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Objectives

To analyze the clinical, analytic and inflammatory characteristics that resembles and diferenciates clozapine inmune response and SARS-CoV-2 infection.

Methods

A case of clozapine-induced pneumonitis during COVID-19 pandemic is described. A mini-review of Clozapine inflammatory effects, antipsychotic-induced pneumonitis and SARS-CoV-2 was performed.

Results

A 33 year old afrolatin male started treatment with clozapine up to 250 mg daily during a hospital stay due to refractory psychosis. The 11th day of treatment he developed fever and respiratory symptoms. The pulmonary auscultation showed sounds generally degreased and O2 basal saturation was 91%, making the most probable causes viral infection (SARS-CoV-2 due to local incidence), nosocomial bacterial infection or pulmonary thromboembolism. The patient was isolated due to suspiction of COVID-19.
The analytics showed leucocytosis (13400/mcL), lymphocytopenia (11.8%), elevated PCR (14.4 mg/dL), Ferritine (506.9 ng/mL), Fibrinogen (663.83 mg/dL) and D-Dimer (1.61 mg/dL). In a second analytic, Interleukin-6 was also elevated (25.8 pg/mL). The angioTC revealed a pleural effusion and ground glass infiltrates in the right lung (figure 1). After 2 consecutive negative PCRs for SARS-CoV-2, the patient received empirical antibiotics for 4 days without improvement and all infectious pannels were negative. Only after two weeks eosinophilia was discovered (800/mcL). We started decreasing clozapine with improvement of the symptoms and resolution after suspending clozapine completely.

Conclusions

Clozapine may induce a generalized inflammatory response that may be mediated by interleukin-6. Frequently, patients treated with clozapine experience fever and very rarely interstitial lung effects or pneumonitis. Symptoms, analytics and implied mechanisms of clozapine-induced inflammatory response resembles viral infections, particularly SARS-CoV-2.

Objectives

Who we are today are shaped by our upbringing and subconscious mind through a pattern. The childhood memories are deeply ingrained and influence how we behave and act. It is not uncommon for the prisoners to commit crime again due to unaddressed suppression of anger. We use drawings to understand prisoners.

Methods

We use Kinetic-house-tree-person (KHTP) drawings and childhood memories as a tool to understand and transform the prisoners by using reverse engineering.The person is asked to draw anything that crosses his/her mind, including 3 essential items: house, tree, people. We can understand the patient by using KHTP Test together with 3 childhood memories from the patient, which include: age of memory, the event that happened, the people around and the feelings during the incident.

Results

KHTP drawings are very effective and accurately reflect the subconscious aspirations, or conflicts the person faced. This drawing interpretation also acts as a reliable screening tool to assess the patients' subconscious attitude towards their life, based on the shape of the tree as tree represent the life force of the person.

Conclusions

Based on criminal’s psychology, criminals have a tendency to repeat their act and also has the unknown need to be caught. They get trapped in a repeated vicious cycle of thoughts. Therefore, KHTP drawing and childhood memories can be a tool to understand and transform the prisoners by reverse engineering their mind. The policeman and the prisoners have a better understanding of themselves and live with less conflict. The quality of life improve with less tendency of committing crimes in the future.

Objectives

Background

Special police departments dedicated exclusively to manage cases of violence against adult women were created in Tunisia in February 2021 in order to facilitate the legal procedure. Chief police officers working in these new departments often ask for requisitioned psychiatry reports during investigation in order to document the psychological effects of the supposed agressions.

Aim

The aim of this study was to describe the cases of women consulting for forensic psychiatric examination at our department and to report medical and legal features.

Methods

Method

Retrospective descriptive study reporting cases of women who complained about violence based on their gender, consulting Mongi Slim Mental Health Department in Marsa, Tunisia, for forensic psychiatric examination asked by a magistrate, during 2020.

Results

Results

Our survey found 211 cases of women. Mean age was 37 years. In this study, 127 (60%) were complaining about marital violence (ex-husband in two cases). Main other accused agressors were : a neighboor, a colleague, a boyfriend, a family member or an unknown stranger. Most women had anxious, depressive symptoms or post-traumatic stress disorder. Those who wished to consult again as patients were managed in our department and recieved psychological care and social and legal advice.

