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Patients with psychiatric disorders often have cognitive impairment. Several deficits have been recognized in patients with mood and/or psychotic disorders. We hypothesized that differences in the levels of deterioration exist between patients with bipolar disorder (BD), major depressive disorder (MDD), and schizoaffective disorder (SAD). The mini-mental state examination, version 2 (MMSE-2), was used with a sample of 160 psychiatric patients to measure cognitive impairment. The aims of this studyssss were as follows: (1) To characterize the differences in cognitive deterioration among patients diagnosed with BD, MDD, or SAD; (2) to explore item difficulty and cutoff points based on the educational level and other variables which are significant for our psychiatric population. Descriptive statistics were used for categorical variables. In addition, a Bonferroni post hoc test and an analysis of covariance (ANCOVA) for the continuous dependent variable were performed. Psychiatric diagnosis and years of education adjusted by several covariates proved to be significant. The 25th percentile were obtained to establish the cutoff points. Each item's difficulty was analyzed using means and chi-square tests. Cognitive deterioration was found in 51% of the patients with SAD, in 31% with BD, and in 18% with MDD.

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Objectives: Poor oral health is an important determinant of general health in patients with mental illnesses. The present study was conducted to evaluate the dental and periodontal status of hospitalized female psychiatric patients in Jazan city, Saudi Arabia. Material and Methods: This study included 82 subjects: 37 psychiatric female patients, and 45 age- and gender- matched healthy controls. Dental caries experience (decayed, missing, and filled teeth index ( DMFT ) and periodontal health status were recorded. SPSS version 21 was used for data analysis, and p-value < 0.05 was considered statistically significant. Results: The mean ages were comparable among the two groups. Psychiatric patients showed poor oral hygiene practices, with only 56.6% reported regularly brushing their teeth as compared with 82.2% of controls (P < 0.05). Control subjects had significantly higher DMFT mean scores than psychiatric female patients. However, psychiatric patients had significantly higher mean scores of missing teeth (M component) and lower restored teeth (F component) as compared with controls. Moreover, the mean attachment loss scores were significantly higher in the psychiatric group (0.76±1.58) compared with controls (0.23; 0.44 p < 0.01). Conclusion: Psychiatric patients showed poor oral hygiene practices and a high prevalence of untreated dental caries and periodontal diseases. Effective oral health promotion strategies need to be implemented to improve the oral health and oral health practices of this group of people. (AU)

Objetivo: A má saúde bucal é um importante determinante da saúde geral em pacientes com doenças mentais. O presente estudo foi realizado para avaliar o estado dentário e periodontal de pacientes psiquiátricos do sexo feminino hospitalizados na cidade de Jazan, Arábia Saudita. Material e Métodos: Este estudo incluiu 82 indivíduos: 37 pacientes psiquiátricas do sexo feminino e 45 controles saudáveis pareados por idade e gênero. A experiência de cárie dentária (índice de dentes cariados, perdidos e obturados (CPOD) e o estado de saúde periodontal foram registrados. O progama SPSS versão 21 foi usado para a análise dos dados, e o valor de p <0,05 foi considerado estatisticamente significativo. Resultados: As médias das idades foram comparáveis entre os dois grupos. Pacientes psiquiátricos mostraram práticas de higiene bucal precárias, sendo que apenas 56,6% relataram escovar os dentes regularmente, em comparação com 82,2% dos controles (P <0,05). Os indivíduos controle tiveram pontuações médias de CPOD significativamente mais altas do que as pacientes psiquiátricas. Os pacientes tiveram escores médios significativamente maiores de dentes perdidos (componente P) e dentes restaurados menores (componente O) em comparação com os controles. Além disso, os escores médios de perda de inserção foram significativamente maiores no grupo psiquiátrico (0,76 ± 1,58) em comparação com os controles (0,23 ± 0,44;p <0,01). Conclusão: Pacientes psiquiátricos apresentaram práticas inadequadas de higiene bucal e uma alta prevalência de cárie dentária e doença periodontal não tratada. Estratégias eficazes de promoção da saúde bucal precisam ser implementadas para melhorar a saúde bucal e as práticas de saúde bucal desse grupo de pessoas (AU)

