Strategies, processes, outcomes, and costs of implementing experience sampling-based monitoring in routine mental health care in four European countries: study protocol for the IMMERSE effectiveness-implementation study.

BACKGROUND: Recent years have seen a growing interest in the use of digital tools for delivering person-centred mental health care. Experience Sampling Methodology (ESM), a structured diary technique for capturing moment-to-moment variation in experience and behaviour in service users' daily life, reflects a particularly promising avenue for implementing a person-centred approach. While there is evidence on the effectiveness of ESM-based monitoring, uptake in routine mental health care remains limited. The overarching aim of this hybrid effectiveness-implementation study is to investigate, in detail, reach, effectiveness, adoption, implementation, and maintenance as well as contextual factors, processes, and costs of implementing ESM-based monitoring, reporting, and feedback into routine mental health care in four European countries (i.e., Belgium, Germany, Scotland, Slovakia). METHODS: In this hybrid effectiveness-implementation study, a parallel-group, assessor-blind, multi-centre cluster randomized controlled trial (cRCT) will be conducted, combined with a process and economic evaluation. In the cRCT, 24 clinical units (as the cluster and unit of randomization) at eight sites in four European countries will be randomly allocated using an unbalanced 2:1 ratio to one of two conditions: (a) the experimental condition, in which participants receive a Digital Mobile Mental Health intervention (DMMH) and other implementation strategies in addition to treatment as usual (TAU) or (b) the control condition, in which service users are provided with TAU. Outcome data in service users and clinicians will be collected at four time points: at baseline (t0), 2-month post-baseline (t1), 6-month post-baseline (t2), and 12-month post-baseline (t3). The primary outcome will be patient-reported service engagement assessed with the service attachment questionnaire at 2-month post-baseline. The process and economic evaluation will provide in-depth insights into in-vivo context-mechanism-outcome configurations and economic costs of the DMMH and other implementation strategies in routine care, respectively. DISCUSSION: If this trial provides evidence on reach, effectiveness, adoption, implementation and maintenance of implementing ESM-based monitoring, reporting, and feedback, it will form the basis for establishing its public health impact and has significant potential to bridge the research-to-practice gap and contribute to swifter ecological translation of digital innovations to real-world delivery in routine mental health care. TRIAL REGISTRATION: ISRCTN15109760 (ISRCTN registry, date: 03/08/2022).

Social participation of rheumatoid arthritis patients: Does illness perception play a role?

OBJECTIVE: Social participation is an important aspect associated with health-related outcomes in chronic diseases. However, little is known about the factors that may affect participation in patients with rheumatoid arthritis (RA). We aimed to examine whether pain, fatigue, anxiety, depression, and illness perception are associated with social participation in patients with RA when controlled for clinical and sociodemographic variables. We also analysed the mediating role of illness perception in the association between physical and psychological variables on social participation. METHOD: We included 157 RA patients (84.7% females; mean age 56.4 ± 13.9 years) who completed the Participation Scale, Brief Illness Perception Questionaire, Generalized Anxiety Disorder Scale, Patient Health Questionnaire, 36-item Short Form Health Survey, and the Visual Analogue Scale. Multiple linear regressions and mediation analyses were used to analyze the data. RESULTS: In the final regression models, illness perception (ß = .42; p ≤ .001) and functional disability (ß = .21; p ≤ .05) were associated with social participation. Income (ß = -.18; p ≤ .05) lost its significance when physical variables were added to the model, and pain (ß = .24; p ≤ .05) and fatigue (ß = -.24; p ≤ .05) when psychological distress was added. No significant role of anxiety, depression, disease activity, or age was identified using regression analyses. Illness perception mediated the association of pain, fatigue, anxiety, and depression with social participation, and the indirect effect varied from 65% to 98%. CONCLUSIONS: Illness perceptions may significantly diminish the impacts of pain, fatigue, anxiety, and depression on social participation in individual RA patients. Therefore, RA patients could benefit from psychological interventions aimed at tackling negative illness perceptions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Case report: Uncovering hidden glucose patterns in medicated versus unmedicated bipolar disorder and comorbid type 1 diabetes mellitus.

