Sex differences in facial emotion recognition in health and psychotic disorders

BACKGROUND

Previous studies examining sex-differences in facial emotion recognition (FER) in psychosis yielded inconsistent results. Although females are considered to be superior in FER in health, it remains unclear whether the specific sex-difference is present in psychosis. We aimed to examine whether women and men differ in FER ability in health and in psychosis, and to explore potential sex differences in the illness' effects on FER.

METHODS

Remitted psychotic patients and controls were assessed using the CANTAB Emotion Recognition Task (ERT) examining accuracies/response latencies in identifying basic emotional expressions. General linear model was performed to assess the effects of group, sex and their interactions on ERT performance.

RESULTS

Healthy females showed FER advantage in comparison to healthy males, while the aforementioned sex-difference was not observed in remitted psychotic patients. Our results also demonstrated the existence of overall FER deficit in psychosis in comparison to healthy controls, as well as the differential illness' effects on the recognition accuracy of facial expression of anger in males and females-suggesting that females with psychotic disorders undergo more profound deterioration of FER ability than their male counterparts.

CONCLUSION

The assessment of sex-differences in FER and other important features of psychosis is important for better understanding of its neurobiological basis and for the development of targeted treatments for improved functioning.

Prescription attitudes and practices regarding clozapine among Serbian psychiatrists: results of a nationwide survey

OBJECTIVE

Despite clozapine being the most effective treatment for treatment-resistant schizophrenia (TRS), a clear explanation as to why it is underutilized and why its initiation is delayed remains unclear. The first aim of the study was to conduct a nation-wide assessment of both the psychiatrists' attitudes of the obstacles for prescribing clozapine as well as their prescription practices. The second aim was to make recommendations, based on the results obtained, for improving the Serbian clozapine guidelines.

METHODS

A questionnaire was conducted consisting of two parts. One regarded the clinical characteristics of the psychiatrists, while the second contained questions about indications for clozapine initiation, clozapine prescribing tendencies, and barriers to clozapine use. The questionnaire was sent to 302 Serbian psychiatrists.

RESULTS

With 161 out of the 302 psychiatrists returning the questionnaires, the response rate was 53.3%. Nearly 60% of the psychiatrists treated 10 or more patients with clozapine, with TRS being the most common indication. Only four psychiatrists (2.5%) had no patients currently on clozapine. Psychiatrists indicated that their fear of agranulocytosis (68%) constituted the greatest obstacle for clozapine prescription, followed closely by weight gain (56%), and sedation (39%). Despite their fear of agranulocytosis, only 83.9% of the psychiatrists monitored leukocytes regularly.

CONCLUSION

In general, psychiatrists in Serbia seem to be confident in prescribing clozapine, even in the absence of clear monitoring guidelines and the possibility of therapeutic drug monitoring. In order to reduce obstacles for clozapine prescription, monitoring laxity, and an overreliance on personal experience, we recommend three modifications of the existing clozapine guideline.

Application of a Novel Modification of the Microbond Test for Evaluation of Adhesive Bond Strength Between Fiber Posts and Dual-Cure Dental Resin Cement

BACKGROUND While several tests can be used in the laboratory evaluation of composite resin-based cement materials, the push-out test remains the most prevalent. Due to difficulties in sample preparation, as well as a highly complex procedure, we attempted to develop an alternative method for testing the bond strength of dental resin cement materials. MATERIAL AND METHODS Ninety-six experimental samples of 2 dual-cure resin cements and 1 fiber post system were prepared for the 2 testing procedures: the push-out test and the modified Microbond test. The degree of monomer conversion was measured by Fourier-transform infrared spectroscopy. RESULTS The push-out test results indicated that the bond strength of dual-cure resin cement differs depending on the tooth root region to which it is applied (p<0.05), In addition, our findings show that Variolink II exhibits a much lower bond strength relative to RelyX ARC. These findings were confirmed by the modified Microbond test results. The monomer conversion rate results indicate average conversion rates of 85.81% and 61.35% for RelyX ARC and Variolnik II, respectively. CONCLUSIONS Our study confirms the practical utility of the modified Microbond test in the assessment of bond strength of dental cement resin-based materials. The proposed test method is particularly useful given that, relative to the push-out test, it requires a much smaller number of preparation and execution steps, thus reducing the potential for introducing errors, while increasing the reliability of the obtained findings.

