20 years on: the legacy of Daksha Emson for perinatal psychiatry.

The tragedy of Daksha's death illustrates both the importance of perinatal mental health and the stigma associated with doctors seeking help. With this letter, we express our hope that the lasting legacy of her and others' tragic stories lies in the continuing improvement and worldwide expansion of perinatal psychiatric services and training so that those in greatest need receive the best care possible wherever - and whoever - they are.

Psychiatric training in perinatal mental health across Europe.

Perinatal mental illness is associated with considerable maternal and infant morbidity and mortality. However, there are currently no specific guidelines on the standards and structure of postgraduate perinatal psychiatric training in Europe. We describe the characteristics of available and desired specialist perinatal psychiatry training from the perspective of European psychiatrists in training. An online survey was conducted among 34 national psychiatric trainee association representatives of the European Federation of Psychiatric Trainees (EFPT). Participants from the countries in which perinatal psychiatry training was available were invited to participate in in-depth follow-up interviews. Six countries out of 34 (18%) reported that specialist training in perinatal mental health was available (Finland, France, Germany, Ireland, Malta, and the UK). The nature of available training varied in duration, the supervision and assessment model employed, and the training scheme context. Of the 28 countries where specialist perinatal psychiatry training was unavailable, the majority of national representatives (22 countries, 76%) wanted specialist perinatal psychiatry training to be included in their national training curricula. There is a gap between the expected skills and the available training for psychiatrists to meet the mental healthcare needs of women in the perinatal period. Given the prevalence and impact of perinatal mental illness and the expressed desires of trainees themselves for specialist training, this finding should prompt urgent action.

An atypical case of corticobasal syndrome with psychotic depression and delusional jealousy.

Corticobasal syndrome (CBS) is one of the Parkinson-plus disorders. While initially defined as a movement disorder rather than cognition, it is now known that CBS is related to various psychiatric symptoms. We describe a patient clinically diagnosed with CBS whose initial presentation was psychiatric and rather atypical. His clinical picture included psychotic depression and delusional jealousy. Misdiagnosing these syndromes may delay the initiation of the treatment and worsen the patients' condition, as well as increase the burden of the caretakers. Finally, COVID-19-related changes in the organization of health services complicated the diagnosis and follow-up processes of this patient.

Characteristics and Outcomes of Psychiatric Inpatients With Severe Mental Illness and COVID-19: Experience From a COVID-19-Specific Acute Psychiatric Ward in Istanbul.

ABSTRACT: Recent studies indicated that psychiatric inpatients with severe mental illness (SMI) are at a greater risk of morbidity and mortality from COVID-19. However, there is still little data about the impact of comorbid COVID-19 infection on the course and outcome of acute exacerbations in this population. We conducted a prospective historically matched case control study. The sociodemographic and clinical characteristics of acute psychiatric inpatients with SMI and comorbid COVID-19 (n = 21) were compared with those of historically-matched non-COVID-19 controls with SMI (n = 42). The outcomes for acute inpatients with SMI and COVID-19 were also investigated. The new-onset SMI rate was relatively higher (23.8%) in the COVID-19 group, which has characteristics similar to those of the non-COVID-19 group except for working status (p < 0.05). The COVID-19 group had a high rate of relapse (47.6%) within 6 months of discharge. Our study suggests that patients with SMI who contracted SARS-CoV-2 may have a higher rate of new-onset mental disorder. Considering the high rate of relapse during the pandemic, chronically ill patients with SMI and COVID-19 should be closely monitored after discharge.

Adverse drug reactions associated with concurrent acute psychiatric treatment and Covid-19 drug therapy.

