National Network of Depression Centers' Recommendations on Harmonizing Clinical Documentation of Electroconvulsive Therapy.

ABSTRACT: Electroconvulsive therapy (ECT) is a highly therapeutic and cost-effective treatment for severe and/or treatment-resistant major depression. However, because of the varied clinical practices, there is a great deal of heterogeneity in how ECT is delivered and documented. This represents both an opportunity to study how differences in implementation influence clinical outcomes and a challenge for carrying out coordinated quality improvement and research efforts across multiple ECT centers. The National Network of Depression Centers, a consortium of 26+ US academic medical centers of excellence providing care for patients with mood disorders, formed a task group with the goals of promoting best clinical practices for the delivery of ECT and to facilitate large-scale, multisite quality improvement and research to advance more effective and safe use of this treatment modality. The National Network of Depression Centers Task Group on ECT set out to define best practices for harmonizing the clinical documentation of ECT across treatment centers to promote clinical interoperability and facilitate a nationwide collaboration that would enable multisite quality improvement and longitudinal research in real-world settings. This article reports on the work of this effort. It focuses on the use of ECT for major depressive disorder, which accounts for the majority of ECT referrals in most countries. However, most of the recommendations on clinical documentation proposed herein will be applicable to the use of ECT for any of its indications.

Artificial Intelligence and Chatbots in Psychiatry.

The utilization of artificial intelligence (AI) in psychiatry has risen over the past several years to meet the growing need for improved access to mental health solutions. Additionally, shortages of mental health providers during the COVID-19 pandemic have continued to exacerbate the burden of mental illness worldwide. AI applications already in existence include those enabled to assist with psychiatric diagnoses, symptom tracking, disease course prediction, and psychoeducation. Modalities of AI mental health care delivery include availability through the internet, smartphone applications, and digital gaming. Here we review emerging AI-based interventions in the form of chat and therapy bots, specifically conversational applications that teach the user emotional coping mechanisms and provide support for people with communication difficulties, computer generated images of faces that form the basis of avatar therapy, and intelligent animal-like robots with new advances in digital psychiatry. We discuss the implications of incorporating AI chatbots into clinical practice and offer perspectives on how these AI-based interventions will further impact the field of psychiatry.

Cross-cultural Comparison of Perceptions and Knowledge About Electroconvulsive Therapy Among Adults Who Screened Positive for Depression in the United States, India, and China.

OBJECTIVE: Despite the established efficacy of electroconvulsive therapy (ECT), negative perceptions and inaccurate knowledge about ECT in the United States and other countries persist. This study examined ECT perceptions and knowledge in the 3 most populous countries in the world. METHODS: We recruited participants who screened positive for depression on the Patient Health Questionnaire 9 (PHQ-9) in the United States (n = 1643), India (n = 1469), and China (n = 328) and compared responses on the ECT-Perception and Knowledge Scale. RESULTS: Although the US sample had significantly higher PHQ-9 scores than the India and China samples, the US sample was less likely to have been offered ECT or to have ever received ECT. Moreover, the US sample scored lower on the ECT Perception and Knowledge subscales than the other samples indicating more negative perceptions and inaccurate knowledge about ECT. Across samples, there were moderate fears about ECT being painful or causing brain damage, and misconceptions about ECT being outdated and adverse effects of induced seizures. Higher PHQ-9 scores were correlated with more negative perceptions. CONCLUSIONS: Greater public education is needed about ECT, particularly in the United States. Misperceptions and lack of knowledge may hinder utilization of ECT in India, China, and the United States.

A Novel Refractory Mood Disorders and Electroconvulsive Therapy Elective for Medical Students: Fighting Stigma through Experience.

Treatment resistant mood disorders (TRMD) have a significant impact on patients and society. Electroconvulsive therapy (ECT) has been shown to be effective for treatment resistant depression (TRD). Despite the effectiveness and safety of ECT, there remains significant stigma surrounding its use. Studies worldwide have shown that many medical students receive their knowledge from the media, which often portrays ECT in a negative light, and very few have exposure to ECT prior to their psychiatric clinical rotations. In this article we highlight the importance of medical education and introduce a novel approach in helping to fight the stigma of ECT through educational intervention for medical trainees that combines active, longitudinal and theoretical learning. By ensuring that trainees have a robust education in this arena, we can help them educate patients about treatment options, improve confidence in prescribing and administering these therapies, and ultimately improve patient and societal outcomes.

