Managing drug-induced psychosis.

Substance-induced psychosis is a secondary psychotic disorder resulting from drug abuse, characterized by one or more psychotic episodes. Drug-induced psychosis is expected to resolve after a 30-day period of sobriety, however, individuals with this condition are more likely to develop severe drug addiction. Compared to primary psychosis, participants with drug-induced psychosis exhibit poorer family history of psychotic diseases, higher insight, fewer positive and negative symptoms, more depressive symptoms, and greater anxiety. Substance-induced psychosis is strongly associated with the emergence of bipolar illness or schizophrenia spectrum disorder, with an increased chance of developing schizophrenia at a younger age. Episodes of self-harm after substance-induced psychosis are strongly linked to an elevated likelihood of developing schizophrenia or bipolar disorder. Effective treatment involves ruling out emergencies, investigating underlying causes, and addressing acute intoxication and withdrawal. Management includes dynamic assessment, intervention, and vigilant monitoring in cases of suicidal behaviour. Antipsychotics may be used for short term, with gradual discontinuation when a person is in a stable condition. Relapse prevention strategies, both medication and non-medication-based, are crucial in long-term management. Conversion rates to schizophrenia or bipolar disorder can be as high as one in three individuals, with cannabis users and those with early-onset substance abuse at the highest risk.

Neurobiological associations between smoking and internalizing disorders.

People with severe mental disorders have a higher mortality rate due to preventable conditions like cardiovascular diseases and respiratory diseases. Nicotine addiction is a preventable risk factor, with tobacco use being twice as high in people with mental disorders. An integrative model that divides mental disorders into externalising, internalising, and thought disorders could be useful for identifying common causalities and risk factors. This review aims to examine the interface between smoking and internalising disorders, specifically schizophrenia, depressive disorders, and anxiety disorders. The review finds that there is a clear association between smoking behaviour and these disorders. Schizophrenia is associated with polymorphisms that result in an imbalance between glutamate and GABA release and abnormalities of dopaminergic pathways. Nicotine improves dopaminergic signalling and balances glutamatergic and GABAergic pathways, improving symptoms and increasing the risk of nicotine dependence. In depressive disorders, smoking is associated with functional changes in brain regions affected by smoking and self-medication. In anxiety disorders, there is a bidirectional relationship with smoking, involving the amygdala and changes in dopaminergic pathways and cortisol production. Smoking poses a threat to people living with psychiatric disorders and calls for further research to assess the interactions between nicotine dependence and internalising and thought disorders.

Understanding food addiction in Post-Bariatric patients.

This study delves into the construct validity of Food Addiction (FA) as evaluated by the modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) within the context of post-bariatric surgery patients in Brazil. Understanding the prevalence, characteristics, and construct validity of FA among individuals who have undergone bariatric surgery is crucial for enhancing patient care and advancing research in this field. Our findings are based on a convenience-based sample of 100 individuals who had undergone bariatric surgery at Hospital Estadual Mário Covas (HEMC) in Brazil. Using mYFAS 2.0, we found that 51% of the participants met the criteria for FA, with 31% classified as severely affected. In our investigation of construct validity, we confirmed a one-dimensional model, in line with prior research using the YFAS and its modified versions. Item Response Theory (IRT) analyses further confirmed the appropriateness of the mYFAS 2.0 items, with all criteria contributing to the latent structure, most exhibiting discrimination values exceeding 0.5, and the majority having values greater than 2. These results provide substantial support for the construct validity of mYFAS 2.0 in our Brazilian subpopulation of post-bariatric surgery patients. Comparative analyses with previous studies revealed a notably higher prevalence of FA in our population, suggesting potential differences between pre- and post-bariatric surgery groups. This study contributes unique insights into the assessment of FA among post-surgery patients and highlights the importance of early detection and intervention in this population. While this study advances our understanding of FA in post-bariatric surgery patients, certain limitations, such as the relatively small sample size and cross-sectional design, warrant consideration. Nevertheless, our findings hold valuable implications for healthcare providers, researchers, and patients in the field of bariatric surgery and FA management. Future research can build upon these foundations to explore long-term FA effects post-surgery and potential interventions to address this issue effectively.

