New-onset psychosis following COVID-19 vaccination: a systematic review.

Background: The emergence of a new coronavirus strain caused the COVID-19 pandemic. While vaccines effectively control the infection, it's important to acknowledge the potential for side effects, including rare cases like psychosis, which may increase with the rising number of vaccinations. Objectives: Our systematic review aimed to examine cases of new-onset psychosis following COVID-19 vaccination. Methods: We conducted a systematic review of case reports and case series on new-onset psychosis following COVID-19 vaccination from December 1st, 2019, to November 21st, 2023, using PubMed, MEDLINE, ClinicalKey, and ScienceDirect. Data extraction covered study and participant characteristics, comorbidities, COVID-19 vaccine details, and clinical features. The Joanna Briggs Institute quality assessment tools were employed for included studies, revealing no significant publication bias. Results: A total of 21 articles described 24 cases of new-onset psychotic symptoms following COVID-19 vaccination. Of these cases, 54.2% were female, with a mean age of 33.71 ± 12.02 years. Psychiatric events were potentially induced by the mRNA BNT162b2 vaccine in 33.3% of cases, and psychotic symptoms appeared in 25% following the viral vector ChAdOx1 nCoV-19 vaccine. The mean onset time was 5.75 ± 8.14 days, mostly reported after the first or second dose. The duration of psychotic symptoms ranged between 1 and 2 months with a mean of 52.48 ± 60.07 days. Blood test abnormalities were noted in 50% of cases, mainly mild to moderate leukocytosis and elevated C-reactive protein. Magnetic resonance imaging results were abnormal in 20.8%, often showing fluid-attenuated inversion recovery hyperintensity in the white matter. Treatment included atypical antipsychotics in 83.3% of cases, typical antipsychotics in 37.5%, benzodiazepines in 50%, 20.8% received steroids, and 25% were prescribed antiepileptic medications. Overall, 50% of patients achieved full recovery. Conclusion: Studies on psychiatric side effects post-COVID-19 vaccination are limited, and making conclusions on vaccine advantages or disadvantages is challenging. Vaccination is generally safe, but data suggest a potential link between young age, mRNA, and viral vector vaccines with new-onset psychosis within 7 days post-vaccination. Collecting data on vaccine-related psychiatric effects is crucial for prevention, and an algorithm for monitoring and treating mental health reactions post-vaccination is necessary for comprehensive management. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023446270.

Psychometric properties and normative data of the Latvian and Russian language versions of the strengths and difficulties questionnaire (SDQ) in the Latvian general adolescent population.

OBJECTIVES: Mental health screening instruments are essential in population health research and clinical practice. The strengths and difficulties questionnaire (SDQ) self-report version has been widely used across the globe to screen for mental health problems in adolescent populations. This study aimed to explore the psychometric properties of the Latvian and Russian language versions of the SDQ in a representative sample of a general population of Latvian adolescents and establish the population-based normative scores. MATERIALS AND METHODS: This analysis was based on data from the international Health Behaviour in School-aged Children study year 2017/2018 Latvian database. The sample comprised 2683 Latvian and 1321 Russian-speaking 11-, 13-, and 15-year-old adolescents. RESULTS: Significant language-based variance was observed in the mean scores of the externalising subscales of the SDQ, with Latvian-speaking adolescents reporting higher levels of conduct problems and hyperactivity. The reliability was satisfactory (ordinal alpha >0.7) only for the prosocial behaviour, emotional, internalising problems, and total difficulties subscales, while conduct, hyperactivity, peer, and externalising problems scales demonstrated lower internal consistency (ordinal alpha 0.5-0.7). Confirmatory factor analysis (CFA) did not support the hypothesised narrow-band five-factor or broad-band three-factor structure of the SDQ. The normative banding scores were calculated for both language variants. CONCLUSIONS: This study suggests that the self-report SDQ must be used cautiously in Latvian adolescents because some SDQ subscales lack reliability. When used in population research, the internalising subscales seem more reliable than the externalising ones. More research is needed regarding the reliability of the SDQ in clinical adolescent populations.

Beliefs in Conspiracy Theories and Mental Health in the Student Community of Latvia During the COVID-19 Outbreak.