HEXACO-60 Personality Trait Inventory: Psychometric characteristics in a sample of medical students from Serbia

The 60-item HEXACO (HEXACO-60) Personality Trait Inventory may be strategically more important for researchers compared to the 100-item HEXACO. The aim of this study was to assess the psychometric properties of the 60-item HEXACO questionnaire in the Serbian language. This cross-sectional study, conducted at three of five Faculties of Medicine during the summer semester of the 2016/2017 academic year, included 617 students. Relevant data were collected by an anonymous questionnaire. Cronbach's α and McDonald's ω coefficients for the total scale were .71 and .72, respectively. Apart from Agreeableness, all other domains showed an adequate level of internal consistency (both Cronbach's α and McDonald's ω coefficients were >.70). Random data eigenvalues obtained on the parallel analysis had higher values than initial exploratory factor analysis eigenvalues up to the sixth factor. Accordingly, it was concluded that six factors should be extracted from the Serbian HEXACO-60. These factors corresponded in item distribution with the original ones. Based on the confirmatory factor analysis, using both 60 items and 24 facets, overall goodness of fit of the Serbian HEXACO-60 was acceptable. Moreover, there were no domains with completely invalid indices, as there were at least two indices that were acceptable for each domain. The Serbian version of the HEXACO-60 has acceptable psychometric properties. This shorter version with 60 items may be more suitable for brief surveys or when the time allocated to fill in a questionnaire is limited.

Does Gender Influence Color Matching Quality?

Objectives: To compare shade matching skills of color normal males and females.

Material and Methods: A total of 174 dental students of both genders (117 females and 57 males, 20 to 25 years old), with no experience in color matching in dentistry, participated in the study. All recruited students passed the Ishihara color vision test for color deficiency, and matched the colors of eight shade tabs using VITA Linearguide 3D-Master shade guide. Standardized lighting conditions were provided using Rite-Lite (Addent Danbury, CT, USA) hand-held shade matching unit. Color differences between the task tabs and selected tabs were calculated using two CIE color difference formulae and students results were evaluated from 10 (for the best match score) to 1 for the 10th best match score. Means and standard deviations were determined. Student’s t-test was used for result analysis (p = .05).

Results: The mean shade matching scores and standard deviations for male and female students were 5.86 (SD 1.38) and 6.10 (SD 1.36), respectively (p = .266). No statistically significant differences in overall and individual target tab scores by gender were recorded.

Conclusion: Within the limitation of this study, it was concluded that gender did not influence color matching quality

The influence of hard segment content on mechanical and thermal properties of polycarbonate-based polyurethane materials

Aliphatic segmented polyurethanes were prepared by one-step procedure in catalytic reaction between polycarbonate diol, hexamethylene-diisocyanate and 1,4-butandiol (as chain extender). The hard segment content TS was varied (17, 24, 30 and 42 wt. %) by changing the ratio of starting compounds. The soft segment is made from flexible aliphatic polycarbonate diol, while hard segments consist of chain extender and diisocyanate component. In order to study the hydrogen bonding formation and phase separation, Fourier transform infrared spectroscopy (FT-IR) was used. Wide angle X-ray scattering (WAXS) was performed to determine a degree of crystallinity and to investigate the phase behavior of prepared elastomers. The effect of TS content on mechanical properties (tensile strength, elongation at break and hardness) was tested. Thermal behavior of prepared novel polycarbonate-based polyurethanes was investigated using differential scanning callorimetry (DSC). It was determined that the elastomer which contains the highest amount of urethane groups in its structure (TS content of 42 wt. %) exhibits the most pronounced phase separation and the highest degree of crystallinity. All prepared polyurethanes exhibit high elongation at break (over 700%). The glass transition temperature Tg of prepared samples was in the temperature region from ?39 to ?36?C, and it was found to be slightly influenced by the soft segment content. The enthalpy of chain segments relaxation in diffused region between hard and soft domains (detected in the temperature range from 35 to 55 ?C) was decreased with the increase of hard segment content. The multiple melting of hard segments (connected with the dissruption of physical crosslinks) appeared above 100 ?C. It was found that the melting enthalpy linearly increases with the increase of urethane group content. Sample with 42 wt. % of TS has the highest value of melting enthalpy (41.5 J/g).