Mental health of ethnic minorities: the role of racism.

Racism and racial discrimination heavily impact on health and mental health of ethnic minorities. In this conceptual paper and narrative review, we aim to report on relevant evidence from the international literature describing the prevalence and the qualitative aspects of mental illness due to racism and ethnic- discrimination in different settings and populations. Some variables related to racism, such as cultural, institutional, interpersonal factors, as well as the concepts of perceived and internalised racism will be described and discussed. These are relevant characteristics in the explanatory model of the relationship between racism and mental health. Epidemiological data on the prevalence of depressive and psychotic symptoms as well as substance abuse/misuse among ethnic minorities in large catchment areas, such as United States and United Kingdom, will be represented. We conclude that anti-racism policies are essential in order to address racism and racial discrimination around the world. Pluralistic societies should be promoted in order to understand mental illnesses among ethnic and cultural minorities. Also, anti-racism programs should be delivered in the educational and health-care settings and their impact evaluated.

Alcohol use disorders in patients with bipolar disorder: a systematic review and meta-analysis.

Alcohol consumption has a key role in more than 200 diseases and health injuries, being an important factor for social and public health costs. Studies with clinical populations show an association between alcohol use disorders (AUD) and bipolar disorder. In this meta-analysis we included studies, reports, or summaries identified in Google Scholar, Lilacs, Medline, and MedCaribe that reported original data published up to 31 January 2023. We included cross-sectional and longitudinal observational studies that investigated the prevalence of AUD in patients with bipolar disorder. We calculated the prevalence rates and conducted a meta-analysis using a random effects model. The meta-analysis included 20 unique studies conducted in 12 countries, with a total sample of 32,886 individuals with bipolar disorder, comprising 17,923 women and 13,963 men, all aged 18 years or older. The prevalence of AUD in individuals with bipolar disorder was found to be 29.12%, while the prevalence of Alcohol Dependence (AD) was 15.87% and the prevalence of Alcohol Abuse (AA) was 18.74%. The high prevalence of AUD individuals with bipolar disorder is important because it highlights the need for targeted interventions to prevent and address comorbid conditions, which may improve treatment outcomes, reduce harm, and promote public health.

Women and MDMA: particularities of gender and sex.

This comprehensive review delves into the intricate interplay between gender/sex and MDMA use, drawing upon recent evidence. It explores how girls, as a means of coping with negative emotions, often resort to drug use, while boys primarily initiate drug use due to peer pressure or sensation-seeking tendencies. Women, frequently having endured traumatic life events, may turn to MDMA as a form of self-medication. Notably, women face an elevated risk of contracting sexually transmitted infections due to their altered mental states and diminished condom use during MDMA consumption. Additionally, females exhibit heightened sensitivity to the subjective effects of MDMA, consistently reporting heightened anxiety, adverse effects, and negative side effects. While women may have a higher susceptibility to hyponatremia, intriguingly, they appear to be less vulnerable to MDMA-induced hyperthermia. Although limited, available data suggest that prenatal MDMA exposure could lead to motor delays in infants, necessitating further research to unravel the potential cognitive effects. Furthermore, MDMA-assisted psychotherapy holds immense promise for addressing post-traumatic stress disorder (PTSD) among female subgroups. These pronounced gender and sex disparities in MDMA use and its effects underscore the pressing need for additional research to develop tailored, effective, and safe treatment approaches that account for these fundamental factors.

Risky business: an examination of drinking games in college settings and their impact: a systematic review.

This systematic review explores the prevalence and impact of Drinking Games (DG) among college students. DGs involve social drinking with the goal of heavy alcohol consumption and are associated with risky behaviours. The review aims to quantify the relationship between DG participation, alcohol consumption, and negative outcomes. It also investigates gender moderation and unexplored motivational factors for DG engagement. Following PRISMA guidelines, 34 studies were included after screening 317 records. The studies comprised n = 34,197 participants and were analysed for various variables, including gender dynamics, motivations, and associated negative consequences. Gender convergence in DG participation was noted, emphasizing the importance of gender-specific interventions. Participants were aware of risks but often perceived negative outcomes as a badge of honour. Motivations for DGs were linked to social interaction and a sense of belonging. Personality traits like sensation seeking and identification with college drinking culture played significant roles in DG engagement and outcomes. The review underscores the need for targeted interventions to address shifting perceptions of negative consequences and consider personality traits when designing preventive measures. It also highlights the significance of gender-specific strategies. However, variations in DG measurement and possible selection bias among heavy drinkers participating in DGs remain limitations. This systematic review provides insights into DG prevalence and its link to negative outcomes among college students. The findings stress the importance of tailored interventions and further research to mitigate risk factors and promote healthier drinking behaviours in this demographic.

