Classification of musical hallucinations and the characters along with neural-molecular mechanisms of musical hallucinations associated with psychiatric disorders

BACKGROUND Musical hallucinations(MH)involve the false perception of music in the absence of external stimuli which links with different etiologies.The pathomechanisms of MH encompass various conditions.The etiological classification of MH is of particular importance and offers valuable insights to understand MH,and further to develop the effective treatment of MH.Over the recent decades,more MH cases have been reported,revealing newly identified medical and psychiatric causes of MH.Functional imaging studies reveal that MH activates a wide array of brain regions.An up-to-date analysis on MH,especially on MH comorbid psychiatric conditions is warranted.AIM To propose a new classification of MH;to study the age and gender differences of MH in mental disorders;and neuropathology of MH.METHODS Literatures searches were conducted using keywords such as“music hallucination,”“music hallucination and mental illness,”“music hallucination and gender difference,”and“music hallucination and psychiatric disease”in the databases of PubMed,Google Scholar,and Web of Science.MH cases were collected and categorized based on their etiologies.The t-test and ANOVA were employed(P<0.05)to compare the age differences of MH different etiological groups.Function neuroimaging studies of neural networks regulating MH and their possible molecular mechanisms were discussed.RESULTS Among the 357 yielded publications,294 MH cases were collected.The average age of MH cases was 67.9 years,with a predominance of females(66.8%females vs 33.2%males).MH was classified into eight groups based on their etiological mechanisms.Statistical analysis of MH cases indicates varying associations with psychiatric diagnoses.CONCLUSION We carried out a more comprehensive review of MH studies.For the first time according to our knowledge,we demonstrated the psychiatric conditions linked and/or associated with MH from statistical,biological and molecular point of view.

Cerebrotendinous xanthomatosis presenting with schizophrenia-like disorder:A case report

BACKGROUND Cerebrotendinous xanthomatosis(CTX)is a rare autosomal recessive lipid-storage disorder caused by mutations in CYP27A1.Psychiatric manifestations in CTX are rare and nonspecific,and they often lead to considerable diagnostic and treatment delay.CASE SUMMARY A 33-year-old female patient admitted to the psychiatric ward for presentation of delusions,hallucinations,and behavioral disturbance is reported.The patient presented with cholestasis,cataract,Achilles tendon xanthoma,and cerebellar signs in adulthood and with intellectual disability and learning difficulties in childhood.After the characteristic CTX findings on imaging were obtained,a pathological examination of the Achilles tendon xanthoma was refined.Replacement therapy was then initiated after the diagnosis was clarified by genetic analysis.During hospitalization in the psychiatric ward,the nonspecific psychiatric manifestations of the patient posed difficulty in diagnosis.After the patient’s history of CTX was identified,the patient was diagnosed with organic schizophrenia-like disorder,and psychotic symptoms were controlled by replacement therapy combined with antipsychotic medication.CONCLUSION Psychiatrists should be aware of CTX,its psychiatric manifestations,and clinical features and avoid misdiagnosis of CTX for timely intervention.

The Relationship between Exercise and Psychotic Symptoms in College Students: A Cross-Sectional Analysis

An increasing number of studies have suggested that increased physical activity is associated with less mental illness.However,the relationship between exercise and psychotic experiences(PEs)is still unknown.The purpose of this study was to explore the relationship between exercise and PEs in college students in the United States.Data from the Health Mind Survey(2020–2021 round)were analyzed.Respondents included 137,916 college students who were asked about exercise and PEs(lifetime psychotic experiences,delusions,and hallucinations).A multivariate logistic regression analysis was used to investigate the relationship between exercise and PEs while controlling for demographic characteristics.There was a significant correlation between exercise and PEs among college students.Compared to students who exercised less than one hour per week,students who exercisedfive or more hours per week had fewer lifetime psychotic experiences.This samefinding obtained for both male and female college students.Thefindings from the present study indicate that exercising forfive or more hours each week is most correlated with decreased PEs among college students.However,experimental studies are required to extend and confirm ourfindings and determine the causality of this relationship.