Maintenance Therapy of Psychosis Spectrum Disorders in a Real-World Setting: Antipsychotics Prescription Patterns and Long-Term Benzodiazepine Use

BACKGROUND

Maintenance therapy of patients with primary psychosis spectrum disorders (PSD) in the Western Balkans has received limited interest so far. The present study aimed to investigate long-term prescription patterns among outpatients with PSD.

METHODS

Information about prescription of antipsychotics (AP), benzodiazepines (BZD) and other psychotropic medication over a 6-month period was collected from outpatients (n = 134; ICD-10 diagnosis F20-29) recruited by a larger multi-site study, to find mean daily number of psychotropic drugs, AP prescription patterns (including AP daily dose, route of administration, monotherapy vs. polypharmacy) and BZD utilization (long-term add-on BZD therapy). Additionally, sex-differences in the variables were explored.

RESULTS

Clinically stable outpatients (age 41.7 ± 11.0; male 62.7%; duration of untreated illness 12.7 ± 8.7 years; mean number of lifetime hospitalizations 2.6 ± 0.7) were prescribed 2.8 ± 1.1 psychotropic medications daily. The mean 6-month AP dose was 14.2 ± 7.8 mg olanzapine equivalents. Long-acting injectable AP was prescribed to 25.2% of the patients. Long-term AP monotherapy was found in 52.7% patients and most of them were prescribed second generation AP (65.2%). Long-term AP polypharmacy (42.7%) was more common in males (p = 0.015). The most frequent co-prescription patterns were first generation AP plus clozapine. The highest rate of long-term AP co-prescription was found for BZD (in 42.7% cases, average 6-months daily dose of 2.8 ± 2.7 mg lorazepam equivalents) and anticholinergics (33.6%).

CONCLUSION

Existing appropriately designed interventions aiming to safely switch the inappropriate therapeutic regimens, i.e. very high prevalence of long-term AP polypharmacy and non-rational BZD co-prescription, should be implemented in the region of Western Balkans.

Structure of Negative Symptoms in Schizophrenia: An Unresolved Issue

Background: Negative symptoms are core features of schizophrenia and very challenging to be treated. Identification of their structure is crucial to provide a better treatment. Increasing evidence supports the superiority of a five-factor model (alogia, blunted affect, anhedonia, avolition, and asociality as defined by the NMIH-MATRICS Consensus); however, previous data primarily used the Brief Negative Symptoms Scale (BNSS). This study, including a calibration and a cross-validation sample (n = 268 and 257, respectively) of participants with schizophrenia, used the Clinical Assessment Interview for Negative Symptoms (CAINS) to explore the latent structure of negative symptoms and to test theoretical and data-driven (from this study) models of negative symptoms. Methods: Exploratory factor analysis (EFA) was carried out to investigate the structure of negative symptoms based on the CAINS. Confirmatory factor analysis (CFA) tested in a cross-validation sample four competing theoretical (one-factor, two-factor, five-factor, and hierarchical factor) models and two EFA-derived models. Result: None of the theoretical models was confirmed with the CFA. A CAINS-rated model from EFA consisting of five factors (expression, motivation for recreational activities, social activities, vocational, and close/intimate relationships) was an excellent fit to the data (comparative fix index = 0.97, Tucker-Lewis index = 0.96, and root mean square error of approximation = 0.07). Conclusions: This study cannot support recent data on the superiority of the five-factor model defined by the NMIH-MATRICS consensus and suggests that an alternative model might be a better fit. More research to confirm the structure of negative symptoms in schizophrenia, and careful methodological consideration, should be warranted before a definitive model can put forward and shape diagnosis and treatment of schizophrenia.

