Using Electroencephalogram-Extracted Nonlinear Complexity and Wavelet-Extracted Power Rhythm Features during the Performance of Demanding Cognitive Tasks (Aristotle's Syllogisms) in Optimally Classifying Patients with Anorexia Nervosa.

Anorexia nervosa is associated with impaired cognitive flexibility and central coherence, i.e., the ability to provide an overview of complex information. Therefore, the aim of the present study was to evaluate EEG features elicited from patients with anorexia nervosa and healthy controls during mental tasks (valid and invalid Aristotelian syllogisms and paradoxes). Particularly, we examined the combination of the most significant syllogisms with selected features (relative power of the time-frequency domain and wavelet-estimated EEG-specific waves, Higuchi fractal dimension (HFD), and information-oriented approximate entropy (AppEn)). We found that alpha, beta, gamma, theta waves, and AppEn are the most suitable measures, which, when combined with specific syllogisms, form a powerful tool for efficiently classifying healthy subjects and patients with AN. We assessed the performance of triadic combinations of "feature-classifier-syllogism" via machine learning techniques in correctly classifying new subjects in these two groups. The following triads attain the best classifications: (a) "AppEn-invalid-ensemble BT classifier" (accuracy 83.3%), (b) "Higuchi FD-valid-linear discriminant" (accuracy 75%), (c) "alpha amplitude-valid-SVM" (accuracy 83.3%), (d) "alpha RP-paradox-ensemble BT" (accuracy 85%), (e) "beta RP-valid-ensemble" (accuracy 85%), (f) "gamma RP-valid-SVM" (accuracy 85%), and (g) "theta RP-valid-KNN" (accuracy 80%). Our findings suggest that anorexia nervosa has a specific information-processing style across reasoning tasks in the brain as measured via EEG activity. Our findings also contribute to further supporting the view that entropy-oriented, i.e., information-based features (the AppEn measure used in this study) are promising diagnostic tools (biomarkers) in clinical applications related to medical classification problems. Furthermore, the main EEG-specific frequency waves are extremely enhanced and become powerful classification tools when combined with Aristotle's syllogisms.

Temperament and character dimensions explain self-reported resilience deficits in patients with affective disorders.

This is the first study exploring how temperament and character personality dimensions impact self-reported resilience in major depressive disorder (MDD) and bipolar disorder (BD). We included 130 euthymic patients with affective disorders (AFD; 66 MDD and 64 BD) and 134 healthy controls (HC). Connor and Davidson resilience scale and Temperament and Character Inventory (TCI-140) were administered. Multiple linear regressions and interaction analyses were performed. Mediation analyses examined if personality dimensions explained group differences in resilience. Resilience was lower in MDD and BD vs. HC and in MDD vs. BD, adjusting for sex, age and education. Higher resilience was predicted by lower harm avoidance (HA) and higher persistence (P) in AFD and MDD, lower HA in BD and higher P and self-directedness (SD) in HC. However, only HA and P had a group-specific effect on resilience in AFD vs. HC. In mediation analyses, specific TCI dimensions at least partially explained differences in resilience: HA, P and SD in AFD or MDD vs. HC; SD in BD vs. HC; P in BD vs. MDD. Concludingly, two temperament traits (HA, P) and a character trait (SD) predict resilience in AFD. Focusing on personality could identify sources of compromised resilience as potential treatment targets.

Efficacy of a conservative physical treatment regimen on psychological status and quality of life in Greek patients with chronic low back pain.