BACKGROUND: The objective of this study was to investigate self-reported changes in mental health and their association with various sociodemographic factors and beliefs in conspiracy theories among university and college students in Latvia during the second state of emergency caused by COVID-19. SUBJECTS AND METHODS: This cross-sectional study was conducted as part of an international research project, where university and college students were anonymously asked to complete an online self-report questionnaire. Changes in anxiety and depression were assessed using self-rated questions. Statistical analysis involved Pearson's chi-square test and univariate binary logistic regression.ression. RESULTS: The study comprised 1047 students, with 828 females (79.08% aged 21.71±0.09). Worsening in self-reported anxiety was more prevalent among females (69.3%, p<0.001), unemployed respondents (70.0%, p=0.003), individuals who were were not working during the lockdown (70.3%, p<0.001), those experiencing deterioration in general health condition (93.0%, p<0.001), and those belonging to or having knowledge of someone in a vulnerable group (69.5%, p=0.004). Worsening self-reported depression was more prevalent in respondents who did not work during the lockdown (63.9%, p=0.014) and those with deteriorating general health conditions (93.0%, p<0.001). Increased odds ratios (OR) for experiencing changes in anxiety and depression were associated with beliefs in the following conspiracy theories: 'Recommended measures are an attempt to restrict human rights' (OR=1.49, p=0.019 and OR=2.40, p<0.001, respectively). Furthermore, increased OR for experiencing changes in depression were associated with beliefs in the following conspiracy theories: 'The COVID-19 vaccine was ready before the virus spread' (OR=3.11, p=0.007), 'COVID-19 has a lower mortality rate" (OR=1.85, p<0.001)', 'Recommended measures are an attempt to restrict human rights' (OR=2.40, p<0.001), and 'The COVID-19 outbreak is the creation of world leaders' (OR=2.17, p=0.003). CONCLUSIONS: Self-reported changes in depression and anxiety were associated with certain beliefs in specific conspiracy theories.

Computer vision-based algorithm to sUppoRt coRrect electrode placemeNT (CURRENT) for home-based electric non-invasive brain stimulation.

OBJECTIVE: Home-based non-invasive brain stimulation (NIBS) has been suggested as an adjunct treatment strategy for neuro-psychiatric disorders. There are currently no available solutions to direct and monitor correct placement of the stimulation electrodes. To address this issue, we propose an easy-to-use digital tool to support patients for self-application. METHODS: We recruited 36 healthy participants and compared their cap placement performance with the one of a NIBS-expert investigator. We tested participants' placement accuracy with instructions before (Pre) and after the investigator's placement (Post), as well as participants using the support tool (CURRENT). User experience (UX) and confidence were further evaluated. RESULTS: Permutation tests demonstrated a smaller deviation within the CURRENT compared with Pre cap placement (p = 0.02). Subjective evaluation of ease of use and usefulness of the tool were vastly positive (8.04 out of 10). CURRENT decreased the variability of performance, ensured placement within the suggested maximum of deviation (10 mm) and supported confidence of correct placement. CONCLUSIONS: This study supports the usability of this novel technology for correct electrode placement during self-application in home-based settings. SIGNIFICANCE: CURRENT provides an exciting opportunity to promote home-based, self-applied NIBS as a safe, high-frequency treatment strategy that can be well integrated in patients' daily lives.

Case report: Treatment-resistant schizophrenia with auto-aggressive compulsive behavior-Successful management with cariprazine.

The present case report describes a patient with treatment-resistant schizophrenia and auto-aggressive compulsive behavior who was effectively treated with a third-generation antipsychotic medication, cariprazine. The diagnosis was made 12 years ago, and the patient has been hospitalized 14 times and undergone various antipsychotic treatments. Despite receiving both inpatient and outpatient care, the patient's response to treatment has been only partial, and he has been classified as a treatment-resistant case. Therefore, the patient was switched to cariprazine, which led to significant improvements in both positive and negative symptoms, as well as the complete reduction of auto-aggressive compulsive behavior. These improvements contributed to the patient's overall social functioning and the achievement of remission, while also avoiding polypharmacy and eliminating the metabolic side effects associated with previous treatments.