Introduction: Type 1 diabetes mellitus is characterized by an absolute insulin deficiency requiring the lifetime intensive insulin therapy accompanied by daily self-monitoring, self-management, ongoing education, and complex diabetes care. Regular patient-clinician shared therapeutic decisions based on age, sex, comorbidities, medications, predicted impact of meals, physical activity, stress, hormonal changes, insulin therapy, and patterns of glycemic changes are key for achieving glycemic targets. The impact of various phases of bipolar disorder and their treatment on continuous glucose levels remains unexplored and calls for future assessments. Case presentation: The present case reports a 41-year-old Caucasian female with an established diagnosis of bipolar II disorder and type 1 diabetes mellitus who discontinued long-term mood-stabilizing pharmacotherapy with quetiapine. Real-time continuous glucose monitoring performed before and 6-months following the discontinuation of quetiapine revealed hidden glucose patterns in medicated versus unmedicated bipolar disorder. Despite the known adverse metabolic effects of quetiapine, the continuous glucose monitoring captured more stable and near-normal continuous glucose values during the antipsychotic treatment compared to unmedicated stages of bipolar disorder with considerably higher glucose values and glucose variability. Conclusion: The case report highlights the importance of the ongoing psychopharmacotherapy of bipolar disorder in comorbid type 1 diabetes mellitus to reduce mood-induced reactivity, emotional urgency, and non-emotional impulsivity that may contribute to dysglycemia. If not effectively treated, the "bipolar diabetes" is likely to progress to multiple psychiatric and somatic complications. The bidirectional links between the phases of bipolar disorder and the corresponding continuous glucose patterns can help advance clinical decision-making and yield innovative1 research that can translate into efficacious clinical practice.

An expert review of clozapine in Eastern European countries: Use, regulations and pharmacovigilance.

OBJECTIVES: To compare the prevalence, regulations, and pharmacovigilance practices of clozapine use in Eastern European countries (except Russia). METHODS: Questionnaires and data from administrative databases (2016 and 2021), package inserts and national guidelines were collected from 21 co-authors from 21 countries. Reports of clozapine adverse drug reactions (ADRs) sent to the global pharmacovigilance database (VigiBase™) were analyzed from introduction to December 31, 2022. RESULTS: Clozapine prescription among antipsychotics in 2021 varied six-fold across countries, from 2.8 % in the Czech Republic to 15.8 % in Montenegro. The utilization of antipsychotics in both 2016 and 2021 was highest in Croatia, and lowest in Serbia in 2016, and Montenegro in 2021, which had half the defined daily dose (DDD)/1000/day compared to the Croatian data. From 2016 to 2021, the prevalence of antipsychotic use increased in almost all countries; the proportion of clozapine use mainly remained unchanged. Differences were detected in hematological monitoring requirements and clozapine approved indications. Only a few national schizophrenia guidelines mention clozapine-induced myocarditis or individual titration schemes. The VigiBase search indicated major underreporting regarding clozapine and its fatal outcomes. By comparison, the United Kingdom had less than half the population of these Eastern European countries but reported to VigiBase more clozapine ADRs by 89-fold and clozapine fatal outcomes by almost 300-fold. CONCLUSION: Clozapine is under-utilized in Eastern European countries. Introducing individualized clozapine treatment schedules may help to maximize clozapine benefits and safety. Major improvement is needed in reporting clozapine ADRs and fatal outcomes in Eastern European countries.

Autogenic Training in Mental Disorders: What Can We Expect?