Discrimination, stigma and mental health: what's next?

Stigma and discrimination are a major ongoing problem in the field of mental health as these impact on patient outcomes, access to and acceptability of therapeutic interventions, their quality of life, general wellbeing, social inclusion and opportunities. Social stereotypes, culture and prejudices all contribute to continuing discrimination in mental health. Different settings where people function may also be sources of discrimination such as work and educational environments. The lack of knowledge and understanding of mental health/illness by individuals, their families, carers and policymakers as well as the social media reporting also impact on social attitudes to discrimination. It has been also described a relevant impact of stigma among specific social minorities reporting poor mental health such as elderly people, youths, sexual variants, persons with disability. Educational programs, raising awareness trainings and proper public policies may be developed in order to reduce stigma at social level with favourable outcomes for people with mental illness.

Exploring correlates of involuntary treatment in substance use disorders: a global systematic review and meta-analysis.

Given the legislative heterogeneity about involuntary treatment and psychoactive substance users, we opted to perform a systematic review and meta-analysis of the correlates of involuntary substance use disorders (SUD) treatment across different countries. We conducted research on the Pubmed database, searching for involuntary SUD treatment data worldwide. The systematic review analysed a total of 36 articles and included a sample of 47,739 patients. Our review highlights the elevated risk of involuntary treatment among male, unmarried individuals with alcohol and/or opioid use disorders. Targeted preventive and therapeutic interventions should focus on addressing the underlying factors contributing to involuntary treatment, such as psychosis, aggressiveness, suicidal ideation, legal problems, and severe social exposure. By targeting these factors and providing comprehensive care, we can strive to improve outcomes and reduce the burden of substance use disorders in this vulnerable population. It is essential to critically examine and understand the factors contributing to the selection of patients for compulsory treatment. By doing so, we can identify potential gaps or inconsistencies in the current processes and work towards ensuring that decisions regarding compulsory treatment are based on sound clinical and ethical principles.

Is self-reported 7-day point prevalence abstinence an useful measure for smoking cessation effectiveness among individuals with mental disorders?

Smoking rates among individuals with mental disorders are higher compared to general population. We aimed to investigate the effectiveness of a smoking cessation treatment among individuals with and without mental disorders. Self-report 7-day point prevalence was used to assess abstinence status among 'intention to treat' (n = 1,213) and 'completers-only' (n = 578) samples. Participants were distributed in (1) ND-only; (2) ND and other substance use disorder (ND-SUD); (3) ND associated with mental disorder but no other SUD (ND-MD); and (4) co-morbid ND, SUD and MD (ND-SUMD). The treatment program was composed by six weeks of group Cognitive Behavioral Therapy (CBT) and medical consultations. Multivariate logistic regression models were applied. Rates of abstinence between ND-only and both ND-MD and ND-SUMD differed in the 'intention-to-treat' sample, with the former group showing the best rate (62.5%, 48% and 45.4% respectively). ND-SUD had the second-best rate of abstinence (56.1%). Differences between groups were not observed among 'completers-only'. Self-report 7-day point prevalence abstinence is economical and reliable to be used in low to middle-income countries. In this study, it showed that the 6-week smoking cessation treatment had a positive effect among completers, which supports the importance of investing in treatment to decrease smoking prevalence in this population.

Unravelling the landscape of Cannabis craving pharmacological treatments: a PRISMA-guided review of evidence.