Chronic Low Back Pain (CLBP) is a very common health problem that has a great negative impact on the quality of life and the psychological well-being of backache patients. Literature findings have shown that a conventional physiotherapeutic approach is a beneficial choice for CLBP management. The aim of this study was to examine the short-term effects of a conservative physical treatment on depression, anxiety, somatic symptom disorders (SSD), quality of life, pain and disability in Greek individuals suffering from CLBP. Seventy-five CLBP patients were recruited using random systematic sampling. All subjects received ultrasound, low-level laser, massage, transcutaneous electrical nerve stimulation (ΤENS) and alongside an exercise program (sum of 10 sessions, 5 times per week). The intervention was assessed by comparing pre and post outcome measurements based on the Hospital Anxiety and Depression Scale (HADS), Somatic Symptom Scale-8 (SSS-8), EuroQol 5-dimension 5-level (EQ-5D-5L), Roland-Morris Disability Questionnaire (RMDQ) and Pain Numerical Rating Scale (PNRS) instruments. The mean age of the sample was 60.8 years (±14.4) and nearly one out of four (25.3%) was obese. After the end of the treatment, there were improvements in EQ-5D-5L indices and decreases in HADS, SSS-8, RMDQ and PNRS scores, which were found to be statistically significant. Greater effect size was found in PNRS (d=0.75), followed by EQ-5D-5L index value scale (d=0.42), SSS-8 (d=0.38), EQ-5D-5L VAS (d=0.36), RMDQ (d=0.29), HADS-A (d=0.16) and HADS-D (d=0.14). Men and women had similar changes in all under-study scales after the treatment, while besides pain scale, the pre-intervention scores as well as the degree of change in all scores were similar across all Body Mass Index (BMI) levels. In conclusion, convectional physical treatment was found to be an effective option in improving considerably the psychological status and quality of life, while also decreasing functional disability and pain in CLBP patients in the short run.

A modern web-based health promotion program for patients in Greece with diabetes 2 and obesity: an interventional study.

BACKGROUND: Health promotion programs are most beneficial in chronic diseases such as diabetes and morbid obesity, which can be positively affected by changes in attitudes, beliefs, and lifestyle. OBJECTIVES: This study aimed to develop an internet-based modern Health Promotion model using interactive online applications through continuing education and participation. METHODS: The goal was to positively impact knowledge, behavior, and quality of life for patients with obesity and/or diabetes. This is a prospective interventional study on patients with obesity or type 2 diabetes. Seventeen two patients who met the inclusion criteria were distributed randomly into two groups (control and intervention) from 2019 to 2021 in Greece. All the participants were given questionaries concerning quality of life anxiety and depression (HADS) attitudes and beliefs, knowledge about their condition and general questions to establish a baseline. A traditional health promotion model was followed for the control group. For participants in the intervention group, a web-based health promotion program was created according to the goals of the research. Participants were instructed to log on 1-2 times a week for 5-15 min, with the understanding that the research team would be monitoring their activities. The website included two knowledge games and personalized educational material based on their needs. RESULTS: The sample comprised 72 patients (36 in control and 36 in the intervention groups). The mean age was 47.8 years for the control group and 42.7 years for the intervention group (p = 0.293). Both study groups had a significant increase in knowledge score on diabetes (Control group:3,24, Intervention group 11,88 p < 0,001) and obesity (Control group:4,9, Intervention group 51,63 p < 0,001) along with a positive attitude score towards fighting obesity (Control group: 1,8, Intervention group 13,6 p < 0,001). Still, the overall change was more remarkable for the intervention group, as indicated by the significant interaction effect of the analysis. Anxiety was decreased only in the intervention group (Control group:0,11, Intervention group - 0,17 p < 0,005). Analysis for QOL during follow-up showed that Physical Health and Level of Independence was improved in both study groups but the degree of improvement was more significant in the intervention group (Control group 0,31,Intervention group 0,73 p < 0,001). Psychological Health was improved only in the intervention group, with better scores at 6 and 12 months compared to controls (Control group 0,28,Intervention group 1,42 p < 0,001). Furthermore, Social relationships were improved only in the intervention group (Control group 0,02, Intervention group 0,56 p < 0,001). CONCLUSIONS: The results of the present study showed that the participants in the intervention group showed significant improvement in knowledge, attitudes, and beliefs after using the internet as a learning tool. The intervention group also showed significantly reduced anxiety and depression arising from chronic illness. All of this resulted in an improved quality of life regarding physical Health, mental Health, and social relationships. Technology and online-based health promotion programs can revolutionize how we approach the prevention and management of chronic and terminal illnesses by improving accessibility, personalizing care, increasing engagement and motivation, improving data analysis, and disease management.

Associations of somatic symptom disorder with pain, disability and quality of life in patients with chronic low back pain.