OBJECTIVE: Psychiatric patients are at increased risk of contamination, morbidity, and mortality associated with COVID-19, together with potentially more pronounced adverse effects. We present and discuss the adverse effects observed in an acute psychiatric clinic that has admitted COVID-19 patients during the first three months of the pandemic in Turkey. METHODS: The COVID-19 treatment schemes were formed in accordance with the national and regional guidelines at the time of admittance, which were mainly based on the use of hydroxychloroquine and other drugs. The sample consisted exclusively of inpatients, and all patients were enrolled in the study regardless of their specific diagnosis or treatment schemes. RESULTS: 4 out of 23 patients (17.4%) had experienced adverse effects, two of which had mild hepatic enzyme elevation and one had mild sinus bradycardia. Of note is that we haven't encountered any serious complications or life-threatening events during inpatient treatment. The most emphasised adverse effect in the literature, namely QTc prolongation and ECG changes, were not observed in our sample. The adverse effects were not found to be significantly associated with patient-related factors nor dose of antipsychotic medication. CONCLUSIONS: From our point of view, non-cardiac adverse effects should not be overlooked while treating comorbid psychiatric and COVID-19 patients.KEY POINTSAcute inpatient psychiatric treatment of patients who have comorbid COVID-19 is a complex situation requiring multidisciplinary action.Adverse drug reactions, which may or not result from the interaction of psychiatric and COVID-19 treatment, should be of concern for this patient group.While there is controversy over the benefits of some of the off-label COVID-19 medications, there should also be discussion over safety and concomitant medication use.In order to be adequately prepared for future escalations of COVID-19 pandemic, psychiatric services should thoroughly evaluate their initial experience with COVID-19, including from the point of drug effectiveness and safety.

Physical Restraint Practices at the Emergency Department of a Mental Health Hospital.

Background: Coercive treatments can lead to ethical, legal, and clinical concerns, especially in emergency settings. The indications and characteristics of patients for whom physical restraint is indicated should be well-evaluated in order to prevent unnecessary practices. The aim of this study was to comprehensively assess the physical restraint practices in psychiatric emergencies and clinical characteristics related to their use. Methods: All patients admitted to the emergency unit of a tertiary mental health hospital between June 1 and June 30, 2022, were included in the sample. Data were retrieved from the manual and electronic medical records. Age, gender, clinical settings, diagnosis, substance use, and other factors were categorized and analyzed, comparing physically restrained and not-restrained patients. Results: Totally, 2051 patients were included in the study (1022 female and 1029 male). The mean age of the participants was 39.5 ± 14.8 years (female: 40.3 ± 14.8 male: 38.4 ± 14.7, P = .004). Seventy-two (3.51%) of the admitted patients were exposed to physical restraint and those had significantly lower number of applications in the past year (P = .020). The median restraint duration was 90 (60-150) minutes. Fifty-four (75.00%) of the physically restrained patients were male (P < .001), and they were significantly younger (mean age 34.5 ± 12.1 vs. 39.5 ± 14.9, P = .005). Clinical diagnoses of restrained patients were significantly different, in favor of psychosis. While 42 (58.33%) of the restrained patients were substance-negative, 15 (20.83%) were screened as positive for at least 1 substance (P < .001). Conclusion: Physically restrained patients differ from others with regard to age, gender, and number of previous applications. Fewer hospital applications in the past year were related to higher incidence of physical restraints.

Current state of cannabis use, policies, and research across sixteen countries: cross-country comparisons and international perspectives.

INTRODUCTION: Varying public views on cannabis use across countries may explain the variation in the prevalence of use, policies, and research in individual countries, and global regulation of cannabis. This paper aims to describe the current state of cannabis use, policies, and research across sixteen countries. METHODS: PubMed and Google Scholar were searched for studies published from 2010 to 2020. Searches were conducted using the relevant country of interest as a search term (e.g., "Iran"), as well as relevant predefined keywords such as "cannabis," "marijuana," "hashish," "bhang "dual diagnosis," "use," "addiction," "prevalence," "co-morbidity," "substance use disorder," "legalization" or "policy" (in English and non-English languages). These keywords were used in multiple combinations to create the search string for studies' titles and abstracts. Official websites of respective governments and international organizations were also searched in English and non-English languages (using countries national languages) to identify the current state of cannabis use, policies, and research in each of those countries. RESULTS: The main findings were inconsistent and heterogeneous reporting of cannabis use, variation in policies (e.g., legalization), and variation in intervention strategies across the countries reviewed. European countries dominate the cannabis research output indexed on PubMed, in contrast to Asian countries (Thailand, Malaysia, India, Iran, and Nepal). CONCLUSIONS: Although global cannabis regulation is ongoing, the existing heterogeneities across countries in terms of policies and epidemiology can increase the burden of cannabis use disorders disproportionately and unpredictably. There is an urgent need to develop global strategies to address these cross-country barriers to improve early detection, prevention, and interventions for cannabis use and related disorders.