Currently, few treatments are available for craving in general, and none of them have received approval for cannabis craving. The objective of this review is to evaluate existing studies analysing treatments for cannabis craving and explore novel treatment possibilities for these patients. The study followed PRISMA guidelines and conducted an extensive database search. Inclusion criteria included human randomised controlled trials examining drug effects on craving symptoms. Exclusion criteria involved studies unrelated to craving, non-pharmacological treatments, duplicates, and non-English/Spanish/Portuguese articles. Our included 22 studies that investigated a wide range of compounds used for cravings related to other drugs, as well as interventions based on healthcare professionals' empirical knowledge. The current pharmacological treatments largely involve off-label drug use and the utilisation of cannabinoid-based medications, such as combinations of THC and lofexidine, oxytocin, progesterone, and N-acetylcysteine. These emerging treatments show promise and have the potential to revolutionise current clinical practices, but further investigation is needed to establish their efficacy. In this context, it is essential to consider non-pharmacological interventions, such as psychotherapy and behavioural treatments. These approaches play a crucial role in complementing pharmacological interventions and addressing the complex nature of the disorder.

Bariatric surgery and its influence on alcohol consumption: Differences before and after surgery - A systematic review and meta-analysis.

BACKGROUND: Through new publications on the subject, the main goal of this article is to seek a change in the pattern of alcohol use before and after bariatric surgery. METHODS: We searched the National Library of Medicine, CINAHL, and PsycINFO databases. We included original articles regarding alcohol consumption before and after bariatric surgery to conduct the systematic review. RESULTS: Our systematic review, which included 18 articles, yielded mixed results. Meta-analysis of six articles did not reveal statistically significant differences in alcohol use behaviours before and one year after bariatric surgery. However, throughout the perspective of follow-up after bariatric surgery, nine out of the twelve articles showed improvement in the pattern of alcohol consumption when evaluated up to two years after the end of the surgical period, and four out of the five articles with monitoring beyond two years showed worsening in consumption, compared to pre-surgery alcohol use behaviours. CONCLUSIONS: Conclusions about the relationship between alcohol consumption and bariatric surgery are challenging primarily because of the variety of the methods used and the alcohol consumption measures. Despite that, our research pointed to an increased risk of alcohol use disorders two years after bariatric surgery.

Psychopharmacology of smoking cessation medications: focus on patients with mental health disorders.

The adverse effects of smoking cessation in individuals with mental health disorders have been a point of concern, and progress in the development of treatment has been slow. The primary first-line treatments for smoking cessation are Nicotine Replacement Therapy, Bupropion, Varenicline, and behavioural support. Nortriptyline and Clonidine are second-line treatments used when the first-line treatments are not effective or are contraindicated. Smoking cessation medications have been shown to be effective in reducing nicotine cravings and withdrawal symptoms and promoting smoking cessation among patients living with mental disorders. However, these medications may have implications for patients' mental health and need to be monitored closely. The efficacy and side effects of these medications may vary depending on the patient's psychiatric condition, medication regimen, substance use, or medical comorbidities. The purpose of this review is to synthesise the pharmacokinetics, pharmacodynamics, therapeutic effects, adverse effects, and pharmacological interactions of first- and second-line smoking cessation drugs, with an emphasis on patients suffering from mental illnesses. Careful consideration of the risks and benefits of using smoking cessation medications is necessary, and treatment plans must be tailored to individual patients' needs. Monitoring symptoms and medication regimens is essential to ensure optimal treatment outcomes.

Comparing the Addiction Severity Index (ASI) and Measurements in the Addictions for Triage and Evaluation (MATE).

Substance use disorder (SUD) assessment and measurement in Brazil, as well as in many other countries, face significant shortcomings. The Measurement in the Addictions for Triage and Evaluation (MATE) was developed as a public domain tool, drawing from validated scales and incorporating World Health Organization International Classification of Functioning, Disability, and Health (ICF) framework. The Brazilian version of the MATE (MATE-pt-BR) was evaluated for its reliability and validity, with a total of 239 subjects participating in the study, and data collected between 11/01/2021 and 09/01/2022. The majority were male (79.2%), with diverse racial backgrounds. The substances most prevalently used in the last 30 days were. Alcohol (73.2%), nicotine (63.6%), and cocaine (44.2%). The mean scores for MATE modules showed variations, with Module Q2 assessing psychological well-being having high internal consistency (Cronbach's alpha = 0.92). MATE-pt-BR demonstrated robust internal consistency, with Module 6 (personality) and Module 2 (medical and psychiatric consultation indicators) being exceptions. MATE-pt-BR exhibited significant correlations among its sections and strong discriminant validity. Moreover, the paper compares MATE-pt-BR with the Addiction Severity Index (ASI-6), which is considered the gold-standard measure for SUD assessments. MATE-pt-BR offers a valuable tool for assessing substance use and related functional impairments in the Brazilian context.