Treatment of Symptom Clusters in Schizophrenia, Bipolar Disorder and Major Depressive Disorder With the Dopamine D3/D2 Preferring Partial Agonist Cariprazine

Cariprazine is currently approved for the treatment of patients with schizophrenia (USA and EU), and for manic, depressive, and episodes with mixed features in bipolar I disorder (USA): several randomized controlled studies have also explored its efficacy in patients with major depressive disorder. This review summarizes its current therapeutic uses and potential advantages for treating the main symptoms of schizophrenia, bipolar I and major depressive disorder, considering its pharmacodynamic properties, efficacy, and tolerability. Its predominantly D3 receptor preferring affinity, with functional selectivity according to the prevailing neuronal environment, contributes to its efficacy across a wide array of psychopathological symptoms (including reality distortion, disorganized thought, negative symptoms, mood disturbance, anhedonia, and cognitive impairment), and to a favorable side effect profile. Cariprazine may be a "drug of choice" in patients with predominant negative and cognitive symptoms of schizophrenia, as well as those with metabolic syndrome. Further investigation of its relative efficacy when compared to aripiprazole or other active comparators is warranted. Its effectiveness in the treatment of bipolar mania, bipolar I depression and bipolar I episodes with mixed features, with minimal accompanying metabolic changes is well-established. The longer half-life and delayed time to relapse in patients diagnosed with schizophrenia when compared to other second-generation antipsychotics represent other advantages, given the high rates of non-adherence and frequent relapses seen in clinical practice. Its efficacy in overlapping symptom domains in other major psychiatric disorders appears promising.

Factor structure of the brief psychiatric rating scale-expanded among outpatients with psychotic disorders in five Southeast European countries: evidence for five factors

The Brief Psychiatric Rating Scale (BPRS) is a useful tool for measuring the severity of psychopathological symptoms among patients with psychosis. Many studies, predominantly in Western countries, have investigated its factor structure. This study has the following aims: (a) to further explore the factor structure of the BPRS-Expanded version (BPRS-E, 24 items) among outpatients with psychotic disorders in Southeast European countries; (b) to confirm the identified model; and (c) to investigate the goodness-of-fit of the three competing BPRS-E factor models derived from previous studies. The exploratory factor analysis (EFA) produced a solution with 21 items grouped into five factors, thus supporting the existence of a fifth factor, i.e., Disorganization. A follow-up confirmatory factor analysis (CFA) revealed a 19-item model (with two items removed) that fit the data well. In addition, the stability of two out of three competing factor models was confirmed. Finally, the BPRS-E model with 5 factors developed in this cross-national study was found to include a greater number of items compared to competing models.

Corrigendum: Structure of Negative Symptoms in Schizophrenia: An Unresolved Issue

[This corrects the article DOI: 10.3389/fpsyt.2021.785144.].

Which affective temperaments are most expressed in patients with chronic sub-jective tinnitus?

BACKGROUND

Although chronic subjective tinnitus is one of the most common symptoms, the background of its pathophysiological mechanism and etiology is not fully understood. No studies are exploring various affective temperaments in persons with chronic tinnitus.

METHODS

We included in this study 57 patients with tinnitus who filled out the Serbian 41-item version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto questionnaire (TEMPS-A) and a short sociodemographic questionnaire. Patients were assessed using audiometry (measuring the hearing threshold for frequencies of 250, 500, 1,000, 2,000, 4,000, and 8,000 Hz) and tympanometry.