Brain-Derived Neurotrophic Factor and Oxidative Stress in Cannabis Dependence.

INTRODUCTION: Neurotrophin levels and oxidative stress markers such as ceruloplasmin and free thiols have been shown to contribute to pathophysiology in several psychiatric disorders. OBJECTIVE: Our aim is to evaluate whether those markers are altered in cannabis dependence. METHODS: Forty-five cannabis-dependent patients diagnosed according to the DSM-IV criteria and 45 healthy controls matched according to sex, age, BMI, and smoking status were enrolled. Brain-derived neurotrophic factor (BDNF), ceruloplasmin, lipid hydroperoxide, and total free thiols were measured in both groups. Those who had psychiatric comorbidities were excluded before sampling. RESULTS: We found significantly increased BDNF, ceruloplasmin, and lipid hydroperoxide, and decreased free thiol levels in patients with cannabis dependence. There is also a positive correlation between BDNF and lipid hydroperoxide (n = r = 0.472, p < 0.001) and a negative correlation between BDNF and total thiols (n = r = -0.412, p = 0.001). CONCLUSIONS: Increased BDNF might be a sign of impaired neuronal plasticity that is crucial for memory formation and adaptive response to drug addiction. Neuronal plasticity in the ventral tegmental area dopaminergic neurons was implied to play a role in substance addiction disorders, and these adaptations can be secondary to oxidative stress. Our findings, including increased lipid hydroperoxide, ceruloplasmin, and decreased free thiols, might support this hypothesis. In conclusion, cannabis dependency alters BDNF levels and increases oxidative stress.

A case of mirror image agnosia and mirrored self-misidentification syndrome in schizophrenia without dementia or structural abnormalities.

Delusional misidentification syndrome (DMS) is an umbrella term encompassing a variety of disorders. One rare form of DMS is the delusional misidentification of one's own reflection, known as "mirrored self-misidentification syndrome". In "mirror image agnosia", the ability to identify the image of self and/or others in the mirror is lost, while the ability to identify the mirror itself is preserved. To our knowledge, mirror image agnosia has never been described in a patient with schizophrenia. Herein we present a case of a patient with schizophrenia with severe delusions of both mirrored self-misidentification and mirror image agnosia without any structural abnormalities or dementia.

Image of Electroconvulsive Therapy in YouTube Videos.

OBJECTIVES: Image of electroconvulsive therapy (ECT) in TV shows and movies have been studied before. However, there is no study about image of ECT on YouTube as one of the most commonly used social media platforms for disseminating health information. Our study aims to study the image of ECT in YouTube videos. METHODS: Key word "Electroconvulsive therapy and ECT" were used to search on Youtube.com and only videos over 50,000 view counts and in English were selected. Above videos were reviewed by an ECT physician and were classified into neutral, negative, and positive groups based on the image of ECT. RESULTS: There were 41 YouTube videos selected based on the criteria as stated above, among which 14 were unrelated with ECT treatment, 8 were neutral, 9 were positive, and 10 were reflecting negative image about ECT. There was no significant difference among view counts of the positive, negative and neutral videos (χ = 2.746, P = 0.253). Furthermore, the most viewed 3 videos showed negative image of ECT. Additionally, only 6 videos showed the modified ECT and one showed both modified and nonmodified ECT. CONCLUSIONS: This is the first study conducted on image of ECT in YouTube videos. We found the stigma against ECT may persist in digital video platforms, such as YouTube.

The Association Between NIMH Funding and h-index in Psychiatry.

