Psychiatric Issues Among Health Professionals.

COVID-19 has increased the interest in the wellbeing of health professionals (HPs) as they have experienced stress, loss, and fatigue-related symptoms. Research evidence from previous epidemics points to an increase in the prevalence of affective, anxiety, and addictive disorders among them. HPs are trained to care for others and to recover from severe stressors. However, they tend to neglect self-care and have difficulties in seeking appropriate help when need it. This new scenario becomes an opportunity to promote a new culture of professionalism whereby caring for the caregivers becomes a priority both at a personal and institutional level.

Inhaled Loxapine as a Rapid Treatment for Agitation in Patients with Personality Disorder: A Prospective Study on the Effects of Time.

Objective: Agitation in patients diagnosed with personality disorders (PD) is one of the most frequent crises in emergency departments (ED). Although many medications have been tested, their effectiveness has been small or non-significant, and no specific drugs are supported by the available evidence. This study aimed to evaluate the efficacy of Inhaled loxapine (IL) as a therapeutic option for agitated patients with PD. Methods: A naturalistic, unicentric, prospective study was carried out. Thirty subjects diagnosed with PD and attending the ED with episodes of agitation were recruited most of whom were women diagnosed with Borderline Personality Disorder. Subjects were treated with a single dose of IL (9.1 mg). Efficacy was assessed with the Clinical Global Impression scale, the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Patients were followed 60 minutes after administration to measure IL effect and its duration. Results: IL exhibited an overall efficacy in managing mild to severe agitation, with a quick onset of effect and persistence. 'Effect of time', where IL efficacy is maintained over time, is more marked in higher-severity agitation. No additional treatments were needed to improve agitation during the follow-up time. Conclusion: Results suggest that IL could be a safe and effective option to manage agitation in PD.

Characteristics of resident physicians accessing a specialised mental health service: a retrospective study.

OBJECTIVES: Little is known about resident physicians being treated at physician health programmes around the world despite the fact that it is a highly demanding training period. This study aims to describe the profiles of resident physicians accessing a specialised mental health service in Spain over a 20-year period and to compare them to consultant-grade physicians. DESIGN: Retrospective observational study. SETTING: Medical records of the Galatea Care Programme for Sick Physicians. PARTICIPANTS: 1846 physicians registered at the Barcelona Medical Council-Association and admitted to the programme from January 1998 to December 2018. PRIMARY AND SECONDARY OUTCOME MEASURES: Number of admissions, sociodemographic and clinical variables, including medical specialty, main diagnosis and need of hospitalisation. RESULTS: Residents accounted for 18.1% (n=335) of the sample and admissions increased over the years. Most residents (n=311; 94.5%) and consultant-grade physicians (n=1391; 92.8%) were self-referred. The most common specialty among residents was family medicine (n=107; 31.9%), followed by internal medicine (n=18; 5.4%), paediatrics (n=14; 4.2%), psychiatry (n=13; 3.9%) and anaesthesiology (n=13; 3.9%). Residents, regardless of year of training, mainly asked for help because of adjustment (n=131; 39.1%), affective (n=77; 23%), anxiety disorders (n=40; 18.8%) and addictions (n=19; 5.7%). There were no significant differences between groups in the main diagnosis and in the variables related to need of hospitalisation. The percentage of residents accessing the programme was higher than in the reference population registered at the Barcelona Medical Council-Association (18.1% vs 7.6%; z=7.2, p<0.001) as was the percentage of family medicine residents (31.9% vs 19.6%; z=5.7, p<0.001). CONCLUSIONS: Residents are more likely than consultant-grade physicians to seek help when suffering from mental disorders. Local primary prevention actions since the beginning of their training period and having access to a well-known highly reliable programme may partly explain these findings.

How Relevant is the Systemic Oxytocin Concentration for Human Sexual Behavior? A Systematic Review.