RESULTS

Our research showed that patients with chronic tinnitus predominantly had anxious affective temperament [anxious-cognitive (AnxC): 26.23 %, anxious-somatic (AnxS): 25.6 %). AnxS was dominant in people without hearing loss (46 %) and males (37.39 %). AnxC was dominant in people with a significant hearing loss and females (30.3 %). Both AnxS and AnxC temperaments correlated with hearing loss in the right ear more than in the left one.

CONCLUSION

Our study revealed that anxious temperaments (AnxC and AnxS) were predominant in patients with chronic subjective tinnitus. Affective temperaments could play a significant role in explaining this disorder's currently unclear pathophysiology of, but further research is needed. HIPPOKRATIA 2020, 24(2): 77-83.

Personality traits and attitude towards euthanasia among medical students in Serbia

OBJECTIVE

Various factors may influence the attitudes of medical students towards euthanasia, including personal values, beliefs, and personality traits. The objective of this study was to examine the attitudes of 2nd and 5th year medical students about euthanasia and the relationship between these attitudes and students' personality traits.

METHODS

Medical students from the Universities of Kragujevac and Belgrade, Serbia, participated in this study. A questionnaire was administered assessing attitudes toward euthanasia and student personality traits (honesty-humility, emotionality, extraversion, agreeableness, conscientiousness, and openness using the HEXACO-60).

RESULTS

More than 50% of students in the second year and 60% of students in the fifth year were supportive of euthanasia. Students in the 5th year were 2.5 times more likely to express a concern that euthanasia needs to be clearly regulated by law compared to students in the second year. Adjusted analyses indicated that lower levels of honesty-humility and emotionality were positively correlated with students' belief that euthanasia should be legalized.

CONCLUSION

Many medical students in Serbia have a positive attitude towards euthanasia. It is important to consider the possible influences of culture, religion, and the law on attitudes towards euthanasia. Undergraduate medical training should include more hours dedicated to palliative care and end-of-life topics to raise awareness of patients' preferences in this regard.

Difficulties in Preventing Repeated Genital Self-Mutilation

Self-mutilation is self-inflicted and intentional damage done to one’s body or one’s body parts without a conscious suicidal intention. The first case of genital self-mutilation was published in 1846, and the first scientific description of genital self-mutilation was written by Stroch in 1901. Since the first case has been described, there have been a relatively small number of described cases of genital self-mutilation in both genders; there have been an even smaller number of cases of repeated genital self-mutilation and only a few descriptions of repetitive forms of male genital self-mutilation in the literature. The aim of our study is to present difficulties in preventing repeated male genital self-mutilation of a patient with an intellectual disability who was diagnosed and treated for epilepsy and psychosis in early adult life and had a previous history of self-destructive behaviour during childhood. Previous literature does not contain many repeated cases of male genital self-mutilation. After evaluating the contribution of each individual factor in the aetiology of self-mutilation, we concluded that every individual factor is significant in the aetiology of self-mutilation; however, no single factor, as well as all the factors put together, is not enough for prevention of self-mutilation. Our conclusion is that all the presented factors in our research (intellectual disability, epilepsy, psychosis, self-destructive tendencies in childhood) have their place in the aetiology of male genital self-mutilation, but none of them are determining factors. This confirms that it is necessary to conduct further research in the field of aetiology of male genital self-mutilation, which would contribute towards more adequate prevention.

Attitudes of Medical and Pharmacy Students Towards Patients Suffering from Schizophrenia