OBJECTIVE: Academic productivity is measured under many domains: number of high impact publications, objective bibliometrics, securing extra-mural funding, etc. Citation impact is measured by an objective bibliometric called h-index. Securing funding from the National Institute of Mental Health (NIMH) is considered prestigious in the field of psychiatry. It is unknown if NIMH takes into consideration the author's h-index during the grant review process. The goal of this study was to determine the correlation between a principal investigator's (PI's) h-index and the NIMH funding. METHOD: Correlational analysis was conducted on publicly available 2012 NIMH funding data to assess the relationship between NIMH funding and a PI's h-index. A simple linear regression was calculated to predict the h-index based on the amount of funding offered to the PI. RESULTS: A total of 139 PIs and their corresponding h-index and NIMH funding (direct, indirect, and total cost) were included. A strong correlation was found between h-index and NIMH funding: direct cost (r = 0.632, p < 0.001); indirect cost (r = 0.570, p < 0.001); and total cost (r = 0.639, p < 0.001). Total funding significantly predicted h-index, ß = 0.821, t (2.599), p < 0.01, and explained a significant proportion of variance in h-index, R 2 = 0.410, F (3, 119) = 27.59, p < 0.001. CONCLUSION: A strong relationship was seen between h-index and securing NIMH funding. Thus, h-index stands out as a reliable measure for assessing the impact of scholarly contributions in academic psychiatry and can be used as an adjunct for performance evaluations, appointment, and promotions in academia.

Increased S100B Levels in Cannabis Use Disorder.

BACKGROUND: It has been determined that cannabis has adverse effects on brain tissue, and that increased S100 calcium binding protein B (S100B) blood levels are markers of neuronal damage. Therefore, the aim of this study was to evaluate the S100B levels in cannabis use disorder. METHOD: Thirty-two patients with cannabis use disorder and 31 matched healthy controls were enrolled in this study. Appropriate blood samples were taken from the enrolled subjects, and the serum S100B protein levels were measured with an electrochemiluminescence immunoassay for the quantification of the protein. FINDINGS: We found significantly increased S100B protein levels in patients with cannabis use disorder. The mean serum concentration of S100B was 0.081 ± 0.018 µg/l in patients with cannabis use disorder, and 0.069 ± 0.018 µg/l in the control group (p = 0.008). INTERPRETATION: Our data suggest that elevated S100B protein levels might indicate neuronal damage in the brains of people with cannabis use disorder.

Tracking down the footprints of bad paternal relationships in dissociative disorders: A diffusion tensor imaging study.

Preclinical studies indicate that stress early in life can cause long-term alterations in brain development. Studies have shown alterations in the brain functions of patients after experiencing trauma. Our aim is to examine whether the integrity of white matter tracts might be affected in dissociative disorder (DD) patients. A total of 15 DD patients and 15 healthy controls were studied, with the groups matched by age and gender. Diffusion-weighted echoplanar brain images were obtained using a 1.5 Tesla magnetic resonance imaging scanner. Regions of interest were manually placed on directional maps based on principal anisotropy. Apparent diffusion coefficient and fractional anisotropy (FA) values of white matter were measured bilaterally in the anterior corona radiata (ACR) and by diffusion tensor imaging in the genu and splenium of the corpus callosum. Significantly lower FA values were observed in the right ACR of DD patients versus healthy individuals. We also found an association between bad paternal relationships and lower FA in the genu of the corpus callosum in female patients. Alterations in the right ACR suggest that diffusion anisotropy measurement can be used as a quantitative biomarker for DD. Paternal relationships may also affect the brain's microstructure in women with DD.

Prolidase activity and oxidative stress in patients with schizophrenia: a preliminary study.

