Changes in state policy for promoting a healthy lifestyle. (A historical aspect).

Healthy lifestyle promotion from the perspective of state policy, journalism, healthcare, sociology, and psychology was analyzed. The objective of the study was to analyze changes in the financial and agitation state policy aimed at increasing the motivational activity of citizens of the Russian Federation towards a healthy lifestyle (HLS) in the Soviet era and at the post-Soviet stage and assess the effectiveness of these measures. The effectiveness of the Soviet propaganda of healthy lifestyles among the population was evaluated. Crisis phenomena in public health, low persuasiveness of the media presentation of the healthy lifestyle value, the COVID-19 pandemic, difficulties in implementing corporate health promotion programs in the workplace at individual en-terprises, and ignoring gender stereotypes in attitudes to health are the reasons that contribute to the adherence of Russian workers to unhealthy behaviors, that cause an increase in the incidence of chronic non-communicable diseases. The historical aspect of changes in state policy for health promotion made it possible to determine the tasks in developing health-saving programs.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Association Between COVID-19 Pandemic and Serious Mental Illness: Systematic Review within Salutogenesis Model for Public Health Management

Background: The outbreak of the COVID-19 pandemic, the constant transformation of the SARS-COV-2 virus form, exposure to substantial psychosocial stress, environmental change, and isolation have led to the inference that the overall population's mental health could be affected, resulting in an increase in cases of psychosis. Objective(s): We initiated a systematic review to determine the impact of the SARS-COV-2 virus and its long-term effects-in both symptomatic and asymptomatic cases-on people with or without psychosis. We envisioned that this would give us an insight into effective clinical intervention methods for patients with psychosis during and after the pandemic. Method(s): We selected fifteen papers that met our inclusion criteria, i.e., those that considered participants with or without psychiatric illness and exposed to SARS-COV-2 infection, for this review and were retrieved via Google, Google Scholar, MEDLINE, PubMed, and PsychINFO Database. Key Gap: There is a dearth of research in understanding how COVID-19 affects people with or without a prior personal history of psychosis. Result(s): The systematic review summary provides insight into the state of knowledge. Insights from the systematic review have also been reviewed from the salutogenesis model's perspec-tive. There is moderate evidence of new-onset psychosis during the COVID-19 pandemic in which some antipsychotics treated the psychotic symptoms of patients while treating for COVID-19. Suggestions and recommendations are made for preventive and promotive public health strategies. Conclusion(s): The Salutogenesis model and Positive Psychology Interventions (PPI) provide another preventive and promotive public health management approach.Copyright © 2023 Bentham Science Publishers.

Scoping Review on Educational Programs for Medical Professionals on the Management of Acute Agitation.

BACKGROUND: Agitation is a common reason for psychiatric consultation in the general hospital. The consultation-liaison (CL) psychiatrist is often tasked with teaching the medical team how to manage agitation. OBJECTIVE: The purpose of this scoping review is to explore what resources the CL psychiatrist has for educational tools on teaching about agitation management. Given the frequency with which CL psychiatrists help with on-the-ground management of agitation, we hypothesized that there would be a scarcity of educational resources to teach front-line providers how to manage agitation. METHODS: Following current Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a scoping review was conducted. The literature search focused on the electronic databases MEDLINE (PubMed), Embase (Embase.com), The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), PsycInfo (EbscoHost), Cumulated Index to Nursing and Allied Health Literature (CINAHL) (EbscoHost), and Web of Science. Using Covidence software, after screening for titles and abstracts, full texts were screened independently and in duplicate according to our inclusion criteria. For data extraction, we created a predefined set of criteria according to which each article was analyzed. We then grouped the articles in the full-text review according to which patient population a curriculum was designed for. RESULTS: The search yielded a total of 3250 articles. After removing duplicates and reviewing procedures, we included 51 articles. Data extraction captured article type and details; educational program information (staff training, web modules, instructor led seminar); learner population; patient population; and setting. The curricula were further divided based on their target patient population, specifically the acute psychiatric patient (n = 10), the general medical patient (n = 9), and the patient with a major neurocognitive disorder such as dementia or traumatic brain injury (n = 32). Learner outcomes included staff comfort, confidence, skills, and knowledge. Patient outcomes included measurements of agitation or violence using validated scales, PRN medication use, and restraint use. CONCLUSIONS: Despite there being numerous agitation curricula in existence, we found that a large majority of these educational programs were done for patients with major neurocognitive disorders in the long-term care setting. This review highlights the gap in education related to agitation management for both patients and providers in the general medical setting, as less than 20% of total studies are focused on this population. The CL psychiatrist plays a critical role in assisting in agitation management in this setting, which often requires collaboration between technicians, nurses, and nonpsychiatric providers. It calls into question whether the lack of educational programs makes the implementation of management interventions more difficult and less effective, even with the assistance of the CL psychiatrist.