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Com a desinstitucionalização psiquiátrica, intensificou-se o papel da família no cuidado cotidiano dos pacientes, resultando em sentimento de sobrecarga. O modelo teórico da sobrecarga prediz que ela poderia ser diminuída por fatores moduladores, como a resiliência, definida como a habilidade para enfrentar adversidades, ajustando-se de forma positiva. Este estudo investigou a relação entre o nível de resiliência e o grau de sobrecarga desses cuidadores. Foram entrevistados 76 familiares de pacientes atendidos em três serviços de saúde mental de duas cidades de Minas Gerais. Foram obtidas correlações significativas entre o nível de resiliência e dois domínios da sobrecarga (assistência na vida cotidiana e supervisão dos comportamentos problemáticos), mas não em relação às preocupações com o paciente, ou o escore global de sobrecarga. Foram identificados os principais fatores associados à sobrecarga, características dos pacientes e dos familiares. Conclui-se pela necessidade de intervenções psicoeducativas dos serviços de saúde mental junto a esses cuidadores.

Since psychiatric deinstitutionalization, patients' family members became responsable for their daily care, resulting in caregiver' burden. The theoretical model of burden predicts that it could be reduced by modulating factors, such as caregivers' resilience, defined as the ability to face adversity and adapt positively to it. This study investigated the relationship between resilience and caregivers' burden. We interviewed 76 family members of psychiatric patients attending three mental health services in two middle size cities of the state of Minas Gerais. Significant correlations were found between the level of caregivers' resilience and two domains of burden (assistance in daily life and supervision of problematic behaviors), but not in relation to the domain of concerns about the patient, or the overall burden score. Burden associated factors were identified, among the variables of patients and caregivers characteristics. The results confirmed that psychoeducational interventions should be provided by the mental health services for these caregivers.

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Background and Aims: Infection with the parasite Toxoplasma gondii has been associated with bipolar disorder in several countries other than Mexico. Therefore, we sought to determine the association between seropositivity to T. gondii and bipolar disorder in a Mexican population. Methods: We performed an age- and gender-matched case-control study of 66 patients with bipolar disorder (WHO International Classification of Diseases, 10th Revision code: F31) and 396 subjects without this disorder from the general population. Anti-Toxoplasma immunoglobulin G (IgG) and IgM antibodies were determined using commercially available enzyme-linked immunoassays. Results: Six (9.1%) of the 66 patients with bipolar disorder and 22 (5.6%) of the 396 controls had anti-T. gondii IgG antibodies (odds ratio [OR] = 1.7; 95% confidence interval [CI] = 0.66-4.36; P = 0.26). Stratification by gender and age did not show a difference in seroprevalence between cases and controls. The frequency of high (> 150 international units/ml) anti-T. gondii IgG levels was similar in cases (n = 2) and in controls (n = 12) (OR = 1.0; 95% CI = 0.21-4.57; P = 1.00). Stratification by International Classification of Diseases, 10th Revision F31 codes showed that patients with F31.3 code had a higher seroprevalence of T. gondii infection than their age- and gender-matched controls (OR = 16.4; 95% CI = 1.25-215.09; P = 0.04). None of the six anti-T. gondii IgG-seropositive patients with bipolar disorder and 4 (18.2%) of the 22 anti-T. gondii IgG-seropositive controls had anti-T. gondii IgM antibodies (P = 0.54). Conclusions: Our results suggest that T. gondii seropositivity is not associated with bipolar disorder in general. However, a specific type of bipolar disorder (F31.3) might be associated with T. gondii seropositivity. Further research to elucidate the role of T. gondii infection in bipolar disorder is needed.