OBJECTIVE: To determine whether serum prolidase levels are associated with the etiopathogenesis of schizophrenia. METHODS: The study was conducted at the psychiatry outpatient clinics of the University Hospitals of Recep Tayyip Erdogan and Afyonkocatepe in spring 2013. It comprised patients with schizophrenia who were consecutively recruited from the Psychiatry outpatient clinics of the hospital. An equal number of healthy individuals were recruited from the community. Each patient underwent a detailed diagnostic evaluation by psychiatry residents by using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV. Serum prolidase activity and oxidative parameters were measured in patient and control groups.The severity of psychotic symptoms was assessed using the positive and negative syndrome scale. SPSS 16 was used for statitistical analysis. RESULTS: There were 30 subjects in each group, with 18 (60%) females among the patients and 21 (70%) among the controls. Serum prolidase level was significantly higher in schizophrenia patients compared to the controls (p < 0.001). Total Oxidative Stress and Oxidative Stress Index parameters were found to be significantly different between the patients and the controls (p = 0.024 and p < 0.001). Serum prolidase level did not show any correlation with markers of oxidative stress in the patients. CONCLUSION: Prolidase activity, glutamate transmission and oxidative stress may be inter-related in the etiopathogenesis of schizophrenia.

Relationship of asymmetrical dimethylarginine, nitric oxide, and sustained attention during attack in patients with major depressive disorder.

We investigated the relationship of serum nitric oxide (NO) and asymmetrical dimethylarginine (ADMA) levels with cognitive functioning in patients with major depressive disorder (MDD). 41 MDD patients (Beck depression scale scores>16) and 44 controls were included in the study. Rey verbal learning and memory test, auditory consonant trigram test, digit span test, Wisconsin card sorting test, continuous performance task (TOVA), and Stroop test scores were found to be impaired in patients with major depressive disorder when compared to healthy controls. There was no significant difference between patient and control groups in terms of serum NO and ADMA. Serum NO levels were correlated with TOVA test error scores and Stroop test time scores, whereas serum ADMA levels were negatively correlated with TOVA test error scores. Metabolic detriments especially in relation to NO metabolism in frontal cortex and hypothalamus, psychomotor retardation, or loss of motivation may explain these deficits.

Large Language Models for Social Determinants of Health Information Extraction from Clinical Notes - A Generalizable Approach across Institutions.

The consistent and persuasive evidence illustrating the influence of social determinants on health has prompted a growing realization throughout the health care sector that enhancing health and health equity will likely depend, at least to some extent, on addressing detrimental social determinants. However, detailed social determinants of health (SDoH) information is often buried within clinical narrative text in electronic health records (EHRs), necessitating natural language processing (NLP) methods to automatically extract these details. Most current NLP efforts for SDoH extraction have been limited, investigating on limited types of SDoH elements, deriving data from a single institution, focusing on specific patient cohorts or note types, with reduced focus on generalizability. This study aims to address these issues by creating cross-institutional corpora spanning different note types and healthcare systems, and developing and evaluating the generalizability of classification models, including novel large language models (LLMs), for detecting SDoH factors from diverse types of notes from four institutions: Harris County Psychiatric Center, University of Texas Physician Practice, Beth Israel Deaconess Medical Center, and Mayo Clinic. Four corpora of deidentified clinical notes were annotated with 21 SDoH factors at two levels: level 1 with SDoH factor types only and level 2 with SDoH factors along with associated values. Three traditional classification algorithms (XGBoost, TextCNN, Sentence BERT) and an instruction tuned LLM-based approach (LLaMA) were developed to identify multiple SDoH factors. Substantial variation was noted in SDoH documentation practices and label distributions based on patient cohorts, note types, and hospitals. The LLM achieved top performance with micro-averaged F1 scores over 0.9 on level 1 annotated corpora and an F1 over 0.84 on level 2 annotated corpora. While models performed well when trained and tested on individual datasets, cross-dataset generalization highlighted remaining obstacles. To foster collaboration, access to partial annotated corpora and models trained by merging all annotated datasets will be made available on the PhysioNet repository.

Lipids and lipoproteins may play a role in the neuropathology of Alzheimer's disease.

