The European Journal of Psychiatry

Haematological and biochemical differences between mania and euthymia

Background and Objectives: The effects of transient hypothalamic dysfunction on the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid axes can be shown by haematological and biochemical parameter changes. We hypothesized that manic episodes will be associated with subclinical inflammation, haemodilution and altered thyroid functions compared to euthymic states. Methods: Patients admitted to the psychiatry clinic with manic episodes were identified. Those having comorbidities, except for thyroid dysfunctions, hypertension, hyperlipidemia, and type 2 diabetes mellitus, were excluded. Complete blood counts, total protein, albumin, and thyroid tests were recorded during the admissions (manic episodes) (Maletic, 2014 #24) and one year later (euthymic states) for the same patients. Results: All studied parameters had significant differences between mania and euthymia. During manic episodes, patients had higher peripheral inflammatory indices (neutrophil/lymphocyte ratio and platelet/lymphocyte ratio), haemodilution (lower haemoglobin, haematocrit, total protein, and albumin), higher thyroxine and lower thyroid-stimulating hormone levels compared to euthymic states. Conclusions: This study supports the hypothesis that compared to euthymic states; manic episodes are associated with low-grade inflammation, haemodilution and thyroid function abnormalities. Monitoring patients'; blood compositions could result in better prognostic evaluations and aid in determining additional systemic treatment options, as well as in generating causal hypothesis to be tested in future studies.

ADHD symptoms in children aged 5 to 15 years in Zhabei District, Shanghai

Background and Objectives: The prevalence of attention deficit hyperactivity disorder (ADHD) and its related factors remains unclear in Shanghai.The aim of this study was to investigate the positive rates of ADHD symptoms and the associated factors in a sample of children aged 5 to 15 years in Zhabei District, Shanghai. Methods: The participants were selected by cluster-stratified sampling of the general information and responses gathered from questionnaires on ADHD symptoms. The questionnaires examined summed up to 9,627. The positive rates of inattention and hyperactivity-impulsivity symptoms and the socio-demographic factors were compared. Results: The positive rates of most ADHD symptoms decreased with age. Children between 5 and 7 years and between 7 and 9 years exhibited the highest ADHD positive rates. Boys showed a higher positive rate of ADHD symptoms compared to girls. Children who were local residents showed a higher rate than nonlocal residents and those of other nationalities. This might be related to the integration of immigrants and those belonging to lower socioeconomic classes. The positive rates of ADHD symptoms decreased with the educational level of the parents, while the parents'; level of education was associated with the severity of the ADHD symptoms. Problems of inattention were more common than problems of hyperactivity, as indicated by the positive rates. Conclusions: The improper educational guidance of ineffective parents, as well as simple and crude attitudes to education, may place children in such a conflicting state, gradually creating psychological problems and resulting in a lack of self-confidence and ADHD.

Prevalence of psychotropic medication use and associated factors in the elderly

Background and Objectives: The object of our study was to estimate the prevalence of psychotropic drug use among non-institutionalised elderly people 65 years or older and identify possible conditioning factors. Methods: A cross-sectional, observational study was carried out of 1161 subjects aged 65 years and older. Participants were randomly selected from health care registry listings. The main outcomes of interest were based on self-reporting and included consumption of psychotropic and other drugs (filed by the ATC Classification System), mood (based on the GDS-VE), cognitive status (Pfeiffer Questionnaire), physical-functional assessment based on Katz score, health problems (ICPC-2 classification WONCA) and socio-demographic variables. Results: The prevalence of self-reported psychotropic drug consumption was 20.5% (95% CI: 18.2 to 22.8). Anxiolytics and hypnotics were consumed by 16.6% of the elderly, antidepressants by 7.0% and antipsychotics by only 2.1%. In multivariate logistical analyses, the use of psychotropics was independently associated with other drug consumption (non-psychotropics), (OR: 4.0, 95% CI: 1.7 to 9.5), presence of established depression (OR: 3.2, 95% CI: 1.3 to 7.6), presence of 4 or more comorbidities (OR: 2.7, 95% CI: 1.9 to 3.8), being female (OR: 2.1, 95% CI: 1.5 to 3.0) and being dependent for basic activities of daily living (OR: 1.7, 95% CI: 1.0 to 2.6). Conclusions: The prevalence of psychotropic drug use among the elderly from Albacete is high. Several factors were identified as potential determinants of psychotropic drug use. It will be important to evaluate the misuse of these drugs in order to inform effective, efficient and safe prescription strategies.