Self-reported suicidal behaviours and associated factors in the general population of Latvia (2010-2018).

BACKGROUND: Latvia has the second highest suicide rate in the European Union - with a total population age-standardized suicide rate of 16.1 per 100,000 inhabitants. AIMS: We aimed to assess the prevalence of different types of self-reported suicidal behaviours in Latvia and determine the associated sociodemographic and health-related factors. METHODS: This study was based on secondary data obtained from the Health Behaviour Among Latvian Adult Population survey. A representative sample of the general population was used, aged 15 to 64 years in 2010, 2012, 2014; and 15 to 74 years in 2016 and 2018 (n = 16,084). Respondents were asked to report the occurrence of life weariness, death wishes, suicidal ideation, suicidal plans and suicide attempts during the previous year. We assessed socio-demographics and health-related factors associated with suicidality. We performed univariate analysis and constructed stepwise multivariate logistic regression models. RESULTS: In 2010 to 2018, 15.6% of responders reported some type of suicidal behaviour (95% CI [15.1, 16.2]). Sociodemographic factors - including non-cohabitation status and Latvian nationality - were associated with mild (life-weariness and death wishes) and serious (suicidal ideation, plans to commit suicide, suicide attempts) types of behaviour. Older age was associated with mild suicidal behaviours, whereas lower educational levels were associated with serious suicidal behaviours. Diagnosed depression, self-reported depression, self-reported anxiety, stress, low mood, alcohol intake habits with heavy drinking episodes (less than monthly, monthly and weekly), perceived health as average or below average, disuse of primary health services were associated with mild and serious types of suicidal behaviour. Current smoking status and absenteeism were associated with mild suicidal behaviour types. Self-reported insomnia, having at least two somatic diagnoses, occasional smoking status, absenteeism with 11 or more days in the last year, receiving disability pension were associated with serious suicidal behaviour types. Musculoskeletal diseases exhibited preventive effects. CONCLUSIONS: Our findings indicate that certain groups of individuals might exhibit greater vulnerability to suicidality.

Point prevalence and sex-specific associated factors of depression in Latvian general population.

Background: This cross-sectional study aimed to determine the current prevalence of depression, and analyze sex-specific associated socio-demographic and health-related factors for depression in a representative sample of the general adult population of Latvia. Methods: Specially trained professional interviewers conducted computer-assisted face-to-face interviews with a multistage stratified probability sample from the general Latvian adult population (n = 2,687). A 9-item Patient Health Questionnaire (PHQ) was used for assessment of depression. Respondents were interviewed using the specially developed questionnaire about sociodemographic factors as well as the alcohol use disorder module of the Mini International Neuropsychiatric Interview. Binary logistic regression was used to calculate the odds ratios (OR) for the univariate and multivariate logistic analyses. Results: The point prevalence of depression according to the PHQ-9 was 6.4% (95% CI 5.8-7.6). After adjustment for all independent variables analyzed, being divorced, widowed, or living separately increased the odds of depression [aOR 2.6 (95% CI, 1.2-5.8), p = 0.02] in males. For females, unfinished primary education [aOR 5.2 (95% CI 2.0-13.6), p = 0.001] and economically inactive status [aOR 2.0 (95% CI, 1.1-3.6), p = 0.03] were strongly associated with depression. Limitations: The cross-sectional design of the study did not allow us to draw conclusions about causality. Patients with bipolar, organic, and symptomatic depression states were not excluded. Conclusion: The prevalence of depression in the general adult population is 6.4%, with the most significant sex-specific factors associated with depression for males - being divorced, widowed, or living separately, and for females it was poor education and economic inactivity.

Successful high dose antipsychotic treatment with cariprazine in patients on the schizophrenia spectrum: Real-world evidence from a Spanish hospital setting.