Alzheimer's disease (AD) and other classes of dementia are important public health problems with overwhelming social, physical, and financial effects for patients, society, and their families and caregivers. The pathophysiology of AD is poorly understood despite the extensive number of clinical and experimental studies. The brain's lipid-rich composition is linked to disturbances in lipid homeostasis, often associated with glucose and lipid abnormalities in various neurodegenerative diseases, including AD. Moreover, elevated low-density lipoprotein (LDL) cholesterol levels may be related to a higher probability of AD. Here, we hypothesize that lipids, and electronegative LDL (L5) in particular, may be involved in the pathophysiology of AD. Although changes in cholesterol, triglyceride, LDL, and glucose levels are seen in AD, the cause remains unknown. We believe that L5-the most electronegative subfraction of LDL-may be a crucial factor in understanding the involvement of lipids in AD pathology. LDL and L5 are internalized by cells through different receptors and mechanisms that trigger separate intracellular pathways. One of the receptors involved in L5 internalization, LOX-1, triggers apoptotic pathways. Aging is associated with dysregulation of lipid homeostasis, and it is believed that alterations in lipid metabolism contribute to the pathogenesis of AD. Proposed mechanisms of lipid dysregulation in AD include mitochondrial dysfunction, blood-brain barrier disease, neuronal signaling, inflammation, and oxidative stress, all of which lead ultimately to memory loss through deficiency of synaptic integration. Several lipid species and their receptors have essential functions in AD pathogenesis and may be potential biomarkers.

Ketofol in electroconvulsive therapy anesthesia: two stones for one bird.

PURPOSE: Propofol and ketamine have become progressively popular in electroconvulsive therapy (ECT) anesthesia, although propofol shortened seizure duration and ketamine might cause cardiotoxicity, psychotic episodes, and delayed recovery. Ketofol is a combination of ketamine and propofol, and the current study was designed to evaluate the effect of ketamine, propofol, and ketofol on hemodynamic profile, duration of seizure activity, and recovery times in patients undergoing ECT. METHODS: Ninety patients (44 women, mean age 27.8 ± 7.2 years) in one ECT session were enrolled and randomized to the propofol, ketamine, or ketofol group. Hemodynamic profile duration of seizure activity and recovery times were recorded. RESULTS: Motor seizure duration in the propofol group was significantly decreased compared to other groups (p < 0.001), whereas spontaneous breathing time in the ketamine group statistically increased compared to the propofol group (p = 0.001), and also eye-opening time (p < 0.001) and obeying-command time (p < 0.001) was significantly increased in the ketamine group compared to other groups. Heart rate (HR) at induction (ketamine 91.2 ± 13.6 vs. propofol 77 ± 13.4 and ketofol 79.9 ± 15.6; p < 0.013; p < 0.08, respectively) was statistically significantly increased in the ketamine group compared to other groups, and HR at the third minute (ketamine 92 ± 12.9 vs. propofol 79.4 ± 9.3 and ketofol 81.5 ± 14.2; p < 0.012, p < 0.048) was also statistically significantly increased in ketamine group compared to other groups. CONCLUSION: The ketofol 1:1 mixture is associated with longer mean seizure time than propofol, and shorter mean recovery times than ketamine, with better hemodynamic stability, without any important side effects in ECT anesthesia.

Personality traits of Turkish handgun license applicants.

Several theories have sought to explain the motivations for handgun possession and the relationship with personality. Perception of handguns also has cultural variations. The aim of the study is to evaluate handgun license applicants' personality profiles. 109 handgun license applicants were included in the study. Temperament and Character Inventory (TCI) scores of the applicants were recorded. Scores were compared with Turkish and American normative data for the Inventory. The study group had significantly lower subscores on novelty seeking, harm avoidance, and higher subscores on reward dependence and persistence compared to Turkish norms and significantly lower subscores on novelty seeking, reward dependence, and self-directedness compared to American norms. Results indicate that Turkish handgun license applicants' personality features are more similar to American norms.

Abused nurses take no legal steps: a domestic violence study carried out in eastern Turkey.

BACKGROUND: Our aim was to evaluate domestic violence among nurses in eastern Turkey. SUBJECTS AND METHODS: Ninety six (96) female nurses with an intimate partner were enrolled. Modified form of Abuse Assessment Screen Questionnaire was used. RESULTS: Twenty two (22.7%) of the participants reported domestic violence. None of them took legal steps. Most frequent domestic violence type was economic abuse (46%). Nurses, whose mothers were exposed to domestic violence, had significantly higher abuse rates. The abused group had also significantly higher smoking and miscarriage rates. CONCLUSIONS: Nurses need to be well informed for taking legal steps in case of domestic violence. Family history, smoking status and abortion rates may be further research focus for risk factors of domestic violence. Legal interventions should be optimized in order to encourage the victims to take legal steps.

