Smartphone-based Ecological Momentary Intervention for secondary prevention of suicidal thoughts and behaviour: protocol for the SmartCrisis V.2.0 randomised clinical trial.

INTRODUCTION: Suicide is one of the leading public health issues worldwide. Mobile health can help us to combat suicide through monitoring and treatment. The SmartCrisis V.2.0 randomised clinical trial aims to evaluate the effectiveness of a smartphone-based Ecological Momentary Intervention to prevent suicidal thoughts and behaviour. METHODS AND ANALYSIS: The SmartCrisis V.2.0 study is a randomised clinical trial with two parallel groups, conducted among patients with a history of suicidal behaviour treated at five sites in France and Spain. The intervention group will be monitored using Ecological Momentary Assessment (EMA) and will receive an Ecological Momentary Intervention called 'SmartSafe' in addition to their treatment as usual (TAU). TAU will consist of mental health follow-up of the patient (scheduled appointments with a psychiatrist) in an outpatient Suicide Prevention programme, with predetermined clinical appointments according to the Brief Intervention Contact recommendations (1, 2, 4, 7 and 11 weeks and 4, 6, 9 and 12 months). The control group would receive TAU and be monitored using EMA. ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of the University Hospital Fundación Jiménez Díaz. It is expected that, in the near future, our mobile health intervention and monitoring system can be implemented in routine clinical practice. Results will be disseminated through peer-reviewed journals and psychiatric congresses. Reference number EC005-21_FJD. Participants gave informed consent to participate in the study before taking part. TRIAL REGISTRATION NUMBER: NCT04775160.

Real-world feasibility and acceptability of real-time suicide risk monitoring via smartphones: A 6-month follow-up cohort.

Active and passive Ecological Momentary Assessment of suicide risk is crucial for suicide prevention. We aimed to assess the feasibility and acceptability of active and passive smartphone-based EMA in real-world conditions in patients at high risk for suicide. We followed 393 patients at high risk for suicide for six months using two mobile health applications: the MEmind (active) and the eB2 (passive). Retention with active EMA was 79.3% after 1 month and 22.6% after 6 months. Retention with passive EMA was 87.8% after 1 month and 46.6% after 6 months. Satisfaction with the MEmind app, uninstalling the eB2 app and diagnosis of eating disorders were independently associated with stopping active EMA. Satisfaction with the eB2 app and uninstalling the MEmind app were independently associated with stopping passive EMA. Smartphone-based active and passive EMA are feasible and may increase accessibility to mental healthcare.

Patients at high risk of suicide before and during a COVID-19 lockdown: ecological momentary assessment study.

The coronavirus disease 2019 (COVID-19) outbreak may have affected the mental health of patients at high risk of suicide. In this study we explored the wish to die and other suicide risk factors using smartphone-based ecological momentary assessment (EMA) in patients with a history of suicidal thoughts and behaviour. Contrary to our expectations we found a decrease in the wish to die during lockdown. This is consistent with previous studies showing that suicide rates decrease during periods of social emergency. Smartphone-based EMA can allow us to remotely assess patients and overcome the physical barriers imposed by lockdown.

The Neurobiology of Borderline Personality Disorder.

This article reviews the most salient neurobiological information available about borderline personality disorder (BPD) and presents a theoretic model for what lies at the heart of BPD that is grounded in those findings. It reviews the heritability, genetics, and the biological models of BPD, including the neurobiology of affective instability, impaired interoception, oxytocin and opiate models of poor attachment or interpersonal dysfunction, and structural brain imaging over the course of development in BPD; and posits that the core characteristic of BPD may be an impairment in emotional interoception or alexithymia.

Empathic accuracy and cognition in schizotypal personality disorder.

Interpersonal dysfunction contributes to significant disability in the schizophrenia spectrum. Schizotypal Personality Disorder (SPD) is a schizophrenia-related personality demonstrating social cognitive impairment in the absence of frank psychosis. Past research indicates that cognitive dysfunction or schizotypy may account for social cognitive dysfunction in this population. We tested SPD subjects and healthy controls on the Empathic Accuracy (EA) paradigm and the Reading of the Mind in the Eyes Test (RMET), assessing the impact of EA on social support. We also explored whether EA differences could be explained by intelligence, working memory, trait empathy, or attachment avoidance. SPD subjects did not differ from controls in RMET, but demonstrated lower EA during negative valence videos, associated with lower social support. Dynamic, multimodal EA paradigms may be more effective at capturing interpersonal dysfunction than static image tasks such as RMET. Schizotypal severity, trait empathy, and cognitive dysfunction did not account for empathic dysfunction in SPD, although attachment avoidance is related to empathic differences. Empathic dysfunction for negative affect contributes to decreased social support in the schizophrenia spectrum. Future research may shed further light on potential links between attachment avoidance, empathic dysfunction, and social support.

