Coping with the mental health impact of COVID-19: A study protocol for a multinational longitudinal study on coping and resilience during the COVID-19 pandemic.

BACKGROUND: Mental health is challenged due to serious life events such as the COVID-19 pandemic and can differ by the level of resilience. National studies on mental health and resilience of individuals and communities during the pandemic provide heterogeneous results and more data on mental health outcomes and resilience trajectories are needed to better understand the impact of the pandemic on mental health in Europe. METHODS: COPERS (Coping with COVID-19 with Resilience Study) is an observational multinational longitudinal study conducted in eight European countries (Albania, Belgium, Germany, Italy, Lithuania, Romania, Serbia, and Slovenia). Recruitment of participants is based on convenience sampling and data are gathered through an online questionnaire. gathering data on depression, anxiety, stress-related symptoms suicidal ideation and resilience. Resilience is measured with the Brief Resilience Scale and with the Connor-Davidson Resilience Scale. Depression is measured with the Patient Health Questionnaire, Anxiety with the Generalized Anxiety Disorder Scale and stress-related symptoms with the Impact of Event Scale Revised- Suicidal ideation is assessed using item 9 of the PHQ-9. We also consider potential determinants and moderating factors for mental health conditions, including sociodemographic characteristics (e.g., age, gender), social environmental factors (e.g., loneliness, social capital) and coping strategies (e.g., Self-efficacy Belief). DISCUSSION: To the best of our knowledge, this is the first study to multi-nationally and longitudinally determine mental health outcomes and resilience trajectories in Europe during the COVID-19 pandemic. The results of this study will help to determine mental health conditions during the COVID-19 pandemic across Europe. The findings may benefit pandemic preparedness planning and future evidence-based mental health policies.

Understanding Attitudes Toward Influenza Vaccination: Insights from a Romanian Family Medicine Patient Population.

INTRODUCTION: Influenza represents a global respiratory virus infection with significant individual and societal implications, leading to considerable economic burdens and substantial mortality rates. Vaccine hesitancy, characterized by delays or refusals despite vaccine availability, presents a growing challenge in achieving adequate vaccination rates globally. AIM: This study aimed to assess the attitudes of Romanian general practitioners' patients toward influenza vaccination during the recommended immunization period. MATERIALS AND METHODS: A prospective multi-centered study involving 319 patients across five Family Medicine Offices in Romania was conducted. Participants completed a 12-item Vaccination Attitudes Examination (VAX) scale, assessing factors influencing vaccine acceptance. Statistical analyses were performed to evaluate the impact of demographic variables and attitudes toward vaccination. RESULTS: The study revealed significant variations in attitudes influencing influenza vaccine acceptance. Trust in vaccine benefits and confidence in natural immunity emerged as primary motivators for vaccine acceptance/denial, whereas concerns about commercial profiteering held lesser importance. Gender and residential environment impacted specific attitudes toward vaccination, while factors such as education and employment status did not significantly influence vaccine acceptance. DISCUSSION: The study underscores the critical role of trust in vaccine benefits as a primary driver for vaccine acceptance, diverging from prevalent conspiracy theories. While gender and residential environment influenced attitudes toward vaccination, education and employment status did not exhibit significant correlations with vaccine acceptance. CONCLUSIONS: Understanding public attitudes toward vaccination is crucial in designing effective public health strategies. This study emphasizes the importance of trust in vaccine benefits in driving vaccine acceptance, offering insights to enhance vaccination initiatives regionally.

The Role of Cognitive Coping Mechanisms in the Psychotherapeutic Approach of the Major Depressive Disorder.