INTRODUCTION: Despite its role in social cognition and affiliative behavior, less is known about the role played by oxytocin in human sexual behavior. AIM: In the present systematic review, we aimed to find the levels of oxytocin related to human sexual arousal and orgasm. METHODS: We conducted the study according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We performed a systematic search in the principal databases for studies that reported collection of salivary or plasmatic samples, with dosage of oxytocin in relation to sexual activity during induction of sexual arousal and orgasm. RESULTS: 414 articles were obtained. After duplicates removal and the application of pre exclusion criteria, 16 articles were considered eligible and 13 articles were included with a Cohen's k of 0.827. Most of the studies used sexual self-stimulation and collected plasmatic or salivary samples to measure oxytocin. The sexual arousal and orgasm were assessed based on subjective reports. MAIN OUTCOME MEASURE: The primary outcomes were the oxytocin levels collected during the induction of sexual arousal and orgasm. CONCLUSIONS: Several studies collected only subjective reports about the sexual arousal and the orgasm. Most of the studies found higher levels of oxytocin during the orgasm or ejaculation. Given the sexual arousal evoked by self-stimulation in which sexual fantasies play an important role, it should be possible to postulate for a role of the oxytocin in sexual desire. In particular, we hypothesize a complex role of the oxytocin in the modulation of sexual fantasies and thoughts that are relevant in the sexual desire and help to trigger genital and sexual arousal. Cera N, Vargas-Cáceres S, Oliveira C, et al. How Relevant is the Systemic Oxytocin Concentration for Human Sexual Behavior? A Systematic Review. Sex Med 2021;9:100370.

The Impact of Psychosis on Sexual Functioning: A Systematic Review.

BACKGROUND: Sexual dysfunction among psychotic patients is highly prevalent. However, most research has focused on antipsychotic side effects on sexual functioning. AIM: To provide evidence by means of a systematic review of the literature about the impact of psychosis on sexual functioning among unmedicated patients. METHODS: Systematic search of MEDLINE (PubMed), Scopus, and Google Scholar for studies that reported sexual functioning among psychotic patients, who were drug-naïve or drug-free for at least 3 weeks before the study. Studies were published in English language between January 1994 and October 2019. We used the approach recommended by PRISMA, and the selection process was carried out by 2 reviewers. OUTCOMES: The outcome measures were sexual function and sexual dysfunctions. RESULTS: A total of 734 articles were obtained, 658 were obtained after duplicates were removed, 612 were excluded after reading the title and abstract, and 46 were included for a complete review of the articles. 5 papers were finally included. A total of 770 cases were included in the systematic review. The prevalence of sexual dysfunction in psychosis varied from 16.8% to 70% and in ultra-high state was 50%. It is noteworthy that those ultra-high-risk (prodromal) patients who develop psychosis had higher rates of sexual impairment. Therefore, we found higher rates of sexual dysfunction among untreated patients, both psychotic and ultra-high risk patients, than healthy controls. CLINICAL IMPLICATIONS: The assessment of sexual behavior should be a part of routine psychiatric examination not only in psychotic but also in ultra-high-risk patients. STRENGTHS & LIMITATIONS: This is the first systematic review about the impact of psychosis on sexual functioning among unmedicated patients. However, scarce and heterogeneous studies were identified. CONCLUSIONS: Impaired sexual functioning is common in the onset of psychosis (or during ultra-high-risk state) and prior to the beginning of treatment. This suggests that psychotic symptoms and sexual dysfunction may have common etiological pathways at the psychosocial and neurobiological levels. Vargas-Cáceres S, Cera N, Nobre P, et al. The Impact of Psychosis on Sexual Functioning: A Systematic Review. J Sex Med 2021;18:457-466.

Comorbidity of ADHD and adult bipolar disorder: A systematic review and meta-analysis.

Attention-deficit / hyperactivity disorder (ADHD) and Bipolar Disorder (BD) are common mental disorders with a high degree of comorbidity. However, no systematic review with meta-analysis has aimed to quantify the degree of comorbidity between both disorders. To this end we performed a systematic search of the literature in October 2020. In a meta-analysis of 71 studies with 646,766 participants from 18 countries, it was found that about one in thirteen adults with ADHD was also diagnosed with BD (7.95 %; 95 % CI: 5.31-11.06), and nearly one in six adults with BD had ADHD (17.11 %; 95 % CI: 13.05-21.59 %). Substantial heterogeneity of comorbidity rates was present, highlighting the importance of contextual factors: Heterogeneity could partially be explained by diagnostic system, sample size and geographical location. Age of BD onset occurred earlier in patients with comorbid ADHD (3.96 years; 95 % CI: 2.65-5.26, p < 0.001). Cultural and methodological differences deserve attention for evaluating diagnostic criteria and clinicians should be aware of the high comorbidity rates to prevent misdiagnosis and provide optimal care for both disorders.

The impact of the COVID-19 pandemic on the mental health of healthcare professionals.

INTRODUCTION: Healthcare professionals (HPs) have been confronted by unprecedented traumatic experiences during the COVID-19 pandemic, especially in countries that had not experienced similar epidemic outbreaks in recent years. AIM: To analyze the impact of the COVID-19 pandemic on the mental health of HPs. METHOD: We comprehensively reviewed the studies published in MEDLINE (PubMed), Web of Science and Google Scholar between December 2019 and May 2020. RESULTS: Most studies report a high prevalence of anxiety and depressive symptoms among HPs that can be associated with: a) COVID-19 exposure; b) epidemiological issues; c) material resources; d) human resources; and e) personal factors. The role of certain variables, before, during and after the pandemic, remains unexplored. Longitudinal studies will help elucidate which factors are associated with a higher risk of developing long-lasting negative effects. Qualitative studies may contribute to understanding the influence of individual and social narratives in HPs' distress. CONCLUSION: A deeper analysis on the individual, institutional, political and socio-cultural factors, meanings and values influencing HPs distress and resilience during the COVID-19 pandemic is needed.

Dual diagnosis among medical residents: a systematic review. / Diagnóstico dual en médicos residentes: una revisión sistemática.

The post-graduate period as a resident doctor (MIR, in Spanish) is usually associated with high emotional distress due to new professional demands and to other psychosocial factors. The objective of this study is to determine the characteristics of dual diagnosis among MIRs. A systematic review was carried out in MEDLINE (PubMed), Web of Science and Google Scholar databases, selecting articles published in English and Spanish between 1984 and 2017. A total of 2,415 articles were obtained: 2,276 were excluded by their title, 105 by the abstract and 17 after a complete review of the article; 17 papers were finally included. The prevalence of depressive symptoms among MIRs ranges from 10.2% to 70%, while the prevalence of anxious symptoms varies from 13.2% to 33.9%, from 6.7% to 25% reported suicidal ideation, 20% hazardous drinking, 2%-13.4% self-prescribed psychotropics, and 2.7%-14% used other drugs. Most studies present important methodological limitations, thus complicating adequate understanding of the phenomenon. High variations in prevalence data are related to differences in the psychometric scales and to disparity in diagnosis criteria, among other limitations. However, most studies report that alcohol and drug use is correlated with severe distress among MIRs. More research is needed to ascertain the nature of dual diagnosis in this professional group in order to effectively prevent and treat its serious consequences.

El período de preparación como médico residente (en español, MIR) suele asociarse a una elevada sobrecarga emocional tanto por las nuevas exigencias profesionales como por otros factores psicosociales. El objetivo de este estudio es conocer las características del diagnóstico dual en los MIRs. Se llevó a cabo una revisión sistemática de las bases de datos MEDLINE (PubMed), Web of Science y Google Scholar, seleccionando artículos publicados en inglés y español entre 1984 y 2017. Se obtuvieron 2.415 artículos: se excluyeron 2.276 por título, 105 por el contenido del resumen y 17 por el contenido del artículo. En la revisión final se incluyeron 17 artículos. La prevalencia de clínica depresiva varía del 10,2% al 70%, de ansiedad entre 13,2% y 33,9%, de ideación suicida entre 6,7% y 25% mientras que el consumo de riesgo de alcohol se encuentra aproximadamente en torno al 20%, entre 2% y 13,4% se auto-prescriben medicamentos psicótropos y del 2,7% al 14% consumen otras sustancias. La mayoría de los estudios analizados adolecen de limitaciones metodológicas importantes lo que dificulta una adecuada comprensión del fenómeno. Las variaciones en las cifras de prevalencia tienen que ver con la disparidad de escalas y de criterios diagnósticos empleados, entre otros factores. Aún así, los estudios muestran que el consumo de alcohol y/u otras sustancias se correlacionan positivamente con el malestar emocional en los MIRs. Se hace necesario mejorar el conocimiento del diagnóstico dual en este grupo profesional para que se puedan prevenir y tratar sus consecuencias de manera más eficaz.

Diagnóstico dual en médicos residentes: una revisión sistemática / Dual diagnosis among medical residents: a systematic review

El período de preparación como médico residente (en español, MIR) suele asociarse a una elevada sobrecarga emocional tanto por las nuevas exigencias profesionales como por otros factores psicosociales. El objetivo de este estudio es conocer las características del diagnóstico dual en los MIRs. Se llevó a cabo una revisión sistemática de las bases de datos MEDLINE (PubMed), Web of Science y Google Scholar, seleccionando artículos publicados en inglés y español entre 1984 y 2017. Se obtuvieron 2.415 artículos: se excluyeron 2.276 por título, 105 por el contenido del resumen y 17 por el contenido del artículo. En la revisión final se incluyeron 17 artículos. La prevalencia de clínica depresiva varía del 10,2% al 70%, de ansiedad entre 13,2% y 33,9%, de ideación suicida entre 6,7% y 25% mientras que el consumo de riesgo de alcohol se encuentra aproximadamente en torno al 20%, entre 2% y 13,4% se auto-prescriben medicamentos psicótropos y del 2,7% al 14% consumen otras sustancias. La mayoría de los estudios analizados adolecen de limitaciones metodológicas importantes lo que dificulta una adecuada comprensión del fenómeno. Las variaciones en las cifras de prevalencia tienen que ver con la disparidad de escalas y de criterios diagnósticos empleados, entre otros factores. Aún así, los estudios muestran que el consumo de alcohol y/u otras sustancias se correlacionan positivamente con el malestar emocional en los MIRs. Se hace necesario mejorar el conocimiento del diagnóstico dual en este grupo profesional para que se puedan prevenir y tratar sus consecuencias de manera más eficaz

The post-graduate period as a resident doctor (MIR, in Spanish) is usually associated with high emotional distress due to new professional demands and to other psychosocial factors. The objective of this study is to determine the characteristics of dual diagnosis among MIRs. A systematic review was carried out in MEDLINE (PubMed), Web of Science and Google Scholar databases, selecting articles published in English and Spanish between 1984 and 2017. A total of 2,415 articles were obtained: 2,276 were excluded by their title, 105 by the abstract and 17 after a complete review of the article; 17 papers were finally included. The prevalence of depressive symptoms among MIRs ranges from 10.2% to 70%, while the prevalence of anxious symptoms varies from 13.2% to 33.9%, from 6.7% to 25% reported suicidal ideation, 20% hazardous drinking, 2%-13.4% self-prescribed psychotropics, and 2.7%-14% used other drugs. Most studies present important methodological limitations, thus complicating adequate understanding of the phenomenon. High variations in prevalence data are related to differences in the psychometric scales and to disparity in diagnosis criteria, among other limitations. However, most studies report that alcohol and drug use is correlated with severe distress among MIRs. More research is needed to ascertain the nature of dual diagnosis in this professional group in order to effectively prevent and treat its serious consequences