Platelet monoamine oxidase activity in obsessive-compulsive disorder.

Response to SSRIs suggests the implication of the serotonergic system in obsessive-compulsive disorder (OCD). However, biological studies on serotonergic function in OCD have yielded contradictory results. Platelet monoamine oxidase (MAO) activity has been proposed as an index of cerebral serotonin activity. The aim of this study was to examine platelet MAO activity in 29 OCD patients and 29 healthy controls matched by age, sex and tobacco use. We also explored the relationship between platelet MAO activity and aggressive obsessions in OCD patients. There were no differences in platelet MAO activity between OCD patients and healthy controls. We found a significant correlation between platelet MAO activity and Y-BOCS scores in the group of patients with Y-BOCS scores >15. OCD patients with aggressive obsessions had significantly lower levels of platelet MAO activity than patients without aggressive obsessions. Our results suggest that platelet MAO activity may be a marker of OCD severity, and that low platelet MAO activity may be associated with aggressive obsessions in OCD patients.

Acute atropine intoxication with psychiatric symptoms by herbal infusion of Pulmonaria officinalis (Lungwort)e

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Background and objectives: Lungwort infusion is a preparation extracted from Pulmonaria officinal is which is occasionally used as a folk remedy for the common cold. The current report aims to describe acute atropine intoxications with delirium caused by Lungwort infusion in several members of the same family. Methods: Description of three case reports. Search of literature through Medline. Results: Three generations of a same family presented acute and moderately severe atropine intoxications after drinking an infusion prepared with Pulmonaria officinalis. Conclusions: Despite the lack of scientific evidence for its clinical use, medicinal plants continue being widely used. In spite of severe adverse effects reported, the general thought is that herbal remedies are harmless. To our knowledge, this is the first report of acute atropine intoxications with psychiatric symptoms secondary to Pulmonaria officinalis in several members of a family. We suspect that the lungwort infusion may have been contaminated with some other substance with atropinic properties (AU)

Psychiatric care and immigration. Preliminary findings in a hospital in Madrid, Spain

This pilot study aims to investigate differences regarding access to psychiatric care, motives for demanding emergency psychiatric care, admission rates, rates of compulsory admission, and main diagnoses in immigrants and natives. Psychiatric emergency visits (n=1,126) and hospitalizations (n=225) were registered in a Spanish Hospital with a catchment area of 280.000 people (19.34% immigrants)between October 20th 2002 and April 30th 2003. Access to psychiatric care, motives for demanding emergency psychiatric care, admission rates, rates of compulsory admission, and main diagnoses in natives and immigrants were compared. Immigrants were more likely to be compulsory admitted, were under-represented in the emergency and hospitalization units, and were less likely to be readmitted. Motives for hospitalization were also different. Immigrants seemed to suffer less drug abuse and more anxiety disorders than natives (possibly reactive conditions related to the stress of migration) (AU)

[Mental disorders in victims of terrorism and their families]. / Trastornos mentales en las víctimas de atentados terroristas y sus familiares.

BACKGROUND AND OBJECTIVE: To find out whether victims of terrorism and their relatives have higher prevalence of affective, anxiety, and alcohol abuse disorders than the general population. MATERIAL AND METHOD: Between January 1997 and January 2001, 544 families affected by terrorist violence in Spain were interviewed. Victims and their relatives (n = 1,021) were evaluated by means of the PRIME-MD. They were classified according to the degree of involvement in the attacks as: relatives of victims (RV), direct victims (DV) and direct victims who were also relatives of other victims (DVRV). Their scores were compared with those of a primary health-care sample. RESULTS: Depressive symptoms were more prevalent among victims (DVRV, 59.2%; DV, 57.6%; RV, 50.2%) than among controls (40.0%) (p = 0.036) and their prevalence was directly related to the degree of involvement in the attacks. Similar results were obtained for anxiety disorders (DVRV, 52.6%; DV, 56.5%; RV, 45.0%, and controls 26.4%) (p = 0.017). Alcohol abuse prevalence (DVRV, 6.6%; RV, 5.9%) was very close to that of the primary health-care sample (4.8%) with the exception of direct victims (DV, 15.9%) in whom it was higher (p = 0.016). CONCLUSIONS: The prevalence of psychopathology was higher among victims of terrorism than among primary health-care patients and it was directly related to the involvement in the attack. Low perceived social support, family and personal history of psychiatric disease, and type of attack (explosives) increased the risk of suffering mental disorders.