Literature findings have suggested that psychological factors, including anxiety, depression and somatic symptom disorder (SSD), are predictors of poor outcomes in individuals with chronic low back pain (CLBP). The aim of this study was to examine the correlations between anxiety, depression and SSD with pain, disability and health-related quality of life (HRQoL) in Greek CLBP patients. Ninety-two participants with CLBP recruited using random systematic sampling from an outpatient physiotherapy department, who completed a battery of paper-and-pencil questionnaires included items on demographic characteristics, as well the Numerical Pain Rating Scale (NPRS) for pain, the Rolland-Morris Disability Questionnaire for disability (RMDQ), the EuroQoL 5-dimension 5-level (EQ-5D-5L) for health status, the Somatic Symptom Scale-8 (SSS-8) for SSD, the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression. A Mann-Whitney test and a Kruskall-Wallis test were used for the comparison of continuous variables between two groups and among more than two groups, respectively. Moreover, Spearman correlations coefficients were used to explore the association between subjects' demographics, SSS-8, HADS-Anxiety, HADS-Depression, NPS, RMDQ and EQ-5D-5L indices. Predictors of health status, pain and disability were assessed using multiple regression analyses, whereas the level of statistical significance was set at p<0.05. The response rate was 94.6% (87 participants, 55 of whom were women) and the mean age of the sample was 59.6 years (SD=15.1). A tendency of weak negative associations was noted between scores of SSD, anxiety and depression with EQ-5D-5L indices, whereas only a weak positive correlation was found between levels of SSD with pain and disability. After examining in a multiple regression analysis, only SSD emerged as prognostic factor of poor HRQoL, greater levels of pain and disability. In conclusion, the elevated scores of SSD significantly predict worse HRQoL, intense pain and severe disability in Greek CLBP patients. Further research is needed to test our findings in larger and more representative samples of the Greek general population.

Non-pharmacological Interventions on Pain and Quality of Life in Chemotherapy Induced Polyneuropathy: Systematic Review and Meta-Analysis.

BACKGROUND/AIM: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment, resulting in pain, numbness, instability, and thus affecting quality of life (QoL), occasionally leading to discontinuation of chemotherapy. Pharmacological treatments are not sufficient. Non-pharmacological interventions (NPIs) have also been tried. This study aimed to systematically review the efficacy of NPIs on pain and QoL in patients suffering from CIPN. MATERIALS AND METHODS: The databases searched were Pubmed, Cohrane, and Scopus for randomized controlled trials (RCTs) published in the last 5 years (2017-2022). Studies were considered eligible, if they assessed adult patients suffering from CIPN because of any chemotherapeutic drug for any type and any stage of cancer and if study protocols included non-pharmacological intervention with a structured protocol. RESULTS: A total of 1,496 records were identified. Finally, 10 RCTs including 495 patients (253 in the intervention group and 242 in the control group) were included for meta-analysis. Intervention protocols included acupuncture (n=6), exercise (n=3), and yoga (n=1). NPIs significantly reduced neuropathic pain. However, the effect on QoL was not significant. CONCLUSION: NPIs are beneficial in the treatment of pain in patients with CIPN but their impact on QoL is not statistically supported. Larger sample sizes, more homogenous in outcome measures and interventions are needed to further explore NPIs' efficacy on CIPN symptoms.

Empathy and Violence in Schizophrenia and Antisocial Personality Disorder.

A paucity of cognitive and affective features of empathy can be correlated with violent behavior. We aimed to identify differences in empathy among four groups in a sample of 100 male participants: (1) 27 violent offenders with schizophrenia, (2) 23 nonviolent patients with schizophrenia, (3) 25 patients with antisocial personality disorder, and (4) 25 subjects from the general population, who formed the control group. Schizophrenia symptoms were quantified with the Positive and Negative Syndrome Scale. Empathy was measured with the empathy quotient. Theory of mind was evaluated using (a) the first-order false-belief task, (b) the hinting task, (c) the faux pas recognition test and (d) the "reading the mind in the eyes" test (revised). Differences noted among the groups were age (controls were younger) and educational status (antisocials were less educated). The empathy quotient scoring (p < 0.001) and theory-of-mind tests (p < 0.001) were distinct between the control group and the three other groups of participants, but not among the three patient groups. Patients with antisocial personality disorder, violent psychotic offenders and psychotic nonviolent patients show no remarkable differences in affective or cognitive empathy tests, but they all present deficits in empathy and theory of mind when compared to controls.

The Impact of the COVID-19 Pandemic and Associated Control Measures on the Mental Health of the General Population : A Systematic Review and Dose-Response Meta-analysis.

