Costs of Schizophrenia at Psychiatric Hospital of Bingerville (Ivory Coast)

Schizophrenia is classified as a priority mental disorder by the World Health Organization (WHO) and accounts for around 35% of diagnoses at the Bingerville Psychiatric Hospital (HPB). The aims of the study were to identify the cost drivers for hospitalization and to calculate the costs of managing schizophrenia in hospital, with a view to planning household expenditure on care. This pilot cross-sectional study involved 31 patients with schizophrenia who had been hospitalized in the various third-category wards at the HPB between 1st January 2019 and 31st May 2020. Sampling was accidental. The methods used to estimate costs were based on the actual costs of drugs, hospitalization and additional examinations which prices were known, and on patients’ estimations for certain expenses such as food and transport. Results: The sex ratio was 3.42, the mean age was 29.52 years. The mean length of stay was 46.19 days, and the most frequent clinical forms were paranoid schizophrenia (41.9%) and schizoaffective disorder (29%). The combination of haloperidol and chlorpromazine was the most common medications for initial treatment (67.8%) and maintenance treatment (41.9%). The average cost of hospitalization at HPB for schizophrenia was XOF 164,412 (€249.90). The average direct medical cost was XOF 105,412 (€160.226) and the average direct non-medical cost was XOF 59,000 (€89.68). The average daily cost of antipsychotic treatment was XOF 795/day (€1.2084). The high cost of drugs as a proportion of hospitalization costs suggested the need of a reflection on the simplification of prescribing practices, assistance in psychiatric emergencies and the development of other alternatives to psychiatric hospitalization in Côte d’Ivoire.

Racial and gender-based disparities and trends in common psychiatric conditions in liver cirrhosis hospitalizations:A ten-year United States study

BACKGROUND Chronic liver disease is associated with various neuropsychiatric conditions.There are currently no large studies assessing and comparing the prevalence of psy-chiatric illnesses based on patient profiles and the etiology of cirrhosis.AIM To examine the trends of hospitalizations among psychiatric conditions in cirrhosis.METHODS We used the National Inpatient Sample database 2016-2019 for the primary diagnosis of liver cirrhosis.The outcomes included the prevalence,trends,and associations of psychiatric diagnoses in these hospitalizations.Chi-square for categorical variables and the Wilcoxon rank test for continuous variables were utilized.RESULTS The prevalence of generalized anxiety disorder(GAD)in liver cirrhosis hospitalizations increased from 0.17%in 2009 to 0.92%in 2019(P<0.001).The prevalence of depression increased from 7%in 2009 to 12%in 2019(P<0.001).Attention deficit hyperactivity disorder(ADHD)prevalence increased from 0.06%to 0.24%.The prevalence of schizophrenia increased from 0.59%to 0.87%(P<0.001).Schizoaffective disorder prevalence increased from 0.10%to 0.35%(P<0.001).Posttraumatic stress disorder(PTSD)prevalence displayed increasing trends from 0.36%in 2009 to 0.93%in 2019(P<0.001).The prevalence of suicidal ideation increased from 0.23%to 0.56%in 2019.Cirrhosis related to alcoholic liver disease[adjusted odds ratios(aOR)1.18,95%CI 1.08-1.29,P<0.001]and non-alcoholic fatty liver disease(NAFLD)(aOR 1.14,95%CI 1.01-1.28,P=0.025)was associated with depression more than other causes.Alcohol-and NAFLD-associated cirrhosis had a stronger link to psychiatric disorders.Females had a higher association with GAD(aOR 2.56,95%CI 2.14-3.06,P<0.001),depression(aOR 1.78,95%CI 1.71-1.84,P<0.001),bipolar disorder(aOR 1.64,95%CI 1.52-1.77,P<0.001]and chronic fatigue(aOR 2.31,95%CI 1.31-4.07,P<0.001)when compared to males.Blacks,Hispanics,and Asian/Native Americans had a significantly lower association with GAD,depression,bipolar disorder,PTSD,and ADHD when compared to the white race.CONCLUSION The prevalence of psychiatric comorbidities in liver cirrhosis hospitalizations has increased over the last decade.Females had a higher association with psychiatric disorders compared to males.Blacks,Hispanics,and Asian/Native Americans had lower associations with psychiatric comorbidities compared to the white race.