Sedation in the ICU: association between dexmedetomidine and 28-day mortality in patients with COVID-19

Introduction: The aim of our study is to evaluate the relationship between dexmedetomidine (DEX) use as a sedative agent in mechanical ventilated ICU patients and 28-day mortality. DEX, a selective alfa-2 adrenergic receptor agonist, widely used for its sedative and analgesic properties, has been linked to increasing parasympathetic tone, reducing the inflammatory response and oxidative stress [1]. Since severe COVID-19 is associated with an hyperinflammatory state, it is hypothesized that DEX might improve outcomes in these patients. Method(s): This is a retrospective observational study of mechanically ventilated patients admitted with COVID-19 pneumonia in the ICU of a tertiary center in Portugal, between March 2020 and December 2021. Logistic regression analysis was performed to evaluate the association of DEX use and 28-day mortality from time of intubation. Result(s): A total of 277 patients were analyzed, 151 in the DEX group and 126 in the no DEX group. Patients in the DEX group were younger (53.3 vs. 63.3 years, p < 0.001), had less comorbidities (2.8 vs. 3.5, p = 0.01), lower SOFA at admission (6.2 vs. 7.1, p = 0.01) but had a prolonged ICU stay (21.4 vs. 15.9, p < 0.001). Male gender (65.6 vs. 69.0, p = 0.54), incidence of obesity (56.3 vs. 46.8, p = 0.12), coronary artery disease (4.0 vs. 7.9, p = 0.16) and atrial fibrillation (4.0 vs. 7.1, p = 0.25) were similar between groups. PaO2/ FiO2 ratio at admission (111.1 vs. 108.1, p = 0.61), days spent in RASS < 3 (13.7 vs. 12.4, p = 0.31) and opioid use (14.8 vs. 13.1, p = 0.16) were also similar. From time of intubation, 28-day mortality in the cohort receiving DEX was 14.7% compared to 59.5% in the no DEX group (OR 0.12;95% CI 0.07-0.21;p = 0.01). Conclusion(s): Use of DEX was associated with lower 28-day mortality in COVID-19 critically ill patients requiring invasive mechanical ventilation in our study analysis. Considering the limitations of a retrospective observational study, RCTs are needed to confirm the results.

Risk factors for nosocomial infections in COVID-19 ICU population

Introduction: The aim of this study is to identify the factors associated with an increased risk of developing nosocomial infections (NI) in COVID-19 patients admitted with pulmonary involvement in the ICU. NI in COVID-19 ICU population are an important cause of morbidity and mortality worldwide and its prompt identification might lead to its prevention and better outcomes. Method(s): This is a retrospective observational study of patients admitted with COVID-19 pneumonia in the ICU of a tertiary center in Portugal, between March 2020 and December 2021. We considered NI as any infection acquired > 48 h post ICU admission. Clinical, analytical and baseline patient data were evaluated. Logistic regression analysis was performed to correlate patient related variables with the development of NI. Result(s): A total of 338 patients were enrolled, from which 167 (47.9%) presented with NI. Baseline characteristics are described in Table 1. In the logistic regression analysis, older age (OR 1.13;95% CI 1.03-1.25;p = 0.013), coronary artery disease (CAD) (OR 28.7;95% CI 1.92-429;p = 0.02), obesity (OR 3.14;95% CI 0.86-11.42;p = 0.008), chronic liver disease (CLD) (OR 104.33;95% CI 1,.04-1008.49;p = 0.04), use of dexamethasone (OR 21.89;95% CI 3.04-157.85;p = 0.002) and days in RASS < 3 (OR 1.4;95% CI 1.05-1.86;p = 0.02) were associated with an increased risk of developing NI in the ICU. Surprisingly, SOFA at admission, days of invasive mechanical ventilation, days of sedation and PaO2/ FiO2 ratio at admission, although statistically significantly different between groups, did not correlate with the risk of infection. Conclusion(s): We identified prolonged deep sedation, corticosteroid use, and patient characteristics (CAD, obesity, CLD, older age) as independent risk factors for NI development in COVID-19 critically ill patients. It is also noteworthy to point out for the presence of confounding variables, including the excessive workload in the ICU during this period, leading to an increase in NI numbers.

