Comparative analysis of anticholinergic burden scales to explain iatrogenic cognitive impairment and self-reported side effects in the euthymic phase of bipolar disorders: Results from the FACE-BD cohort

Bipolar disorders (BD) are characterized by cognitive impairment during the euthymic phase, to which treatments can contribute. The anticholinergic properties of medications, i.e., the ability of a treatment to inhibit cholinergic receptors, are associated with cognitive impairment in elderly patients and people with schizophrenia but this association has not been well characterized in individuals with remitted BD. Moreover, the validity of only one anticholinergic burden scale designed to assess the anticholinergic load of medications has been tested in BD. In a literature review, we identified 31 existing scales. We first measured the associations between 27 out of the 31 scales and objective cognitive impairment in bivariable regressions. We then adjusted the bivariable models with covariates: the scales significantly associated with cognitive impairment in bivariable and multiple logistic regressions were defined as having good concurrent validity to assess cognitive impairment. In a sample of 2,031 individuals with euthymic BD evaluated with a neuropsychological battery, two scales had good concurrent validity to assess cognitive impairment, whereas chlorpromazine equivalents, lorazepam equivalents, the number of antipsychotics, or the number of treatments had not. Finally, similar analyses with subjective anticholinergic side-effects as outcome variables reported 14 scales with good concurrent validity to assess self-reported peripheral anticholinergic side-effects and 13 to assess self-reported central anticholinergic side-effects. Thus, we identified valid scales to monitor the anticholinergic burden in BD, which may be useful in estimating iatrogenic cognitive impairment in studies investigating cognition in BD.

Longterm course of neuropsychological symptoms and ME/CFS after SARS-CoV-2-infection: a prospective registry study

A significant proportion of patients after SARS-CoV-2 infection suffer from long-lasting symptoms. Although many different symptoms are described, the majority of patients complains about neuropsychological symptoms. Additionally, a subgroup of patients fulfills diagnostic criteria for ME/CFS. We analyzed a registry of all patients presenting in the out-patients clinic at a German university center. For patients with more than one visit, changes in reported symptoms from first to second visit were analyzed. A total of 1022 patients were included in the study, 411 of them had more than one visit. 95.5% of the patients reported a polysymptomatic disease. At the first visit 31.3% of the patients fulfilled ME/CFS criteria after a median time of 255 days post infection and and at the second visit after a median of 402 days, 19.4% still suffered from ME/CFS. Self-reported fatigue (83.7-72.7%) and concentration impairment (66.2-57.9%) decreased from first to second visit contrasting non-significant changes in the structured screening. A significant proportion of SARS-CoV-2 survivors presenting with ongoing symptoms present with ME/CFS. Although the proportion of subjective reported symptoms and their severity reduce over time, a significant proportion of patients suffer from long-lasting symptoms necessitating new therapeutic concepts.

Perspectives on weak interactions in complex materials at different length scales

Nanocomposite materials consist of nanometer-sized quantum objects such as atoms, molecules, voids or nanoparticles embedded in a host material. These quantum objects can be exploited as a super-structure, which can be designed to create material properties targeted for specific applications. For electromagnetism, such targeted properties include field enhancements around the bandgap of a semiconductor used for solar cells, directional decay in topological insulators, high kinetic inductance in superconducting circuits, and many more. Despite very different application areas, all of these properties are united by the common aim of exploiting collective interaction effects between quantum objects. The literature on the topic spreads over very many different disciplines and scientific communities. In this review, we present a cross-disciplinary overview of different approaches for the creation, analysis and theoretical description of nanocomposites with applications related to electromagnetic properties.

Physicians' and medical students' beliefs and attitudes toward psychotic disorders: A systematic review

OBJECTIVE

The aim of this study was to analyze physicians' and medical students' (MS) beliefs and attitudes toward people with psychotic disorders.

METHODS

This systematic review follows the PRISMA guidelines. It was conducted on 5 databases (Pubmed, PsycINFO, Pascal & Francis, Scopus and EMBASE) with a keyword string combining words for physicians' and students' professional status, attitudes toward people, and psychotic disorders. No limitations on publication dates were imposed.

RESULTS

This review includes 39 articles, among which quantitative studies are in the majority, and general practioners are mainly represented. Schizophrenia is the main condition used to illustrate psychotic disorders and measure stigmatizing attitudes. Physicians' and MS' beliefs toward people with psychotic disorders are mainly represented by dangerousness and unpredictability. They can be reinforced with socio-demographic criteria (age and female gender) or physicians' beliefs about the disease's etiology. The desire for social distance is higher toward patients with schizophrenia compared to other psychiatric disorders, and medical care could be impacted with a tendency to refer them at psychiatric specific care or to anticipate their difficulties and to modify their treatment plan. Stigma scores remain globally high during medical training. Even if specific anti-stigma trainings have a positive impact on beliefs and attitudes, these effects do not last in time.

CONCLUSION

This review highlights the importance to explore physicians' and medical students' representations about patient with psychosis to understand better their difficulties in the management of these patients.

Effects of the COVID-19 pandemic on suicide attempts in a rural region in Germany, a 5-year observational study

BACKGROUND

The COVID-19 pandemic and public life restrictions may have a negative impact on people's mental health. Therefore, we analyzed whether this condition affected the occurrence of suicide attempts (SA) over 20 months during the pandemic period.

METHODS

We included patient records according to DSM-5 criteria for suicidal behavior disorders (n = 825) between Jan 1, 2017, and Dec 31, 2021. We applied interrupted time-series Poisson regression models to investigate the effect of the pandemic on SA occurrence, time trends, and seasonal patterns in the whole group of patients as well as stratified by age and gender.

RESULTS

There was no significant effect of the pandemic on the occurrence of SA in the overall group. However, we observed a significant impact of the pandemic on the seasonal pattern of SA, also the variance differed significantly (pre-pandemic mean ± variance: 13.33 ± 15.75, pandemic: mean ± variance: 13.86 ± 7.26), indicating less periodic variation in SA during the pandemic. Male patients and young adults mainly contributed to this overall effect. Subgroup analysis revealed a significant difference in SA trends during the pandemic in older adults (>55 years) compared with younger adults (18-35 years); SA numbers increased in older adults and decreased in younger adults as the pandemic progressed.

LIMITATIONS

A few patients may have received initial care in an emergency department after SA without being referred to psychiatry.

CONCLUSIONS

In general, the COVID-19 pandemic and related measures did not significantly affect the occurrence of SA but did significantly affect the dynamics. In addition, the pandemic appeared to affect suicidal behavior differently across age groups as it progressed. Particularly for the older adult group, negative long-term effects of the pandemic on suicidal behavior can be derived from the present results, indicating the need to strengthen suicide prevention for the elderly.

Recommendations for diagnosing and managing individuals with glutaric aciduria type 1: Third revision

Glutaric aciduria type 1 is a rare inherited neurometabolic disorder of lysine metabolism caused by pathogenic gene variations in GCDH (cytogenic location: 19p13.13), resulting in deficiency of mitochondrial glutaryl-CoA dehydrogenase (GCDH) and, consequently, accumulation of glutaric acid, 3-hydroxyglutaric acid, glutaconic acid and glutarylcarnitine detectable by gas chromatography/mass spectrometry (organic acids) and tandem mass spectrometry (acylcarnitines). Depending on residual GCDH activity, biochemical high and low excreting phenotypes have been defined. Most untreated individuals present with acute onset of striatal damage before age 3 (to 6) years, precipitated by infectious diseases, fever or surgery, resulting in irreversible, mostly dystonic movement disorder with limited life expectancy. In some patients, striatal damage develops insidiously. In recent years, the clinical phenotype has been extended by the finding of extrastriatal abnormalities and cognitive dysfunction, preferably in the high excreter group, as well as chronic kidney failure. Newborn screening is the prerequisite for pre-symptomatic start of metabolic treatment with low lysine diet, carnitine supplementation and intensified emergency treatment during catabolic episodes, which, in combination, have substantially improved neurologic outcome. In contrast, start of treatment after onset of symptoms cannot reverse existing motor dysfunction caused by striatal damage. Dietary treatment can be relaxed after the vulnerable period for striatal damage, that is, age 6 years. However, impact of dietary relaxation on long-term outcomes is still unclear. This third revision of evidence-based recommendations aims to re-evaluate previous recommendations (Boy et al., J Inherit Metab Dis, 2017;40(1):75-101; Kolker et al., J Inherit Metab Dis 2011;34(3):677-694; Kolker et al., J Inherit Metab Dis, 2007;30(1):5-22) and to implement new research findings on the evolving phenotypic diversity as well as the impact of non-interventional variables and treatment quality on clinical outcomes.

Interference inhibition in offending and non-offending pedophiles: A preliminary event-related fMRI study

The ability to inhibit behavior is thought to be an import skill for avoiding criminal conduct, especially when combined with personal predispositions or criminogenic needs such as a pedophilic preference disorder. While previous research emphasized the relationship between impulsivity and child sexual offending, not pedophilia per se, studies on the underlying neurobiological mechanisms in subdomains of impulsivity remained scarce. Here, we focused on interference inhibition and examined event-related functional magnetic resonance imaging (fMRI) data of three groups of men performing a color-word Stroop task: (1) pedophiles with a history of CSO (P+CSO, n = 11), (2) pedophiles without a history of CSO (P-CSO, n = 8) and (3) non-pedophilic, non-offending healthy controls (HC, n = 10). On the behavioral level, P+CSO revealed increased Stroop interference as compared to P-CSO and HC. Moreover, increased Stroop interference in P+CSO was accompanied by enhanced conflict-related activity in left superior parietal cortex and precentral gyrus as compared to P-CSO. Albeit behavioral analyses of error and post-error processing revealed no significant between-group differences, P-CSO showed increased post-error-related activity in left posterior cingulate, precuneus and middle temporal gyrus as compared to P+CSO. Our preliminary data highlight inhibition deficits in offending as compared to non-offending pedophiles or healthy men and suggest that functional alterations in attention reallocation and impulse suppression/control may moderate the risk for committing CSO in men suffering from pedophilia.

Oncologists’ beliefs about people with psychotic disorders : a qualitative study

Introduction

Cancer is the second major cause of death among people with psychotic disorders. With the same incidence, mortality in these patients remains higher than in the general population. As stigma has been identified as a risk factor for excess mortality, we focused on oncologists’ beliefs and attitudes towards people with psychotic disorders.

Objectives

The aim of this study was to uncover physicians’ representations about the impact of psychosis on oncological care.

Methods

In this qualitative study, individual semi-structured interviews were conducted with 20 physicians working in oncology in the University Hospital of Brest (France). Transcribed interviews were thematically analyzed. This study meets the COREQ criteria.

Results

Psychosis is described as a broad-spectrum condition whose severity ranges from the “mild” patient with imperceptible abnormality to the “severe” patient with cognitive and affective deficits. Oncologists identified behavioral and emotional symptoms which may modify the patient-physician relationship with difficulties to interact. Some of them consider that these patients are not interested in their health and will not get involved in oncological care. While the psychotic disorder is not considered as a limiting factor per se, oncologists felt concerned about being stigmatizing. They mentioned different aspects (like anticipation of non-compliance or inability to get help) that lead to changes in conventional treatment regimens and may result in a loss of opportunity.

Conclusions

Oncologists’ beliefs may lead to stigmatizing attitudes towards people with psychotic disorders who may not be given the best possible chances. Thus, these specific elements should be the basis for collaboration between psychiatrists and oncologists.

Disclosure

No significant relationships.

Genetic testing in the context of familial hypercholesterolaemia: organisational and ethical aspects

Background

Molecular genetic diagnostics (GDx) is an increasingly used tool in the so-called ‘precision medicine'. For a structured implementation of GDx in screening programmes (SP), organisational and ethical implications must be considered. Our research report addresses implementation aspects of GDx in different health care systems and ethical considerations in the context of familial hypercholesterolaemia (FH)-a malfunction of the lipid metabolism.