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Background: With around 800,000 people taking their own lives every year, suicide is a growing health concern. Understanding the factors that underlie suicidality and identifying specific variables associated with increased risk is paramount for increasing our understanding of suicide etiology. Neuroimaging methods that enable the investigation of structural and functional brain markers in vivo are a promising tool in suicide research. Although a number of studies in clinical samples have been published to date, evidence about neuroimaging correlates for suicidality remains controversial. Objective: Patients with mental disorders have an increased risk for both suicidal behavior and non-suicidal self-injury. This manuscript aims to present an up-to-date overview of the literature on potential neuroimaging markers associated with SB and NSSI in clinical samples. We sought to identify consistently reported structural changes associated with suicidal symptoms within and across psychiatric disorders. Methods: A systematic literature search across four databases was performed to identify all English-language neuroimaging articles involving patients with at least one psychiatric diagnosis and at least one variable assessing SB or NSSI. We evaluated and screened evidence in these articles against a set of inclusion/exclusion criteria and categorized them by disease, adhering to the PRISMA guidelines. Results: Thirty-three original scientific articles investigating neuroimaging correlates of SB in psychiatric samples were found, but no single article focusing on NSSI alone. Associations between suicidality and regions in frontal and temporal cortex were reported by 15 and 9 studies across four disorders, respectively. Furthermore, differences in hippocampus were reported by four studies across three disorders. However, we found a significant lack of replicability (consistency in size and direction) of results across studies. Conclusions: Our systematic review revealed a lack of neuroimaging studies focusing on NSSI in clinical samples. We highlight several potential sources of bias in published studies, and conclude that future studies should implement more rigorous study designs to minimize bias risk. Despite several studies reporting associations between SB and anatomical differences in the frontal cortex, there was a lack of consistency across them. We conclude that better-powered samples, standardized neuroimaging and analytical protocols are needed to continue advancing knowledge in this field.

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Abstract Background This study was carried out at Punjab Institute of Mental Health and Centre for Nuclear Medicine Mayo Hospital, Lahore. It is aimed at the possible association of thyroid malfunctioning with suicide attempts of patients. Objective Determination of thyroid function status of suicidal psychiatric patients and their comparison with psychiatric patients without suicide attempt or ideation. Methods Total 54 patients with either past history of suicide attempt or current suicidal ideation were selected for analysis of their thyroid function status (age 15-55 years). Age matched 50 non-suicide psychiatric patients were included for comparison. Results Two patients with suicide attempt had overt thyroid dysfunction. Remaining patients had serum FT4, FT3 and TSH level within normal range. Suicide attempter patients had lower FT4 but increased FT3 and TSH levels compared to suicidal ideation patients. Serum FT4 and TSH levels in suicidal patients were not different from psychiatric patients. Serum FT3 in suicidal patients was lower than psychiatric patients (3.7 ± 0.8 vs. 4.3 ± 0.5; p < 0.05). Female suicidal patients had lower FT3 levels compared to male patients (3.4 ± 0.6 vs. 3.9 ± 0.8 pmol/L; p < 0.05). Discussion Local suicidal patients have higher incidence of overt thyroid disorder and lower FT3 levels compared to non-suicidal psychiatric patients.

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Abstract There is a high prevalence of drug use among psychiatric patients, favoring worse prognosis and situations of vulnerability. The aim of this study was to understand the perception and management of mental health professionals related to the use of drugs among people receiving psychiatric care. Semi-structured interviews were conducted with 16 professionals. Through thematic analysis, three categories were constructed: (1) Identification of drug use, performed with some difficulty through self-reports, collected by doctors and nursing assistants, being the essential link; (2) Actions taken to manage drug use situations, focusing on abstinence counseling and many referrals; (3) Presence of moral discourses in the care offered. The team reports difficulties in dealing with situations of drug use among patients, from identification to management. The different ways of dealing with consumption were related to how the professional understands the use of drugs.

Resumo Há alta prevalência de consumo de drogas entre pacientes psiquiátricos, favorecendo pior prognóstico e situações de vulnerabilidade. O objetivo deste estudo é compreender a percepção e o manejo de profissionais de saúde mental sobre o uso de drogas entre pessoas em tratamento psiquiátrico. Foram realizadas entrevistas semiestruturadas com 16 profissionais. Foram construídas três categorias a partir de análise temática: (1) Identificação do uso de drogas, realizada com certa dificuldade por meio de autorrelato colhido por médicos e auxiliares de enfermagem, destacando-se o vínculo como essencial; (2) Ações realizadas para manejar situações de uso de drogas, focadas na orientação para abstinência e resultando em muitos encaminhamentos; (3) Presença de discursos morais no cuidado oferecido. A equipe relata dificuldades para lidar com situações de consumo de drogas relatadas pelos pacientes, desde a identificação até o manejo. As diferentes formas de lidar com o consumo mostram-se relacionadas ao modo como o profissional de saúde mental compreende o uso de drogas.