Selective serotonin reuptake inhibitors and risk reduction for cardiovascular disease in patients with schizophrenia: A controversial but promising approach

Patients with schizophrenia(SCZ)are at high risk of cardiovascular disease(CVD)due to an inherited predisposition,a sedentary life style and the use of antipsychotic medications.Several approaches have been taken to minimize this risk but results continue to be unsatisfactory.A potential alternative is prescribing selective serotonin reuptake inhibitors(SSRIs).SSRIs decrease platelet aggregation and reduce the risk of coronary heart disease in patients with depression.We therefore aim to investigate whether there is evidence that supports the use of SSRIs to reduce the risk for CVD in SCZ.A review of the literature revealed five published reports relating to the impact of SSRIs on CV risk in SCZ.Three trials assessed the influence on metabolic parameters of fluvoxamine when combined with clozapine.Two of those studies found improvements with fluvoxamine.Of the other two reports,one indicates SSRIs as a group caused minimal but statistically significant increments in total cholesterol,low-density lipoprotein and triglyceride.The second report suggests that when SSRIs are combined with antipsychotics,the metabolic impact depends on the antipsychotic prescribed.While there are promising results,no conclusions can be made currently on whether SSRIs increase or decrease CV risk in SCZ.Further studies are needed to resolve this matter.

Cognitive behavioural therapy for auditory hallucinations in schizophrenia:A review

AIM To provide an updated of recent findings about efficacy of cognitive-behavior therapy(CBT) in reduction of command hallucinations.METHODS Pub Med/MEDLINE,Cochrane Library,the Cumulative Index to Nursing and Allied Health Literature,PsycI NFO,Clinical Trial.gov searches were performed using the keywords "hallucinations","behavioural therapy" and " cognitive therapy" in order to identify relevant articles published during the years of 2011 to 2016.No language limits were used.Studies conducted within control group,reviews,editorials,were excluded.Data on efficacy,acceptability and tolerability were extracted by three authors independently.Disagreements were resolved in a consensus meeting or by another reviewer.RESULTS A total of eight articles were eligible for inclusion.Two are randomized clinical trials(RCTs) and six are observational studies.The two RCTs included showed a greater efficacy of CBT compared to standard care on auditory hallucinations(AHs).Nevertheless,they considered different CBT models,particularly Treatment of Resistant Command Hallucinations and Cognitive Therapy for Command Hallucinations.As regards non RCT-studies,all papers included showed reduction on frequency and severity of AHs and distress related to them.However,the lack of content details within non-RCTs studies decreased their comparability.In terms of predictive variables,our findings show that negative symptoms at baseline appeared to be the strongest predictor of the treatment efficacy.Indeed,negative symptoms showed a significant negative correlation on outcome.CONCLUSION Although more conclusive studies are still needed,we found some preliminary evidence for the efficacy of CBT in the treatment of command hallucinations.

Associative stigma in family members of psychotic patients in Flanders:An exploratory study

AIM: To assess presence and severity of associative stigma in family members of psychotic patients and factors for higher associative stigma.METHODS: Standardized semi-structured interview of 150 family members of psychotic patients receiving full time treatment. This study on associative stigma in family members of psychotic patients was part of a larger research program on the burden of the family, using "Interview for the Burden of the Family" and the chapters stigma, treatment and attribution from the "Family interview Schedule". The respondents were relatives, one per patient, either partner or parent. The patients had been diagnosed with schizophrenia or schizo-affective disorder. All contacts with patients and relatives were in Dutch. Relatives were deemed suitable to participate in this research if they saw the patient at least once a week. Recruitment took place in a standardized way: after obtaining the patient's consent, the relatives were approached to participate. The results were analyzed using SPSS Version 18.0. RESULTS: The prevalence of associative stigma in this sample is 86%. Feelings of depression in the majority of family members are prominent. Twenty-one point three percent experienced guilt more or less frequent, while shame was less pronounced. Also, 18.6% of allrespondents indicated that they tried to hide the illness of their family member for others regularly or more. Three six point seven percent really kept secret about it in certain circumstances and 29.3% made efforts to explain what the situation or psychiatric condition of their family member really is like. Factors with marked significance towards higher associative stigma are a worsened relationship between the patient and the family member, conduct problems to family members, the patients' residence in a residential care setting, and hereditary attributional factors like genetic hereditability and character. The level of associative stigma has significantly been predicted by the burden of aggressive disruptions to family housemates of the psychotic patient.CONCLUSION: Family members of psychotic patients in Flanders experience higher associative stigma compared to previous international research. Disruptive behavior by the patient towards in-housing family members is the most accurate predictor of higher associative stigma.

