In treatment-resistant major depression, ketamine was noninferior to ECT for treatment response.

SOURCE CITATION: Anand A, Mathew SJ, Sanacora G, et al. Ketamine versus ECT for nonpsychotic treatment-resistant major depression. N Engl J Med. 2023;388:2315-2325. 37224232.

Psychiatry Resident Physicians Experience Personal and Professional Grief, Burnout and Depression: Results From a National Survey.

BACKGROUND: Resident physicians experience personal and professional stressors throughout training. These experiences may increase levels of burnout, depression, and grief. Understanding how these stressors impact trainees is essential for improving wellbeing during residency. OBJECTIVE: We examined the prevalence and associations between burnout, depression, and grief among a national sample of psychiatry resident physicians. METHODS: A survey including validated scales for burnout (Modified Maslach Burnout Inventory-Health Services Survey [MBI]), depression (Patient Health Questionnaire-9 [PHQ-9]), and grief (Traumatic Grief Inventory Self Report [TGSIR]) was distributed to 296 psychiatry program directors in January 2023 for dispersal to their respective residents. RESULTS: Fifty-seven participants completed the survey out of 245 participants who opened and started the survey (23.3%). All participants were current psychiatry residents. MBI scores averaged 21.2 (SD 6.5, range 11-40); 11 participants reported high levels of burnout (scores >27; 19.3%). PHQ-9 scores averaged 3.42 (SD 3.0, range 0-14), with 8 responses meeting the criteria for moderate depressive symptoms (scores >10-14; 14.0%). Suicidal ideation was reported by 5 of 57 participants (8.7%). TGISR scores averaged 12.2 (SD 11, range 0-43); no participants met the criteria for pathologic grief. TGISR scores were correlated with MBI (r = .30; P = .02) and PHQ-9 scores (r = .53; P < .0001). MBI scores were also correlated with PHQ-9 scores (r = .54; P < .0001). CONCLUSIONS: Non-pathological grief was correlated with burnout and depression. 14% to 20% of psychiatry residents reported clinically significant levels of burnout and depression. Future studies should aim to further characterize burnout, depression, and grief in larger samples of trainees.

Top Ten Tips Palliative Care Clinicians Should Know About the Physical Manifestations of Psychiatric Illness and Treatment.

Addressing the psychiatric aspects of serious illness in palliative care (PC) is crucial to both care delivery and outcomes. Psychiatric comorbidities are common among patients with PC needs and can significantly impact their total burden of symptomatic distress, overall quality of life, functional independence, and healthcare utilization. Yet, these aspects of care are often deferred to mental health consultant teams in the context of busy PC services and often limited human resources. To provide comprehensive and person-centered care, PC clinicians must understand the interplay between medical conditions and psychiatric presentations within a biopsychosocial framework to respond empathically, efficiently, and effectively. This article is the first of a two-part series developed in collaboration with a group of psychiatric-palliative care specialists. This article explores ten common physical manifestations of psychiatric illness and treatment among patients facing serious illnesses. The second article will provide pragmatic tips PC clinicians should know about the psychiatric manifestations of nonpsychiatric serious illness and treatment. Combined, these two articles support a holistic approach that PC clinicians can use to prioritize and integrate both mental and emotional well-being throughout the continuum of serious illness.

Top Ten Tips Palliative Care Clinicians Should Know About the Psychiatric Manifestations of Nonpsychiatric Serious Illness and Treatments.

Mental health issues are widespread and significant among individuals with serious illness. Among patients receiving palliative care (PC), psychiatric comorbidities are common and impact patient quality of life. Despite their prevalence, PC clinicians face challenges in effectively addressing the intricate relationship between medical and psychiatric disorders due to their complex, intertwined and bidirectionally influential nature. This article, created collaboratively with a team of psychiatric-palliative care experts, is the second in a two-part series examining the bidirectional relationship between medical and psychiatric illness in PC. This article explores 10 prevalent psychiatric manifestations associated with severe illness and its treatment. Building upon the first article, which focused on 10 common physical manifestations of psychiatric illness among patients receiving PC, these two articles advocate for an integrated approach to PC that prioritizes mental and emotional wellbeing across the continuum of serious illness.

Preoperative comorbidity and modes of failure in revision hip arthroplasty: a single-surgeon series in a tertiary referral centre.