Mental health issues and psychological risk factors among Paraguayan healthcare workers during the COVID-19 pandemic.

BACKGROUND: There is an increasing concern regarding the mental health of healthcare workers during the COVID-19 pandemic. AIMS: This study aimed to assess the psychological impact of the COVID-19 exposure among Paraguayan healthcare workers. METHODS: A cross-sectional descriptive study has been carried out in five hospitals of Paraguay. Demographic and occupational exposure to COVID-19 were collected through a short questionnaire. Mental health status was assessed with the GAD-7, the PHQ-9, and the PCL-C. Logistic regression was used to determine psychological risk factors. RESULTS: 432 participants were surveyed. 218 (50.46%) were physicians. The prevalence of symptoms of anxiety, depression and PTSD was 48.15, 41.90, and 5.79%, respectively. There were no significant differences in anxiety (128 [29.63%] vs. 80 [18.52%]; p = 0.3303), depression (102 [23.61%] vs. 79 [18.29%]; p = 0.6703), or PTSD (14 [3.24%] vs. 11 [2.55%]; p = 0.8074) between frontline versus second-line workers. Main risk factors associated with psychological distress included work experience <5 years for depression and a COVID-19 positive diagnosis or having family/friends with a COVID-19 positive diagnosis for PTSD. CONCLUSIONS: Paraguayan healthcare workers reported high prevalence of anxiety, depression, and a low prevalence of PTSD. A positive diagnosis of COVID-19 and work experience <5 years are important psychological risk factors.

Post-acute sequelae of SARS-CoV-2 infection: relationship of central nervous system manifestations with physical disability and systemic inflammation.

BACKGROUND: Despite the multitude of clinical manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC), studies applying statistical methods to directly investigate patterns of symptom co-occurrence and their biological correlates are scarce. METHODS: We assessed 30 symptoms pertaining to different organ systems in 749 adults (age = 55 ± 14 years; 47% female) during in-person visits conducted at 6-11 months after hospitalization due to coronavirus disease 2019 (COVID-19), including six psychiatric and cognitive manifestations. Symptom co-occurrence was initially investigated using exploratory factor analysis (EFA), and latent variable modeling was then conducted using Item Response Theory (IRT). We investigated associations of latent variable severity with objective indices of persistent physical disability, pulmonary and kidney dysfunction, and C-reactive protein and D-dimer blood levels, measured at the same follow-up assessment. RESULTS: The EFA extracted one factor, explaining 64.8% of variance; loadings were positive for all symptoms, and above 0.35 for 16 of them. The latent trait generated using IRT placed fatigue, psychiatric, and cognitive manifestations as the most discriminative symptoms (coefficients > 1.5, p < 0.001). Latent trait severity was associated with decreased body weight and poorer physical performance (coefficients > 0.240; p ⩽ 0.003), and elevated blood levels of C-reactive protein (coefficient = 0.378; 95% CI 0.215-0.541; p < 0.001) and D-dimer (coefficient = 0.412; 95% CI 0.123-0.702; p = 0.005). Results were similar after excluding subjects with pro-inflammatory comorbidities. CONCLUSIONS: Different symptoms that persist for several months after moderate or severe COVID-19 may unite within one latent trait of PASC. This trait is dominated by fatigue and psychiatric symptoms, and is associated with objective signs of physical disability and persistent systemic inflammation.

Homelessness and Depressive Symptoms: A Systematic Review.

