Sleep disorders and Alzheimer's disease pathophysiology: The role of the Glymphatic System. A scoping review.

BACKGROUND: Alzheimer's disease (AD) is highly intertwined with sleep disturbances throughout its whole natural history. Sleep consists of a major compound of the functionality of the glymphatic system, as the synchronized slow-wave activity during NREM facilitates cerebrospinal and interstitial long-distance mixing. OBJECTIVE: The present study undertakes a scoping review of research on the involvement of the glymphatic system in AD-related sleep disturbances. DESIGN: we searched Medline, Embase, PsychInfo and HEAL-link databases, without limitations on date and language, along with reference lists of relevant reviews and all included studies. We included in vivo, in vitro and post-mortem studies examining glymphatic implications of sleep disturbances in human populations with AD spectrum pathology. A thematic synthesis of evidence based on the extracted content was applied and presented in a narrative way. RESULTS: In total, 70 original research articles were included and were grouped as following: a) Protein aggregation and toxicity, after sleep deprivation, along with its effects on sleep architecture, b) Glymphatic Sequalae in SDB, yielding potential glymphatic markers c) Circadian Dysregulation, d) Possible Interventions. CONCLUSIONS: this review sought to provide insight into the role of sleep disturbances in AD pathogenesis, in the context of the glymphatic disruption.

FACTORS ASSOCIATED WITH NON-ATTENDANCE TO OUTPATIENT CONSULTATION-LIAISON PSYCHIATRY APPOINTMENTS: A RETROSPECTIVE COHORT STUDY.

BACKGROUND: Non-attendance to outpatient mental health appointments is associated with adverse clinical and financial outcomes. The aim of this study was to investigate the rates of non-attendance to outpatient Consultation-Liaison Psychiatry (CLP) appointments and the factors associated with non-attendance. SUBJECTS AND METHODS: Retrospective cohort study, including two groups of data: 950 initial and 3503 follow-up appointments between 01/01/2015 and 31/12/2019. We employed descriptive statistics, parametric/non-parametric tests and logistic regression analysis. We used a range of environmental, socio-demographic and service-related characteristics as independent parameters and non-attendance as the dependent parameter. RESULTS: Initial and follow-up non-attendance rates were 27.5% and 18.8% respectively. Opting-out text message reminders was associated with both initial and follow-up non-attendance. Higher education was associated with initial non-attendance, whereas lower education with follow-up non-attendance. Other factors associated with non-attendance to initial appointments were: English being the participant's primary communication language, having an appointment with a psychiatrist as opposed to a trained nurse or Cognitive Behavioural Therapist, and longer waiting time. Follow-up non-attendance was also associated with younger age, shorter driving distance and higher income/employment. CONCLUSION: We suggest that improving opt-in rates through a combination of staff and patient education and promotion, improving waiting lists, reducing the stigma associated with seeing a psychiatrist, but also perhaps targeting different socio-economic groups of patients with different strategies should be the focus of policy making to tackle non-attendance. Further research into patient-related and environmental factors, such as day of the week, driving distance, language of primary communication, education, income and employment is warranted in order to design more effective policies and improve engagement with CLP, but also psychiatric services in general.

A novel conceptual framework for the functionality of the glymphatic system.

The glymphatic system is responsible for the clearance of the potentially harmful metabolic waste of the central nervous system. The prevalent theory is that the cerebrospinal fluid (CSF) circulates in the perivascular space (PVS) and through the astrocytes' aquaporin-4 channels (AQ-4), and it is then drained by the lymphatic vessels after mixing with interstitial fluid (ISF). However, there is little evidence supporting this hypothesis. A deeper understanding of the physiology of the glymphatic system could transform the way we understand neuropathology and our approach to treating neurological and neuropsychiatric disorders. In this review, we introduce a new conceptual framework for the functionality of the glymphatic system, offering new directions for future research. We propose that CSF and ISF exchange flow depends on arterial pulsation, respiration, posture, and sleep. PVS changes due to disrupted cerebral autoregulation, alternations of intrathoracic pressure, venous flow, and body position can also influence the glymphatic flow. The role of respiration remains controversial due to the variety of parameters that interfere with glymphatic functionality. Slow-wave sleep is important for glymphatic clearance due to neuronal electromagnetic synchronization and expansion of the interstitial space. Therefore, sleep and vascular disorders, as well as aging, may hinder glymphatic flow and induce a noxious milieu of susceptibility to neurodegenerative disorders because of metabolic waste accumulation. We lastly introduce a new idea postulating that electromagnetic induction may constitute one of the propelling forces for the convectional current and mixing of CSF and ISF.

Somatic symptoms associated with mental distress during the COVID-19 pandemic: a systematic review.