Comparative study of self-compassion and sense of coherence in nurses of psychiatric hospitals

Objective:Nurses,due to the nature of their job,are subjected to various forms of stress and physical and psychological injuries.Self-compassion and a sense of coherence have attracted much attention in research in recent years as having high potential for improving the health and performance of people in the workplace.The present study aimed to compare self-compassion and the sense of coherence in nurses working in psychiatric hospitals and other hospitals of Kerman University of Medical Sciences.Methods:The present study was a descriptive-comparative study of applied type conducted on 100 nurses of Shahid Beheshti Psychiatric Hospital in Kerman by the census method and 100 nurses of other hospitals of Kerman University of Medical Sciences by the stratified random sampling method.The instruments included the self-compassion questionnaire and the sense of coherence questionnaire.Data were analyzed using the Statistical Package for Social Sciences software.Results:The results of the present study showed that self-compassion and sense of coherence were higher in psychiatric nurses(39.35±7.7 and 53.02±8.01)than among other nurses(36.03±5.81 and 49.76±6.30).There was a direct and moderate relationship between a sense of coherence and self-compassion(P-value<0.005).The higher the score of compassion for oneself,the higher was the score of sense of coherence.Furthermore,the sense of coherence had a direct and weak relationship with all dimensions of self-compassion,except for the extreme imitation dimension,which showed a direct and moderate relationship to other dimensions(P-value<0.001).Conclusions:Self-compassion and a sense of coherence,as a form of self-communication,increase nurses’satisfaction and reduce nurses’job stress and,as a result,job performance is improved.

Criteria for Determining the Need for Admission of People with Dementia to Dementia Nursing Wards of Psychiatric Hospitals in Japan

Purpose: This study aims to establish criteria to determine the need for admission of people with dementia to dementia nursing wards of psychiatric hospitals—based on the experience of nurses working in dementia nursing wards. Methods: Semi-structured interviews were conducted with nurses who had worked in dementia nursing wards of psychiatric hospitals for more than 3 years, to collect data related to the “condition at the time of admission and the process of hospitalization of dementia patients”. Data were analyzed using the content analysis approach. Focusing on “What is the condition of patients with dementia admitted to the dementia nursing ward?”, we created codes according to similarities in the meaning, and classified these into categories where they were evaluated to fully fit in. Results and Discussion: The analysis yielded 4 categories, and 44 codes. The four categories are as follows: [Appearance of a state where self-control is difficult] which expresses a state where behavioral and psychological symptoms of dementia (BPSD) have appeared, and the remaining three categories [Insufficient support provided], [Appearance of symptoms that make living difficult], and [Appearance of physical symptoms that require treatment] express the states that may trigger the appearance of BPSD. These show that the appearance of BPSD is a criterion for determining hospitalization. By providing support to prevent the states described in the 44 codes, nurses may help people with dementia avoid being hospitalized in dementia nursing wards in psychiatric hospitals.

Psychiatric Day Hospital and Its Impact on Patients Clinical Stability: The Reality of Faro (Portugal) Unit

Psychiatric Day Hospitals are alternatives to classic hospitalization, staying in an intermediate position between full-time hospitalization and outpatient treatment. The main purpose of this work was to investigate the impact of the therapeutic program developed in a Psychiatric Day Hospital (of Faro-Portugal) on the clinical stability of the patients. It is a descriptive-correlational retrospective study, implemented through the consultation of the SCLINIC computer platform regarding the years 2015, 2016 and 2017. The records of 127 users were analysed. There was a predominance of mood disorders (n = 55;43.3%), followed by schizophrenia, schizotypal and delusional disorders (n = 43, 33.9%). The majority of patients had a structured occupational plan after discharge (n = 106, 83.46%). In the year following the frequency of Day Hospital, compared to the year prior to admission, there was a reduction in the number of full-time hospitalizations, outpatient visitations/consultations, prescribed drugs and emergency episodes, with statistically significant differences. The positive impact of the frequency of Day Hospital had on patients’ clinical stability was the improvement in all studied variables. The Psychiatric Day Hospital of Faro-Portugal contributes to decreasing the number of full time hospitalizations, outpatient visitations/consultations and emergency episodes, maintaining patients’ clinical stability and reducing the public financial costs related to their therapeutic intervention.

