Huntington's disease prevalence in Asia: a systematic review and meta-analysis.

INTRODUCTION: The epidemiological studies on Huntington's disease (HD) in the Asian population suggest that prevalence rates are significantly lower than in the Western population. We conducted a systematic review of epidemiological studies of HD in Asia to compare the level of impact of the disease on the Asian population. METHODS: Original articles and reviews about HD prevalence in the Asian population were found through databases such as Embase, Medline, and PsychInfo. Relevant articles were analysed by scrutinising of references, including specific key words. A meta-analysis was performed on prevalence rates to find the degree of similarities with I2. Point Prevalence was measured as the number of people affected by HD in a 100,000 population and expressed as Point Prevalence (PP)= Number of people affected/100,000 with 95% Confidence Intervals (CI95). RESULTS: Results from the random-effect meta-analysis show the highest point prevalence of HD in the Middle East with PP=4.0 (CI95=2.90-5.30). The lowest point prevalence was found in the Chinese population with PP=0.25 (CI95=0.16-0.36). Europe remains at a high prevalence compared to Asian countries with PP=1.00 (CI95=0.82-1.19). The overall prevalence in Asia is PP=0.70 (CI95=0.44-1.0). CONCLUSION: Our study reveals that HD disease affects the population of Asia to a lesser extent than in Europe. The plausible explanation for differences in prevalence is that in some countries, the affected individuals will not self-refer to HD screening for fear of social stigma, negative influence in marriage, and lack of genetic and neurological testing. Another explanation is that studies that used genetic testing exclusively were able to identify the CAG repeats, subgroups of CAG repeat A1 & A2, and haplogroup C, which has less predisposition to high HD prevalence in Asians compared to the Caucasian population.

Biopsychosocial theories of borderline personality disorder: a meta-synthesis and psychopathological network model from a systematic review.

BACKGROUND: Borderline personality disorder (BPD) is a complex mental health condition with an altered image of self, impulsive acts, suicidal ideation, and self-harm requiring intensive care in outpatient and inpatient settings. The biopsychosocial (BPS) model adopted in the current study extracted the outcomes of a research about the diagnosis, causes and treatment of BPD. A network model helped link these results in a unitary model with applications in clinical practice for assessment and intervention. METHODS: We conducted a literature review of current studies on the BPS causes of BPD and merged them through meta-synthesis. The results were then elaborated with a psychopathological network analysis for linking the extracted factors with higher degree of centrality in the network and merged in a final comprehensive model. RESULTS: The theoretical modelisation suggests that BPS causes merged with the diathesis-stress model persistently activate the cortico-limbic system and prefrontal cortex, induce neuroinflammation, and stimulate suicidal and parasuicidal ideation and behaviours modulated by psychological and pharmacological treatment. CONCLUSIONS: Using a network model in psychopathology allowed the merging of data about BPD into a unitary and dynamic pattern which can be helpful to direct assessments and interventions in clinical practice.

Factitious disorder comorbid with borderline personality disorder and dysthymia: from medically unexplained physical symptoms to functional neurological disorder.

INTRODUCTION: In this study, we introduce the concept of comorbidity between factitious disorder (FD), borderline personality disorder (BPD), dysthymia (DY), medically unexplained physical symptoms (MUPS) and functional neurological disorder (FND) characterising patients who may tend to exaggerate physical or psychiatric symptoms of presentation to a general or psychiatric hospital with a constellation of signs that do not receive confirmation from further clinical and instrumental assessments. The similarities between these syndromes and the constant presence of borderline personality in the psychopathology make it the possible link between all these syndromes. MATERIALS AND METHODS: The authors captured the typical appearance and characterisation of FD-BPD-DY-MUPS-FND (Com-1) syndrome in adult and non-forensic acute psychiatric hospitals in the United Kingdom (UK) and adjacent liaison psychiatric teams through case vignettes. Each case vignette merged similar clinical cases and was cross-analysed using information from various mental health and medical professionals and bridging primary and secondary carers' records. RESULTS: The findings suggest striking similarities between the syndromes making borderline personality the bridge pathology for FD, MUPS and FND. The complexity of the diagnosis of these cases is discussed in the study, together with prototypical presentations. CONCLUSIONS: Improving the management of these often-occurring diseases requires multidisciplinary coordination across psychiatry, general care, neurology and surgery departments.

Comorbidity Between Factitious and Borderline Personality Disorder: A Narrative Analysis.