Revision hip arthroplasty is associated with higher morbidity post-operatively than primary surgery. We reviewed data on 102 consecutive patients (124 procedures) undergoing revision hip arthroplasty by a single surgeon from January 2005 to June 2009 in 2 institutions. Indications of failure: 62% aseptic loosening, 15% infection, 11.5% fracture, 10.6% dislocation or instability and 0.9% implant failure. Preoperative comorbidities: 28.4% cardiac, 4% respiratory and 6.8% diabetic. Morbidity: 3.9% complication rate (5 of 124 procedures). 73.5 median age and 46% over 75 years old. Modes of failure in our population leading to revision hip arthroplasty are similar to other studies. We showed a low morbidity following revision hip arthroplasty despite significant preoperative comorbidities and a high proportion of elderly patients. In conclusion, gender, age (>75) and preoperative comorbidities should not deter from revision surgery.

Grief in Medical Students: The Short and Long-Term Impacts on Health and Well-Being.

CONTEXT: Healthcare workers often experience grief stemming from the loss of patients under their care. The impact of personal grief on healthcare workers' wellbeing is less well described, particularly for trainees. To better characterize the prevalence and impact of personal grief on the mental and physical health of medical students, we conducted a survey of medical students at our institution. METHODS: An electronic Qualtrics survey was distributed to all currently enrolled medical students at our institution. After an initial question screening for loss before or during medical school, our survey assessed (1) basic demographic data; (2) relationship to the deceased; (3) impact of the loss on trainee health; and (4) utilization of institutional supports for grief. RESULTS: A total of 344 (68.8%) students responded to our survey. Two hundred and 25 (65.4%) students had experienced personal loss prior to or during medical school. 53.7% experienced more than 1 loss, with most of these losses (62.5%) occurring more than 2 years prior to the survey date. Up to 40% of respondents reported at least 1 psychologically distressing symptom that persisted beyond 1 year. Most students (93.8%) relied on family members for support; however, 23.2% of students indicated they would use institutional resources if available. CONCLUSION: Most medical students have experienced bereavement before or during medical school, which has had significant impact on their well-being. While medical students did not typically utilize institutionally based resources, many students expressed interest in such resources.

COVID-19-associated psychosis: A systematic review of case reports.

OBJECTIVES: To describe the comorbidities, presentations, and outcomes of adults with incident psychosis and a history of COVID-19. METHODS: We completed a descriptive systematic review of case reports according to PRISMA guidelines, including cases of adult patients with incident psychosis and antecedent or concurrent COVID-19. We extracted patient demographics, comorbidities, clinical course, and outcomes, and assessed cases for quality using a standardized tool. RESULTS: Of 2396 articles, we included 40 reports from 17 countries, comprising 48 patients. The mean age of patients was 43.9 years and 29 (60%) were males. A total of 7 (15%) had a documented psychiatric history, 6 (13%) had a substance use history and 11 (23%) had a comorbid medical condition. Delusions were the most common (44 [92%]) psychiatric sign and psychosis lasted between 2 and 90 days. A total of 33 (69%) patients required hospitalization to a medical service and 16 (33%) required inpatient psychiatric admission. The majority (26 [54%]) of cases did not assess for delirium and 15 (31%) cases were judged to be of high risk of bias. CONCLUSIONS: Despite the growing awareness of COVID-19's association with incident psychosis at a population level, cases of COVID-19-associated psychosis often lacked clinically relevant details and delirium was frequently not excluded. PROSPERO registration number: CRD42021256746.

Tracking of parents' attitudes to their children's oral health-related behavior-Oslo, Norway, 2002-04.

OBJECTIVES: To investigate dental beliefs and attitudes of a diverse group of parents from their children when they were aged 3 and 5 years old and to identify possible mediators for a group composed of the parents with the most negative dental attitudes. MATERIAL AND METHODS: Data were collected by parental questionnaire when the children were aged 3 years in 2002 and again 2 years later. The inclusion criteria were children with mothers from Norway (N group) or non-Western countries (IM(1) group). Questionnaires were extensive and had previously been used in a multicenter study. Three composite attitudinal variables relating to oral hygiene, diet and parental indulgence were calculated and an "attitudinal risk group" identified. The association between those variables and the assignment to the group was measured by odds ratio (bivariate and multiple logistic regression). RESULTS: The N parents' dental attitudes were significantly more positive in 2004 when their children were 5 years old than when they were 3 years old (p < 0.0001), but this was not the case among immigrant parents. "Education" and "Immigrant status" [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.6-7.0; and OR 2.8, CI 1.1-7.3, respectively] were significantly associated with the defined "attitudinal risk group". CONCLUSIONS: Only dental attitudes among N parents were significantly more positive in 2004 than in 2002. Not having higher education and being of non-Western background were associated with belonging to the "attitudinal risk group". Culturally tailored programs of dental health education are needed to promote more positive attitudes to oral health.