Prevalence of Medication Non-Adherence among Psychiatric Patients in a Tertiary Hospital in Nigeria

Background: The consequences of non-adherence to prescribed medications by psychiatric patients for both patients and the health care system are myriad and grave. Aim: The study was designed to ascertain the prevalence of medication non-adherence among psychiatric patients and identify factors that aid this malady. Methods: This prospective, cross-sectional study was carried out within a 4 month period at the out-patient psychiatric clinic of the University of Port Harcourt Teaching Hospital;using the Medication Adherence Rating Scale (MARS) and a self designed questionnaire containing socio-demographic and psychiatric illness variables. Results: A total number of 111 patients who participated in the study were analyzed. The cohort comprises 22 (19.8%) schizophrenics, 38 (34.2%) mood disorder patients, 24 (21.6%) anxiety disorder patients, 10 (9.0%) patients suffering from substance abuse and 17 (15.3%) with other psychiatric diagnoses (somatoform and personality disorders). Most of the patients were male (53;47.7%), aged between 21 - 30 yrs (44;39.6%), unemployed (38;34.2%), as single (58;52.3%). The prevalence of non-adherence to medications among the cohort studied is 39.6%. There was a significant association between consistency in taking one’s medications and MARS scores but none between socio-demographic variables and MARS score. Conclusion: The rate of medication non adherence among the subjects in this study was 39.6%. The three most important reasons reported for this behaviour include: Feeling that they had recovered from their illness and hence have been cured, belief that their illness was of a spiritual origin and hence would not be amenable to orthodox medicine and the side effects of the medications. Non adherence to medication increases the risk of psychiatric morbidity and mortality and efforts at curbing this trend must be eclectic.

The Views of Family Members about Nursing Care of Psychiatric Patients Admitted at a Mental Hospital in Malawi

Family members of a mentally ill person play a crucial role in the recovery of their sick relative. They care for their sick relatives at home and in hospital. Some views of family members indicate that they get satisfaction from participating in nursing care of their sick relative. The aim of this study was to describe the views of family members about nursing care of psychiatric patients admitted at a mental hospital in Malawi. A qualitative study design was used and data were collected from ten participants through in-depth interviews. Ethical approval was granted by relevant authorities. Data were analysed using Colaizzi method. The findings fell into the following four themes that emerged: family participation in nursing care;nurses’ skills and experience in caring;respect for psychiatric patients and interactions and information sharing. This study offers valuable information about the views of families regarding nursing care of psychiatric patients. They are involved in the care of their sick relatives although there is lack of effective cooperation between them and nurses. The lack of collaboration made families receive inadequate information about their sick relative. Therefore, it is imperative that nurses are competent in implementing family involvement in nursing care.

Relationship between Level of Knowledge on Anger Control and Occurrence of Real Assaultive Behaviour in Patients (20 - 45 Years) Admitted at a National Referral Psychiatric Hospital in Zimbabwe

Background: Aggressive tendencies from psychiatric inpatients are increasingly becoming problematic at a national referral psychiatric hospital in Zimbabwe. No research has been done in this context to determine the dynamics around this disturbing phenomenon. Objectives: To determine the level of knowledge on anger control, to determine the occurrence of real assaultive behaviour and to examine the relationship between level of knowledge on anger control and occurrence of real assaultive behaviour in patients aged 20 - 45 years admitted at a national referral psychiatric hospital in Zimbabwe. Method: A descriptive correlational design was used. Seventy-six respondents aged between 20 and 45 years were selected using simple random sampling. A structured interview was used to collect data. The occurrence of real assaultive behaviour was adapted from the Staff Observation and Aggression Scale completed by observing patients during the assaultive behaviour occurrence. Patient observation was done by the psychiatric trained nurses who were specifically trained for this study to fill the part of the data collection instrument that needed observation. Data were analysed using descriptive statistics, Pearson Correlation Coefficient test and simple regression analysis. Results: Results showed a Pearson coefficient test of (r = -3.47, p Conclusions: Results call for collaboration of mental health practitioners to empower patients with anger control skills.