Conclusions

This study points a serious problem in society which is gender based violence against women, through review of legal psychiatric examination. We found that marital violence was the most prevalent. It is crucial to plan actions at the political, and social levels in order to prevent gender violence and help victims.

Objectives

The relationship between schizophrenia and violence is complex. The aim of this multicentre case-control study was to examine and compare the characteristics of a group of forensic psychiatry patients with a schizophrenia spectrum disorder and a history of significant interpersonal violence to a group of patients with the same diagnosis but no lifetime history of interpersonal violence.

Methods

Overall, 398 patients (221 forensic and 177 controls patients) were recruited across five European Countries (Italy, Germany, Poland, Austria and the United Kingdom) and assessed using a multidimensional standardized process.

Results

The most common primary diagnosis in both groups was schizophrenia (76.4%), but forensic patients more often met criteria for a comorbid personality disorder, almost often antisocial (49.1 vs 0%). The forensic patients reported lower levels of disability and better social functioning. Forensic patients were more likely to have been exposed to severe violence in childhood. Education was a protective factor against future violence as well as higher levels of disability, lower social functioning and poorer performances in cognitive processing speed tasks, perhaps as proxy markers of the negative syndrome of schizophrenia. Forensic patients were typically already known to services and in treatment at the time of their index offence, but often poorly compliant.

Conclusions

This study highlights the need for general services to stratify patients under their care for established violence risk factors, to monitor patients for poor compliance and to intervene promptly in order to prevent severe violent incidents in the most clinically vulnerable.

Objectives

Covert administration of medication (CoAdM) by caregivers to persons with severe mental illness (SMI) is a common practice in India. The studies which have tried to capture this practice are sparse. The objective of the study was to explore the prevalence and predictors of CoAdM.

Methods

We performed a cross sectional study in the outpatient department at National Institute of Mental Health and Neurosciences(NIMHANS), Bangalore, India between April 2019 and November 2019. We used a semi-structured questionnaire to interview the caregivers of persons with SMI to assess the prevalence and clinico-socio-demographic correlates of covert administration of medication (CoAdM) . Sociodemographic variables were analyzed using descriptive statistics and predictors of covert medication were analyzed by binary logistic regression.

Results

A total of 300 caregivers were interviewed. 96(32%) of the patients were given medication covertly in their lifetime, and 19(6.3%) were given medication covertly in the last 1 year. Female gender (B = -0.65, p =0.03) and Insight into illness (B=-0.64, p <0.05) were negatively correlated with CoAdM. Likewise, poor adherence to medication (B=0.78, p=0.001) and higher number of drug default related relapses (B=0.22, p =0.019) positively correlated with CoAdM by the caregivers.

Conclusions

In India, one-third of people with severe mental illness were found to be receiving covert administration of medication by caregivers. Gender, level of insight, number of drug default-related relapses, and level of medication adherence were all identified to be predictors of patients receiving medication covertly.

Objectives

The COVID-19 pandemic represented a paradigm shift in mental health care specifically and in health care in general, worldwide. The main objective of the study is to describe the profile of patients with COVID-19 infection attended by the Psychiatry Service during the first wave.

Methods

An observational, retrospective study was carried out. 71 individuals in total, with a confirmed diagnosis of COVID-19 with the reverse transcriptase polymerase chain reaction (PCR) technique were analyzed. These individuals had been referred to the Psychiatry Service by another specialist. They all belonged to an inpatient hospital in the metropolitan area of Madrid, Spain. All of the data was extracted from the medical records and ethical approval was obtained from the local ethics committee.

Results

93% of the sample had a psychiatric diagnose after the initial evaluation and adjustment disorder (44%) was the most frequent. There was a significant association between a previous psychiatric history and a specific consultation on drug interaction with drugs used to treat COVID-19 and psychiatric medication (P=0.0036) and the use of corticosteroids for the COVID-19 infection and the need to prescribe psychiatric treatment for mental symptoms (P= 0.012).

Conclusions

The current study depicts the concern specialists initially had regarding the possible drug interactions between psychopharmacological treatment and the drugs needed for COVID-19. It also shows how the use of corticosteroids predicted the need of further psychopharmacological treatment in COVID-19 patients for mental symptoms.