The Global Mental Health Assessment Tool Primary Care and General Health Setting Version (GMHAT/PC) - Spanish version: a validity and feasibility study

Background and Objectives: The study aims to assess the feasibility and the level of agreement between the Spanish version GMHAT/PC diagnosis and psychiatrists'; ICD-10 based clinical diagnosis. Methods: Participants in the study ranged from those who were in remission to others who had different mental illnesses. They were recruited from inpatient and outpatient mental health settings. All consecutive patients were interviewed using Spanish version of GMHAT/PC and they were assessed independently by psychiatrists to in order to get their ICD-10 based diagnosis. Results: Two hundred ninety-nine patients participated in the study. The mean duration of interview was 12.5 minutes. There is an acceptable to good level of agreement between the GP';s (GMHAT/PC) diagnoses and the psychiatrists'; (clinical) diagnoses of any mental illness, Kappa 0.58 95% C.I (0.46, 0.72). There is good level of sensitivity (81%) and specificity (92%), with GPs correctly identifying 242 out of the 250 participants diagnosed with mental illness and 27 out of 35 of those without. Conclusions: The finding of the study suggest that GMHAT/PC Spanish version used by GPs detected mental disorders accurately and it was feasible to use GMHAT/PC (Spanish version) in Latin America settings.

Stability in the choice of method during the period preceding a suicide attempt and in attempt repeaters

Background and Objectives: Understanding the mental processes preceding a suicidal act is important for the potential to intervene. This study investigates stability and possible changes of suicide methods considered during the time immediately preceding a suicide attempt. Methods: Patients who had attempted suicide were interviewed shortly thereafter with regard to whether there was a change in the conception of the method to be used during the period preceding the attempt. In addition, the course of methods applied in previous suicide attempts was assessed in attempt repeaters. Results: In total, 130 patients were included. In 63.1% one method only was envisaged during the entire suicidal crisis, in 26.9% the initial and the actual method differed. Stability rate was higher in those older than 40 years, if the duration of the suicidal crisis was ≤ 60 minutes and if a non-violent suicide method was initially intended. Of repeaters, 46.5% used the same method in all recorded attempts. Use of a non-violent method in the first suicide attempt predicted method stability in subsequent attempts. Conclusions: Focusing on one single suicide method during the time immediately preceding a suicide attempt is common. Reduced flexibility to rapidly switch mentally to another method may contribute to explain the effectiveness of limiting access to suicide means for suicide prevention.

Psychological and behavioral problems in children of war veterans with Post Traumatic Stress Disorder

Background and Objectives: Posttraumatic stress disorder (PTSD) caused by war trauma experiences affects veterans'; ability to meet their parental obligations, which can lead to the appearance of psychological and behavioral problems in their children. We explored, based on the parents'; assessment, whether the children of veterans with PTSD exhibit more psychological and behavioral problems and whether there are differences in relation to the age and sex of the child. Methods: The study group consisted of 91 children from 50 veterans receiving treatment for the war-related PTSD at the Psychiatric Department of the University Clinical Hospital Mostar. The control group consisted of 98 children of 50 war veterans without PTSD who were selected from veteran associations by the snowball method. The following instruments were used in the study: General Demographic Questionnaire, Harvard Trauma Questionnaire-Bosnia and Herzegovina version and the Strengths and Difficulties Questionnaire for children. Results: Children of veterans with PTSD have more pronounced psychological and behavioral problems (U = 2372.5; P < 0.001) compared to the children of veterans without PTSD. Male children of veterans with PTSD have more frequent behavioral problems (χ² = 7.174; P = 0.025) compared to the female children, and overall, they more frequently exhibit borderline or abnormal psychological difficulties (χ² = 6.682; P = 0.029). Children exhibiting abnormal levels of hyperactivity are significantly younger than children who exhibit normal or borderline levels of hyperactivity (Kruskal-Wallis = 3.982; P = 0.046). Conclusions: The children of war veterans with PTSD have more psychological and behavioral problems in comparison with the children of veterans without PTSD.