ABSTRACT: The present systematic review aimed to summarize data on the prevalence and treatment of depressive symptoms among homeless people. We referred to the PubMed and Google Scholar databases to identify relevant studies on the topic. Among the 43 included studies, we found great variability in the prevalence of depressive symptoms among homeless people (ranging from 9.9% to 77.5%). Comparative studies among the homeless versus nonhomeless population showed that rates of depressive symptoms are 5 to 14 times higher in the homeless population. Similar differences were also found for suicidal ideation. The lack of research and treatment plans for this specific population further encourages more evidence and special therapeutic intervention. Although little has been found in the literature, a substantial improvement in the quality of life and reduction in depressive symptoms was demonstrated when therapeutic interventions were performed among homeless people (i.e., housing, nursing, access to community care and effective services and supports programs, mindfulness, pharmacological treatment).

Analysis of global prevalence of mental and substance use disorders within countries: focus on sociodemographic characteristics and income levels.

This report presents the prevalence of mental and substance use disorders around the world discussing the impact of geographical, sociodemographic, and income characteristics on national epidemiological differences. We analysed data from the Institute of Health Metrics and Evaluation database published in 2019. The global prevalence of mental disorders was 13.0%, with higher prevalence of anxiety disorders rate (4.1%), followed by depressive disorders (3.8%, including major depressive disorder 2.49% and dysthymia 1.35%), intellectual disability (1.5%), ADHD (1.1%), conduct disorders (0.5%), bipolar disorders (0.5%), autism spectrum disorder s (0.4%), schizophrenia (0.3%), and eating disorders (0.2%, including bulimia nervosa 0.13% and anorexia nervosa 0.05%). The worldwide prevalence of substance-use disorders was 2.2%, not surprisingly, with higher prevalence of alcohol-use disorders (1.5%) than other drug-use disorders (0.8% total including: cannabis 0.32%; opioid 0.29%, amphetamine 0.10%; cocaine 0.06%). In general, high-income countries reported higher levels of mental and substance use disorders, with the exceptions of conduct and depressive disorders (no significant differences were found among low- and high-income countries), and intellectual disability (with higher prevalence in low-income countries). In regions of the America's prevalence rates of mental and substance use disorders were higher than in Europe. Western Pacific countries reported high levels of schizophrenia, and depressive disorders were highly prevalent in Africa as well as in the Americas. Intellectual disability reported higher rates in Eastern Mediterranean and South-East Asia. We discuss the cross-cultural variations in mental health expenditure and literacy as well as stigma-related factors and some of the environmental risk factors possibly related to these prevalence differences.

LGBT + medical students and disclosure of their sexual orientation: more than in and out of the closet.

Medical students face many challenge in their academic path. The disclosure of their own sexual orientation may be problematic since it impacts negatively on their acceptance in the educational environmental and the course of their career. Mental health issues may also occur among medical students as consequences of their perceived homophobia as well as stigma after the coming out. Research shows that students' attitude to the sexual orientation disclosure may vary across countries and cultures as well as students' homophobic attitudes towards sexual minorities: the latter should be addressed since prejudice might affect the quality of medical care for LGBT+ (Lesbian, Gay, Bisexual, Transgender) patients. We suggest that more education and training on LGBT + health issues is needed in the medical students' core-curricula: this would improve the health care of sexual minorities and LGBT + students' acceptance in the academic milieu.

New approaches for mental health of social minorities.

Mental health of social minorities is a challenge of modern psychiatry. It is largely described that people reporting sexual, cultural, religious variations are exposed to an amount of social stress deriving from the contrast between their minority status and the dominant societal norms and values. Minority stress leads to higher level of psychosocial distress and mental illness among these vulnerable populations. This conceptual research paper reports on evidences regarding the mental health issues related to the minority social condition and proposes a set of actions to address these challenges in a global perspective. Specifically, political, social and educational interventions are discussed in order to contrast stigma, discrimination, promote integration and health services for vulnerable populations. Policymakers are invited to deliver ad-hoc policies on minorities and homeless people with specific funding to address related public mental health issues. Educational programs are encouraged in the school setting as well as in the training of health care professionals in order to improve the level of acceptance and competencies in the treatment of minorities' health needs. We firmly believe there is no healthy society without healthy minorities.