Real-world evidence fills in an important gap by providing data on the effectiveness and tolerability of new medications in everyday patients. In this data collection form a Spanish hospital, the effectiveness and tolerability of cariprazine were evaluated in 14 patients who were admitted to the hospital due to an acute episode of schizophrenia or schizoaffective disorder. The collected data included demographic characteristics, history of disorder and previous treatment, and details of cariprazine therapy such as dosing, side effects and measurements of effectiveness via scales. Difference between admission and discharge on the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression-Severity (CGI-S) scale scores were evaluated using the Wilcoxon Signed-Rank test. Significant improvement was detected in nearly all patients (one patient dropped out) as measured by the BPRS Total, Negative symptom, Positive symptom, and Hostility scores. At admission, patients were markedly-moderately ill and at discharge the severity was reduced to borderline ill and normal according to the CGI-S. The CGI-Improvement scale also indicated very much and much improvement at discharge. Importantly, patients left the hospital with high doses of cariprazine, i.e., 7.5 mg/day or even 9.0 mg/day, but this did not cause safety problems; cariprazine well-tolerated as only a few patients experienced side effects such as akathisia. The results provide novel evidence regarding the tolerability and effectiveness of cariprazine in high doses patients on the schizophrenia spectrum.

Examining the synergistic effects of a cognitive control video game and a home-based, self-administered non-invasive brain stimulation on alleviating depression: the DiSCoVeR trial protocol.

Enhanced behavioral interventions are gaining increasing interest as innovative treatment strategies for major depressive disorder (MDD). In this study protocol, we propose to examine the synergistic effects of a self-administered home-treatment, encompassing transcranial direct current stimulation (tDCS) along with a video game based training of attentional control. The study is designed as a two-arm, double-blind, randomized and placebo-controlled multi-center trial (ClinicalTrials.gov: NCT04953208). At three study sites (Israel, Latvia, and Germany), 114 patients with a primary diagnosis of MDD undergo 6 weeks of intervention (30 × 30 min sessions). Patients assigned to the intervention group receive active tDCS (anode F3 and cathode F4; 2 mA intensity) and an action-like video game, while those assigned to the control group receive sham tDCS along with a control video game. An electrode-positioning algorithm is used to standardize tDCS electrode positioning. Participants perform their designated treatment at the clinical center (sessions 1-5) and continue treatment at home under remote supervision (sessions 6-30). The endpoints are feasibility (primary) and safety, treatment efficacy (secondary, i.e., change of Montgomery-Åsberg Depression Rating Scale (MADRS) scores at week six from baseline, clinical response and remission, measures of social, occupational, and psychological functioning, quality of life, and cognitive control (tertiary). Demonstrating the feasibility, safety, and efficacy of this novel combined intervention could expand the range of available treatments for MDD to neuromodulation enhanced interventions providing cost-effective, easily accessible, and low-risk treatment options.ClinicalTrials.gov: NCT04953208.

Students' mental health during the pandemic: results of the observational cross-sectional COVID-19 MEntal health inTernational for university Students (COMET-S) study.

Introduction: The aim of the study was to search rates of depression and mental health in university students, during the COVID-19 pandemic. Materials and methods: This is an observational cross-sectional study. A protocol gathering sociodemographic variables as well as depression, anxiety and suicidality and conspiracism was assembled, and data were collected anonymously and online from April 2020 through March 2021. The sample included 12,488 subjects from 11 countries, of whom 9,026 were females (72.2%; aged 21.11 ± 2.53), 3,329 males (26.65%; aged 21.61 ± 2.81) and 133 "non-binary gender" (1.06%; aged 21.02 ± 2.98). The analysis included chi-square tests, correlation analysis, ANCOVA, multiple forward stepwise linear regression analysis and Relative Risk ratios. Results: Dysphoria was present in 15.66% and probable depression in 25.81% of the total study sample. More than half reported increase in anxiety and depression and 6.34% in suicidality, while lifestyle changes were significant. The model developed explained 18.4% of the development of depression. Believing in conspiracy theories manifested a complex effect. Close to 25% was believing that the vaccines include a chip and almost 40% suggested that facemask wearing could be a method of socio-political control. Conspiracism was related to current depression but not to history of mental disorders. Discussion: The current study reports that students are at high risk for depression during the COVID-19 pandemic and identified specific risk factors. It also suggested a role of believing in conspiracy theories. Further research is important, as it is targeted intervention in students' groups that are vulnerable both concerning mental health and conspiracism.