Mental health outcomes in patients discharged after COVID-19 hospitalization: the case report of a male nurse in the context of occupational surveillance program of health care workers

This case study draws attention on mental health sequelae that emerged in the context of the COVID-19 outbreak after recovery from hospitalization, even in subjects without personal psychiatric history. The case involves a 65-year-old male shift nurse who took SARS-COV-2 infection through a co-worker and that had been hospitalized for interstitial pneumonia from April 6 to April 17. After recovery, he developed psychiatric symptoms overlapping between different dimensions of psychiatric disorders and started to be followed by the Occupational Health Department of a Major University Hospital in central Italy. He reported a score of 28 at the Peritraumatic Distress Inventory and of 39 at the Self-Rating Anxiety State. He was treated with a combination therapy of SSRI and NaSSA antidepressants with clinical remission. In this case study, authors discuss the possible overlapping role of post-traumatic stress and anxiety symptoms in patients discharged after COVID-19 hospitalization that may deserve appropriate classification, treatment and follow up with the future goal to refine clinical management of post and long COVID syndromes of subjects who present low abnormalities in other specialty investigations.Copyright © 2022 EDIZIONI MINERVA MEDICA.

Effect of a repeated verbal reminder of orientation on emergence agitation after general anaesthesia for minimally invasive abdominal surgery: a randomised controlled trial.

BACKGROUND: An orientation strategy providing repeated verbal reminders of time, place, and person has been widely used for the non-pharmacological management of delirium. We hypothesised that using this strategy could reduce emergence agitation and improve recovery profiles. METHODS: This prospective observer-blinded RCT included male and female patients aged 18-70 yr undergoing minimally invasive abdominal surgery. During emergence from general anaesthesia, subjects in the orientation group (n=57) were provided a repeated reminder, including orientation: '(Patient's name), you are now recovering from general anaesthesia after surgery at Seoul National University Hospital, open your eyes!' via noise-cancelling headphones, whereas those in the control group (n=57) only heard their name: '(Patient's name), open your eyes!'. The primary outcome was the incidence of emergence agitation (Riker sedation agitation scale [SAS] ≥5). The incidence of dangerous agitation (SAS=7), maximal SAS score in the operating room, and recovery profile until 24 h postoperatively were evaluated as secondary outcomes. RESULTS: The incidence of emergence agitation in the operating room was significantly lower in the orientation group than in the control group (16/57 [28.1%] vs 38/57 [66.7%]; relative risk [95% confidence interval], 0.5 [0.3-0.7]; P<0.001). The incidence of dangerous agitation (0 [0.0%] vs 10 [17.5%], P=0.001) and the median maximal SAS score (4 [4-5] vs 5 [4-6], P<0.001) were also lower in the orientation group. Secondary outcomes, other than agitation-related variables, were comparable between the two groups. CONCLUSIONS: Repeated verbal stimulation of orientation may serve as a simple and easily applicable strategy to reduce emergence agitation after general anaesthesia. CLINICAL TRIAL REGISTRATION: NCT05105178.

Mixed Depression in the Post-COVID-19 Syndrome: Correlation between Excitatory Symptoms in Depression and Physical Burden after COVID-19.

The relationship between depression and post-COVID-19 disease syndrome (post-COVID-19 syndrome) is established. Nevertheless, few studies have investigated the association between post-COVID-19 syndrome and mixed depression, i.e., a specific sub-form of depression characterized by high level of excitatory symptoms. Aims of the present study are: (a) to compare the post-COVID-19 syndrome's burden in depressed and non-depressed patients, and (b) to investigate the correlation between post-COVID-19 syndrome's burden and the severity of mixed depression. One thousand and forty six (n = 1460) subjects with post-COVID-19 syndrome were assessed. Subjects were divided into those with (DEP) or without (CONT) depression. Sociodemographically, post-COVID-19 syndrome's symptoms number and type were compared. In DEP, association between levels of excitatory symptoms and the presence of post-COVID-19 syndrome's symptoms were additionally assessed. DEP showed greater percentages of family history of psychiatric disorders than CONT. DEP showed higher percentages of post-COVID-19 symptoms than CONT. A greater level of excitatory symptoms were associated to higher frequencies of post-COVID-19 syndrome' symptoms. Higher levels of post-COVID-19 syndrome's symptoms in DEP corroborate the evidence of a common pathway between these two syndromes. Presence of excitatory symptoms seem to additionally add a greater illness burden. Such findings might help clinicians choose the appropriate treatment for such states. More specifically, therapies aimed to treat excitatory symptoms, such as antipsychotics and mood stabilizers, might help reduce the illness burden in post-COVID-19 patients with mixed depression.

Effect of COVID-19 on Working Women's Physical and Mental Health: A Descriptive Study of Pre and Post Pandemic Era

Background and Aim: In 2019, the World Health Organization (WHO) recognized the coronavirus outbreak as a pandemic and a public health emergency of global significance. Recent studies have revealed that these restrictions and women's anxiety of the virus itself may have had an adverse effect on their mental health. Children and family members are spending more time at home;thus, society needs to be conscious of how this is affecting working women's emotional and physical health especially in the absence of any assisting maid. Thus, the purpose of this study was to evaluate how the COVID-19 pandemic lockdown affected working women's physical and mental health. Material(s) and Method(s): To examine the effects of COVID-19 on the physical and emotional health of working women, a cross-sectional survey was conducted. