The scratch card gambler: a hidden reality

Scratch cards-otherwise known as scratch tickets or instant lotteries-are a highly accessible type of lottery, due to its relative accessibility and affordability. In Portugal, the popularity of scratch cards has experienced substantial growth, with almost no regulatory reaction whatsoever. This study aims to describe the sociodemographic characteristics of scratch card gamblers, prevalent gambling habits, and their perceptions regarding scratch card gambling. This study also determines the constancy of pathological scratch card gambling, and the possible impact of regulatory measures. We found that about half of the participants studied were at risk of pathological gambling and scratch cards seem to have a clear potential for enticing higher spending in vulnerable consumers, compared to other forms of gambling games. Perception biases regarding gambling are frequent and almost no one afflicted seeks help. Regulatory measures are crucial to regulate potential problematic behaviors, specifically in high-risk persons. There is an urgent need to act, made clear by both present findings and numerous precedent warnings regarding scratch card gambling hazards.

Suicide, Stigma and COVID-19: A Call for Action From Low and Middle Income Countries

Suicide is a global health issue that needs to be addressed. The COVID-19 pandemic has resulted in an increased mental health burden. Stigma has obstructed efforts to prevent suicide as individuals who need urgent support do not seek appropriate help. The influence of stigma is likely to grow in tandem with the COVID-19 pandemic. The stigmatization of persons with mental illnesses is widespread worldwide, and it has substantial effects on both the individual and society. Our viewpoints aim to address the probable link between stigma and suicide in the wake of the current pandemic and propose ideas for reducing suicide-related stigma.

Absence of Longer Reorientation Times in Patients Undergoing Electroconvulsive Therapy and Concomitant Treatment with Lithium

Objective

Lithium is a drug of choice in the treatment of bipolar disorder and refractory depressive disorders. However, previous research suggests lithium has a negative cognitive impact in recovery from electroconvulsive therapy (ECT) and a higher risk of delirium, so patients are often required to stop taking lithium before ECT, despite risk of relapse. We studied the cognitive impact of serum lithium levels in patients undergoing ECT.

Methods

This was an observational prospective study. Serum lithium levels, thyroid and biochemical parameters were measured prior to each ECT session. Time elapsed from the anesthetic induction to the electrical stimulus and then to the patients’ reorientation was recorded, as well as the motor seizure duration and electroencephalogram (EEG) seizure duration. A statistical analysis using a linear mixed model was run while adjusting for confounding factors.

Results

Ten participants underwent a total of 86 ECT sessions (41% right unilateral ultrabrief pulse, and 59% bilateral brief pulse). A negative interaction between lithium levels and reorientation time was found among those doing bilateral brief pulse ECT. No association was observed in patients doing unilateral ultrabrief pulse ECT. No significant relationship was observed between lithium and both motor and EEG-assessed seizure duration.

Conclusion

This study suggests that low to moderate serum lithium levels (< 0.7 mmol/L) might have no harmful cognitive effects in patients under right unilateral ultrabrief pulse and bilateral brief pulse ECT.

Electroconvulsive Therapy in Refractory Obsessive-Compulsive Disorder: A Case Report

ABSTRACT

Electroconvulsive therapy (ECT) is a treatment of undisputed efficacy for severe and treatment-resistant psychiatric disorders. Notwithstanding extensive data on efficacy and safety, it is significantly underused, corresponding to one of the most stigmatized approaches in psychiatry. The list of problems for which ECT is potentially effective does not include obsessive-compulsive disorder (OCD), resulting in only a few available case reports in the literature in which OCD is the target of this specific therapeutic strategy. The authors describe a patient with refractory OCD for whom ECT was prescribed, with remarkable clinical response and functional improvement. The existence of a clear response to ECT in reported cases of OCD, albeit in a globally small number of patients, should make it essential to identify predictors of ECT response that could assist clinicians in assessing and guiding such cases, particularly those labeled as refractory to treatment.

Wax Removal and Diamondback Moth Performance in Collards Cultivars

The diamondback moth Plutella xylostella (Linnaeus, 1758) (Lepidoptera: Plutellidae) is an herbivorous specialist on Brassicaceae species. Brassicas spp. plants developed a range of defenses (chemical, physical, and morphological) to prevent herbivores attack. In this study, we reported the antixenotic and antibiotic effects of outermost layer of two species of epicuticular wax of Brassicaceae, Brassica oleracea L. var. "Santo Antônio," and Hybrid Kope F1 100MX, on larvae and adult of P. xylostella. In the choice experiment, P. xylostella adults showed an oviposition preference for collard cultivars Santo Antônio (control) and Hybrid Kope F1 100MX with wax removal. In the no-choice experiment, oviposition was 6.4 times higher in the Hybrid Kope F1 100MX with wax removal than without wax removal. There were significant differences among larvae feeding on leaf disks of Hybrid Kope F1 100MX in the treatments with (65.3 mg) and without wax removal (23.5 mg). The net reproduction rate (R ₀ ), and intrinsic (rm) and finite rates of increase (λ) of P. xylostella in the cv. Santo Antônio were bigger in the treatment without wax removal (R ₀  = 50.4, rm = 0.23 and λ = 1.26) than treatment with wax removal (R ₀  = 28.5, rm = 0.20 and λ = 1.22). However, only the R ₀ value was affected by mechanical wax removal in the Hybrid Kope F1 100MX (with wax removal R ₀  = 43.3 and without wax removal R ₀  = 30.8). In conclusion, the results indicate that collard's wax is important to accessibility and development of P. xylostella, and its removal changes the resistance of collard's varieties to P. xylostella.

Magnitude and Allele Frequency of Cry1F Resistance in Field Populations of the Fall Armyworm (Lepidoptera: Noctuidae) in Brazil

Bacillus thuringiensis (Bt) corn producing the Cry1F protein was the first highly efficacious Bt corn deployed against the fall armyworm Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae) in Brazil, but reduced efficacy of this technology against the fall armyworm has been reported in some regions of the country. Here, we surveyed Cry1F resistance allele frequency and susceptibility of eight S. frugiperda populations collected in 2013 from non-Bt fields in different regions of Brazil. In F1 screen experiments, the overall frequency of the Cry1F resistance alleles in Brazilian populations was estimated at 0.24, with 95% credibility interval between 0.18 and 0.25. In concentration-response bioassays, five of the eight populations surveyed exhibited significant resistance levels, which were over 32 times higher than that of the standard susceptible laboratory strain. The estimates of Cry1F resistance allele frequency were positively correlated with those of median effective or lethal concentrations (i.e., EC50 or LC50). These results show that the allelic frequency and the magnitude of Cry1F resistance are high in field populations of S. frugiperda in Brazil, indicating a challenging situation for resistance management.

Impact of medical comorbidity in psychiatric inpatient length of stay

Background: Medical comorbidity is associated with worse psychiatric outcomes, reduced functioning and higher services use, including inpatient psychiatric care.Aim: We explored the relation between medical comorbidity and length of stay, adjusting for potential confounders.Methods: We retrospectively analyzed an administrative database comprising all inpatient admissions between 2005 and 2014 at the Department of Psychiatry and Mental Health at Vila Nova de Gaia/Espinho Healthcare Center, Vila Nova de Gaia - Portugal. Psychiatric diagnosis and medical comorbidity were coded according to single-level and multi-level classification schemes, respectively, as proposed by the Clinical Classification Software.Results: We included a total of 4613 psychiatric inpatient admissions. The prevalence of medical comorbidity was 25.4% and it was associated with an average increase of 3.5 days (p < 0.001) in length of stay, comparing to patients without medical comorbidity. After adjusting for potential confounders, such as age, sex and year of discharge, medical comorbidity was associated with a 13% increase in length of stay.Conclusions: Medical comorbidity has measurable effects in inpatient outcomes, such as the length of stay and should be a major focus for intervention, in ambulatory care but also during psychiatric hospitalization.

Risperidone, a risk factor for valproate-induced encephalopathy?

Valproate-induced encephalopathy (ViE) has been increasingly reported and several risk factors have been proposed. We report a case whereby a patient became encephalopathic while treated with valproate and upon initiation of risperidone. The underlying mechanism could be risperidone's interference with valproate's binding to albumin, raising free valproate levels, which would impair the urea cycle and reduce ammonia conversion, leading to a hyperammonemic encephalopathy. The present case suggests a causal link, although further studies will be necessary to establish this. Nevertheless, clinicians should be aware of this possible interaction and consider carefully before concomitant administration of valproate and risperidone, mainly in patients with other risk factors for ViE, so this complication can be avoid or promptly diagnosed and treated.