Clinical Utility of the Parent-Report Version of the Strengths and Difficulties Questionnaire (SDQ) in Latvian Child and Adolescent Psychiatry Practice.

Background and Objectives: Screening instruments can be crucial in child and adolescent mental healthcare practice by allowing professionals to triage the patient flow in a limited resource setting and help in clinical decision making. Our study aimed to examine whether the Strengths and Difficulties Questionnaire (SDQ), with the application of the original UK-based scoring algorithm, can reliably detect children and adolescents with different mental disorders in a clinical population sample. Materials and Methods: a total of 363 outpatients aged 2 to 17 years from two outpatient child psychiatry centres in Latvia were screened with the parent-report version of the SDQ and assigned clinical psychiatric diagnoses. The ability of the SDQ to predict the clinical diagnosis in major diagnostic groups (emotional, conduct, hyperactivity, and developmental disorders) was assessed. Results: The subscales of the parent-report SDQ showed a significant correlation with the corresponding clinical diagnoses. The sensitivity of the SDQ ranged 65-78%, and the specificity was 57-78%. The discriminative ability of the SDQ, as measured by the diagnostic odds ratio, did not quite reach the level of clinical utility in specialised psychiatric settings. Conclusions: We suggest the SDQ be used in primary healthcare settings, where it can be an essential tool to help family physicians recognise children needing further specialised psychiatric evaluation. There is a need to assess the psychometric properties and validate the SDQ in a larger populational sample in Latvia, determine the population-specific cut-off scores, and reassess the performance of the scale in primary healthcare practice.

Validation of the generalized anxiety disorder scales (GAD-7 and GAD-2) in primary care settings in Latvia.

Background: Anxiety disorders are the most prevalent mental disorders in the world and have an important impact on the global burden of disease. Generalized anxiety disorder (GAD) is the most prevalent anxiety disorder encountered in primary care. There are no available validated anxiety screening tools in primary care in Latvia. We aimed to validate both a seven-item and a two-item generalized anxiety disorder scale (GAD-7 and GAD-2) in the Latvian and Russian languages, to detect generalized anxiety disorder (GAD) in primary care settings in Latvia. Methods: During a 1-week period, all patients aged 18 years or older visiting their GP (general practitioners) with any health concern at 24 primary care settings throughout Latvia were invited to complete the GAD-7 in their native language (Latvian or Russian). Criterion validity was assessed against the Mini International Neuropsychiatric Interview (MINI). Results: The study sample included 1,459 participants who completed the GAD-7 and the MINI. The GAD-7 items showed good internal reliability [Cronbach's alpha 0.87 for Latvian version and 0.85 for Russian version (for Latvia) of the GAD-7]. A cut-off score for detecting GAD of 5 or above was estimated for Latvian version of the GAD-7 (sensitivity 75.4%, specificity 68.9%, respectively) and 7 or above for Russian version of the GAD-7 (sensitivity 73.3%, specificity 84.1%, respectively). The internal reliability of the GAD-2 was lower for both languages (Cronbach's alpha 0.75 for Latvian version and 0.68 for Russian version of the GAD-2). A cut-off score of 2 or above was established for both the Latvian, and Russian versions of the GAD-2 (sensitivity 78.9 and 83.3%; specificity 63.7 and 69.1% for the Latvian and Russian versions of the GAD-2, accordingly) for detecting GAD. Conclusions: This is the first study to report criterion validity of the Latvian and Russian (for Latvia) versions of the GAD-7 and GAD-2, assessed in a nationwide study conducted at the primary care level.

Anxiety Screening among the General Population of Latvia and Associated Factors.

