[SLEEP MONITORING FOR PREDICTION OF MAJOR DEPRESSION RECURRENCE IN PATIENTS AT HIGH RISK - A PROSPECTIVE STUDY].

INTRODUCTION: Objective: To examine the feasibility of sleep monitoring using an innovative wearable technology, as a predictive tool for MDE (major depressive episode) recurrence in high risk patients.

Association of ethnic concordance between patients and psychiatrists with the management of suicide attempts in the emergency department.

BACKGROUND: Suicide attempt is a psychiatric emergency that can be treated with different approaches. Understanding of patient- and physician-related determinants of psychiatric interventions may help to identify sources of bias and improve clinical care. OBJECTIVE: To evaluate the demographic predictors of psychiatric intervention in the emergency department (ED) following a suicide attempt. METHODS: We analyzed all ED visits in Rambam Health Care Campus following suicide attempts carried out by adults between 2017-2022. Two logistic regression models were built to examine whether patient and psychiatrist's demographic variables can predict 1) the clinical decision to provide a continued psychiatric intervention and 2) the setting for the psychiatric intervention (inpatient or outpatient). RESULTS: In total, 1,325 ED visits were evaluated, corresponding to 1,227 unique patients (mean age; 40.47±18.14 years, 550 men [41.51%]; 997 Jewish [75.25%] and 328 Arabs [24.75%]]), and 30 psychiatrists (9 men [30%]; 21 Jewish [70%] and 9 Arabs [30%]). Demographic variables had a limited predictive power for the decision to intervene (R²=0.0245). Yet, a significant effect of age was observed as intervention rates increased with age. In contrast, the type of intervention was strongly associated with demography (R²=0.289), with a significant interaction between patient and psychiatrist's ethnic identities. Further analysis revealed that Arab psychiatrists preferentially referred Arab patients to outpatient over inpatient treatment. CONCLUSIONS: The results indicate that while demographic variables, and specifically patient and psychiatrist's ethnicity, do not affect clinical judgement for psychiatric intervention following a suicide attempt, they do play a major role in selecting treatment setting. Further studies are required to better understand the causes underlying this observation and its association with long-term outcomes. Yet, acknowledging the existence of such bias is a first step towards better culturally mindful psychiatric interventions.

Sleep Monitoring Using WatchPAT Device to Predict Recurrence of Major Depression in Patients at High Risk for Major Depression Disorder Recurrence: A Case Report.

Background: Major depressive disorders are strongly correlated with alterations in sleep pattern and architecture, including changes in the Rapid Eye Movement (REM) phase. However, it is still unknown whether sleep alterations precede other depression-related symptoms, particularly in patients with recurrent depressive episodes at relapse risk. Case Presentation: We initiated a study aimed at examining the value of ambulatory sleep monitoring using a WatchPAT device, in predicting recurrence of Major depression. Depression was assessed monthly with the Beck Depression Inventory version II (BDI-II). Here we present the case of a 63 years old woman, with a history of recurrent depressive episodes. AT the time of recruitment, she was asymptomatic, she experienced recurrence of Major depression 3 months into the study. We observed a significant reduction of the Rem Latency parameters 5 weeks prior to BDI-II score increase, reflecting major depressive episode recurrence. Conclusion: Though our results are preliminary, they suggest that ambulatory sleep monitoring can be used as a simple and accessible tool, predicting recurrence of Major Depressive episodes in patients at high risk, thus enabling early treatment intervention.

Long-term outcome of neonates with suspected Hirschsprung's disease, but normal rectal biopsy.

BACKGROUND AND OBJECTIVES: Hirschsprung's disease (HD) must always be considered in very early-onset constipation. Although HD has a well-described clinical course, little is known about those neonates in whom HD was excluded. We aimed to describe the long-term clinical outcomes of neonates with a clinical suspicion of HD that was excluded by rectal suction biopsy. METHODS: This is a single-center double-cohort comparative study. Neonates who underwent rectal mucosa biopsy for suspected HD were age and sex matched with healthy controls. A survey on clinical outcomes, stooling patterns, and other gastrointestinal (GI)-related conditions was sent to parents. Pathology slides were re-reported by an experienced histopathologist blinded to the clinical data. RESULTS: A total of 51 neonates were included [25 cases, 26 controls; 41% males, median time of follow-up 4.25 years (interquartile range 2.7-6.9)]. Nine (36%) of patients in the case group required prolonged laxative use for constipation during the first year of life compared with 0 (0%) controls (P<0.001). This difference was maintained at the end of follow-up, with 5 (20%) versus 0 (0%), respectively (P=0.02). Case neonates were significantly more likely to be hospitalized or to be diagnosed with a chronic GI-related condition than the controls (33 vs. 12%, P=0.01; and 19 vs. 8%, P=0.04, respectively). CONCLUSION: Neonatal constipation is associated with long-term GI-related disorders and should be considered clinically significant even when the diagnosis of HD is excluded. Neonates with early-onset abnormal stooling patterns should be monitored with adequate pediatrician or pediatric gastroenterologist follow-up.