Machine Learning Based Psychotic Behaviors Prediction from Facebook Status Updates

With the advent of technological advancements and the widespread Internet connectivity during the last couple of decades,social media platforms(such as Facebook,Twitter,and Instagram)have consumed a large proportion of time in our daily lives.People tend to stay alive on their social media with recent updates,as it has become the primary source of interactionwithin social circles.Although social media platforms offer several remarkable features but are simultaneously prone to various critical vulnerabilities.Recent studies have revealed a strong correlation between the usage of social media and associated mental health issues consequently leading to depression,anxiety,suicide commitment,and mental disorder,particularly in the young adults who have excessively spent time on socialmedia which necessitates a thorough psychological analysis of all these platforms.This study aims to exploit machine learning techniques for the classification of psychotic issues based on Facebook status updates.In this paper,we start with depression detection in the first instance and then expand on analyzing six other psychotic issues(e.g.,depression,anxiety,psychopathic deviate,hypochondria,unrealistic,and hypomania)commonly found in adults due to extreme use of social media networks.To classify the psychotic issues with the user’s mental state,we have employed different Machine Learning(ML)classifiers i.e.,Random Forest(RF),Support Vector Machine(SVM),Naïve Bayes(NB),and K-Nearest Neighbor(KNN).The used ML models are trained and tested by using different combinations of features selection techniques.To observe themost suitable classifiers for psychotic issue classification,a cost-benefit function(sometimes termed as‘Suitability’)has been used which combines the accuracy of the model with its execution time.The experimental evidence argues that RF outperforms its competitor classifiers with the unigram feature set.

Effects of age and sex on clinical high-risk for psychosis in the community

BACKGROUND Recent reports of both heightened prevalence rates and limited clinical relevance of clinical high-risk(CHR)criteria and their relevant symptoms in children and adolescents indicate an important role of neurodevelopment in the early detection of psychoses.Furthermore,sex effects in CHR symptoms have been reported,though studies were inconclusive.As sex also impacts on neurodevelopment,we expected that sex might have an additional contribution to age in the prevalence and clinical relevance of CHR symptoms and criteria.AIM To investigate age and sex effects on CHR criteria and symptoms and their association with psychosocial impairment and mental disorder.METHODS In this cross-sectional cohort study,n=29168-to 40-year-olds,randomly drawn from the population register of the Swiss canton Bern,were assessed in semistructured interviews by phone or face-to-face for CHR symptoms and criteria using the Structured Interview for Psychosis-Risk Syndromes and the Schizophrenia Proneness Instrument in its child and youth,and adult version,respectively.Furthermore,social and occupational functioning and DSM-IV axis I disorders were assessed.Simple and interaction effects of age and sex on CHR symptoms and criteria,and interaction effects of age,sex,and CHR symptoms and criteria on presentation of functional impairment and of non-psychotic disorder were investigated using logistic regression analyses.RESULTS Altogether,542(18.6%)participants reported any CHR symptom;of these,261(9.0%)participants reported any one of the 11 criteria relevant cognitive and perceptual basic symptoms,and 381(13.1%)any one of the five attenuated or transient psychotic symptoms(attenuated psychotic symptoms/brief intermittent psychotic symptoms).Fewer participants met any one of the CHR criteria(n=82,2.8%)or any one of the three recently recommended CHR criteria(n=38,1.3%).Both age and sex were significantly(P<0.05)associated with CHR symptoms and criteria,mostly by younger age and female sex.Though slightly differing between symptom groups,age thresholds were detected around the turn from adolescence to adulthood;they were highest for cognitive basic symptoms and CHR criteria.With the exception of the infrequent speech disorganization attenuated psychotic symptom,the interaction of age with CHR symptoms and criteria predicted functional impairment;whereas,independent of each other,sex and CHR symptoms mostly predicted mental disorders.CONCLUSION Age and sex differentially impact on CHR symptoms and criteria;these differences may support better understanding of causal pathways.Thus,future CHR studies should consider effects of sex and age.