Factors Contributing to Parasuicide among Patients Aged 18 - 35 Admitted at a National Psychiatric Hospital, Zimbabwe

The purpose of the study was to determine factors contributing to parasuicide among patients aged 18 - 35 admitted at the national referral psychiatric hospital in Zimbabwe. A purposive sample of 32 respondents was selected for the study. Data were collected using a structured interview guide. All (100%) of parasuicide participants had mental illness and were experiencing severe financial difficulties. Early identification and response to these problems would have prevented morbidity associated with parasuicide.

Clarifying the Strengths-Oriented Attitude among Nurses in Psychiatric Hospitals in Japan

Japanese psychiatric mental health systems are being steadily improved. Psychiatric nurses’ attitude towards strengths of persons with mental disability is critical in order to promote de-institutionalization of patients. However, nurses’ attitudes, particularly their Strengths-Oriented Attitude (SOA) has not been well studied and explained. The purpose of this study was to clarify the SOA of nurses working in psychiatric hospitals in Japan. There were 1148 Psychiatric Registered Nurses (PRN) and Psychiatric Practical Nurses (PPN) employed at 17 psychiatric hospitals in Japan who consented to participate in the study. The self-administered questionnaire was mailed and returned between October 2013 and January 2014. The subjects’ SOA was evaluated using the Strengths-Oriented Attitude Inventory (SOAI) developed by the authors based on the work by Rapp and Goscha. The actual SOA and its relationship to individual characteristics were also analyzed to clarify the SOAI. Factor analysis revealed four components of the SOAI: Factor 1 = “Nursing practice based on the assessment which focused on social resources”;Factor 2 = “Nursing practice based on the holistic assessment of person with mental disability”;Factor 3 = “Support in community which respected the person’s way of living”;and Factor 4 = “Emphasize of the strengths of individual with mental disability.” Results indicated a high orientation toward Factors 2 and 4, but a low orientation toward Factors 1 and 3. There were no significant differences between age, years of psychiatric nursing experience, academic background, and subjects’ SOA. However, differences were observed in gender, current workplace, work position, type of license, and work experience. The subjects showed low orientation toward social resources and respected the patient’s way of life. Nurses working in psychiatric mental health institutions should receive continuing education courses designed to increase their orientation toward Factors 1 and 3.

Patient Satisfaction with Psychiatric Services: A Survey at a Nigerian Federal Teaching Hospital

Background: Patient satisfaction, a measure of the extent to which a patient is content with the health care which he or she receives from his or her health care provider, is an effective means of evaluating the performance of a hospital leading to service improvement and attraction of more patients. In a country whose leadership currently calls for change of attitude of the citizenry, it is pertinent to assess how this change has been accepted in health institutions, especially among the most stigmatized group of patients, by assessing the latter’s level of satisfaction with the quality of services provided. Objectives: The study, carried out over a period of six months (1st May to 30th October, 2016), assessed the satisfaction of patients with the quality of care provided at the psychiatric outpatient department of the Federal Teaching Hospital, Abakaliki, Nigeria. Methods: Data were extracted from eligible participants using a sociodemographic/clinical profile questionnaire and the Charleston Psychiatric Outpatient Satisfaction Questionnaire. Results: 422 patients (53.6% males, 46.4% females) participated. Their mean age was 32.20 ± 11.35 years. Schizophrenia was the commonest diagnosis. The respondents appeared quite satisfied with the quality of services. Satisfaction with the helpfulness of the record officers was topmost in the administrative scale (92.9%) with satisfaction with the amount of time waited to be seen by doctor, the least (76.3%) while on the environmental scale, appearance of the doctor’s consulting room was most satisfying (93.4%) and cost of service the least (73.5%). 90.5% were satisfied with the overall quality of service provided and 94.8% indicated willingness to recommend the facility to others. Satisfaction was most affected by self-perceived mental and physical health. Conclusion: Patient satisfaction is a simple way to evaluate hospital services. Continual assessment of patient satisfaction is recommended to enable authorities improve on areas considered less satisfactory while sustaining service areas deemed highly satisfactory.