The depressive disorder represents nowadays an important global health problem, with severe effects for the affected person and for the society as a whole. The psycho-social factors are a major risk element in the onset of depression, overlapping both on the individual vulnerabilities of the affected person, and on the coping mechanisms, especially the disadaptive one. Our study aims were the comparative evaluation of the cognitive coping mechanisms in the evolution of depression and in determining the quality of the therapeutic response in two samples of depressive patients benefiting from pharmacologic treatment, respectively pharmacologic therapy and cognitive-behavioral psychotherapy. The most frequently used cognitive coping strategies in the depressive patients from the two samples in the study were predominantly maladaptive, more precisely ruminating, catastrophizing, self-culpability, respectively putting into perspective. It was evident though that the adaptative coping mechanisms, such as accepting the current situation, positive refocus and positive re-evaluation, are protective factors contributing to reaching psycho-social rehabilitation and granting support to the combined therapeutic intervention. Consequently, the identification of coping mechanisms dominant in each individual with major depression is required in order to increase the efficiency of cognitive behavior therapy as enhancer for pharmaco-therapy.

The Influence of the Inflammatory Bowel Diseases on the Perceived Stress and Quality of Life in a Sample of the South-Western Romanian Population.

BACKGROUND: Inflammatory bowel diseases (IBD) represent a category of chronic diseases of gastrointestinal tract with a long-term evolution which includes flares and periods of remission. The aim of the study is to identify and quantify the relationship between IBD status, perceived stress, coping mechanisms, and patients QOL. METHODS: Cross-sectional study on two samples consisting of 70 IBD patients monitored in the Gastroenterology Department of the Emergency Clinical County Hospital Craiova, Romania, respectively 70 healthy volunteers. Collected data include socio-demographic details, personal and familial medical history, clinical status, presumed risk factors, perceived stress (Perceived Stress Scale-PSS), coping strategies (COPE questionnaire) and Health-Related Quality of Life (HRQOL-SF-36 scale). RESULTS: Perceived stress was considerably higher on IBD subjects (p<0.0001). The assessment of HRQOL has shown that patients had the best perception over their physical and emotional domains of SF-36 (p<0.0001), while the most often coping mechanisms used are those from the problem-focused category. CONCLUSIONS: There is a significant relationship between increased activity of IBD and higher level of stress, that led to the development of problem-focused coping strategies. We did not find a strong correlation between lower HRQOL levels and the items considered as potential risk factors.

Perceived Stress in Hepatitis C Virus Infected Patients under the DAA-Based Therapy.

The Hepatitis C Virus (HCV) infection often associates medical and mental health conditions which lead to increased levels of distress. Our study aimed at assessing the level of perceived stress on a sample of 90 HCV infected patients treated with Direct-Acting Antiviral (DAA) agents for 12 weeks, and its possible correlations with clinical and evolutionary elements. The evaluation was conducted in three phases: before administration of the DAAs (BSL), at the End of the Treatment (EOT), and 24 weeks after the BSL (Sustained Viral Response­SVR). The perceived stress was measured using the Perceived Stress Scale (PSS). The efficiency of the DAA treatment reduced the levels of stress (98.99% moderate and high stress at BSL to 70.00% at SVR). It was observed, for the entire study period (BSL to SVR), that the decrease in the perceived stress severity was significantly associated with demographic items such as gender (p < 0.01), urban environment (p < 0.001), the age of the subjects (p < 0.05), and clinical data such as F4 degree of fibrosis (p = 0.001) and overweight or obesity class II (p < 0.01). The perceived stress is directly associated with the severity of the HCV infection, and it could be significantly lowered by an efficient therapeutic approach, as DAAs are nowadays.

An Efficient System for Eye Movement Desensitization and Reprocessing (EMDR) Therapy: A Pilot Study.

In this paper, we describe an actuator-based EMDR (eye movement desensitization and reprocessing) virtual assistant system that can be used for the treatment of participants with traumatic memories. EMDR is a psychological therapy designed to treat emotional distress caused by a traumatic event from the past, most frequently in post-traumatic stress disorder treatment. We implemented a system based on video, tactile, and audio actuators which includes an artificial intelligence chatbot, making the system capable of acting autonomously. We tested the system on a sample of 31 participants. Our results showed the efficiency of the EMDR virtual assistant system in reducing anxiety, distress, and negative cognitions and emotions associated with the traumatic memory. There are no such systems reported in the existing literature. Through the present research, we fill this gap by describing a system that can be used by patients with traumatic memories.

Depressive and Anxious Symptoms in Hepatitis C Virus Infected Patients Receiving DAA-Based Therapy.

