster sampling and surveyed by Chinese Military Mental Health Scale (CMMHS) before, during and after peacekeeping deployment. Results: The total CMMHS score (48.90 ± 21.15), depression factor (7.25 ± 3.43), interpersonal sensitivity (4.20 ± 2.15) of Chinese peacekeepers were significantly higher than the Chinese military norm (23.04 ± 14.70, 2.47 ± 2.46, 3.95 ± 2.97 respectively) (p<0.01). The total score and anxiety, somatization factor score of the transporting group were significantly higher than those of the medical group (P <0.05); All CMMHS factors in the transporting group and the medical group were higher than those of the engineering group (p<0.01). CMMHS factors score of the peacekeepers positively correlated with the age, military service duration, years of eudcation and military rank (r = 0.107 ~ 0.523, p<0.05); stepwise linear regression analysis revealed that years of eudcation was the main influence factor for peacekeepers' mental health (t = 2.288 ~ 4.358, p<0.05 ~ 0.01). Conclusions: The mental health status of Chinese peacekeepers was worse than average Chinese servicemen. Peacekeepers of different mission groups had different degree of mental damage, and the years of education was the main influence factor for peacekeepers' mental health, whereas age, military service duration as well as military rank were the secondary influence factors.

Delirium and functionality: the impact of delirium on the level of functioning

Background and Objectives: Studies have shown showed that delirium affects the long-term functional status, however, the acute effect of delirium on functioning has been less documented. The purpose of this analysis was to examine the acute impact of delirium on the level of functioning. Methods: All patients were recruited at the Memorial Sloan Kettering Cancer Center (MSKCC). The Memorial Delirium Assessment Scale (MDAS) and Karnofsky scale of Performance Status (KPS) were recorded at baseline (T1), 2-3 days (T2) and 4-7 days (T3). A secondary analysis in respect to sociodemographic and medical variables, aspects of delirium, and level of functioning was performed. Results: Delirium severity at baseline did not affect the level of functioning, however, resolved delirium resulted in substantial functional recovery compared to persistent delirium at T2 (30.2 and 23.5) and T3 (35.1 and 26.2). Patients with persistent functional impairment were not different in age, pre-existing dementia or brain metastasis compared to those with functional recovery. However, brain cancer, terminal illness, hypoxia and multiple etiologies caused persistent functional decline. Although delirium severity was not different at baseline, delirium was more severe in the functionally-impaired at T2 and T3. Similarly, delirium resolution was inferior in these patients in contrast to the functionally-recovered at T2 (25% and 65.4%) and T3 (62.5% and 83.3%). On the contrary, the duration of delirium affected functional recovery; shorter delirium predicted faster functional recovery. Conclusions: Delirium caused an acute functional decline and appropriate management of delirium with antipsychotics reversed this decline. On the contrary, shorter duration of delirium was associated with faster functional recovery. Brain cancer, terminal illness, hypoxia, and multiple etiologies were confounders for persistent delirium and functional impairment.

Antibiomania after triple therapy for Helicobacter Pylori: Two case reports and a review of physiopathology

Background and Objectives: The onset of manic symptoms in middle age requires clinicians to consider possible reversible causes, especially in patients with no previous psychiatric history. A number of drugs have been implicated as being among possible causes. The term antibiomania appeared to define cases of antibiotic-induced manic symptoms. This is a serious, but rare, adverse event. Several studies have described antimicrobial agents as being responsible for antibiomania. Our objective is to investigate the possible induction of manic symptoms by clarithromycin through two case reports and a review of the literature. Methods: We report two cases of clinical manic psychotic symptoms arising in the context of treatment with triple therapy for Helicobacter pylori eradication. In addition, we summarize, in an unsystematic way, previously published evidence and pathophysiological mechanisms proposed. Conclusions: These and other previously published cases suggest that the use of triple therapy, and especially of clarithromycin, should always be considered as a possible cause of acute manic or psychotic episode. Published evidence on the pathophysiological mechanisms is speculative so the identification and dissemination of a larger number of antibiomania cases and systematic study of them may help us to understand the underlying pathophysiological mechanisms and improve our diagnostic skills.