Pimavanserin for the treatment of psychosis in Alzheimer’s disease: A literature review

BACKGROUND Alzheimer’s disease(AD)is among the most prevalent forms of dementia in the world and neuropathological studies suggest similar high prevalence of mixed(AD+vascular)dementias.Approximately 25%-50%of individuals with AD develop psychosis sometime during their illness.The presence of psychosis in AD worsens outcomes.Currently there are no United States Food and Drug Administration(FDA)approved medications for the treatment of psychosis in AD.Pimavanserin,a novel atypical antipsychotic medication,was approved by the FDA for the treatment of hallucinations and delusions associated with Parkinson disease psychosis and is currently in clinical trials for the treatment of psychosis in AD.AIM To evaluate the existing literature regarding the use of pimavanserin for treating psychosis among individuals with AD.METHODS A literature review of clinical studies of pimavanserin treatment for psychosis in individuals with AD was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.Trials were identified by systematically searching PubMed,MEDLINE,EMBASE,Cochrane Central Register of Controlled Trials,Web of Science,and Scopus through October 2019.The 5-point Jadad scoring system was used to assess the methodologic quality of the randomized placebo-controlled trials.RESULTS A total of 499 citations were retrieved and pooled in EndNote and de-duplicated to 258 citations.This set was uploaded to Covidence for screening.Two separate screeners(Srinivasan S and Tampi RR)evaluated the titles,abstracts,and full text of eligible articles.Of the identified 258 abstracts,98 articles underwent full text review and 2 publications from 1 randomized controlled trial(RCT)were included in the final analysis.The quality of evidence was assessed to be of good methodologic quality,scoring 4 out of 5 using the 5-point Jadad questionnaire with the Jadad Scoring calculation.This systematic review found only one RCT that evaluated the use of pimavanserin for the treatment of psychosis among individuals with AD.This phase 2 trial resulted in two publications,the second of which was a subgroup analysis from the original study.The evidence from these two publications showed that pimavanserin improves psychotic symptoms among individuals with AD when compared to placebo at week 6.CONCLUSION Pimavanserin may be a pharmacologic consideration for the treatment for psychosis in AD.Additional RCTs are needed to assess the evidence of effectiveness before pimavanserin is considered a standard treatment.

Psychotic symptoms in bipolar disorder and their impact on the illness:A systematic review

BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder(BD)and can have an adverse effect on its course,outcome,and treatment.However,despite a considerable amount of research,the impact of psychotic symptoms on BD remains unclear,and there are very few systematic reviews on the subject.AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed.An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021.Combinations of the relevant Medical Subject Headings terms were used to search for these studies.Articles were selected after a screening phase,followed by a review of the full texts of the articles.Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.RESULTS This systematic review included 339 studies of patients with BD.Lifetime psychosis was found in more than a half to two-thirds of the patients,while current psychosis was found in a little less than half of them.Delusions were more common than hallucinations in all phases of BD.About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms,particularly during manic episodes.Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression.Although psychotic symptoms were not more severe in BD,the severity of the illness in psychotic BD was consistently greater.Psychosis was usually associated with poor insight and a higher frequency of agitation,anxiety,and hostility but not with psychiatric comorbidity.Psychosis was consistently linked with increased rates and the duration of hospitalizations,switching among patients with depression,and poorer outcomes with mood-incongruent symptoms.In contrast,psychosis was less likely to be accompanied by a rapid-cycling course,longer illness duration,and heightened suicidal risk.There was no significant impact of psychosis on the other parameters of course and outcome.CONCLUSION Though psychotic symptoms are very common in BD,they are not always associated with an adverse impact on BD and its course and outcome.

Investigation of attitudes toward mental illness among nursing students in Indonesia