Background and Objectives: The aim of this study was to determine the point prevalence of at least mild anxiety symptoms and symptoms of generalized anxiety disorder in the Latvian general population, and to analyze the associated factors. Materials and Methods: A computer-assisted face-to-face survey was conducted in 2019−2020 with a multistage stratified probability sample of the Latvian general adult population (n = 2687). Anxiety was assessed using the 7-item Generalized Anxiety Disorder (GAD-7) scale; a score of ≥5 was defined as indicating the presence of mild symptoms of anxiety, and a score of ≥10 as the cutoff for identifying cases of generalized anxiety disorder. The Patient Health Questionnaire 9 (PHQ-9) and MINI International Neuropsychiatric Interview (M.I.N.I.) modules were used for assessing comorbid conditions. Multinomial logistic regression was conducted. Results: The point prevalence of mild anxiety symptoms was 10.9%. The point prevalence of generalized anxiety disorder symptoms was 3.9%. Higher odds of mild anxiety symptoms were detected in respondents of a young age (vs. 65 y.o. and older, aOR 3.1, p < 0.001), unmarried respondents (vs. married/cohabiting, aOR 1.5, p = 0.02), those living in the capital city (aOR 1.6, p = 0.008) or rural areas (aOR 1.5, p = 0.03) (vs. other towns), respondents with poor self-rated health (vs. good, aOR 2.6, p < 0.001), and diagnosed alcohol use disorder (aOR 1.9, p < 0.001), suicidal behavior (aOR 2.4, p < 0.001), and symptoms of depression (aOR 6.4, p < 0.001) (vs. no such conditions). As for symptoms of generalized anxiety disorder, female sex (vs. males, aOR 2.5, p = 0.003), age below 44 years (vs. 65+, aOR 6.2, p = 0.002), average self-rated health (vs. good, aOR 2.6, p = 0.005), and poor self-rated health (vs. good, aOR 5.3, p < 0.001), together with comorbid suicidal behavior (aOR 6.1, p < 0.001) and symptoms of depression (aOR 43.4, p < 0.001) (vs. no such conditions), increased the odds. Conclusions: Young age, poor self-rated health, and comorbid symptoms of depression and suicidal behavior were significant factors associated with symptoms of both mild anxiety and generalized anxiety disorder. Being unmarried, living in the capital city or rural areas, and alcohol use disorder were associated with mild anxiety symptoms alone. Female sex was associated with generalized anxiety disorder symptoms alone.

Determinants of Anxiety in the General Latvian Population During the COVID-19 State of Emergency.

Background: The COVID-19 pandemic and its restrictive public health measures have seriously affected mental health of society. Social, psychological, and health-related factors have been linked to anxiety in the general population. Aim: We investigate the association of various sociopsychological and health-related determinants of anxiety and identify the predicting factors for anxiety in the general population during the COVID-19 state of emergency from in Latvia. Methods: We conducted an online survey using a randomized stratified sample of the general adult population in July 2020 for 3 weeks. Anxiety symptoms were measured using the State-Trait Anxiety Inventory (STAI-S). Sociodemographic, health-related, sociopsychological characteristics and suicidality were identified using the structured questionnaire. The statistical analysis included Pearson's chi-square test, post hoc analysis, and binomial logistic regression. Results: The weighted study sample included 2,608 participants. The mean STAY-S score of the total sample was 22.88 ± 12.25. In the total sample, 15.2% (n = 398) of participants were classified as having anxiety. The odds ratio (OR) of having anxiety was higher in females (OR = 2.44; 95% CI 1.75-3.33) and people who had experienced mental health problems in the past (OR = 1.45; 95% CI 1.03-2.04), had suicide attempt in the past (OR = 1.68; 95% CI 1.08-2.59), were worried about their health status due to COVID-19 (OR = 1.64; 95% CI 1.36-1.16), were worried about stigmatization from others if infected with COVID-19 (OR = 1.18; 95% CI 1.03-1.35), were worried about information regarding COVID-19 from the Internet (OR = 1.24; 95% CI 1.08-1.43), persons who were lonely (OR = 1.90; 95% CI 1.54-2.34), and persons with negative problem orientation (OR = 1.26; 95% CI 1.06-1.51). Protective factors were identified as having good self-rated general health (OR = 0.68, 95 % CI 0.58-0.81), maintaining a daily routine (OR = 0.74, 95 % CI 0.61-0.90), having financial stability (OR = 0.66, 95 % CI 0.55-0.79), and having good psychological resilience (OR = 0.90, 95 % CI 0.87-0.94). Conclusions: This is the first study to report a prevalence of anxiety in the general population of Latvia. Certain factors that predict anxiety, as well as protective factors were identified.