OBJECTIVE: The primary objective of this article was to systematically review the prevalence of somatic symptoms in patients, healthcare workers and general population during the COVID-19 pandemic. The secondary objectives were to record the association between somatic symptoms and indices of mental distress and to record the qualitative characteristics of such somatic complaints. METHODS: Following the PRISMA methodology we systematically searched PubMed, Scopus and Google Scholar for primary research reporting on somatic symptoms in association with mental distress. We specifically sought papers reporting on bodily distress disorder, somatic symptoms disorder or medically unexplained symptoms. RESULTS: 1569 papers were retrieved, which yielded 36 relevant studies after screening. 15 studies referred to healthcare workers, 13 to general population, 5 to COVID-19 patients, 2 compared medical with non-medical professionals and 1 was studying COVID-19 patients some of which were also healthcare workers. The reported prevalence of somatic symptoms ranged from 7.4% to 67.8%. Commonly seen symptoms were shortness of breath, dyspnea, palpitations and pain in arms, legs and joints. CONCLUSIONS: Our systematic review suggests that somatic symptoms are very frequent during the pandemic and are often linked to mental distress. All three population groups are affected.

Factors associated with increased suicidality risk following referral for isotretinoin commencement.

OBJECTIVE: To establish whether there is a significant change in suicidality risk following psychiatric assessment for commencement of isotretinoin and identify factors that underpin any potential risk change. METHOD: Retrospective cohort study. Suicidality risk was defined as a combination of the following: (i) actual/intended self-harm and/or attempted/completed suicide, and (ii) increased service utilisation associated with suicidal ideation/behaviour. All patients referred to Psychiatry for assessment prior to commencement of isotretinoin between 2014 and 2019 were examined. Inclusion criteria: >16 years of age, assessed for commencement of isotretinoin, complete clinical records. Data were collected by reviewing the Electronic Patient Records. Fifty-seven patients were eligible. We employed descriptive statistics, parametric/non-parametric/normality tests and logistic regression analysis, using socio-demographic and clinical characteristics as independent parameters, and suicidality risk as the dependent parameter. RESULTS: Actual/intended self-harm/attempted suicide decreased significantly following assessment without significant change in service utilisation. Female gender, absence of protective factors and assessment by Consultation-Liaison Psychiatry were linked to increased suicidality risk, after controlling for age, ethnicity, recommendation for isotretinoin, and substance misuse. CONCLUSIONS: Psychiatric assessment is helpful before commencing isotretinoin. Female gender, and absence of ongoing psychopharmacological and/or psychological intervention and/or regular psychiatric follow-up predict increased suicidality risk among patients assessed for prescription of isotretinoin.

Do patients with schizophrenia have higher infection and mortality rates due to COVID-19? A systematic review.

People with mental illness are known to have poorer physical health outcomes. Among them, patients with schizophrenia spectrum disorders are disproportionately burdened. A number of recent studies have highlighted that patients with schizophrenia are particularly at risk from COVID-19. The aim of this systematic review is to clarify whether patients with schizophrenia spectrum disorders are at greater risk for poor COVID-19 outcomes. We conducted a systematic review of the literature following the PRISMA guidelines, using PubMed, PsycINFO (via Ovid) and Scopus as databases, to identify all studies which investigated infection and/or mortality rate from SARS-CoV-2 in patients with schizophrenia spectrum disorders. Following a formal screening process, seven studies met our inclusion criteria. The results of these seven studies were reported using odds ratios or adjusted odds ratios. The collective results indicated a moderate, but statistically significant effect for higher infection rates, and a strong statistically significant effect for higher mortality rates in patients with schizophrenia. Our findings indicate that people with schizophrenia have a high risk of being infected by the new coronavirus and have a significantly higher mortality rate than the general population. There are contradictory findings concerning other outcomes, including the frequency of intensive care unit admissions for this group. Collectively, these results indicate that people with schizophrenia spectrum disorders may be more vulnerable to being infected and more likely to die due to COVID-19, and yet their access to Intensive Care Units does not seem to be higher. We conclude that patients with schizophrenia constitute a vulnerable group for COVID-19 related infection and mortality, consequently there is a necessity for this vulnerable group of people to have better access to healthcare, including priority in nationwide COVID-19 vaccination programs and expedited intensive care treatment. Our conclusion adds to the ongoing debate arguing for equitable access to healthcare for people with schizophrenia spectrum disorders.

Primary and secondary prevention strategies against illicit drug use among adults aged 18-25: a narrative review.

OBJECTIVES: We reviewed the literature for preventive programs against illicit drug use that specifically target adults aged 18-25 (i.e. emerging adults). METHODS: Narrative review of preventive programs that have a high strength of recommendation according to the US Preventive Services Task Force (USPSTF) grading system. RESULTS: Prevention programs that met the criteria are school and college based, family-based, community based, peer-led, workplace-based, and technology-based interventions. They target the known modifiable risk factors associated with illicit drug use among adolescents and young adults. CONCLUSION: The preventive programs we reviewed are utilizing evidence-based strategies for the prevention of illicit drug use. Further research is needed to formulate new and effective preventive strategies for the reduction of illicit drug use by emerging adults.