Objective:People with mental illness(PMI)are often stigmatized or experience negative attitudes from society.In particular,nursing students'attitudes toward PMI will influence the quality of care these patients receive.Some factors influencing attitudes toward PMI among nursing students have been identified.The present study aimed to examine factors influencing attitudes toward mental illness among nursing students in Indonesia.Methods:Nursing students(n-317)were assessed for attitudes toward mental illness using the Community Attitude toward the Mentally Ill questionnaire.Details regarding sociodemographic variables(age,gender,ethnicity,year of study,monthly family income,personal experience with mental illness,family history of mental illness,and knowing or having direct contact with PMI)and knowledge about mental illness by using Mental Health Knowledge Schedule questionnaire were also obtained.Results:The mean Community Attitude toward the Mentally Ill questionnaire score was 103.75±9.15,with the highest mean of the four subscales being that of authoritarianism 27.97±2.87 followed by social restrictiveness,community mental health ideology,and benevolence 27.52±3.68,24.38±3.80,and 23.89±3.27,respectively.The factors significantly associated with nursing students'attitudes toward mental illness were age(r=-0.18,P=0.001),year of study(H=16.65,P<0.001),knowing or having direct contact with PMI(Z=-2.35,P=0.019),and knowledge of mental illness(r=-0.22,P<0.001).Conclusions:Several demographic variables,direct contact with PMI,and level of knowledge about mental illness can contribute to variations in attitudes toward PMI among nursing students in Indonesia.Education and direct contact with PMI serve as intervention strategies to reduce negative attitudes and stigma associated with mental illness among nursing students.

Where to seek help? Barriers to beginning treatment during the first-episode psychosis

Objective:As decreasing the duration of untreated psychosis has been highlighted as key indicator in relation to improved prognosis,this study aims to identify the access barriers to beginning early treatment of young people in first-episode psychosis(FEP),based on family reports on the experience of perceiving illness and help-seeking.Method:A qualitative research was carried out with 12 relatives of 12 young people passing through their first psychiatric hospital admission as a result of their FEP.Depth interviews were used for data collection and thematic content method for data analysis.Results:Barriers to beginning treatment were lack of knowledge and difficulty in recognizing mental illness,lack of knowledge on where to seek specialized treatment,and stigma and resistance to psychiatric treatment.Conclusion:It was demonstrated that the family members are protagonists in the search for treatment of young people in their FPE,given that the initiative for seeking treatment came from them.

Mifepristone modulates serotonin transporter function

Regulating serotonin expression can be used to treat psychotic depression. Mifepristone, a glu- cocorticoid receptor antagonist, is an effective candidate for psychotic depression treatment. However, the underlying mechanism related to serotonin transporter expression is poorly un- derstood. In this study, we cloned the human brain serotonin transporter into Xenopus oocytes, to establish an in vitro expression system. Two-electrode voltage clamp recordings were used to detect serotonin transporter activity. Our results show that mifepristone attenuates serotonin transporter activity by directly inhibiting the serotonin transporter, and suggests that the se- rotonin transporter is a pharmacological target of mifepristone for the treatment of psychotic depression.

CADASIL syndrome(cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)presenting as psychosis

Cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy(CADASIL) is the most common monogenic form of cerebral small-vessel disease characterised by recurrent strokes. Behavioural disturbance also presents in a significant proportion of subjects as neurotic spectrum disorders and psychotic features are rarely reported. In this case report, we highlight a 32-year-old man with CADASIL syndrome, who had overt psychotic symptoms with neurological signs later on.

Raising attention to attention deficit hyperactivity disorder in schizophrenia

Schizophrenia and attention deficit hyperactivity disorder(ADHD) are two psychiatric disorders with a negative impact on quality of life of individuals affected. Although they are classified into distinct disorders categories, attentional dysfunction is considered as a core feature in both conditions, either at the clinical then pathophysiological level. Beyond the obvious clinical overlap between these disorders, the Research DomainCriteria approach might offer an interesting perspective for disentangling common circuits underpinning both disorders. Hence, we review evidences regarding the overlap between schizophrenia and ADHD, at the clinical level, and at the level of underlying brain mechanisms. The evidence regarding the influence of environmental risk factors in the emergence of both disorders, and their developmental trajectories is also reviewed. Among these, we will try to elucidate the complex relationship between stimulants use and psychotic symptoms, discussing the potential role of ADHD medication in inducing psychosis or in exacerbating it. We aim that, taken together, these findings may promote further investigation with important implications both for clinicians and research. In fact, considering the amounting evidence on the overlap between schizophrenia and ADHD, the delineation of their boundaries might help in the decision for diagnosis and treatment. Moreover, it may help to promote interventions focused on the prevention of both schizophrenia and ADHD, by the reduction of recognized environmental risk factors.