Methods

The overview of (inter-)national FH test strategies, characteristics, and ethical aspects of (predictive) GDx is based on an iterative manual literature search in the G-I-N Library and the Trip-Database, followed by a search on health specific web pages. A revision of the Socratic approach by Hofmann et al. assists in analysing ethical aspects.

Results

We selected nine countries for a detailed comparison. Important components in FH treatment are the detection method, clinical criteria indicating a diagnosis, diagnostic tools, implementation, recommendations concerning cascade screening, genetic counselling, registries, and awareness programmes. Detection and diagnosis of index patients comprise of opportunistic approaches or organised systematic screenings in non-specialized or specialized settings. The use of GDx is most often recommended after a clinical diagnosis. In the course of cascade screening of at-risk family members, GDx is partly recommended in existing strategies. Ethical issues especially concern autonomy, informed consent and privacy (addressed during the process of genetic counselling). As a diagnosis by GDx impacts at risk family members, increased risk for intra-familial conflicts arise, e.g. disclosure of test results.

Conclusions

Implementing GDx results in a number of organisational and ethical challenges. Especially, investing in professional and well-trained genetic counsellors seems to be paramount, as the numerous ethical questions require sensitive communication.

Key messages

Our report provides a basis for decision makers to resolve implementation issues of molecular genetic diagnostics in the context of familial hypercholesterolaemia beyond (cost-) effectiveness/safety. In our report we discuss important ethical aspects of molecular genetic diagnostics in the context of familial hypercholesterolaemia that need to be considered by healthcare decision makers.

Health Outcomes of Infants with Vitamin B12 Deficiency Identified by Newborn Screening and Early Treated

OBJECTIVE

To evaluate the clinical outcomes at age 1.5 ± 0.5 years of infants with vitamin B₁₂ deficiency identified by newborn screening (NBS).

STUDY DESIGN

Prospective multicenter observational study on health outcomes of 31 infants with vitamin B₁₂ deficiency identified by NBS. Neurodevelopment was assessed by the Denver Developmental Screening Test.

RESULTS

In 285 862 newborns screened between 2016 and 2019, the estimated birth prevalence of vitamin B₁₂ deficiency was 26 in 100 000 newborns, with high seasonal variations (lowest in summer: 8 in 100 000). Infants participating in the outcome study (N = 31) were supplemented with vitamin B₁₂ for a median (range) of 5.9 (1.1-16.2) months. All achieved age-appropriate test results in Denver Developmental Screening Test at age 15 (11-23) months and did not present with symptoms characteristic for vitamin B₁₂ deficiency. Most (81%, n = 25) mothers of affected newborns had a hitherto undiagnosed (functional) vitamin B₁₂ deficiency, and, subsequently, received specific therapy.

CONCLUSIONS

Neonatal vitamin B₁₂ deficiency can be screened by NBS, preventing the manifestation of irreversible neurologic symptoms and the recurrence of vitamin B₁₂ deficiency in future pregnancies through adequate treatment of affected newborns and their mothers. The high frequency of mothers with migrant background having a newborn with vitamin B₁₂ deficiency highlights the need for improved prenatal care.

Newborn screening and disease variants predict neurological outcome in isovaleric aciduria

