Effects of diazepam on hippocampal blood flow in people at clinical high risk for psychosis.

Elevated hippocampal perfusion has been observed in people at clinical high risk for psychosis (CHR-P). Preclinical evidence suggests that hippocampal hyperactivity is central to the pathophysiology of psychosis, and that peripubertal treatment with diazepam can prevent the development of psychosis-relevant phenotypes. The present experimental medicine study examined whether diazepam can normalize hippocampal perfusion in CHR-P individuals. Using a randomized, double-blind, placebo-controlled, crossover design, 24 CHR-P individuals were assessed with magnetic resonance imaging (MRI) on two occasions, once following a single oral dose of diazepam (5 mg) and once following placebo. Regional cerebral blood flow (rCBF) was measured using 3D pseudo-continuous arterial spin labeling and sampled in native space using participant-specific hippocampus and subfield masks (CA1, subiculum, CA4/dentate gyrus). Twenty-two healthy controls (HC) were scanned using the same MRI acquisition sequence, but without administration of diazepam or placebo. Mixed-design ANCOVAs and linear mixed-effects models were used to examine the effects of group (CHR-P placebo/diazepam vs. HC) and condition (CHR-P diazepam vs. placebo) on rCBF in the hippocampus as a whole and by subfield. Under the placebo condition, CHR-P individuals (mean [±SD] age: 24.1 [±4.8] years, 15 F) showed significantly elevated rCBF compared to HC (mean [±SD] age: 26.5 [±5.1] years, 11 F) in the hippocampus (F(1,41) = 24.7, pFDR < 0.001) and across its subfields (all pFDR < 0.001). Following diazepam, rCBF in the hippocampus (and subfields, all pFDR < 0.001) was significantly reduced (t(69) = -5.1, pFDR < 0.001) and normalized to HC levels (F(1,41) = 0.4, pFDR = 0.204). In conclusion, diazepam normalized hippocampal hyperperfusion in CHR-P individuals, consistent with evidence implicating medial temporal GABAergic dysfunction in increased vulnerability for psychosis.

Factors influencing the length of stay in forensic psychiatric settings: a systematic review.

BACKGROUND: Forensic psychiatry is often associated with long admissions and has a high cost of care. There is little known about factors influencing length of stay (LOS), and no previous systematic review has synthesised the available data. This paper aims to identify factors influencing the LOS in forensic psychiatry hospitals to inform care and interventions that may reduce the length of admissions. METHODOLOGY: A systematic review was conducted by searching major databases, including PubMed, EMBASE and PsycInfo, from inception until May 2022. Observational studies conducted in forensic hospitals that examined associations between variables of interest and LOS were included. Following data extraction, the Newcastle‒Ottawa Scale was used for quality appraisal. No meta-analysis was conducted due to heterogeneity of information; a quantitative measure to assess the strength of evidence was developed and reported. RESULTS: A total of 28 studies met the inclusion criteria out of 1606 citations. A detailed quantitative synthesis was performed using robust criteria. Having committed homicide/attempted homicide, a criminal legal status with restrictions, and a diagnosis of schizophrenia-spectrum disorders were all associated with longer LOS. Higher Global Assessment of Functioning (GAF) scores were associated with a shorter LOS. CONCLUSION: High-quality research examining factors associated with LOS in forensic psychiatry is lacking, and studies are heterogeneous. No modifiable characteristics were identified, and thus, practice recommendations were not made. There is an increasing necessity to understand the factors associated with longer admissions to inform care and increase success in reintegration and rehabilitation. This paper provides recommendations for future research.

Factors Associated With Oral Anticoagulant Use in Patients With Atrial Fibrillation and Mental Disorders.

Objective: This study aims to identify how mental illness severity interacts with oral anticoagulant (OAC) patterns among people with atrial fibrillation (AF).Methods: AF patients with comorbid mental illness (classified using ICD-10) were identified from the South London and Maudsley Biomedical Research Centre Case Register. CHA2DS2-VASc and ORBIT scales were used to calculate stroke and bleeding risks, respectively, whereas Health of the Nation Outcome Scales (HoNOS) assessment was used for functional impairment.Results: Overall, 2,105 AF patients were identified between 2011 and 2019. Serious mental illness (SMI) was associated with lower prescription of any OAC (adjusted risk ratio [aRR]: 0.94; 95% CI, 0.90-0.99). A total of 62% of SMI patients at risk of stroke were not prescribed an OAC. In the AF cohort, alcohol or substance dependence and activities of daily living (ADL) impairment were associated with lower prescription of warfarin (aRR: 0.92; 95% CI, 0.86-0.98 and aRR: 0.96; 95% CI, 0.93-0.99, respectively). Among people with AF and SMI, warfarin was less likely to be prescribed to people with self-injury (aRR: 0.84; 95% CI, 0.77-0.91), hallucinations or delusions (aRR: 0.92; 95% CI, 0.85-0.99), ADL impairment (aRR: 0.91; 95% CI, 0.84-0.99), or alcohol or substance dependence (aRR: 0.92; 95% CI, 0.87-0.98). Among people with AF and comorbid substance use disorder, self-injury (aRR: 0.78; 95% CI, 0.64-0.96), cognitive problems (aRR: 0.84; 95% CI, 0.70-0.99), and other mental illnesses (aRR: 0.83; 95% CI, 0.70-0.99) were associated with lower prescription of warfarin.Conclusions: An OAC treatment gap for AF patients with comorbid SMI relative to other mental illnesses was identified. The gap was wider in those with dependence comorbidities, positive symptoms, self-injury, or functional impairment.J Clin Psychiatry 2024;85(1):23m14824. Author affiliations are listed at the end of this article.