Opioid-induced Somatic Activation: Prevalence in a Population of Patients With Chronic Pain.

Context and objective Opioids have heterogeneous side effects including a well-known effect of sedation; however, the opposing effect of stimulation, or somatic activation, has been largely ignored or overlooked. The objective of this study is to determine the prevalence of opioid-induced somatic activation (OISA). Methods We conducted a retrospective chart review of 189 patients seen by a single clinical psychiatrist/pain specialist. During the initial encounter, the clinician took a standardized history of every opioid currently or previously taken by the patients, and enquired if the patients had experienced a somatically activating or sedating effect per opioid. Results Patients recalled an average exposure to 5.1 opioids (SD: 1.9). Ninety-one patients (48.1%; mean: 1.6) reported somatic activation, while 118 (62.4%; mean: 1.7) reported sedation from at least one opioid. Fifty-eight patients (30.7%) identified at least one opioid as activating, and another as sedating. The distribution of OISA did not significantly differ by gender, race, primary pain diagnosis, or depression. The distribution of OISA by oxycodone significantly differed compared to morphine sulfate (27.3% vs 8.9%; p: 0.005), while sedation did not (29.0% vs 24.3%; p: 0.46). Conclusions In this study, we quantified the previously unstudied phenomenon of OISA. This phenomenon appears dependent on opioid type with some opioids, such as oxycodone, appearing more likely to have this effect. Given current concerns about the risks of opioids in high-risk populations, future studies are needed to study this phenomenon to arrive at an accurate determination of the potential risks and benefits of OISA.

Top Ten Tips Palliative Care Clinicians Should Know About Bereavement and Grief.

Palliative care (PC) focuses on caring for the whole person, from birth to death, while managing symptoms and helping to navigate medical complexities. Care does not stop at the time of death, however, as assisting patients, families, and fellow clinicians through grief and bereavement is within PC's purview. Unfortunately, many clinicians feel unprepared to deal with these topics. In this article, PC and hospice clinicians define and explain bereavement, distinguish normative grief from pathological grief, offer psychometrically sound scales to screen and follow those suffering from grief, and discuss the interaction between grief and bereavement and the physical and mental health of those who are left behind after the death of a loved one.

Top Ten Tips Palliative Care Clinicians Should Know About Psychopharmacology.

Palliative care (PC) providers often prescribe psychotropic medications to address psychological and physical suffering of patients with serious medical illness. Consideration must be given to the significant medical comorbidities of the patient when selecting a medication. This article seeks to provide guidance on how to safely and effectively select a psychotropic agent for depression, anxiety, and other distressing symptoms for patients with serious illness. To do so, we draw upon a team of physicians and a pharmacist with training in psychiatry and PC to highlight the "Top 10" tips for selecting a psychotropic medication to provide relief for patients with serious medical illness.

Greater than the sum of the parts: Impact of radiographer clinical image interpretation.

Radiographer preliminary image evaluation, within strong governance and audit systems, can help reduce diagnostic errors in the emergency setting. Radiographers, clinicians and radiologists should work together as a team to improve patient care and outcomes.

Implicit domain adaptation with conditional generative adversarial networks for depth prediction in endoscopy.

PURPOSE: Colorectal cancer is the third most common cancer worldwide, and early therapeutic treatment of precancerous tissue during colonoscopy is crucial for better prognosis and can be curative. Navigation within the colon and comprehensive inspection of the endoluminal tissue are key to successful colonoscopy but can vary with the skill and experience of the endoscopist. Computer-assisted interventions in colonoscopy can provide better support tools for mapping the colon to ensure complete examination and for automatically detecting abnormal tissue regions. METHODS: We train the conditional generative adversarial network pix2pix, to transform monocular endoscopic images to depth, which can be a building block in a navigational pipeline or be used to measure the size of polyps during colonoscopy. To overcome the lack of labelled training data in endoscopy, we propose to use simulation environments and to additionally train the generator and discriminator of the model on unlabelled real video frames in order to adapt to real colonoscopy environments. RESULTS: We report promising results on synthetic, phantom and real datasets and show that generative models outperform discriminative models when predicting depth from colonoscopy images, in terms of both accuracy and robustness towards changes in domains. CONCLUSIONS: Training the discriminator and generator of the model on real images, we show that our model performs implicit domain adaptation, which is a key step towards bridging the gap between synthetic and real data. Importantly, we demonstrate the feasibility of training a single model to predict depth from both synthetic and real images without the need for explicit, unsupervised transformer networks mapping between the domains of synthetic and real data.

Top Ten Tips Palliative Care Clinicians Should Know About Mental Health and Serious Illness.

Palliative care has long recognized the importance of treating the whole person to address a patient's physical, mental, and spiritual suffering. To address psychological suffering, palliative care often draws upon the pharmacotherapy and psychotherapy offered by psychiatry. Several new developments have occurred in the past decade within psychiatry that impact palliative care. For example, the recent updating of the Diagnostic and Stastistical Manual of Mental Disorders has led to renewed discussions on how to best distinguish grief from depression or recognize that both may be present at the same time. In this article, we draw upon a team of psychiatric, palliative care, and dual-trained physicians to highlight the "Top 10" tips from psychiatry to provide relief for patients with chronic disease or at the end of life.

Parental risk attitudes and caries-related behaviours among immigrant and western native children in Oslo.

OBJECTIVES: Immigrant children make up a large proportion of the school populations in many western cities. It is likely that their parents have different attitudes and knowledge of dental health than resident populations, and thus provide a challenge to public dental services. This study sought to map existing disparities in oral health among immigrant and western native children in Oslo and to identify differences in parental, cultural and ethnic beliefs and attitudes towards oral health and caries-related behaviours. METHODS: Caries was recorded of 735 children (3- and 5-year olds), supplemented with radiographs among 5-year olds. Their parents responded to a questionnaire. RESULTS: Immigrant background, consumption of sweet drinks at bed and social status were the dominant caries risk indicators among the 3-year olds. Among the 5-year olds, the caries risk indicators were immigrant background, parental indulgence, attitude to diet, attitude to oral hygiene, social status and age starting toothbrushing. Being an immigrant was closely associated with higher caries prevalence and experience. Parental attitudes to oral hygiene, diet and indulgence, and caries-related behaviours distinguished immigrants from western natives. CONCLUSIONS: The results suggest that immigrant groups in western societies require different information packages, modified strategies for forming oral hygiene habits and attitudes related to dental care of children, and encouragement to exercise discipline on factors known to be risks for oral health. These strategies must recognize that immigrants and western natives attach different levels of importance to oral health and dental parameters. It should be paid extra attention to some caries high-risk subgroups.

Dental status and measures of deprivation in Clermont-Ferrand, France.

BACKGROUND: Many background variables, such as socioeconomic status (SES), may be measured at the level of the individual or using some ecological indicators. OBJECTIVES: This study aimed to examine, in 5- and 10-year-olds in Clermont-Ferrand, the relationship between household SES indicators, SES measured as an area-based ecological variable and dental status. METHODS: All 5- and 10-year-olds attending public schools in deprived and semi-deprived zones (n = 15) and six other randomly selected schools in Clermont-Ferrand were invited to participate. All children were examined clinically. On a questionnaire, parents provided sociodemographic information. RESULTS: Of the children invited, 84% (880 children) were examined. Mean dft of 5-year-olds was 0.93 (SD 2.27); 26.5% had at least one tooth affected. The caries experience (DMFT) of 10-year-olds was 0.85 (SD 1.14) and 37.2% had permanent tooth caries experience. Caries experience varied significantly with school deprivation status: the greater the deprivation score, the more likely was poor dental health. Country of birth, parents' employment status, family size and health insurance type were significantly related to dental status. Logistic analyses estimated the importance of SES and ecological variables; deprivation influenced dental status in 5-year-olds even when household SES indicators were considered. In 10-year-olds, caries experience was influenced by household SES, immigrant background, father's employment and family size. CONCLUSION: The use of school deprivation as an ecological measure status was useful for identifying population subgroups with different levels of oral health, particularly in young children. This indicator of social deprivation could be used for targeting preventive programmes to high caries risk communities defined geographically.

Does personality at college entry predict number of reported pain conditions at mid-life? A longitudinal study.

UNLABELLED: The purpose of this study was to evaluate whether personality traits, as assessed by the Minnesota Multiphasic Personality Inventory (MMPI), at time of college entry can predict the number of reported pain conditions at an approximate 30-year follow-up for 2332 subjects, 1834 men and 498 women, who were administered the MMPI on entry to the University of North Carolina (Chapel Hill) between 1964 and 1966. In 1997, a follow-up was conducted in which subjects were administered a self-report questionnaire regarding whether they had experienced 1 or more chronic pain conditions. Analyses of the relationship between the MMPI clinical scales at college entrance and the report of number of chronic pain conditions at follow-up were conducted. Among male participants, elevations of Scales 1 (Hypochondriasis), 3 (Hysteria), and 5 (Masculinity/Femininity) predicted increases in number of chronic pain conditions at follow-up. For female participants, elevations in Scales 1, 3, and 6 (Paranoia) predicted increases in number of chronic pain conditions at follow-up. The current study suggests that a statistically significant relationship exists between MMPI responses at college entry and reports of chronic pain conditions at mid-life. PERSPECTIVE: This study found a small, but significant relationship between elevations on MMPI scales measuring hypochondriasis and hysteria and the report of chronic pain conditions at follow-up. The study is important because it is the first to examine how personality assessed in younger adults relates to the number of chronic pain conditions reported 30 years later.