BACKGROUND: Factitious disorder (FD) illnesses have increased recently, primarily due to comorbidity with borderline personality disorder (BPD). Psychiatrists, hospital doctors, and general practitioners are interested in and concerned about patients with comorbid FD-BPD. SUBJECTS AND METHODS: We used a qualitative analysis of prototypical narratives collected as vignettes by merging individual contributions, case histories, naturalistic observations, and data from mental health practitioners into specific descriptions. Our study used a phenomenological and narrative method to illustrate the contents and behaviours in FD-BPD comorbidity. RESULTS: Fourteen case vignettes were created from our case studies. These categories included knowledge of symptoms and medical terms, dramatisation, symptoms ambiguity, unexplainable deterioration of symptoms, symptom inventiveness, craving for painkillers, conflicts with health carers, hospital migration, piling of medication and search for invasive diagnostic procedures. CONCLUSIONS: The combined use of narrative analysis and naturalistic observation has helped identify a unique comorbid condition of FD-BPD, which is not yet clearly described in its behavioural components by the international literature. The current study presents novel findings into a condition becoming progressively popular in psychiatric and medical settings.

Should mindfulness-based cognitive therapy be used for psychosis? A systematic review of the literature and meta-analysis.

BACKGROUND: In England, psychosis incidence is 31.7×100,000 persons per year. Mindfulness-based interventions for psychosis (MBIp) might reduce its symptoms; however, the research outcomes on its effect size (ES) vary considerably. This project aims to ascertain the existing evidence. METHODS: Eight publications from a pool of over 260 studies were extracted and analysed at meta-analysis for ES as satisfying the inclusion criteria. RESULTS: MBIp has a moderate ES (r=0.34; p<.001) on psychosis with a 95% confidence interval (CI) of 0.26-0.42 (small to high). DISCUSSION: MBIp improves psychosis symptoms. However, the studies analysed show heterogeneity in ES. Hence only conditional recommendations can be made for MBIp.

The assessment of interprofessional practice in mental health nursing with ethnographic observation and social network analysis: a confirmatory and bibliometric network study using VOSviewer.

INTRODUCTION: Despite numerous techniques for assessing mental health nursing abilities and accomplishments, most practice in psychiatric wards is based on observable clinical behaviours and actions. VOSviewer can perform bibliographic network analysis (BNA), extracting all central topics that identify core behavioural skills in mental health nursing and essential elements in interprofessional practice (IPP). AIM: The current study captures the critical concepts in mental health nursing assessment by performing a BNA of essential topics on ethnography, social network analysis, and interprofessional care. METHODS: A qualitative BNA with a VOSviewer extracted relevant topics from a total of 542 articles obtained from Microsoft API. A subsequent confirmatory quantitative analysis with NVIVO weighed the percentages of the relevant issues and words extracted by the VOSviewer. Boolean keywords searched were 'ethnography,' 'social network analysis,' 'interprofessional', 'psychiatry' and 'hospital'. RESULTS: Major themes identified in ethnography, IPP, and social network analysis for nursing assessment were those of 'communication' (11.63%), 'whole' (9.29%), 'knowledge' (7.66%), 'person' (7.52%), 'activity' (6.31%) and 'collaboration' (6.10%). DISCUSSION: The current study has proven the value of BNA in extracting relevant topics in target literature. VOSviewer captured salient issues in mental health nursing assessment, including ethnographic observations, social network analysis, and IPP. The results confirmed the value of focusing on collaborative care, reciprocity, knowledge management, and information sharing in assessing mental health nursing performances.

COVID-19, loneliness, social isolation and risk of dementia in older people: a systematic review and meta-analysis of the relevant literature.

OBJECTIVES: During the COVID-19 lockdown, social isolation and feelings of loneliness (SIFL) in the older population have increased, and they can be a risk of dementia, especially in vulnerable older people. The current research is a systematic review meta-analysis of the studies that approach the risk of dementia in older people with SIFL. METHODS: The ten studies selected for meta-analysis utilised an opportunistic sample of older people in the community from age 50 to above with no dementia and enrolment. The populations consisted of cohorts of an average of 8,239 people, followed for a mean period of 6.41 years. Random effect meta-analysis summarised the Cox Proportional Hazard Ratios and Relative Risks of the individual studies. RESULTS: Results of the meta-analysis show that in older people, the risk of developing dementia because of the impact of prolonged loneliness and social isolation is about 49 to 60% [HR/HR = 1.49; CI95=1.37-1.61] higher than in those who are not lonely and socially isolated. CONCLUSION: The biopsychosocial model of dementia supports the need for more integrated social programs and reduced risks for the older persons who, during the COVID-19 lockdown, have suffered from deprivation of support from primary carers and restricted social interactions.KeypointsDuring the COVID-19 lockdown, social isolation and feelings of loneliness in the general population have increased.Older persons are more vulnerable to social isolation and feelings of loneliness (SIFL).SIFL in older people has been associated with an increased risk of dementia.The current study's findings suggest the need to improve healthcare policies to reduce the impact of SIFL in older persons during the COVID-19 pandemic.