Autogenic training (AT) is a well-established self-induced relaxation technique based on autosuggestion. From the past two decades, an increasing number of AT studies strongly suggests the practical usefulness of psychophysiological relaxation in the area of medicine. Despite this interest, to date, limited critical clinical reflection on the application and effects of AT in mental disorders exists. The present paper reviews psychophysiological, psychopathological, and clinical aspects of AT in persons with mental disorders with emphasis on implications for future research and practice. Based on a formal literature search, 29 reported studies (7 meta-analyses/systematic reviews) were identified that examined the effects and impact of AT on mental disorders. The main psychophysiological effects of AT include autonomic cardiorespiratory changes paralleled by central nervous system activity modifications and psychological outputs. Studies demonstrate consistent efficacy of AT in reducing anxiety and medium range positive effects for mild-to-moderate depression. The impact on bipolar disorders, psychotic disorders, and acute stress disorder remains unexplored. As an add-on intervention psychotherapy technique with beneficial outcome on psychophysiological functioning, AT represents a promising avenue towards expanding research findings of brain-body links beyond the current limits of the prevention and clinical management of number of mental disorders.

Bipolar disorder and type 2 diabetes mellitus: A bidirectional relationship

Background and objectivesOver the past few decades, research has revealed complex interactions between type 2 diabetes mellitus (T2DM) and a wide range of comorbid conditions. The present paper sought to examine the relationship between bipolar disorder and T2DM and clarify the clinical impact of therapeutic interventions, highlighting the interpretation and implications of recent literature reports.MethodsThe PubMed electronic database was searched for keywords “bipolar disorder” AND “diabetes” OR “glucose”. Based on this literature search, 15 meta-analyses/systematic reviews and numerous research studies were identified that examined interrelationships between bipolar disorders and T2DM.ResultsPatients with bipolar disorder have higher rates of T2DM compared to the general population. Further, type 2 diabetic patients with comorbid bipolar disorder often experience deteriorated long-term glucose control and increased cardiovascular morbidity and mortality. Recent literature suggests shared risk factors and underlying disease mechanisms. In addition, genetic factors, sedentary life-style, lack of exercise, increased simple carbohydrate intake, adverse effects of bipolar pharmacotherapy, and bipolar depressive symptoms phenomenology may affect glucose metabolism.ConclusionsThe observed bidirectional interaction merits screening for psychiatric disorders in T2DM and vice versa to allow for early detection and treatment of this at risk population. Selection of drugs with neutral metabolic effects and dose individualization hold significant promise for optimizing therapy with antipsychotic and antidiabetic agents. (AU)

Tear fluid biomarkers in major depressive disorder: Potential of spectral methods in biomarker discovery.

Spectroscopic methods represent a group of analytical methods that demonstrate high potential in providing clinically relevant diagnostic information, such as biochemical, functional or structural changes of macromolecular complexes that might occur due to pathological processes or therapeutic intervention. Although application of these methods in the field of psychiatric research is still relatively recent, the preliminary results show that they have the capacity to detect subtle neurobiological abnormalities in major depressive disorder (MDD). Methods of mass spectrometry (MALDI-TOF MS), zymography, synchronous fluorescence spectroscopy (SFS), circular dichroism (CD) spectroscopy, Fourier-transform infrared (FTIR) spectroscopy and atomic force microscopy (AFM) were used to analyze the human tear fluid of subjects with MDD. Using MALDI-TOF MS, two diagnostically significant peaks (3747 and 16 411 m/z) were identified with an AUC value of 0.89 and 0.92 in tear fluid of subjects with MDD vs controls, respectively. We also identified various forms of matrix metalloproteinase 9 in subjects with MDD using zymography and synchronous fluorescence spectra (SFS) showed a significant increase in fluorescence intensity at 280 nm. CD spectra were redshifted in tear fluid of subjects with MDD vs healthy controls. FTIR spectroscopy showed changes in the positions of peaks for amide A, I, II in tear fluid of subjects with MDD vs controls. Moreover, atomic force microscopy (AFM) showed different pattern in the crystal structures of tear fluid components in subjects with MDD. SFS, CD, FTIR spectroscopy, AFM and MALDI-TOF MS confirmed, that the human tear fluid proteome could be helpful in discriminating between the group of subjects with MDD and healthy controls. These preliminary findings suggest that spectral methods could represent a useful tool in clinical psychiatry, especially in establishing differential diagnosis, monitoring illness progression and the effect of psychiatric treatment.