BACKGROUND: To what extent the COVID-19 pandemic and its containment measures influenced mental health in the general population is still unclear. PURPOSE: To assess the trajectory of mental health symptoms during the first year of the pandemic and examine dose-response relations with characteristics of the pandemic and its containment. DATA SOURCES: Relevant articles were identified from the living evidence database of the COVID-19 Open Access Project, which indexes COVID-19-related publications from MEDLINE via PubMed, Embase via Ovid, and PsycInfo. Preprint publications were not considered. STUDY SELECTION: Longitudinal studies that reported data on the general population's mental health using validated scales and that were published before 31 March 2021 were eligible. DATA EXTRACTION: An international crowd of 109 trained reviewers screened references and extracted study characteristics, participant characteristics, and symptom scores at each timepoint. Data were also included for the following country-specific variables: days since the first case of SARS-CoV-2 infection, the stringency of governmental containment measures, and the cumulative numbers of cases and deaths. DATA SYNTHESIS: In a total of 43 studies (331 628 participants), changes in symptoms of psychological distress, sleep disturbances, and mental well-being varied substantially across studies. On average, depression and anxiety symptoms worsened in the first 2 months of the pandemic (standardized mean difference at 60 days, -0.39 [95% credible interval, -0.76 to -0.03]); thereafter, the trajectories were heterogeneous. There was a linear association of worsening depression and anxiety with increasing numbers of reported cases of SARS-CoV-2 infection and increasing stringency in governmental measures. Gender, age, country, deprivation, inequalities, risk of bias, and study design did not modify these associations. LIMITATIONS: The certainty of the evidence was low because of the high risk of bias in included studies and the large amount of heterogeneity. Stringency measures and surges in cases were strongly correlated and changed over time. The observed associations should not be interpreted as causal relationships. CONCLUSION: Although an initial increase in average symptoms of depression and anxiety and an association between higher numbers of reported cases and more stringent measures were found, changes in mental health symptoms varied substantially across studies after the first 2 months of the pandemic. This suggests that different populations responded differently to the psychological stress generated by the pandemic and its containment measures. PRIMARY FUNDING SOURCE: Swiss National Science Foundation. (PROSPERO: CRD42020180049).

A one-year longitudinal study on suicidal ideation, depression and anxiety during the COVID-19 pandemic.

This longitudinal study aimed to examine the within-person changes in suicidal ideation, depression, and anxiety between the first wave of COVID-19 pandemic and the third wave (i.e., one year later), while nationwide lockdowns were in effect. Among 720 respondents, 4.72% presented suicidal ideation, which appeared unaltered one-year post-pandemic onset, while both depression (21.25% versus 28.06%) and anxiety (12.08% versus 18.47%) increased significantly, adjusting for gender, age, and mental health history. Suicidal ideation, depression, and anxiety during the third pandemic wave were independently associated with crucial socio-demographic, clinical, psychological and psychopathological variables, in the stepwise regression analyses performed.

Effectiveness of a hybrid arts-based Cognitive Behavioral Therapy intervention for patients with non-malignant chronic pain.

Chronic Pain (CP) is defined as pain that persists or recurs for more than 3 to 6 months and may be conceived as a health condition in its own right. CP is a frequent condition, affecting an estimated 20% of people worldwide and requires special treatment and care. CP can contribute to depression, anxiety, sleep disturbances, poor quality of life and increased health care costs. Psychosocial approaches based on a cognitive conceptualization of pain can provide a solid foundation for research and clinical work. The development of a 10 week-session group treatment was based on key principles from the literature on Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) and Creative Arts Therapy, integrated with advances in research on CP management framework. The aim of this study is to evaluate a CBT-CP arts-based group intervention for patients with non-malignant CP addressing the biopsychosocial factors that influence pain perception. A total of 100 University Pain Management Unit outpatients participated, 50 in the intervention group and 50 in the control group (treatment as usual). In analyses of the pretest-posttest research design intervention including all participants, treatment gains were observed in almost all domains examined: severity of pain measured by the Brief Pain Inventory, conceptualization of mental pain measured by the Orbach and Mikulincer Mental Pain Scale, tolerance for psychological pain measured by the Tolerance for Mental Pain Scale, anxiety and depression levels measured by the Hospital Anxiety and Depression Scale, and quality of life measured by the WHO Quality of Life-BREF Questionnaire. The participants' mean age was 52.3 years and most were female (84%). Findings suggest that postprogram, there was significant reduction in pain intensity (p<0.001), depressive symptoms (p<0.001), confusion about pain (p=0.037), and improvement of emotional distress tolerance (p=0.012) and global health-related quality of life (p<0.001) in the intervention group. Beneficial effects can be expected from the implementation of an integrated CP intervention (including: creative and CBT techniques) reappraising some of the coping responses defined as adaptive within current psychosocial non-malignant CP regimens.