The Prevalence of Huntington Disease in Asia Highlights Needs in Clinical, Genetic and Instrumental Diagnosis: A Systematic Review and Meta-Analysis.

The epidemiological analyses on Huntington's Disease (HD) indicate that prevalence rates in the Asian population are significantly lower than in the Western population. The research aims to explore the prevalence of HD in Asian countries. Point Prevalence (PP) is equivalent to the number of people affected by HD per 100,000 inhabitants. A meta-analysis was completed on prevalence rates to extract the global PP and the degree of heterogeneity of I² to confirm or discard similarities of PP of HD in Asian countries. Nine major studies were identified. A random-effect meta-analysis showed PP prevalence in Asia of 0.52 (CI95%=0.36-0.75). There is also a significant difference between PP of Asia vs Europe (p<0.001), confirming a lower prevalence of HD in Asian countries except for Pakistan, Punjab, and Gujarat, which have the higher prevalence in Asia. Our study reveals that Huntington's Disease affects Asia's population with variable figures globally to a lesser extent than Europe, although some Middle East countries present the highest global prevalence. The possible reasons are explored. The following are take-home messages derived from the current study. HD in Asia shows a point prevalence lower than European Countries, probably due to differences in clinical, instrumental and diagnostic procedures. Stigma linked to HD and its impact on family and society can reduce people's mindfulness to undergo targeted assessment. Further research is required to estimate the true prevalence of HD worldwide and promote better diagnostic screening using genetic testing. The true prevalence of HD is probably underestimated, and there is the need to provide education in the general population about this condition and testing.

Social Network Analysis of Alzheimer's Teams: A Clinical Review and Applications in Psychiatry to Explore Interprofessional Care.

INTRODUCTION: Understanding the social networks of professionals in psychiatric hospitals and communities working with Persons With Alzheimer's (PWA) disease helps tackle the knowledge management in patient care and the centrality of team members in providing information and advice to colleagues. OBJECTIVES: To use Social Network Analysis (SNA) to confirm or reject the hypothesis that psychiatric professionals have equal status in sharing information and advice on the care of PWA and have reciprocal ties in a social network. METHODS: The sample consisting of 50 psychiatric professionals working in geriatric psychiatry in the UK completed an anonymous online survey asking them to select the professional categories of the colleagues in the interprofessional team who are most frequently approached when providing or receiving advice about patient care and gathering patient information. SNA is both a descriptive qualitative analysis and a quantitative method that investigates the degree of the prestige of professionals in their working network, the reciprocity of their ties with other team members, and knowledge management. RESULTS: The social network graphs and numerical outcomes showed that interprofessional teams in geriatric psychiatry have health carers who play central roles in providing the whole team with the knowledge necessary for patient care; these are primarily senior professionals in nursing and medical roles. However, the study reported that only 13% of professionals had reciprocal ties with knowledge sharing within teams. CONCLUSION: The current research findings show that knowledge management in interprofessional teams caring for PWA is not evenly distributed. Those with apparently higher seniority and experience are more frequently consulted; however, other more peripheral figures can be equally valuable in integrated care.

Weight gain and obesity in general adult psychiatric inpatients: a longitudinal and cross-sectional study.