Hepatitis C virus (HCV) represents the most important etiologic factor for advanced fibrosis/cirrhosis and hepatocellular carcinoma associated with a psychological dimension. Our study aims to assess, on a sample comprising of 90 HCV-infected subjects (96.67% F3-F4 METAVIR), the relationship between Direct-Acting Antiviral (DAA) therapies and the psychological effects of the liver disease, focused on the anxious and depressive symptoms. The comprehensive evaluation was done before starting the DAA treatment (BSL), after 12 weeks (End of Treatment-EOT), respectively after another 12 weeks (Sustained Viral Response-SVR). Presumable depressive and/or anxious symptoms were evaluated by Hospital Anxiety and Depression Scale (HADS). The reported depressive symptoms decreased from 21.11% (BSL) to 1.11% (SVR) (p < 0.00001), while the anxious ones dropped from 43.34% (BSL) to 4.44% (SVR) (p < 0.00001), without a clear evolutionary pattern. We identified no statistically significant interaction between comorbidities (anemia, CKD, obesity) over HADS scores evolution (p > 0.05), while the DAAs side-effects (fatigue, headache, pruritus) significantly influenced the anxious and depressive symptoms (p < 0.05). During and after the DAA-based therapy, patients with HCV infection presented a significantly reduced rate of the associated depressive and anxious relevant symptoms.

Romanian psychiatric residents' opinions on factors that influence their decision to emigrate: A 5-year follow-up study.

INTRODUCTION: To evaluate the situation of migration of psychiatrists from Romania and a prioritization exercise of main factors related with psychiatric residents' decision to emigrate could be a starting point of elaboration of a strategy of reforms. Important changes have been done in economic status of residents in 2018. The impact of these measures in changing opinions was checked. METHODS: This is a cross sectional evaluation study on a randomized selected sample of Romanian psychiatric residents' opinions on factors that influence decision of migration in EU countries in two time points, 2015 and 2020. RESULTS: Thirty-eight percent of residents intend to work abroad comparing with 78% before the economic changes (25.8% vs. 71.7% for a limited period of time and 15.7% vs. 28.3% intend to emigrate) and 2% vs. 5% intend to leave the specialty. The important factors for decision to emigrate changed from "Better working conditions" (15.7% vs. 37.3% residents) to "Better training"; the factor "respect and appreciation by colleagues" remained important for 19.1% versus 17.9%. "Lack of working place for partner" was considered by 26.7% of responders as an important disadvantage of working abroad. "Being far from family members", which was considered 5 years ago by 64.2% of responders as an important disadvantage of working abroad, nowadays concerns only 6.7%, probably because it seems easier to go abroad together with the family members. CONCLUSIONS: The factors (better training in psychiatry and psychotherapy, better supervision, more involvement in research) that influence the residents' decision to emigrate represent the starting points for future reforms in educational and medical system in psychiatry.

The Effect of Switching to Long-Acting Injection (LAI) Antipsychotic Therapy on Patients with Schizophrenia.

MATERIAL AND METHOD: We analyzed 362 patients with schizophrenia admitted during 2016 in an acute psychiatric ward and in a chronic psychiatric ward, diagnosed with paranoid or other schizophrenia, according to DSM-IV-TR, which, after remission of the symptoms of the acute episode, they benefited from antipsychotic therapy only in oral formulation. For some of these patients we instituted maintenance therapy with depot formulas. Patients were followed for up to two years. RESULTS: Comparing the level of adherence to therapy, we found a statistically significant improvement, from 42.96% to 76.30%. Although we estimate that adherence to LAI therapy is over 90%, almost a quarter of patients have given up this type of treatment at some point due to side effects. Carrying out the comparative analysis of the number of hospitalizations per year, from the past and from the follow-up period, as well as of the scores registered at the scales used (PANSS, CGI, GAS, WHOQOL), in dynamics, we demonstrated the appearance of statistically significant changes. CONCLUSIONS: the administration of antipsychotic therapy through LAI-type depot formulas can improve the therapeutic adherence of the patient with schizophrenia, thus improving the evolution of the disease and the quality of life.