Modern bioethical issues: Euthanasia, physician assisted suicide and abortion. Comparative study of attitudes between physicians and law professionals.

We aimed to examine and compare the attitudes of physicians and law professionals on modern bioethical issues. Euthanasia, physician assisted suicide and abortion were selected for this study, as they underline the conflict between human life as a fundamental value, and the individual's right to self-determination. The demand of euthanasia and physician assisted suicide services reflects each person's right to decide on the way their life will end, while the legalization of abortion determines the individual's right to self-determination. These are complex issues with moral, religious and social implications, and as such tend to divide public opinion. In order to investigate their attitudes, physicians of all specialties, as well as law professionals from all over Greece, were invited to participate in the study. In total, 220 professionals responded to the call and participated in the survey. The professionals involved showed fairly high rates of agreement in all the issues studied, but a significant difference in results was found when the occupation of participants was set as a criterion, with physicians being more negative to euthanasia, physician assisted suicide and abortion than lawyers. Religiousness, age and male sex were negatively correlated with "positive" attitudes towards euthanasia, physician assisted suicide and abortion. Moreover, participants' attitudes towards euthanasia and physician assisted suicide were found to predict their attitudes towards abortion, indicating a single ideological direction of agreement or disagreement, accordingly. Individuals' attitudes and opinions are complicated issues, not easy to be categorized. However, it is of scientific interest to shape a legislative framework that is close to the social consensus, ideological evolution and moral needs. This study tried to pave the way for a modern approach to the issues of euthanasia, physician assisted suicide and abortion.

Differential association of cortisol with visual memory/learning and executive function in Bipolar Disorder.

The association of cortisol with cognition has been understudied in Bipolar Disorder (BD); available evidence is inconsistent while it is unknown whether cortisol's effects vary across neurocognitive domains implicating different brain structures. This study aimed to examine the association of cortisol with two cognitive tasks targeting visual memory and executive function (planning) in BD, related to the hippocampus and prefrontal lobe, respectively. Cambridge Neuropsychological Test Automated Battery (CANTAB) tasks targeting paired associative learning (PAL) and planning (Stockings of Cambridge; SOC) were administered to 60 BD type I patients. Basal serum cortisol was also measured. Higher cortisol was associated with worse performance in PAL, but not SOC, after controlling for gender, education, illness duration and treatment with mood stabilizers. This is the first study to examine the association of cortisol with neurocognitive function in BD while controlling for clinicodemographic and treatment-related factors. We found a significant association of cortisol with hippocampal-related visual memory/learning but not with prefrontal lobe-related executive function, suggesting domain-specific underlying mechanisms of cognitive dysfunction in BD. Future studies should further explore cortisol's brain structure-specific effects on cognitive functioning in BD.

Olfactory capacity in anorexia nervosa: correlations with set-shifting ability.

PURPOSE: The purpose of this study is to examine olfactory capacity in adults with anorexia nervosa (AN), in terms of odor identification and odor threshold and search for possible correlations between odor identification and cognitive flexibility in this population. METHODS: Thirty-nine patients diagnosed with AN and 60 healthy participants, participated. Odor identification was assessed using the University Pennsylvania Smell Identification Test and a two alternative forced choice, ascending method with n-butanol was used to assess odor threshold. Cognitive flexibility was determined using the Intra/Extra-Dimensional Set-Shift test (IED), a subtest of the Cambridge Neuropsychological Test Automated Battery (CANTAB). RESULTS: Patients with AN presented a poorer performance in odor identification compared with controls (p = 0.001). No differences were found in odor threshold, between the two groups. Patients with AN exhibited poor cognitive flexibility compared with controls (p = 0.003). A significant correlation between odor identification and cognitive flexibility was documented in AN (p = 0.01), but not in controls. CONCLUSION: Our findings suggest that olfactory capacity is altered in AN: Qualitative characteristics of olfaction were affected in patients with AN (lower odor identification), while there was no difference in quantitative characteristics (odor threshold) compared with controls. Furthermore, odor identification in AN was correlated to cognitive flexibility. LEVEL OF EVIDENCE: Level III: case-control analytic study.