Patient and Provider Perspectives on Medication Non-adherence Among Patients with Depression and/or Diabetes in Diverse Community Settings - A Qualitative Analysis.

Background: Diabetes and depression affect a significant percentage of the world's total population, and the management of these conditions is critical for reducing the global burden of disease. Medication adherence is crucial for improving diabetes and depression outcomes, and research is needed to elucidate barriers to medication adherence, including the intentionality of non-adherence, to intervene effectively. The purpose of this study was to explore the perspectives of patients and health care providers on intentional and unintentional medication adherence among patients with depression and diabetes through a series of focus groups conducted across clinical settings in a large urban area. Methods: This qualitative study utilized a grounded theory approach to thematically analyze qualitative data using the framework method. Four focus groups in total were conducted, two with patients and two with providers, over a one-year period using a semi-structured facilitation instrument containing open-ended questions about experiences, perceptions and beliefs about medication adherence. Results: Across the focus groups, communication difficulties between patients and providers resulting in medication non-adherence was a primary theme that emerged. Concerns about medication side effects and beliefs about medication effectiveness were identified as perceptual barriers related to intentional medication non-adherence. Practical barriers to medication adherence, including medication costs, forgetting to take medications and polypharmacy, emerged as themes related to unintentional medication non-adherence. Conclusion: The study findings contribute to a growing body of research suggesting health system changes are needed to improve provider education and implement multicomponent interventions to improve medication adherence among patients with depression and/or diabetes, both chronic illnesses accounting for significant disease burden globally.

Current knowledge and attitudes of psychiatric nurses toward electroconvulsive therapy.

PURPOSE: This study assessed the current knowledge and attitudes of psychiatric nurses toward electroconvulsive therapy (ECT). DESIGN AND METHODS: A quantitative, nonexperimental study was conducted at a large psychiatric hospital in the United States. The Questionnaire on Attitudes and Knowledge (QuAKE) Scale was used to conduct the assessment among a convenient sample of 158 psychiatric nurses. FINDINGS: Participants' responses to questions that elicited knowledge of ECT ranged from 45% to 99% and positive attitudes ranged from 21% to 96%, revealing increased levels when compared with the low to average knowledge and positive attitudes noted in previous studies. PRACTICE IMPLICATIONS: Targeted ECT education is needed among psychiatric nurses with limited knowledge and negative attitudes toward ECT.

Melatonin Receptor Gene Polymorphism in Bipolar-I Disorder.

BACKGROUND AND AIM: In patients with Bipolar-I Disorder (BD-I), circadian rhythm and sleep disorders are frequently observed. Melatonin is a main regulatory hormone for the circadian rhythm. Certain studies have shown the relationship of melatonin receptor gene polymorphism with psychiatric diseases. In this study, it was aimed to investigate the relationship between BD-I and -184T>C (rs2119882) polymorphism in melatonin receptor 1A (MTNR1A) gene and -1193C>T (rs4753426) polymorphism in melatonin receptor 1B (MTNR1B) gene. METHODS: The study included 108 patients diagnosed with BD-I and 95 healthy people as the control group. Real-time PCR (RT-PCR) method was used to evaluate the polymorphism of MTNR1A gene-184T>C. Genotyping of MTNR1B gene-1193C>T polymorphism was done by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: In terms of MTNR1B gene-1193C>T polymorphism, homozygous CC genotype was found to be increased in BD-I patient group compared to the control group (p <0.05). Similarly, a statistically significant difference was found between the patients and the control group in terms of allele frequencies too (p <0.05). However, no relation between BD-I and MTNR1A gene-184T>C polymorphism was found (p >0.05). CONCLUSION: The results of the study revealed that MTNR1B gene-1193C>T polymorphism may play a role in BD-I genetic etiology and may be among the causes of sleep disorder and circadian rhythm disorder seen in these patients.