Anti-Epileptic Drug Prescription in a Psychiatric Hospital Outpatient Clinic in Southeast Nigeria

The optimum control of seizures requires adequate dosing of appropriately selected anti-epileptic medications. The availability of AEDs in Nigeria is limited and this constrains the prescription latitude of clinicians. This study was conducted to describe the prescribing pattern of anti-epileptic drugs in the outpatient service of a psychiatric facility in southeast Nigeria. The case records of the epileptic patients attending the outpatient clinic of a psychiatric hospital were retrieved, reviewed and data abstracted with a prepared proforma. The information extracted include age, sex, marital status, residence, type of seizure and anti-seizure medications prescribed, frequency of administration and dosage among other variables. Of the 178 patients whose prescriptions and case records were assessed, males constituted 62.9% and females 37.1%. Most of the patients were single (78.1%) and the group had a mean age of 25.6 ± 10.9 years. Generalized tonic-clonic seizures predominated (61.2%) among the seizure types, whilst complex partial seizure type was identified in 35.4% of the patients. Patient diagnosis relied heavily on the use of clinical description alone. About 92.7% of the patients were treated with monotherapy, whereas 7.3% received two anti-epileptic drug combinations. Carbamazepine was the most frequently prescribed drug, and was utilized in the treatment of 87.9% of patients receiving monotherapy and 92.3% of individuals receiving two drug combinations. Adjunctive medications like benzodiazepines were rarely utilised to improve the effect of the AEDs. The patients that received polytherapy could only be distinguished from those that received monotherapy by higher frequency of epileptic auras and higher mean dose of AEDs per day. The predominant use of monotherapy is in accordance with the treatment recommendations and needs to be encouraged. The greater use of carbamazepine is probably related to its perceived benefits in the control of behavioural symptoms.

Stigma and Non-Disclosure in Psychiatric Patients from a Southeast Asian Hospital

Objective: We compared stigma experienced by psychiatric patients and controls in various social domains and hypothesized higher levels of stigma and higher rates of non-disclosure by psychiatric patients. Methods: Psychiatric outpatients and a control group of medical outpatients were assessed for experienced discrimination through a structured questionnaire that included adapted items from the Discrimination and Stigma Scale (DISC-12). Controls were assessed on discrimination related to physical, rather than mental health issues. Statistical analyses were conducted with Pearson’s chi-squared tests and one-way Analyses of Variance (ANOVA). Results: In total, 202 patients comprising 99 psychiatric patients and 103 controls gave consent to the study. Psychiatric patients experienced higher levels of discrimination (F (1, 196) = 24.4, p F (1, 196) = 22.5, p Conclusion: Our study confirmed that psychiatric patients experienced considerable stigma and coped by non-disclosure of their condition.

Acute and delayed psychiatric sequelae among patients hospitalised with COVID-19:a cohort study using LIFE study data

Background Characterising the psychiatric sequelae of coronavirus disease 2019(COVID-19)can inform the development of long-term treatment strategies.However,few studies have examined these sequelae at different time points after COVID-19 infection.Aims The study aimed to investigate the incidences and risks of acute and delayed psychiatric sequelae in patients hospitalised with COVID-19 in Japan.Methods This retrospective cohort study was conducted using a database comprising healthcare claims data from public health insurance enrollees residing in a Japanese city.We analysed a primary cohort comprising patients hospitalised with COVID-19 between March 2020 and July 2021 and two control cohorts comprising patients hospitalised with influenza or other respiratory tract infections(RTI)during the same period.We calculated the incidences of acute(1–3 months after infection)and delayed(4–6 months after infection)psychiatric sequelae.These sequelae were identified using diagnosis codes and categorised as mood/anxiety/psychotic disorder,mood disorder,anxiety disorder,psychotic disorder or insomnia.Multivariable logistic regression models were used to estimate the odds ratios(ORs)of psychiatric sequelae occurrence after COVID-19 infection compared with influenza and other RTI.Results The study population with acute psychiatric sequela consisted of 662 patients with COVID-19,644 patients with influenza,and 7369 patients with RTI who could be followed for 3 months;the study population with delayed psychiatric sequelae consisted of 371 patients with COVID-19,546 patients with influenza,and 5397 patients with RTI who could be followed for 6 months.In the analysis of acute psychiatric sequelae,COVID-19 had significantly higher odds of mood/anxiety/psychotic disorder(OR:1.39,p=0.026),psychotic disorder(OR:2.13,p<0.001),and insomnia(OR:2.59,p<0.001)than influenza,and significantly higher odds of insomnia(OR:1.44,p=0.002)and significantly lower odds of anxiety disorder(OR:0.56,p<0.001)than other RTI.In the analysis of delayed psychiatric sequelae,COVID-19 had significantly higher odds of psychotic disorder(OR:2.25,p=0.007)than influenza,but significantly lower odds of anxiety disorder(OR:0.55,p=0.011)than other RTI.Conclusions COVID-19 was generally associated with an increased risk of psychiatric sequelae occurring within 3 months after infection,but had a lower risk of new psychiatric sequelae developing 4–6 months after infection.