Neurophysiological and ultrasonographic comparative study of autonomous nervous system in patients suffering from fibromyalgia and generalized anxiety disorder.

BACKGROUND: Fibromyalgia (FM) and generalized anxiety disorder (GAD) share common clinical features: they both affect women more than men, their diagnosis is based solely on clinical criteria, and some of the symptoms such as anxiety, aches and muscle tension, sleep disorders, and cognitive dysfunction occur in both diseases. For both conditions, an underlying dysregulation of the autonomic nervous system (ANS) has been proposed. OBJECTIVE: The aims of this study were to investigate ANS dysfunction in FM and GAD and compare them with controls. METHODS: Sympathetic skin response (SSR) from palm and sole and cross-sectional area (CSA) of bilateral vagus nerves (VN) were measured in 28 healthy controls, 21 FM patients, and 24 GAD patients. RESULTS: CSA of VN was significantly smaller in FM patients (right: 1.97 ± 0.74mm2, left: 1.75 ± 0.65 mm2) and GAD patients (right: 2.12 ± 0.97mm2, left: 1.71 ± 0.86 mm2) compared to controls (right: 3.21 ± 0.75 mm2, left: 2.65 ± 1.13 mm2, p < 0.001, but did not differ between the two patient groups. SSR parameters were similar between patients and controls. SSR latency correlated to clinical scales (FM Widespread Pain Index) in the FM group (r = 0.515, p = 0.02 and r = 0.447, p = 0.05) for the upper and lower limbs respectively, but no other correlation between clinical and neurophysiological parameters was identified. CONCLUSION: This study confirms similar ANS abnormalities in FM and GAD that fairly distinguish them from controls and support the hypothesis of a common pathophysiological substrate underlying both conditions.

Gender, age at onset, and duration of being ill as predictors for the long-term course and outcome of schizophrenia: an international multicenter study.

BACKGROUND: The aim of the current study was to explore the effect of gender, age at onset, and duration on the long-term course of schizophrenia. METHODS: Twenty-nine centers from 25 countries representing all continents participated in the study that included 2358 patients aged 37.21 ± 11.87 years with a DSM-IV or DSM-5 diagnosis of schizophrenia; the Positive and Negative Syndrome Scale as well as relevant clinicodemographic data were gathered. Analysis of variance and analysis of covariance were used, and the methodology corrected for the presence of potentially confounding effects. RESULTS: There was a 3-year later age at onset for females (P < .001) and lower rates of negative symptoms (P < .01) and higher depression/anxiety measures (P < .05) at some stages. The age at onset manifested a distribution with a single peak for both genders with a tendency of patients with younger onset having slower advancement through illness stages (P = .001). No significant effects were found concerning duration of illness. DISCUSSION: Our results confirmed a later onset and a possibly more benign course and outcome in females. Age at onset manifested a single peak in both genders, and surprisingly, earlier onset was related to a slower progression of the illness. No effect of duration has been detected. These results are partially in accord with the literature, but they also differ as a consequence of the different starting point of our methodology (a novel staging model), which in our opinion precluded the impact of confounding effects. Future research should focus on the therapeutic policy and implications of these results in more representative samples.

An age-period-cohort study of completed suicides in Greece: Patterns and implications for suicide prevention.

Suicide is a dynamic phenomenon. Psychiatric medication intake, illicit drug and alcohol use or the preference for particular suicide methods shift continuously over time. To capture such variations -and their potential implications for suicide prevention-, we researched the forensic records of suicide cases for the period 1992-2016 at a large department of forensic medicine and conducted age-period-cohort (APC) analyses of our sample (1162 suicides, 77.45% males, 22.25% females). We primarily investigated socio-demographic and toxicological parameters. Benzodiazepine, alcohol and illicit drug use increased considerably towards the younger cohorts. The segment of individuals of foreign nationality raised significantly too; likewise, the proportion of prison suicides. Hanging appears increasingly preferred by the younger APCs (the opposite is true for jumping). Hanging seems more popular among males, prisoners, and those under the influence of illicit drugs; jumping by females and those less likely to have consumed alcohol or illicit drugs. Given that the method of a prior attempt, if a highly lethal one, usually gets repeated in the completed suicide, a history of an attempt by hanging should never be underestimated. The mental health needs of immigrants and prisoners look inadequately addressed. Young-middle aged immigrant prisoners appear a group at high suicide risk.