Resumen Hay alta prevalencia de consumo de drogas entre pacientes psiquiátricos, favoreciendo peor pronóstico y situaciones de vulnerabilidad. El objetivo de este estudio es comprender la percepción y el manejo de profesionales de salud mental sobre el uso de drogas entre personas en tratamiento psiquiátrico. Se realizaron entrevistas semiestructuradas con 16 profesionales. Con análisis temático se construyeron tres categorías: (1) Identificación del uso de drogas, realizada con cierta dificultad por medio de autorrelato recogido por médicos y auxiliares de enfermería, destacándose el vínculo como esencial; (2) Acciones realizadas para manejar situaciones de uso de drogas, siendo éstas enfocadas en la orientación hacia abstinencia y ocurriendo muchos encaminamientos; (3) Presencia de los discursos morales en el cuidado ofrecido. El equipo relata dificultades para lidiar con situaciones de consumo de drogas entre los pacientes, desde la identificación hasta el manejo. Las diferentes formas de lidiar con el consumo se muestran relacionadas con el modo en que el profesional de salud mental comprende el uso de drogas.

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O objetivo do estudo foi avaliar os fatores sociodemográficos associados à assertividade de familiares cuidadores de pacientes psiquiátricos. A amostra foi composta por 53 familiares que cuidavam de pacientes atendidos em um Centro de Atenção Psicossocial (CAPS) de uma cidade de porte médio de Minas Gerais. Os instrumentos de medida utilizados foram a Escala de Assertividade Rathus (RAS), que avalia um fator geral de inibição e três fatores específicos de timidez, agressividade e assertividade no sentido de fazer valer seus direitos, e um questionário sociodemográfico e clínico. Os resultados mostraram que ter menor grau de escolaridade e viver sozinho foram fatores preditores de maior grau de inibição e timidez, assim como menor agressividade e assertividade, e possuir um trabalho foi preditor de maior agressividade. Estes resultados apontam para subgrupos de familiares que necessitam de maior apoio e orientação para desenvolver as habilidades necessárias ao relacionamento com os pacientes, no desempenho do papel de cuidadores. Um melhor repertório de assertividade dos familiares, para saber lidar com os comportamentos dos pacientes, poderá contribuir para que eles tenham um menor grau de sobrecarga e melhores condições de prestar cuidados cotidianos aos pacientes. Intervenções psicoeducacionais em serviços de saúde mental poderão desenvolver estas habilidades. (AU)

The aim of the study was to evaluate the association between sociodemographic factors and the assertiveness of family caregivers of psychiatric patients. The sample consisted of 53 family caregivers of patients attended at a Community Mental Health Center (CAPS) in a midsize city of Minas Gerais. The instruments used were the Rathus Assertiveness Scale (RAS), which evaluates a general inhibition factor and three specific factors of shyness, aggressiveness and assertiveness in assuring personal rights, and a sociodemographic and clinical questionnaire. The results showed that lower educational level and living alone were predictors of higher degree of inhibition and shyness as well as lower aggressiveness and assertiveness, and having a job was a predictor of higher aggressiveness. These results point to subgroups of families who need to receive more support and guidance in order to develop the necessary relationship skills for the performance of patients' caregivers role. A better family assertiveness repertoire in dealing with patients' behavior can contribute to a lower degree of family burden and better condition for them to provide daily care to patients. Psychoeducational interventions in mental health services can develop these skills. (AU)