Objectives

Since the gender distribution of psychiatrists is widely variable across countries and female psychiatrists may be underrepresented in some aspects of psychiatry such as academia and leadership, this study sought to examine how much progress Sri Lankan psychiatry has made towards achieving gender parity in its different domains.

Methods

Relevant information about psychiatrists and trainees were extracted from name directories published on the official websites of Sri Lanka College of Psychiatrists, postgraduate institute of medicine and each medical school in Sri Lanka. Citation impact of academic psychiatrists was assessed using Google scholar profiles. The gender of authors who have published in the local psychiatry journal was determined by two independent raters.

Results

Females accounted for 46.3% of psychiatrists currently working in state hospitals and 50.7% of life members of the College. Among psychiatrists recruited recently (2012-2020), 61.5% were female, with a clear upward trend for females. Among university lecturers in psychiatry, 54.5% were female. Gender ratio among professors was 1:1. Two thirds (66.7%) of the department heads were female. Research productivity, assessed using h-index and total citations, was not significantly different between male and female academics. In the local psychiatry journal, published biannually between 2010-2020, 45.6% of first authors and 43.5% of all authors were female; 62.5% of its editors were female. In the Sri Lanka College of Psychiatrists, 30% of psychiatrists who held the presidential post were female.

Conclusions

Gender parity has been achieved in many aspects of psychiatry in Sri Lanka, and possibly in the future, females may become overrepresented.

Objectives

Early-life stress and later-on stressful events increase the subsequent depression risk. However, few studies have been conducted to examine specific and cumulative effects of these stressors on the depression when considering the role of psychosocial stressors. Guided by the biopsychosocial perspective, this study examined to what extent the stressors associated with the depression risk while considering the role of genetic predispositions.

Methods

Data analyzed are from ZEPSOM, which is a community-based cohort from Southwest of Montreal. 1351 participants with information on life-time depression across a 10-year follow-up were included. Stressful events across the life span were operationalized as specific, cumulative and latent profiles of stressful experiences. Latent profile analysis was used to explore the clustering of stressors including childhood maltreatment, parent-child relationship and stressful life events. Multivariate logistic regression was used to examine the association between specific, cumulative and latent profile of stressors and subsequent depression.

Results

Different domains of childhood maltreatment, child-parent bonding and stressful life events predicted subsequent depression. Furthermore, a significant association between cumulative stressful experiences and depression was found. Three latent profiles of stressors were identified named “low level of stress”, “moderate-level of stress” and “high-level of stress”. Individuals with high-level of stress had higher risk of depression after adjusting for genetic predispositions and demographic characteristics.

Conclusions

The present study provides robust evidence to support the accumulation and composition of early- and later-on lifetime psychosocial stressors in subsequent depression even considering genetic predispositions. Mental health promotion could be achieved by decreasing lifetime stressful experiences and targeting specific integrated stressors patterns.

Objectives

Despite increased emphasis on gender correlates of mental health disorders among young girls, little research exists on how gender factors influence young women’s postnatal psychological distress in India. This study aims to determine whether gender disadvantage factors are associated with psychological distress among young women in rural India, where the child sex ratio is lower than the national average.

Methods

A cross-sectional survey was conducted in rural Pune, India. A total of 229 young married women who had a live birth in last 12 months were screened for psychological distress. The predictors of psychological distress were estimated using multivariable logistic regression analyses. The statistical significance level for multivariable logistic regression was set at p < 0.05 and p < 0.10.

Results

Psychological distress was found among 50 respondents (21.9%). The multivariable logistic regression showed that young women who were married before 18 years had 2.19 times higher odds of distress than women who were married after 18 years. Young women who gave birth to a female infant had 2.43 times higher odds of distress than those who gave birth to a male infant. Lack of partner support and experience of postnatal health complications were other predictors.

Conclusions

Study findings ascertain the role of gender disadvantage factors in causing psychological distress. From a public health perspective, early identification and treatment of psychological distress among young mothers is imperative, along with addressing gender inequitable practices. Further, counselling to husband and family to promote gender equity and partner support must be incorporated into routine postnatal care.