Isovaleric aciduria (IVA), a metabolic disease with severe (classic IVA) or attenuated phenotype (mild IVA), is included in newborn screening (NBS) programs worldwide. The long-term clinical benefit of screened individuals, however, is still rarely investigated. A national, prospective, observational, multi-center study of individuals with confirmed IVA identified by NBS between 1998 and 2018 was conducted. Long-term clinical outcomes of 94 individuals with IVA were evaluated, representing 73.4% (for classic IVA: 92.3%) of the German NBS cohort. In classic IVA (N = 24), NBS prevented untimely death except in one individual with lethal neonatal sepsis (3.8%) but did not completely prevent single (N = 10) or recurrent (N = 7) metabolic decompensations, 13 of them occurring already neonatally. IQ (mean ± SD, 90.7 ± 10.1) was mostly normal but below the reference population (P = .0022) and was even lower in individuals with severe neonatal decompensations (IQ 78.8 ± 7.1) compared to those without crises (IQ 94.7 ± 7.5; P = .01). Similar results were obtained for school placement. In contrast, individuals with mild IVA had excellent neurocognitive outcomes (IQ 105.5 ± 15.8; normal school placement) and a benign disease course (no metabolic decompensation, normal hospitalization rate), which did not appear to be impacted by metabolic maintenance therapy. In conclusion, NBS reduces mortality in classic IVA, but does not reliably protect against severe neonatal metabolic decompensations, crucial for favorable neurocognitive outcome. In contrast, individuals with mild IVA had excellent clinical outcomes regardless of metabolic maintenance therapy, questioning their benefit from NBS. Harmonized stratified therapeutic concepts are urgently needed.

Anxiety in depression

Introduction

There are different clinical forms combining anxiety and depression and it is essential to identify them because they will require different management. Among these clinical forms, there is that including anxiety as a symptom within the depressive episode: the anxious depression.

Objectives

The objective is to find the characteristics of this anxious depression.

Methods

We conducted a literature review on the PubMed® site giving access to the MEDLINE® database, as well as on the Google Scholar® search engine and retained 127 articles.

Results

By studying anxiety as a symptom of the depression, we identify on the pathophysiological level different neurobiological mechanisms (neuroanatomical, biological, immunological and endocrinological) involved in types of symptoms of different anxiety. Thus, by adopting a dimensional point of view, we can say that there are various anxiety symptoms which can be included in multiple forms of anxiety within the depression: psychic anxiety (anxiety and irritability), somatic anxiety (hypochondria, sweating, cardiological, respiratory, gastrointestinal and urinary symptoms), motor anxiety (agitation), anxious arousal (somatic anxiety, fear, panic) or anxious apprehension (anticipatory anxiety and worry). The prognosis which emerges from it is of a more pejorative evolution, and has specificities on which an increased attention is required, such as suicidal behavior which is more frequently described for example. The treatment must be psychotherapeutic, sociotherapeutic, and medication by antidepressant treatment, with SSRIs in the first line.

Conclusions

It is therefore essential to identify the clinical presentation of the anxious depression because it has specific semiological, neurobiological, prognostic and therapeutic characteristics.

Disclosure

No significant relationships.

Attentional salience and the neural substrates of response inhibition in borderline personality disorder

BACKGROUND

Impulsivity is a central symptom of borderline personality disorder (BPD) and its neural basis may be instantiated in a frontoparietal network involved in response inhibition. However, research has yet to determine whether neural activation differences in BPD associated with response inhibition are attributed to attentional saliency, which is subserved by a partially overlapping network of brain regions.

METHODS

Patients with BPD (n = 45) and 29 healthy controls (HCs; n = 29) underwent functional magnetic resonance imaging while completing a novel go/no-go task with infrequent odd-ball trials to control for attentional saliency. Contrasts reflecting a combination of response inhibition and attentional saliency (no-go > go), saliency processing alone (oddball > go), and response inhibition controlling for attentional saliency (no-go > oddball) were compared between BPD and HC.

RESULTS

Compared to HC, BPD showed less activation in the combined no-go > go contrast in the right posterior inferior and middle-frontal gyri, and less activation for oddball > go in left-hemispheric inferior frontal junction, frontal pole, superior parietal lobe, and supramarginal gyri. Crucially, BPD and HC showed no activation differences for the no-go > oddball contrast. In BPD, higher vlPFC activation for no-go > go was correlated with greater self-rated BPD symptoms, whereas lower vlPFC activation for oddball > go was associated with greater self-rated attentional impulsivity.

CONCLUSIONS

Patients with BPD show frontoparietal disruptions related to the combination of response inhibition and attentional saliency or saliency alone, but no specific response inhibition neural activation difference when attentional saliency is controlled. The findings suggest a neural dysfunction in BPD underlying attention to salient or infrequent stimuli, which is supported by a negative correlation with self-rated impulsiveness.