Caries experience in the primary dentition among French 6-year-olds between 1991 and 2000.

BACKGROUND: There are few national caries preventive policies for children in France. Various surveys suggest that in the late 1980s, oral health of the 6-year olds in France was poorer than in those of other European countries. In Val de Marne (a Department just east of Paris) a public dental service was established in 1991. A programme to inform preschool staff about dental diseases was commenced and volunteers brought oral health information to parents and health professionals. Periodical monitoring of primary tooth caries of 6-year olds was planned. AIM: The aim of the study was to evaluate changes in primary tooth caries in 6-year olds over the 10 years of the programme. METHODS: Participating 6-year olds, randomly selected, were examined in schools by dentists. Clinical data were collected (WHO criteria). Sociodemographic data were collected through questionnaire. Statistical analysis involved comparison of mean values, variance analysis and chi-square test for categorical variables. RESULTS: The proportions of children with caries experience were, 38.9%, 30.6% and 22.2% in 1991, 1995 and 2000 respectively (P < 0.01). The dft index decreased from 1.74 to 1.39 and 1.05 respectively. About 75% of children with dental caries remained untreated. Children of non-European native parents or belonging to low socioeconomic families remained those most affected by dental caries in 2000. CONCLUSION: Dental caries in 6-year olds improved between 1991 and 2000 in Val de Marne but caries remained a socially inequitable disease. Most children did not have access to dental care. The situation requires changes to the dental care provision system.

A 1-year study of osteoinduction in hydroxyapatite-derived biomaterials in an adult sheep model: part I.

The study presented here investigated hydroxyapatite biomaterials implanted in soft-tissue sites in adult sheep to determine whether these materials are osteoinductive and whether the rate of osteoinduction can be increased by manipulating the composition and porosity of the implants. For the study, 16.8-mm x 5-mm discs were prepared from mixtures of hydroxyapatite and beta-tricalcium phosphate. Five mixtures of hydroxyapatite-ceramic and hydroxyapatite-cement paste forms were studied: 100 percent hydroxyapatite-ceramic (Interpore), 60 percent hydroxyapatite-ceramic, 100 percent hydroxyapatite-cement paste, 60 percent hydroxyapatite-cement paste, and 20 percent hydroxyapatite-cement paste. Biomaterials were implanted in subcutaneous and intramuscular soft-tissue pockets in 10 adult sheep. Cranial bone grafts of equal dimension were implanted as controls. One year after implantation, the volume of all biomaterials and bone grafts was determined from a computed tomographic scan, and porosity and bone formation were determined using backscatter electron microscopy. Cranial bone and the 20 percent hydroxyapatite-cement paste implants demonstrated significant volume reduction in all sites after 1 year (p < 0.001). No significant difference in volume of the remaining four biomaterials was found. There was no significant change in pore size in the ceramic implants (range, 200 to 300 micro) and in the cement-paste implants containing 60 percent hydroxyapatite or more (range, 3 to 5 nm). Pore size in the cement-paste implants containing 20 percent hydroxyapatite increased significantly with resorption of the tricalcium-phosphate component, reaching a maximum of 200 to 300 micro in the periphery, where the greatest tricalcium-phosphate resorption had occurred. Both ceramic biomaterials demonstrated lamellar bone deposition within well-formed haversian systems through the entire depth of the implants, ranging from a mean of 6.6 percent to 11.7 percent. There was minimal bone formation in the cement-paste implants containing 60 percent hydroxyapatite or more. In contrast, cement-paste implants containing 20 percent hydroxyapatite demonstrated up to 10 percent bone replacement, which was greatest in the periphery of the implants where the greatest tricalcium-phosphate resorption had occurred. This study confirms the occurrence of true osteoinduction within hydroxyapatite-derived biomaterials, when examined using backscatter techniques. In this study, the rate of osteoinduction was greatest when a porous architecture was maintained, which was best achieved in ceramic rather than cement-paste forms of hydroxyapatite. Porosity and resultant bone formation in cement-paste implants can be improved by combining hydroxyapatite with a rapidly resorbing component, such as tricalcium phosphate.