Delusional parasitosis as premotor symptom of parkinson's disease:A case report

BACKGROUND Delusional parasitosis is characterized by a false belief of being infested with parasites,insects,or worms.This illness is observed in patients with Parkinson’s disease and is usually related to dopaminergic treatment.To our knowledge,no cases of delusional parasitosis have been reported as a premotor symptom or nonmotor symptom of Parkinson’s disease.CASE SUMMARY A 75-year-old woman presented with a complaint of itching that she ascribed to the presence of insects in her skin,and she had erythematous plaques on her trunk,arms,buttocks,and face.These symptoms started two months before the visit to the hospital.She took medication,including antipsychotics,with a diagnosis of delusional parasitosis,and the delusion improved after three months.A year later,antipsychotics were discontinued,and anxiety and depression were controlled with medication.However,she complained of bradykinesia,masked face,hand tremor,and mild rigidity,and we performed fluorinated N-3-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane positron emission tomography(PET),which showed mildly decreased DAT binding in the right anterior putamen and caudate nucleus.Parkinson’s disease was diagnosed on the basis of PET and clinical symptoms.CONCLUSION In conclusion,delusional parasitosis can be considered a non-motor sign of Parkinson’s disease along with depression,anxiety,and constipation.

Clinical high-risk criteria of psychosis in 8–17-year-old community subjects and inpatients not suspected of developing psychosis

BACKGROUND In children and adolescents compared to adults,clinical high-risk of psychosis(CHR)criteria and symptoms are more prevalent but less psychosis-predictive and less clinically relevant.Based on high rates of non-converters to psychosis,especially in children and adolescents,it was suggested that CHR criteria were:(1)Pluripotential;(2)A transdiagnostic risk factor;and(3)Simply a severity marker of mental disorders rather than specifically psychosis-predictive.If any of these three alternative explanatory models were true,their prevalence should differ between persons with and without mental disorders,and their severity should be associated with functional impairment as a measure of severity.AIM To compare the prevalence and severity of CHR criteria/symptoms in children and adolescents of the community and inpatients.METHODS In the mainly cross-sectional examinations,8–17-year-old community subjects(n=233)randomly chosen from the population register of the Swiss Canton Bern,and inpatients(n=306)with primary diagnosis of attention-deficit/hyperactivity disorder(n=86),eating disorder(n=97),anxiety including obsessive–compulsive disorder(n=94),or autism spectrum disorder(n=29),not clinically suspected to develop psychosis,were examined for CHR symptoms/criteria.Positive items of the Structured Interview for Psychosis-Risk Syndromes(SIPS)were used to assess the symptomatic ultra-high-risk criteria,and the Schizophrenia Proneness Instrument,Child and Youth version(SPI-CY)was used to assess the 14 basic symptoms relevant to basic symptom criteria.We examined group differences in frequency and severity of CHR symptoms/criteria usingχ^(2) tests and nonparametric tests with Cramer’s V and Rosenthal’s r as effect sizes,and their association with functioning using correlation analyses.RESULTS The 7.3%prevalence rate of CHR criteria in community subjects did not differ significantly from the 9.5%rate in inpatients.Frequency and severity of CHR criteria never differed between the community and the four inpatient groups,while the frequency and severity of CHR symptoms differed only minimally.Group differences were found in only four CHR symptoms:suspiciousness/persecutory ideas of the SIPS[χ2(4)=9.425;P=0.051,Cramer’s V=0.132;and Z=-4.281,P<0.001;Rosenthal’s r=0.184],and thought pressure[χ^(2)(4)=11.019;P=0.026,Cramer’s V=0.143;and Z=-2.639,P=0.008;Rosenthal’s r=0.114],derealization[χ2(4)=32.380;P<0.001,Cramer’s V=0.245;and Z=-3.924,P<0.001;Rosenthal’s r=0.169]and visual perception disturbances[χ^(2)(4)=10.652;P=0.031,Cramer’s V=0.141;and Z=-2.822,P=0.005;Rosenthal’s r=0.122]of the SPI-CY.These were consistent with a transdiagnostic risk factor or dimension,i.e.,displayed higher frequency and severity in inpatients,in particular in those with eating,anxiety/obsessive–compulsive and autism spectrum disorders.Low functioning,however,was at most weakly related to the severity of CHR criteria/symptoms,with the highest correlation yielded for suspiciousness/persecutory ideas(Kendall’s tau=-0.172,P<0.001).CONCLUSION The lack of systematic differences between inpatients and community subjects does not support suggestions that CHR criteria/symptoms are pluripotential or transdiagnostic syndromes,or merely markers of symptom severity.