The Relationship of Food Addiction With Other Eating Pathologies and Impulsivity: A Case-Control Study.

The concept of food addiction (FA) has become central in recent years in understanding the psychological etiology of obesity. In this matched case-control study from Turkey, it was aimed to examine the prevalence of FA and related risk factors in four consecutive body mass index (BMI) categories. The case group consisted of pre-operative bariatric surgery patients with BMI over 35.0 kg/m2 (n = 40) and the control group was composed of age- and gender- matching individuals from the other categories, namely obese (n = 35), overweight (n = 40), and normal weight (n = 40). The Yale Food Addiction Scale (YFAS) and a standardized clinical interview using the DSM-5 substance use disorders criteria adopted for FA, the Eating Disorder Examination Questionnaire (EDEQ) and the Barratt Impulsivity Scale (BIS-11) were used as assessment instruments. It was found that FA was significantly associated with more serious eating pathologies, more frequent weight-cycling and earlier onset of dieting, higher impulsivity, and higher BMI. Motor and total impulsivity scores showed a positive albeit week correlation with the severity of FA but no significant correlation with BMI, indicating a relationship between impulsivity and weight gain in some but not all individuals. The severity of FA predicted the increase in BMI. Our findings suggest that FA is associated with weight gain in a group of individuals, plausibly through impulsive overeating. Emphasis on FA and its clinical implications such as addiction-based treatments may improve outcomes in obesity and facilitate health promotion.

Psychiatry Trainees' Attitudes, Knowledge, and Training in Addiction Psychiatry-A European Survey.

Background: Although psychoactive substance use disorders (PSUDs) are a domain of mental health, addiction psychiatry is only formally recognized as a subspecialty in a few European countries, and there is no standardized training curriculum. Methods: A 76-item questionnaire was developed and disseminated through an online anonymous data-collecting system and hand-to-hand amongst psychiatric trainees from the 47 European countries of the Council of Europe plus Israel and Belarus. Results: 1,049/1,118 psychiatric trainees from 30 European countries completed the questionnaire. Fifty-nine-point nine percent of trainees stated to have training in addictions. Amongst the trainees who described having training in addictions, 43% documented a not well-structured training and 37% an unsatisfactory training, mainly due to poor acquired knowledge. Overall, 97% of trainees stated that addiction represents a core curriculum for their training. Overall, general adult psychiatric trainees reported a better knowledge in addictions, compared to trainees in child and adolescent psychiatry. Conclusion: Despite a growing spread of PSUDs in European countries, addiction psychiatry is a relatively poorly trained field within psychiatry training programs. Further research should investigate reasons for poor training and timings of the educational activities to optimize experiential education training in addiction psychiatry.

Current state of cannabis use, policies, and research across sixteen countries: cross-country comparisons and international perspectives

Abstract Introduction Varying public views on cannabis use across countries may explain the variation in the prevalence of use, policies, and research in individual countries, and global regulation of cannabis. This paper aims to describe the current state of cannabis use, policies, and research across sixteen countries. Methods PubMed and Google Scholar were searched for studies published from 2010 to 2020. Searches were conducted using the relevant country of interest as a search term (e.g., "Iran"), as well as relevant predefined keywords such as "cannabis," "marijuana," "hashish," "bhang "dual diagnosis," "use," "addiction," "prevalence," "co-morbidity," "substance use disorder," "legalization" or "policy" (in English and non-English languages). These keywords were used in multiple combinations to create the search string for studies' titles and abstracts. Official websites of respective governments and international organizations were also searched in English and non-English languages (using countries national languages) to identify the current state of cannabis use, policies, and research in each of those countries. Results The main findings were inconsistent and heterogeneous reporting of cannabis use, variation in policies (e.g., legalization), and variation in intervention strategies across the countries reviewed. European countries dominate the cannabis research output indexed on PubMed, in contrast to Asian countries (Thailand, Malaysia, India, Iran, and Nepal). Conclusions Although global cannabis regulation is ongoing, the existing heterogeneities across countries in terms of policies and epidemiology can increase the burden of cannabis use disorders disproportionately and unpredictably. There is an urgent need to develop global strategies to address these cross-country barriers to improve early detection, prevention, and interventions for cannabis use and related disorders.