BACKGROUND: Weight gain and obesity are significantly linked to mental illness. There have been different theories trying to explain weight gain to psychiatric inpatients, such as physical inactivity and lifestyle, the effect of psychotropic drugs, increased food intake triggered by depression, and comorbidity between mental illness and obesity. The current research is a longitudinal and cross-sectional study collecting the electronic records of weight of psychiatric inpatients in a period spanning from one to ten years to address these theories. METHODS: We collected the electronic records relative to weight measurement that are conducted weekly and relative to 240 non-forensic psychiatric inpatients (124 males and 116 females) and for a period from 1 to 10 years. Mean ages for males was 39.65 years (SD=±11.66) and females 40.88 years (SD=±13.73). They accessed a psychiatric inpatient service in the United Kingdom. The coefficient of determination R2 calculated the time variation in bodyweight in the period span, while the Chi-square statistic evaluated the differences in outcomes. RESULTS: Our longitudinal study shows that R2=0.17 (95% CI=0.14-0.20) for males and 0.27 (95% CI=02.0-0.34) for females. There was a statistically significant difference between the R2 (c2: p<.05) for both genders. The average Body Mass Index (BMI) for male psychiatric inpatients was 27.05 (SD=±5.92), corresponding to WHO Overweight Class. The average BMI for female psychiatric inpatients was instead 31.21 (SD=±7.73), corresponding to WHO Obesity Class I. The difference in BMI was statistically significant for both genders (c2: p<.001). DISCUSSION: In our study, only 27% of the difference in body weight in females and 17% in males was explainable by the time variable with a small to moderate effect size. Our findings appear to support the theory that overweight and morbid obesity might be comorbid with psychiatric illnesses and independent from the therapeutic regimen. Overall, females' BMI is more pathological. CONCLUSION: During lengthy admissions, only modest changes in body weight were observed in our research. Our findings would suggest that metabolic syndrome and therefore elevated BMI, overweight, and obesity might be comorbid with psychiatric illnesses and might be independent of the length of admissions.

Psychiatric training during covid-19 pandemic benefits from integrated practice in interprofessional teams and ecological momentary e-assessment.

OBJECTIVES: During the current covid-19 pandemic, healthcare students had to stop their face-to-face attendance at medical colleges and universities. This condition has resulted in a change in how learning and assessment of psychiatric and interprofessional practice occur. The pandemic has also increased clinical mentors' need to follow their mentees' educational progress via virtual technology, including smartphone-based educational apps. The aim of the study is to propose a model in psychiatric and medical interprofessional practice e-assessment. METHODS: In this study, 228 undergraduate healthcare students underwent a training period in interprofessional practice across specialties being assessed by Ecological Momentary e-Assessment (EMeA), and consisting of ongoing or before/after Interprofessional Education (IPE) learning evaluations with the assistance of an IPE-app linked to online surveys. The Goodness of Fit Test Chi-square and t-test statistics analyzed the data. RESULTS: Surveys during, at entry and exit points in IPE captured increased percentages of learners, specifically, reporting high patient satisfaction with interprofessional teams (c2=22.54; p<.01), learners experiencing very good quality of care when delivered by interprofessional teams (c2=30.02; p<.01) assessed by distance technology, and learners selecting less frequently peers from the same clinical background when support was needed in patient care (c2=19.84; p<.01). CONCLUSIONS: Contextual assessment (in the real-time and real-world scenario) of IPE learning moments via EMeA shows its value and applicability during the current covid-19 pandemic when the assessment of learning cannot occur face-to-face between learners and teachers. All healthcare students, including those on psychiatric rotations, could log in their progress, self-reflective assessments, and responses to coordinated care in interprofessional teams, without needing direct contact with their clinical tutors, and while treating patients with mental and physical illnesses, also including covid-19 positive patients.

Case reports of first psychiatric presentations during CoViD-19 pandemic.

CoViD-19 pandemic has created a global concern in the whole population. The psychiatric and social impact of the viral infection is recorded differently by the community. However, more vulnerable individuals with negative psychiatric history are presenting to mental health hospitals for admission, assessment and treatment due to abnormal reactions to CoViD-19 pandemic. The current study reports six clinical cases of first psychiatric presentation that were characterised by sudden onset of symptoms, manic and psychotic symptoms, adverse response to stress, psychomotor agitation and behaviours out of character. The presentation was short-lived and responded to typical antipsychotics and antidepressants. The posed diagnoses were acute and transient psychotic disorder and acute stress reaction.

Psychiatry in Time of COVID-19 Pandemic.

COVID-19 or Coronavirus pandemic has generated a very serious and grave global concern regarding the health of every person in the whole world. Besides, due to the rapid diffusion of the viral infection, there are already alarms on how to deal with the psychiatric aspects of COVID-19 pandemic in persons with an established diagnosis of psychiatric disorders, staff, and those in self-isolation. What is the influence of COVID-19 on mental health? The current study will review the psychiatric implications of COVID-19 pandemic on the general population, the bearing of social isolation, the prevention behaviours, and clinical cases of people who required psychiatric admission to hospital due to the emotional impact of COVID-19 social circumstances.