Research over the past twenty years has shown that the attitudes of health care workers and students towards people who are suffering from schizophrenia have become more negative. The aim of our study was to investigate the attitudes of medical and pharmacy students towards patients with schizophrenia and explore the differences in attitudes between study groups and students in different years. Materials and methods: Second- and fifth-year medical and pharmacy students from the Faculty of Medical Sciences at the University of Kragujevac were included in an observational, prospective, cross-sectional study. The sample consisted of 113 students from the pharmacy and medical schools who were chosen via random sampling. The students completed a two-part questionnaire. Th e first part contained questions about sociodemographic characteristics, whereas the second part was a translated version of the Mental Illness: Clinician’s Attitudes (MICA) v4 scale. Results: There is a statistically significant difference (р<0.05) in the attitudes towards people with schizophrenia between second- and fifth-year medical and pharmacy students (with lower scores in both groups in fifth-year students). Of the total number of students who had lower summed scores on the Likert scale, 51.3% had previously finished medical high school, whereas 28.3% had previously finished regular high school. Conclusion: Our results showed a statistically significant difference in attitudes towards people with schizophrenia between second- and fifth-year students as well as a difference related to previous high school education. This stresses the importance of levels of knowledge about schizophrenia to reducing the stigmatization of patients who suffer from this disorder.

Surveillance frequency in resected esophageal cancer: Towards personalization of follow-up

INTRODUCTION

In spite of advances in curative management of esophageal cancer, a significant proportion of patients have early recurrence following resection. The role of CT-guided surveillance remains undefined. This study aims to determine if follow-up can be personalised, to allow detection of clinically relevant recurrence, while reducing low-yield surveillance for patients.

METHODS

A retrospective review was conducted encompassing patients undergoing esophagectomy with curative intent from 1st March 2018-31st May 2022. Routine 3-monthly CT scanning was conducted for 2 years, followed by 6-monthly surveillance for 1 year, and annual surveillance to 5 years. Disease characteristics, time to recurrence and time to death were recorded and interrogated to determine their impact on recurrence and personalization of surveillance.

RESULTS

In total, 190 patients underwent surveillance. Seventy-one (37 %) developed recurrence, with most in the first two years. Those who recurred were younger (63 vs 67, p < 0.001), had higher pathologic staging (p < 0.001), higher tumour regression grade (p = 0.005), higher lymph node ratio (p < 0.001) and high-risk histology (p < 0.001). Most recurrences detected were asymptomatic (94 %). A personalised surveillance score was devised. With strict criteria, 12 % of patients could be excluded from surveillance without compromising detection of asymptomatic recurrence. By broadening criteria, a larger portion of patients could avoid imaging, with a small number of asymptomatic recurrences missed. This would require significant balancing of the risk-benefit ratio for individuals.

CONCLUSION

Intensive surveillance post-resection of esophageal cancer will detect most recurrences while asymptomatic, potentially facilitating intervention. In select patients, routine surveillance could be excluded without compromising oncologic or patient outcomes.

Exploring real-world prescribing patterns for maintenance treatment in bipolar disorders: a focus on antidepressants and benzodiazepines

OBJECTIVE

Bipolar disorders (BD) are characterized by highly recurrent nature, necessitating adequate maintenance treatment for long-term disorder control. This study aimed to investigate real-world prescribing patterns among outpatients with BD, focusing on the utilisation of antidepressants (AD) and benzodiazepines (BDZ).

METHODS

We analysed prescription patterns of the five main groups of psychotropic medications (antipsychotics, mood stabilizers, AD, BDZ, and anticholinergic medications) and their relationships with basic socio-demographic and clinical data in a sample of 107 clinically stable BD outpatients (75.7% female, age 44.8 ± 11.7).

RESULTS

Maintenance therapy predominantly involved polypharmacy (92.5%), with mood stabilizers (87.9%) and antipsychotics (80.4%, predominantly second-generation) being the most commonly prescribed. Our findings highlight a high percentage of patients prescribed AD (50.5%) and BDZ (54.2%). BDZ patients, compared to the non-BDZ group in maintenance treatment, were significantly older with longer psychiatric history and a decreased likelihood of comorbid personality disorder diagnoses.

CONCLUSIONS

This study offers insights into prescribing practices within a university psychiatric clinic in the Western Balkans. The prevalent use of polypharmacy in real-world clinical settings, along with high percentage of patients prescribed AD and BDZ, suggests a gap between guideline recommendations and clinical practice, indicating a lack of consensus or standardized approaches in clinical practice.