Rehabilitative Outcomes after Hip Fracture in a Special Care Unit for Persons with Dementia and Behavioral and Psychotic Symptoms

Aim: Hip fracture implies severe problems to older people;special concerns regard persons with dementia, due either to cognitive impairment, or to behavioral and psychic symptoms. This study illustrates rehabilitative outcomes of these patients discharged by a special care unit ruled by “GentleCare” principles. Method: 54 patients [89% females, aged 82.3 years (range 66 - 94)] followed a post-surgery rehabilitative program carried out by a physiotherapist and an occupational therapist, supported by a psychologist. The multidimensional assessment consisted of cognition evaluation (Mini Mental State Examination, Clinical Dementia Rating, Global Deterioration Scale), functional evaluation (Barthel Index, Tinetti Gait and Balance, Bedford Alzheimer Nursing Severity scale), behavioral evaluation (UCLA Neuropsychiatric Inventory) and comorbidity evaluation (Cumulative Illness Rating Scale). Results: All parameters improved, including the 5 most frequent behavioral and psychic symptoms that usually preclude admission in ordinary rehabilitation units. 24% of improvement in Barthel Index total score was explained by agitation and apathy at discharge, in a multiple linear regression model: better functional levels corresponded to smoother behavioral problems. Most patients improved;70.5% of them were discharged to home. Conclusion: A prosthetic approach enables valuable results in the rehabilitation of severely demented patients with hip fracture also in presence of behavioral symptoms.

Epidemiological Approach to the Use of Psychotropic Medications at Moulay El Hassan Hospital, in the Gharb Region of Morocco

The use of psychotropic drugs is important in Morocco related to the large amount of sufferers by psychiatric disorders, according to a survey of the Moroccan Ministry of Health (2010). A prevalence of 26.5% of depressive disorders, and 9% for generalized anxiety disorder, and 5.6% of psychotic disorders was recorded within population, hence the importance to describe the use and assess the prevalence of psychotropic and socio-economic factors was associated with their use. Our research is a retrospective study, carried out between February 2010-December 2013, holding a sample of 5618 patients aged between 1 and 90 years old. The study is concerned with drawing social and clinical data from patients’ records. The different classes of psychotropic drugs prescribed to patients in the psychiatric department Moulay El Hassan Hospital, vary between antidepressants (36%), antipsychotics (32%), anxiolytics (10%), anti-epileptics (9%), the class of diverse “sulpiride” (7%), anti-parkinsonian (6%), and hypnotics were prescribed in rare cases. The relationship between socio-economic factors and the take of a psychotropic treatment was very strong in Morocco. In contrast, the patients support showed by close families and the health care staff remain a challenge for Moroccan population.

Empowerment according to Persons with Severe Mental Illness: Development of the Netherlands Empowerment List and Its Psychometric Properties

Objectives. It is unclear whether and to what extent purportedly empowering practices in mental health care, like rehabilitation programs, recovery-supporting mental health care environments and peer-run services, contribute to the process of empowerment. Several American empowerment questionnaires have been developed in recent years, facilitating the measurement of empowerment outcomes. Given likely major transatlantic cultural differences in a value-sensitive concept such as empowerment, this article describes the development of the Netherlands Empowerment List (NEL) and its psychometric properties. Methods. Patients in Dutch mental health services provided meaning to the empowerment concept from which the NEL was derived. Based on 531 completed questionnaires, analyses in agreement with COSMIN criteria examined aspects of internal consistency, content validity, structural validity, convergent validity, discriminant validity, reproducibility and responsiveness of the NEL. Results. The NEL is a 40-item self-report questionnaire with six subscales: Social support, Professional help, Connectedness, Confidence and purpose, Self-management and Caring community. Internal consistency (Cronbach’s alpha = 0.94), aspects of validity, reproducibility (intraclass correlation = 0.79) and responsiveness were good. Correlation with existing scales was the highest for the Mental Health Confidence Scale (r = 0.78) and the lowest for the Boston Empowerment Scale (r = 0.61). Conclusion. The NEL appears to be a suitable instrument to capture the dimension of empowerment in European mental health settings.