Characterisation of a conspiracy believers and their mental health during the COVID-19 emergency state in Latvia.

BACKGROUND: A wave of believers in conspiracies has emerged amid the COVID-19 crisis. The purpose of this study was to characterise an individual who believes in conspiracies and to discover whether believing in them is associated with mental health. METHODS: Data was collected as an online survey in a randomised, stratified cohort in July 2020 as a part of the National Research Program of Latvia. The precisely selected and segmented database corresponding to the general population of Latvia was used. Non-parametric tests to compare medians and Spearman correlation to measure the strength of the relationship were applied. RESULTS: The weighted study sample consisted of 2608 participants. A positive correlation was detected between age and belief in conspiracies among females (r = 0.061; p = 0.017). Median conspiracy theory points were significant as follows: individuals who have primary or high school education (p < 0.001) rather than higher education; females (p < 0.001) who resided in a town (p < 0.001) as opposed to occupying the capital; divorcees (p = 0.022) in contrast with those being in a relationship; along with those being unemployed (p < 0.001) compared to the employed, or students. Depressed respondents more often than healthy individuals believed that COVID-19 was created in a laboratory (p < 0.05), that this virus is a result of a 5G antenna (p < 0.05) and that it is a sign of divine power to destroy our planet (p = 0.001). CONCLUSION: The important messages conveyed to the public should be reviewed so that they are more relatable and comprehensible. Furthermore, additional attention should be paid to critical thinking in education programs.

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.

Suicidality and Its Relation with Physical and Mental Conditions: Results from a Cross-Sectional Study of the Nationwide Primary Care Population Sample in Latvia.

Background and Objectives: Physical and mental conditions are important risk factors for suicidality. However, there is no clear understanding of these relationships and the effect of co-occurrence on suicidality. We aimed to investigate the associations between current suicidality and mental disorders, physical conditions, and health-related factors in the nationwide primary care population in Latvia. Materials and Methods: A cross-sectional study was performed within the framework of the National Research Program BIOMEDICINE 2014-2017 at 24 primary care settings across Latvia in 2015. Adult patients were evaluated over one week at each facility. Socio-demographic variables, physical condition, and health-related factors were assessed on-site by trained psychiatrists. Mental disorders and suicidality were determined using the Mini International Neuropsychiatric Interview, and assessments were conducted over the telephone within two weeks after the visit to the general practitioner. Results: Of the 1485 cases, 18.6% reported suicidality. Only current depression, any anxiety disorder, any alcohol use disorder, and physical-mental multimorbidity were significantly associated with suicidality in the multivariate logistic regression analysis. Gastrointestinal diseases were associated with current depression alone (odds ratio (OR) 10.36; 95% confidence interval (CI) 2.34-45.76) and comorbid depression with any anxiety disorder (OR 7.55; 95% CI 2.15-26.49) among persons with current suicidality. Conclusions: Screening for depression, anxiety, and alcohol use disorders regularly among patients with physical illness may be important to help recognise suicidality in primary care that could improve the quality of life of patients and prevent suicides.

Factors Related to COVID-19 Preventive Behaviors: A Structural Equation Model.