What mental health experts in Slovakia are learning from COVID-19 pandemic?

INTRODUCTION: The COVID-19 pandemic was confirmed to have spread to Slovakia on 6th March 2020. To date of paper submission, it has very favorable course. However, since the beginning healthcare workers have been working under increasing pressure, anxiety and fear. AIM: Authors evaluated the psychosocial impact of COVID-19 pandemic on mental health experts and their clinical practice in Slovakia. MATERIALS AND METHODS: A total of 157 mental health experts (79% women) submitted their responses via online questionnaire. RESULTS: The most frequent occupation categories were 38.2% outpatient psychiatrists, 26.1% inpatient psychiatrists and 20.4% psychologists. The mental health experts felt maximum of stress during the peak of Slovak COVID-19 crisis, which was identified as the situation just after the declaring the state of emergency by Slovak government. The main sources of stress were statistical data, prognoses and other public presented information. Mental health experts felt mainly personal stress, then general and working stress. They identified also pathological effect of COVID-19 pandemic on the mental status of their patients, especially with anxiety and affective disorders and advantages of use of telemedicine. CONCLUSION: Psychosocial support in Slovakia was newly organized in COVID-19 pandemic for medical professionals, patients and other inhabitants under high stress within a very short time. This unexpected situation has revealed to Slovakia the need for reform of the mental healthcare system.

Autism and education-Teacher policy in Europe: Policy mapping of Austria, Hungary, Slovakia and Czech Republic.

BACKGROUND: This report maps autism and special education needs (SEN) policies, alongside teacher responsibilities in the education of children with SEN in Austria, Hungary, Czech Republic, and Slovakia. METHODS AND PROCEDURE: A policy path analysis using a scoping review as an underlying methodological framework was performed. OUTCOMES AND RESULTS: The end of communism and accession to the European Union were critical for the countries under study. They passed crucial policies after international policies and adopted a three-stream approach towards providing education: (1) special schools; (2) special classes in mainstream schools; or (3) mainstream classes. Special schools remain for children that cannot participate in mainstream schools. Teachers are given high levels of responsibility. CONCLUSION AND IMPLICATIONS: Changes in international guidance greatly impacted Austria, Hungary, Slovakia and the Czech Republic. The education systems aim for inclusion, though segregation remains for children that cannot thrive in mainstream schools. Teachers are pivotal in the education of children with SEN, more so than with typical children.

The altered circadian pattern of basal insulin requirements - an early marker of autoimmune polyendocrine syndromes in type 1 diabetes mellitus.

OBJECTIVES: The purpose of the present paper is to propose and introduce novel biomarkers of autoimmune polyendocrine syndromes that are relevant to the early diagnosis and optimal medical management of the patients who already suffer from type 1 diabetes mellitus. METHODS: We hypothesize and demonstrate on a case study that various organ-specific autoimmune endocrinopathies can result in lowered basal insulin requirements, leading to unexplained hypoglycemia. RESULTS: It can be hypothesized that hypothyroidism in patients with type 1 diabetes mellitus may deteriorate glycemic control and can lead to an increased rate of hypoglycemia, particularly the overnight and morning hypoglycemia. Thus, the decreased requirements for particularly overnight basal insulin can be an early marker of the autoimmune polyendocrine syndrome-3 with subclinical autoimmune thyroiditis in immune-mediated type 1 diabetes mellitus. Further, it could be proposed that unexplained hypoglycemia during the late afternoon or evening could be an early marker of the autoimmune polyendocrine syndrome-2 with subclinical autoimmune Addison disease in immune-mediated type 1 diabetes mellitus. As a result, an altered circadian pattern of basal insulin requirements can occur, characterized by a decreased late afternoon basal insulin rate. CONCLUSIONS: After exclusion of other causes, the unexplained reoccurring hypoglycemia can be a remarkable feature of autoimmune polyendocrine syndromes in immune-mediated type 1 diabetes mellitus on intensive insulin replacement therapy.