Strengthening Parental Identity of Incarcerated Fathers through Innovative Practices of Drama in Education.

This paper focuses on an innovative research initiative conducted within a Greek Detention Center. The project explores the paternal identity of incarcerated fathers with the primary objective of reinforcing their parental attitudes, skills, and practices. Despite the challenges imposed by incarceration, it is widely acknowledged that individuals can, and indeed should, continue to exercise their parental roles. This serves as the central premise of our research. A Detention Center in Greece was carefully selected through a process of feasibility sampling for this study, encompassing a participant group of 16 incarcerated fathers. The adoption of an action research methodology was deemed most appropriate for the execution of this parenting program. The research initiative comprised of 10 unique workshops, underpinned by principles of drama in education. These workshops provided the incarcerated fathers with opportunities to explore alternative methods of interaction with their children. The study concluded with a demonstrable enhancement in the paternal identity of the incarcerated fathers, affirming the initial research goals of the project. This provides evidence for the potential of such innovative approaches in supporting the development of stronger parental attitudes, skills, and practices among incarcerated parents.

Clozapine augmentation with long-acting antipsychotic injections: A case series and systematic review.

BACKGROUND: Up to 30% of patients with a diagnosis of treatment-resistant psychosis remain symptomatic despite an optimal trial with the gold standard treatment, clozapine. Emerging evidence suggests the clinical utility of long-acting injections (LAI) in such clinical scenarios. In this study, we aimed to describe clozapine augmentation with LAIs in an inner London hospital and explore the literature on the clinical effectiveness of this treatment modality. METHODS: Patients prescribed clozapine, who were commenced on a LAI between 2007 and 2023 by the United Kingdom's largest mental health trust, were identified from electronic patient records. First, routine clinical data were used to describe the use, effectiveness, and safety of this augmentation strategy. Second, we conducted a literature search up to 1st June 2023 to identify published studies describing clinical outcomes after clozapine augmentation with a LAI. Clinical outcomes were collated and presented in a table, including hospitalisation rates and quantitative clinical assessments using validated scales. RESULTS: Of the 1248 patients prescribed clozapine in SLaM, three patients (0.2%) received augmentation with the following LAIs: olanzapine embonate, paliperidone palmitate and pipotiazine palmitate. This treatment strategy was clinically effective and generally well tolerated in all three cases. Twelve published studies between 2010 and 2022 were included in the review. Eight distinct LAIs were reported (4 first and 4 second generation antipsychotics), with risperidone and paliperidone most widely studied. All the identified studies were observational including mirror-image studies, case series and case reports. Duration of follow up varied from 3 months to 3 years. There was evidence that the use of LAIs with clozapine can significantly reduce clinical symptoms, hospitalisation rates and bed days. No serious adverse effects were reported. CONCLUSION: This preliminary evidence suggests clinical utility of LAIs in alleviating residual symptoms and subsequently reducing hospitalisation rates in patients optimised on clozapine treatment. The current study warrants further investigations including a randomised controlled study to establish the clinical efficacy, tolerability, and place in therapy of this treatment modality.

Cutaneous Impact Location Predicts Intracranial Injury Among the Elderly Population with Traumatic Brain Injury.

Background: Traumatic brain injury (TBI) is one of the most common trauma-related diagnoses among the elderly population treated in emergency departments (ED). Identification of patients with increased or decreased risk of intracranial bleeding is of clinical importance. The objective of this study was to evaluate the implication of cutaneous impact location (CIL) on the prevalence of intracranial injury after suspected or confirmed TBI irrespective of its severity. Methods: This was a retrospective, single-center, descriptive observational study of geriatric patients aged 65 years and older treated for suspected or confirmed TBI in a trauma surgery ED. The primary outcome of the study was the assessment of a CIL of the injury and its association with the prevalence of intracranial lesions found on a head computed tomography scan. Results: Among 381 patients included in the analysis, the CIL of interest (temporo-parietal and occipital impacts) was present among 178 (46.7%) cases. Thirty-six (9.5%) patients were diagnosed with intracranial bleeding. The prevalence of intracranial bleeding was higher in the CIL of interest group compared with other locations outside (12.9% vs 6.4%; p = 0.030). CIL of interest was a predictor of intracranial bleeding (p = 0.033; OR: 2.17; 95% CI: 1.06 to 4.42). Conclusion: The CIL of head injury is a predictor of intracranial lesions among geriatric patients with traumatic brain injury. Physicians should be aware of this association when assessing elderly patients with head injuries. More studies are needed to develop a clinical management tool incorporating CIL to guide the diagnosis of TBI in this population.