El objetivo del estudio fue evaluar los factores sociodemográficos predictivos de la asertividad de los cuidadores familiares de pacientes psiquiátricos. La muestra estuvo conformada por 53 familiares asistidos en un CAPS de una ciudad de tamaño mediano de Minas Gerais, Brasil. Los instrumentos de medida utilizados fueron la Escala Rathus Asertividad (RAS), que evalúa un factor de inhibición general y tres factores específicos de la timidez, agresividad y asertividad para tener la valoración de sus derechos, además de un cuestionario sociodemográfico y clínico. Los resultados mostraron que tener menos educación y vivir solo fueron predictores de mayor grado de inhibición y timidez, y menos agresividad y asertividad, y tener un trabajo era un factor predictivo de aumento de la agresividad. Estos resultados indican subgrupos de familias que necesitan más apoyo y orientación para desarrollar las habilidades relacionales necesarias para o desempeño de la función de cuidador. Un mejor repertorio de la asertividad de los familiares, para saber cómo lidiar con el comportamiento de los pacientes puede contribuir para que tengan un menor grado de sobrecarga y sean más capaces de proporcionar atención diaria a los pacientes. Las intervenciones psicoeducativas en los servicios de salud mental pueden desarrollar estas habilidades. (AU)

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We assessed the association of Toxoplasma gondii infection and depression in a sample of psychiatric patients and control subjects without depression. We performed an age- and gender-matched case-control study of 89 patients suffering from depression attended in a public psychiatric hospital in Durango City, Mexico and 356 control subjects without depression from the general population of the same city. Participants were tested for the presence of anti-Toxoplasma IgG and IgM antibodies using enzyme-linked immunoassays. Anti-T. gondii IgG antibodies were found in 11 (12.4%) of the 89 cases and in 22 (6.2%) of the 356 controls (OR = 2.14; 95% CI: 1.00-4.59; P = 0.04). Anti-T. gondii IgM antibodies were found in four (19%) of 21 anti-T. gondii IgG seropositive controls but not in 11 anti-T. gondii IgG seropositive cases (P = 0.27). Patients aged 30 years old and younger had a significantly higher seroprevalence of T. gondii infection than controls of the same age group (P = 0.001). Results of the present study suggest a potential association between T. gondii infection and depression. Furthers studies to confirm our results and to determine the epidemiology of T. gondii in young depressed patients should be conducted.

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BACKGROUND: The parasite Toxoplasma gondii (T. gondii) may invade the brain and might induce behavioral changes. We sought to determine the association of T. gondii infection and mixed anxiety and depressive disorder. METHODS: Through an age- and gender-matched case-control seroprevalence study, we examined 65 patients suffering from mixed anxiety and depressive disorder (WHO ICD-10 code: F41.2) attending in a public hospital of mental health and 260 control subjects without this disorder from the general population. Sera of participants were analyzed for anti-Toxoplasma IgG and IgM antibodies using enzyme-linked immunoassays. RESULTS: Fifteen (23.1%) of the 65 patients and 18 (6.9%) of the 260 controls had anti-T. gondii IgG antibodies (odds ratio (OR): 4.03; 95% confidence interval (CI): 1.90 - 8.53; P < 0.001). The frequency of high (> 150 IU/mL) anti-T. gondii IgG levels was similar in cases and controls (OR: 0.25; 95% CI: 0.05 - 1.06; P = 0.05). Seroprevalence was similar in male cases and controls (P = 1.0); however, seroprevalence was significantly higher in female cases than in female controls (OR: 7.08; 95% CI: 2.83 - 17.67; P < 0.00001). Patients aged 31 - 50 years old had a significantly higher seroprevalence of T. gondii infection than controls of the same age group (OR: 21.04; 95% CI: 5.22 - 84.80; P < 0.00001). Anti-T. gondii IgM antibodies were found in four (26.7%) of the 15 anti-T. gondii IgG seropositive cases and in 10 (55.6%) of the 18 anti-T. gondii IgG seropositive controls (P = 0.15). CONCLUSIONS: Results support for the first time an association between seropositivity to T. gondii and mixed anxiety and depressive disorder. Further research to confirm this association and to determine the seroepidemiology of T. gondii infection in patients with this disorder is needed.