Nurses Perception towards Determinants of Turnover in Psychiatric and General Hospital, Makkah Province

Background: Nurses leaving the profession are of concern to the government. This turnover can take the form of leakage and waste of both human and financial resources for governments that spend money on training nurses. Little is known about the intention to stay or determinants of job satisfaction among nurses in the Makkah region of Saudi Arabia. Aims: The study explores the determinants of intention to stay, job satisfaction, organizational commitment and self-efficacy among nurses. Methods: A cross-sectional study was designed, with a total of 175 nurses in the period between March 2017-July 2017. Results: No statistically significant differences were identified in intention to stay, job satisfaction, organizational commitment and self-efficacy between the psychiatric and the general nurses. A significant correlation was found between nationality, education and income, and intention to stay, job satisfaction, organization commitment and self-efficacy (p Conclusions: The study added various determinants of nurse turnover to the existing body of knowledge, relating to the factors concerning intention to stay, job satisfaction, organizational commitment and self-efficacy amongst general and psychiatric nurses.

Advance Planning in the Context of a Psychiatric Acute Care Hospital:Acceptance of a Trialogical Pilot Project

A joint crisis plan is a written consensus-orientated agreement between mental health service users and professionals.The instrument is used to regulate a potential future hospital treatment.At the Clinics of Upper Bavaria(kbo-Kliniken des Bezirks Oberbayern)representatives of the clinics,the organized relatives and those affected developed the pilot project“Joint Crisis Plan”in a trialogical process.The pilot project was evaluated between 2015 and 2017.The qualitative study looked at the experiences with the implementation of the instrument medical treatment agreement in different local settings.In doing so it considered the complex effects of“advance directives”on various levels such as the subjective importance and meaning as experienced by the patients,the effects on face-to-face interactions between patients and the medical staff,and the effects on institutional structures.And it considered the local influence—such as medical cultures or economic and institutional conditions—on the implementation process and the use of this instrument.The results showed that patients need numerous competences to complete a joint crisis plan.Likewise the instrument affects self-efficacy and self-images of the patients and the relation between the patients and the clinical staff in a positive way.But if the joint crisis plan is insufficiently implemented,the instrument generates rather a mortification of the self.

Need for education of psychiatric evaluation of offenders with mental disorders:A questionnaire survey for Japanese designated psychiatrists

BACKGROUND The management of offenders with mental disorders has been a significant concern in forensic psychiatry.In Japan,the introduction of the Medical Treatment and Supervision Act in 2005 addressed the issue.However,numerous psychiatric patients at risk of violence still find themselves subject to the administrative involuntary hospitalization(AIH)scheme,which lacks clarity and updated standards.AIM To explore current as well as optimized learning strategies for risk assessment in AIH decision making.METHODS We conducted a questionnaire survey among designated psychiatrists to explore their experiences and expectations regarding training methods for psychiatric assessments of offenders with mental disorders.RESULTS The findings of this study’s survey suggest a prevalent reliance on traditional learning approaches such as oral education and on-the-job training.CONCLUSION This underscores the pressing need for structured training protocols in AIH consultations.Moreover,feedback derived from inpatient treatment experiences is identified as a crucial element for enhancing risk assessment skills.