Background: While COVID-19 has rapidly spread around the world, and vaccines are not widely available to the general population, the World Health Organization outlines preventive behavior as the most effective way to limit the rapid spread of the virus. Preventive behavior is associated with a number of factors that both encourage and discourage prevention. Aim: The aim of this research was to study COVID-19 threat appraisal, fear of COVID-19, trust in COVID-19 information sources, COVID-19 conspiracy beliefs and the relationship of socio-demographic variables (gender, age, level of education, place of residence, and employment status) to COVID-19 preventive behavior. Methods: The data originate from a national cross-sectional online survey (N = 2,608) undertaken in July 2020. The data were analyzed using structural equation modeling. Results: COVID-19 threat appraisal, trust in COVID-19 information sources, and fear of COVID-19 are all significant predictors of COVID-19 preventive behaviors. Together they explain 26.7% of the variance of this variable. COVID-19 conspiracy beliefs significantly negatively predict COVID-19 threat appraisal (R 2 = 0.206) and trust in COVID-19 information sources (R 2 = 0.190). COVID-19 threat appraisal contributes significantly and directly to the explanation of the fear of COVID-19 (R 2 = 0.134). Directly, as well as mediated by COVID-19 conspiracy beliefs, threat appraisal predicts trust in COVID-19 information sources (R 2 = 0.190). The relationship between COVID-19 threat appraisal and COVID-19 preventive behaviors is partially mediated by fear of COVID-19 (indirect effect 28.6%) and trust in information sources (15.8%). Socio-demographic variables add very little in prediction of COVID-19 preventive behavior. Conclusions: The study results demonstrate that COVID-19 threat appraisal is the most important factor associated with COVID-19 preventive behavior. Those Latvian residents with higher COVID-19 threat appraisal, experienced higher levels of fear of COVID-19, had more trust in COVID-19 information sources, and were more actively involved in following COVID-19 preventive behaviors. COVID-19 conspiracy beliefs negatively predict COVID-19 threat appraisal and trust in COVID-19 information sources, but not the COVID-19 preventive behaviors. Socio-demographic factors do not play an important role here.

Factors related to depression, distress, and self-reported changes in anxiety, depression, and suicidal thoughts during the COVID-19 state of emergency in Latvia.

PURPOSE: Evidence suggests that the 2020 COVID-19 pandemic might have deleterious effects on the population's mental health and psychiatric outcomes. We examined the prevalence of depression, distress, and suicidal thoughts and their association with social and economic factors during the state of emergency in a nationwide representative sample of the general population in Latvia. MATERIALS AND METHOD: An online survey was conducted using a randomized stratified sample of the general adult population in July 2020 for 3 weeks. Distress, depression, suicidal thoughts, and self-reported changes in mental health were identified using a structured questionnaire. The statistical analysis included chi-square tests, analyses of variance, and multivariate forward-stepwise linear regressions. RESULTS: The study sample included 2608 respondents. Clinical depression was present in 5.75% and distress in 7.82%. Suicidal thoughts increased in 13.30% of those with a history of clinical depression, and 27.05% of those with a history of suicidal attempts. The variables that were associated with increases in self-reported anxiety, depressive thoughts, suicidal ideation, and being currently depressed/distressed included lower general health, increased fears of contracting COVID-19 or having family members contract it and die, history of suicidality, increased family conflicts, decreased religiosity, caring for a vulnerable person. Protective factors included positive changes in family relationships and economic situation, maintaining one's basic routine, and having more people living in the household. CONCLUSIONS: Further research and interventions should focus specifically on these factors. The study's findings can help to develop future strategies for management of psychological support for different groups in general population.

The effectiveness and safety of cariprazine in schizophrenia patients with negative symptoms and insufficient effectiveness of previous antipsychotic therapy: an observational study.

The aim of the study was to examine the effectiveness and safety of cariprazine in routine psychiatric settings on schizophrenia patients with negative symptoms who have been treated with antipsychotics previously but without sufficient success. This was an open-label, flexible-dose, 16-week, observational study in Latvia. The primary outcome measure was an array of anamnesis-based clinical questions on schizophrenia symptoms rated on a seven-point scale. Other outcome measurements were the clinical global impression improvement (CGI-I) and severity (CGI-S) scales. Safety parameters included spontaneous reports of adverse events and specific assessments of extrapyramidal side-effects. A mixed model for repeated measures was fit to the data to evaluate the mean change from baseline for all visits. A total of 116 patients enrolled in the study (completion: 83%). Change from baseline to termination in symptom control was statistically significant (-7.3; P < 0.001), with the most improvement in negative symptoms (-6.3; P < 0.001). Over 70% of patients improved minimally or much based on the CGI-I scores at the final visit, and the CGI-S scores indicated an overall improvement in severity from moderately to mildly ill. 40% of patients experienced treatment-emergent adverse events. Over 70% of doctors were satisfied with the effectiveness and tolerability of cariprazine. Cariprazine significantly improved negative symptoms in schizophrenia patients.