Current challenges for psychiatry in Greece.

Psychiatry in Greece is undergoing a prolonged reform. Deinstitutionalisation is at an advanced stage and there are active efforts to support primary care and community psychiatry, and to establish local administration of services in each sector of the country (i.e. the equivalent of Mental Health Trusts in the UK). Quality assurance and continuing professional development require further development, as do a series of other issues pertaining to the day-to-day clinical practice of psychiatrists. Recent economic difficulties have undoubtedly affected the mental health of the population, but also mental health services and psychiatrists themselves. These financial difficulties coupled with pre-existing organisational issues present important, yet rectifiable, challenges. We conclude by identifying preventive psychiatry as an especially important target for progress and by advocating for continued support for the public system of mental healthcare as well as for the continued psychiatric reform.

The synergy of the refugee crisis and the financial crisis in Greece: Impact on mental health.

BACKGROUND: The current global financial crisis that started in 2008 resulted in a significant decline in global trade, slowing/reversing economic growth worldwide, and a dramatic increase in public sector debt. At the same time, the global migrant/refugee crisis has reached extreme rates, with millions of people being forced to abandon their homes and communities because of war, political violence or related threats. There is a broad consensus about the deleterious consequences of these crises on psychological well-being, depression, anxiety disorders, insomnia, alcohol abuse and suicidal behavior. Although the separate consequences of economic recession and immigration are extensively discussed in previous research, we know very little about the processes through which the intersection of economic crisis and migrant crisis contributes to the vulnerabilities of natives and migrants during these crises. Of particular concern is the status of children, adolescents and their families, who constitute one of the most vulnerable groups in society. AIM: To discuss the contexts that economic and migrant crises shape and suggest possible effects of this intersection on mental health risks, especially among children, adolescents and their families, through reflecting on the recent experience in Greece. METHOD: Review of the literature and critical analysis of the effects of the confluent crises. CONCLUSION: The interactive effects of these two crises need further exploration. Novel and diverse models of psychological understanding need to be developed in order to manage the effects of the confluent crises. The role of mental health professionals is crucial in this respect, offering culturally flexible, accommodating and empathetic approaches, allowing healing and acceptance in the face of adversity.

The financial crisis and the future of mental health in Greece.

The recent financial crisis in Greece has affected the mental health of the population as well as mental health service provision and planning. These new adverse circumstances call for the profession's swift response. In this paper we make evidence-based suggestions for urgent, as well as longer-term, mental health reform. We consider psychiatric prevention and mental health promotion to be the central principles to abide by in the long term. We also offer suggestions for important current issues, including the devolution and coordination of decision-making, the further development of community psychiatry and the implementation of sectorisation, support for service user involvement, the reform of psychiatric education and the creative integration of mental health service provision with Greek culture. We conclude that enhanced participation of the profession in decision-making and service planning can result in cost-effective, evidence-based reform.

The state of psychiatry in Greece.

Greek psychiatry is presently in a transitional period. Following a large-scale reform effort that started in the mid 1980s, de-institutionalization and establishment of numerous community services has been achieved to a great extent. However, sectorization, development of primary care policies, inter-sectoral communication and long-range planning have not been achieved and deficiencies in the provision of care for children, adolescents, old people, individuals with autism, with intellectual disabilities and with eating disorders as well as deficiencies in forensic psychiatric services have been identified. Thus, the Greek psychiatric reform is an unfinished reform. The financial crisis that has recently hit the country has had a serious impact on the population and especially on vulnerable groups such as individuals with psychiatric disorders. Continuation of psychiatric reform to its desired extent has become problematic. This situation calls for re-orientation of the national mental health strategy towards more realistic and priority-orientated goals, i.e. securing a satisfactory level of function of the existing services, persisting in the implementation of the basic targets of psychiatric reform, creating the necessary infrastructure but avoiding the creation of expensive facilities of secondary importance.

The delusional misidentification syndromes: strange, fascinating, and instructive.

The delusional misidentification syndromes (Capgras' syndrome, Frégoli syndrome, intermetamorphosis syndrome, syndrome of subjective doubles) are rare psychopathologic phenomena that occur primarily in the setting of schizophrenic illness, affective disorder, and organic illness. They are grouped together because they often co-occur and interchange, and their basic theme is the concept of the double (sosie). They are distinguished as hypoidentifications (Capgras' syndrome) and hyperidentifications (the other three syndromes). In this review, we present the basic hypotheses that have been put forward to explain these syndromes and propose that the appearance of these syndromes must alert physicians to investigate the existence of possible organic contributions.