Self/other Perception Mediates Between Personality and Suicidal Ideation in Young Adults

Background and Objectives: Individual differences in vulnerability to suicidal ideation have been recently addressed to internal working models of attachment. However, to date, research has mainly focused on adolescents. Few studies have investigated the role of adult attachment and personality dimensions in suicidal ideation, either examined from a mediational perspective. In this study, we aimed at testing a theoretical model in which Self/other perception mediates between personality and suicidal ideation in young adults. Methods: Dimensions of Attachment (self/other perception), Personality (the Big Five factor model), and Suicidal Ideation (hopelessness and depression) were assessed in a community sample of 319 young adults from Northern Italy. Structural Equation Modeling and mediation analysis were conducted. Controlling for demographic variables (i.e., gender, age, education, and job), we tested three structural models. Results: The final model confirmed our hypothesis that self/other perception mediates between personality (high neuroticism and low extraversion) and suicidal ideation, providing excellent fit to data. Conclusions: In line with the conceptual framework of the Attachment Theory, findings suggest that failure to resolve attachment-related distress is related to the emergence of negative self/other models in adults. Such internal models are likely to attenuate the association between neuroticism and extraversion with depressive symptoms, hopelessness and suicidal ideation.

Deficit of perineuronal oligodendrocytes in the inferior parietal lobule is associated with lack of insight in schizophrenia

Background and Objectives: Previously we reported a significant reduction in the numerical density of oligodendrocytes and oligodendrocyte clusters in the inferior parietal lobule (IPL) in schizophrenia that was associated with lack of insight. We also found a significant decrease in the number of perineuronal oligodendrocytes (PnOl) in the prefrontal cortex in schizophrenia and therefore we hypothesized that there may also be a deficit of PnOl in the IPL in schizophrenia and that it could be associated with poor insight. Methods: We estimated the number of PnOl adjacent to pyramidal neurons in layer 3 of BA39 and BA40 in Nissl stained sections from 24 males with schizophrenia and 24 normal male controls from the Stanley Parietal Collection. The schizophrenia group was divided into three subgroups based on level of insight: poor, fair or good. Results: We found a significant deficit of PnOl in layer 3 of BA39 and BA40 in the schizophrenia group as compared to the control group (p<0.01). In the control group but not in the schizophrenia group in BA39 the number of PnOl was significantly higher in the left hemisphere compared to the right hemisphere. In schizophrenia, in BA39 the number of PnOl was decreased in the subgroup with poor insight vs. controls. In BA40 the subgroups with both poor and fair insight were decreased vs. controls (p<0.01). In BA40 the subjects with fair insight also differed from those with good insight (p<0.01). Conclusions: The reduction of PnOl in the IPL in schizophrenia is associated with impaired insight and lack of hemispheric asymmetry.

Whose "successful ageing"?: lay- and researcher-driven conceptualisations of ageing well

Background and Objectives: To date, there is no consensus definition of successful ageing (SA). In the literature, conceptualisations of SA are generally researcher-driven operational definitions or layperson perspectives. The current study aims to systematically review and compare quantitative operational definitions of SA with qualitative, layperson perspectives of SA. Methods: PubMed, PsycInfo, ISI Web of Knowledge, EmBase and CINAHL databases were searched using the words "successful ageing" and related terms. Peer-reviewed studies positing quantifiable operational definitions of SA were included, as were studies that conducted exploratory qualitative study of layperson perspectives of SA. Results: Marked differences in the focus of SA conceptualizations between researchers and laypersons were revealed. Qualitative studies demonstrated a greater emphasis on psychosocial aspects of SA, such as attitude whilst quantitative studies were generally biomedically focused, e.g. physical functioning/disability. Conclusions: Little concordance in classification of SA is found across the two perspectives such that an individual may be simultaneously classified as unsuccessfully ageing from a biomedical approach and successfully ageing from a layperson perspective. Most studies have been conducted in North America and the UK using non-clinical populations, resulting in limitations on generalizability. Alternative perspectives of SA must be taken into consideration in the practical application of SA.