The Peripheral Hospital as Focal Point for Pacemaker Activity: Review of the Last 300 Implantations Carried out at the Haute Correze Hospital Center

Background: Pacemaker implantation is a very old activity which has revolutionized the cardiology practice throughout the world. This activity is effective at the Haute Correze Hospital Center since more than 20 years. Due to progress in this area, and the increasing request within this center located at the outskirts of town, we set out to evaluate our pacemaker activity in general and more specifically to assess the post-procedural complications in our series patients. Methodology: This was a retrospective longitudinal study. Data were recorded for period of 90 months from 27/05/2016 to 19/11/2023. This data collection was possible via a specific register completed by computerized patient data from the SillageTM software. All files of patients implanted with single or dual chamber pacemakers were included, generator replacements, upgrading procedures and addition of leads were excluded. The sampling was non-probabilistic, consecutive and non-exhaustive. Statistical analysis was carried out using the Excel 2019 spreadsheet and SPSS version 23 software. The quantitative variables were presented as mean ± standard deviation, the qualitative data as proportions. Results: A total of 303 first-time pacemaker’s implantations were carried out during the study period (rate of 40 per year). The average age in the population was 79.7 ± 9.4 years (44 - 99 years) with a male predominance of 63.7% (n = 193). Atrioventricular block (2nd and 3rd degree) was the main indication for pacemaker implantation in 42.9% of cases (n = 130). Patients were most often implanted with a dual-chamber pacemaker (57.7%, n = 175). The approach was most often cephalic in 72.6% of cases (n = 220), followed by the subclavian access in 27.4% of cases (n = 84). The average fluoroscopy time was 7.9 min ± 2.4 (1 - 43). The average irradiation dose in gray/cm2 was 12.4 ± 9.3 (0.22 - 117.5). The average length of hospitalization was 7 ± 4 (2 - 26) days. The overall complication rate at one year was 12.9% (n = 39). These complications are distributed as follows: Leads dislodgement in 8.2% (n = 25), hematoma 3.6% (n = 11) all without clinical consequences, pneumothorax 0.7% (n = 2), both cases of pneumothorax did not require specific care, infection (superficial) in 0.3% (n = 1). Leads dislodgement occurred after a median time of 18 days (IQR: 3 - 36). The earliest dislodgement was observed on D0 and the latest on D207. No serious complications were recorded. The average atrial threshold at implantation/first control/last follow-up was 0.7/1.3/0.8 V, respectively. The average ventricular threshold at implantation/first control/last follow-up was 0.5/1.08/0.87 V, respectively. The average atrial detection at implantation/first control/last follow-up was 3.2/2.3/ 2.05 mv, respectively. The average ventricular detection at implantation/first control/last follow-up was 10.3/11.03/10.8 mv. The average atrial impedance at implantation/first control/last follow-up was 610/457/457 ohms. The average ventricular impedance at implantation/first control/last follow-up was 754/547/563 ohms. Conclusion: Pacemaker implantation is safe at the Haute Correze Hospital Center with a relatively low rate of complications, in this case an almost zero major infection and no serious hematoma. The peripheral hospital should remain a focal point of this activity in order to respond more quickly to the needs of the populations.

Lactate:a prospective target for therapeutic intervention in psychiatric disease

Although antipsychotics that act via monoaminergic neurotransmitter modulation have considera ble therapeutic effect,they cannot completely relieve clinical symptoms in patients suffering from psychiatric disorde rs.This may be attributed to the limited range of neurotransmitters that are regulated by psychotropic drugs.Recent findings indicate the need for investigation of psychotropic medications that target less-studied neurotransmitte rs.Among these candidate neurotransmitters,lactate is developing from being a waste metabolite to a glial-neuronal signaling molecule in recent years.Previous studies have suggested that cerebral lactate levels change considerably in numerous psychiatric illnesses;animal experiments have also shown that the supply of exogenous la ctate exerts an antidepressant effect.In this review,we have described how medications targeting newer neurotransmitte rs offer promise in psychiatric diseases;we have also summarized the advances in the use of lactate(and its corresponding signaling pathways)as a signaling molecule.In addition,we have described the alterations in brain lactate levels in depression,anxiety,bipolar disorder,and schizophrenia and have indicated the challenges that need to be overcome before brain lactate can be used as a therapeutic target in psychopharmacology.