Cerebral Venous Sinus Thrombosis and Thrombotic Events After Vector-Based COVID-19 Vaccines: A Systematic Review and Meta-analysis.

BACKGROUND AND OBJECTIVES: There is accumulating evidence supporting an association between the thrombosis and thrombocytopenia syndrome (TTS) and adenovirus vector-based vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Yet TTS and TTS-associated cerebral venous sinus thrombosis (CVST) remain poorly characterized. We aim to systematically evaluate the proportion of CVST among TTS cases and assess its characteristics and outcomes. METHODS: We performed a systematic review and meta-analysis of clinical trials, cohorts, case series, and registry-based studies with the aim to assess (1) the pooled mortality rate of CVST, TTS-associated CVST, and TTS and (2) the pooled proportion of patients with CVST among patients with any thrombotic event and TTS. Secondary outcomes comprised clinical characteristics of patients with postvaccination thrombotic event. This meta-analysis is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was written according to the Meta-analysis of Observational Studies in Epidemiology proposal. RESULTS: Sixty-nine studies were included in the qualitative analysis comprising 370 patients with CVST out of 4,182 patients with any thrombotic event associated with SARS-CoV-2 vector-based vaccine administration. Twenty-three studies were included further in quantitative meta-analysis. Among TTS cases, the pooled proportion of CVST was 51% (95% confidence interval [CI] 36%-66%; I 2 = 61%). TTS was independently associated with a higher likelihood of CVST when compared to patients without TTS with thrombotic events after vaccination (odds ratio 13.8; 95% CI 2.0-97.3; I 2 = 78%). The pooled mortality rates of TTS and TTS-associated CVST were 28% (95% CI 21%-36%) and 38% (95% CI 27%-49%), respectively. Thrombotic complications developed within 2 weeks of exposure to vector-based SARS-CoV-2 vaccines (mean interval 10 days; 95% CI 8-12) and affected predominantly women (69%; 95% CI 60%-77%) under age 45, even in the absence of prothrombotic risk factors. DISCUSSION: Approximately half of patients with TTS present with CVST; almost one-third of patients with TTS do not survive. Further research is required to identify independent predictors of TTS following adenovirus vector-based vaccination. REGISTRATION INFORMATION: The prespecified study protocol has been registered in the International Prospective Register of Ongoing Systematic Reviews PROSPERO (CRD42021250709).

Similar or Different Neuropsychological Profiles? Only Set Shifting Differentiates Women With Bipolar vs. Borderline Personality Disorder.

There is ongoing debate about the similarities and differences between bipolar disorder (BD) and borderline personality disorder (BPD). Very few studies have concurrently assessed their neuropsychological profile and only on a narrow array of neuropsychological tests. We aimed to investigate the differences of these two patient groups on visual memory, executive function, and response inhibition. Twenty-nine BD patients, 27 BPD patients and 22 controls (all female) were directly compared on paired associates learning (PAL), set shifting (ID/ED), problem solving (SOC), and response inhibition (SSRT) using Cambridge Neuropsychological Test Automated Battery (CANTAB). Rank-normalized outcomes were contrasted in one-way ANOVA tests. Discriminant analysis was finally performed to predict BD or BPD patient status. BD patients performed significantly worse than controls on all tasks. BPD patients performed significantly worse than HC on all tests except SST. Significant differences between the two patient groups were recorded only on ID/ED, where BPD patients performed worse (p = 0.044). A forward stepwise discriminant analysis model based on ID/ED and SOC predicted correctly patients' group at 67.9% of cases. In conclusion, BD and BPD female patients appear to be more similar than different as regards their neuropsychological functions. This study is the first to show that BPD patients display more deficits than BD patients when directly compared on the set shifting executive function test, a marker of cognitive flexibility. Discerning BD from BPD patients through neuropsychological performance is promising but would improve by using additional subtler tests and psychometric evaluation.