The differential diagnosis of ulcerative colitis versus angiodysplasia of the colon with ischemic colitis.

Ulcerative colitis and Crohn's disease are the inflammatory bowel diseases with a continuously increasing of prevalence. Their exact causes are still not well known and, more than that, they are raising up serious issues of diagnosis. The same difficulties of diagnosis are encountered in the case of the colonic angiodysplasia or ischemic colitis (IC). Colonic angiodysplasia is a common vascular abnormality of the gastrointestinal tract, being diagnosed mostly in the elderly persons, in a similar manner to the IC. For all these diseases comorbidities plays their important role both as causes of the onset and aggravating factors during the evolution. The differential diagnosis between these three conditions needs a complex and multidisciplinary approach, involving at least clinical evaluation, endoscopic and imaging assessments, and histopathological exam.

Hepatitis C Virus Infection and the New Therapeutical Approach.

Hepatitis C virus represents one of the most important public health problems nowadays. Several epidemiological studies have shown a continuous increasing rate of prevalence and incidence with severe consequences in terms of mortality. During the last decades, the treatment of the liver infection has evolved, and now there are available new therapies with better side-effect' profiles and bigger efficiency. The needs for more therapeutically efficacy also stand behind the numerous comorbidities associated to the liver disease, and also for assuring better quality of life for patients and their families.

Neurobiological and pharmacological arguments for customization of cognitive behavioral psychotherapy in the treatment of major depressive disorder.

INTRODUCTION: Depression represents a public health issue because it significantly increases the risk of disabilities and premature mortality, decreases the quality of life, and increases the costs of care. The incomplete remissions favor the aggravation of neurobiological dysfunctions and pathogenesis of severe somatic comorbidities. The etiopathogenic mechanisms of depression are complex and involve multisystemic risk factors (genetic, neuroanatomic, neurobiochemical, neuroendocrine and psychosocial). Cognitive behavioral therapy (CBT) is used in all the stages of depression, as independent therapeutic method or as support of pharmacotherapy. PATIENTS, MATERIALS AND METHODS: This study has evaluated the therapeutic response of depression in M (medication) group with 136 patients under pharmacotherapy, compared with P (psychotherapy and medication) group with 137 patients treated simultaneously with medication and CBT, and the factors that can improve therapeutic management. RESULTS: Patients with depression had predominantly a reactive onset, recurrent evolution of at least four episodes, and frequent somatic comorbidities. After treatment, a significant improvement of depressive symptomatology was recorded especially in M group (72.06%), compared to P group (88.32%), p<0.01, as well as a significant difference in regaining functional skills (69.12% - M group, 93.43% - P group; p<0.001). The therapeutic response was significantly correlated with age (p<0.01), social-economical involvement and education level. CONCLUSIONS: CBT demonstrated efficiency in the treatment of major depressive disorder in association with pharmacotherapy. The therapeutic approach should rely on the pathogenic biological models that would highlight the prediction indicators for the therapeutic response and for the evolution of depression, as well as considering the psychological profile of each patient.

Development of a Software for Treat-To-Target Strategy Implementation and Increasing Quality of Life in Patients with Inflammatory Bowel Disease.

The management of each form of the inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn's disease (CD), represents a challenge for the clinician and patient. The treatment paradigm was shifted from achievement of a symptomatic control of the disease, to the prevention of bowel damage, disease progression and disability, and better quality of life. These goals were related with the treat-to-target (T2T) strategies developed for a proper treatment optimization. The T2T strategy is based on the assessments of the biochemical markers (C-Reactive Protein-CRP and fecal calprotectin-FCAL), clinical targets (multiple clinical scoring systems), endoscopic targets (resolution of ulceration and friability, and histologic targets. Another objective of the treatment is the obtaining of a higher level of improvement for the patient's quality of life (QoL). One of the most reliable ways for a better management of IBD is represented by the IT instruments. In this respect, we developed under the auspices of RCCC (Romanian Club of Crohn's and Colitis) between 2018-2019 a new software for collecting medical data of IBD patients, according to STRIDE recommendations, in order to have continuous access to their evolutionary history and all therapeutically aspects. The software proved to be a valuable tool for clinician with a positive impact on clinical, economic, and patient-centred outcomes in IBD.

Factors that influence access to mental health services in South-Eastern Europe.

INTRODUCTION: Access to mental health (MH) services is unequal worldwide and changes are required in this respect. OBJECTIVES: Our aim was to identify the delay to the first psychiatry consult and to understand patients' characteristics and perspectives on the factors that may influence the delay, among a sample of participants from three Southeastern European Countries. MATERIALS AND METHODS: The WHO Pathway Encounter Form questionnaire was applied in 400 patients "new cases" and a questionnaire on the factors influencing the access was administered to the same patients, as well as to their caretakers and MH providers. RESULT AND DISCUSSIONS: The average profile of the patient "new case" was: married female older than 40 years, with an average economic status and no MH history. The mean delay was up to 3 months and the most important factors that were influencing the delay were stigma and lack of knowledge regarding MH problems and available current treatments. CONCLUSIONS: Future policies trying to improve the access to psychiatric care should focus on increasing awareness about MH problems in the general population.

Clinical and biological outcomes of prolonged treatment with haloperidol in schizophrenia.

Paranoid schizophrenia with long-term course is a challenge for the clinical and therapeutic research, particularly because chronic course is difficult to identify due to the high rate of mortality in this category of patients. The therapeutic stability on an antipsychotic molecule (haloperidol) is indeed an exception, since the current trend in the case of unfavorable course is based on therapeutic versatility and polypharmacy. Haloperidol is the first-generation antipsychotic that is referred in the therapeutic guidelines as the "golden standard" regarding its efficacy on positive symptoms. The research in fundamental and molecular psychopharmacology has shown the aggressivity of this molecule on the secondary and tertiary signaling chains, including mitochondrial alterations. On male patients with paranoid schizophrenia (positive symptoms) and a chronic course of more than 35 years who received exclusively haloperidol, our study demonstrated an negative outcome with the loss of social functioning, persistence of positive symptoms, chronic extrapyramidal symptoms and mild cognitive impairment. The neuroimaging evaluations have shown atrophy in the temporal poles, posterior ventriculomegaly, cerebellar atrophy and calcification on choroid plexus and pineal gland. The difference between the histological changes induced by haloperidol on animal model and the ones on the patients in our study is located in the frontal cortex, thus suggesting the presence of two neurobiological models of schizophrenia in men: fronto-striatal and temporal-limbic-striatal. The persistence of extrapyramidal symptoms during the treatment with haloperidol may be considered as a clinical marker of the risk for negative outcome and a potential indication for the therapeutic switch.

The microvascular alterations in frontal cortex during treatment with antipsychotics: a post-mortem study.

INTRODUCTION: Schizophrenia is the most severe psychiatric illness, with a biological support in the brain. There is evidence that the adequate dopamine balance in the frontal cortex is associated with a better outcome of the disorder, while the alteration of dopamine mechanism at this level may affect the vascular system leading to secondary neuronal alterations. Our study was conducted post-mortem and its objective was to identify the alterations in the neuronal architecture, in the integrity of the microvascular unit in the frontal cortex of patients treated with potent and excessive D2-blocking antipsychotics. MATERIALS AND METHODS: We studied post-mortem sections of the frontal cortex of three patients (two women and one man) diagnosed with schizophrenia or schizophrenia-spectrum disorders and treated with antipsychotics for the last 24 months. The slides were prepared according to the classical histopathological protocols. RESULTS: Various alterations were found at the neural and vascular levels in the frontal cortex. The most significant was the neural loss as the result of severe changes in the microvessels (diameter reduction, hyaline and collagen deposits, edema, pinocytosis and vacuolization). DISCUSSION: The evidences shown in our study highlight the fact that antipsychotics with potent antagonist action on D2 receptors may affect the neurovascular unit and small vessels in frontal cortex by altering the balance vasoconstriction-vasodilatation, thus reducing the blood flow and metabolism and generating structural microvascular changes proportional with the level of apoptosis at this level. The functional integrity of the dopaminergic system in frontal cortex depends on the vascular support and the capabilities of the neurovascular unit and any dysfunction increases the neuronal loss with clinically significant changes. CONCLUSIONS: The pathological data of our study raises the hypothesis for the pathogenic stages at the level of microvessels in the frontal cortex of the patients with schizophrenia or schizophrenia-spectrum disorders treated with D2-blocking antipsychotics: a stage with functional, reversible alterations that may be correlated with the impairments of working memory and presence of extrapyramidal symptoms and a lesional, irreversible stage with significant deterioration of cognition and global functioning. Further studies are needed to verify this hypothesis.

Circadian malfunctions in depression - neurobiological and psychosocial approaches.

Depression leads to disturbances in physiological rhythms, which result in disturbances in circadian sleep-wake cycles, hormonal secretion patterns and fluctuations in mood, all of which can be objectively measured. These disturbances, which are associated with depression, can be also used to define depression. Beyond these "transversal" time-related symptoms, there are the "longitudinal" time-related symptoms, since depression evolves over a long period of time, with a profound impact on a person's life and is often associated with long-term psychosocial consequences (Mendlewicz, 2010). The circadian rhythm reflects an approximate 24-hour cycle in the biochemical, physiological and behavioral processes of living entities, which crucially influences human well-being and health. Increasing evidence from clinical and neurobiological research suggests that disrupted temporal organization impairs behavior, cognition, mood, sleep and social activity and may be implicated in mental disorders. It has been proposed that circadian malfunction is a major core feature of mood disorders, depression in particular. In depressed patients, circadian rhythms and homeostatic processes are disrupted, thereby affecting mood, sleep, activity and a variety of biological functions such as hormone secretion and body temperature (Hajak & Landgrebe, 2010). Sleep difficulties are among the most current symptoms in depressed patients. Insomnia is often the reason why depressed patients seek help and relief of sleep disturbance may encourage compliance with antidepressant treatment. Apart from the discomfort that sleep problems produce, they may lead to exhaustion, poor functioning and they are associated with an increase in suicide risk (Wilson et al., 2013).

Prenatal depression and stress - risk factors for placental pathology and spontaneous abortion.

Prenatal stress and depression affects 10-25% of pregnant women and is associated with disruption of fetal neurodevelopment, higher rates of placental abnormalities, preeclampsia, spontaneous abortion, or preterm birth. Markers of genetic vulnerability are catechol-O-methyltransferase, monoamine oxidase-A, variation of serotonin transporters, low levels of dopamine-beta-hydroxylase, and brain derived neurotrophic factor Val66Met (BDNF), while hyperactivity of HPA (hypothalamic-pituitary-adrenal) axis and massive release of endogenous cortisol, regulated by metalloproteinase-1, -2, -3 and -9, and are involved both in depressive symptoms and neurodevelopmental abnormalities in fetus. In women with prenatal stress and depression which suffered spontaneous abortion were observed placental abnormalities as regular shape and necrotic villi, decidua with large areas of necrosis, acute inflammation and effusion areas correlated with increase in proinflammatory factors, immune deficit and infections, hyaline type fibrosis, intervilos and deciduous intense hemorrhage, associated with increase of vascular endothelial growth factor. Taking into account the important societal and economic costs becomes important for an interdisciplinary approach, in which pregnancy and its risks are a central point for women mental health.

Stress in medical students.

Stress has been defined as the state of a body threatened by imbalance under the influence of agents or conditions endangering its homeostatic mechanisms but the concept have multiple meanings in correlation with the origin and biological support of its effects. Also, stressors are multiple, recording one of the highest levels during the academic studies. For the medical students, stress represents an important challenge, especially during the first year of medical school, caused by the absence of a learning strategy, the sleepless night before the exam and also an unhealthy food intake during the exams. The coping strategies are important, their background being represented by the social support, especially within the family, and emotional, the passions of the medicine students being the most important stress-combating factor. Gender represents also an important factor for the stress vulnerability, manifested through medical and psychiatric symptoms. In order to train good doctors, fair and above all healthy, it is important to consider not only the information we want to transmit, but also the context in which we educate.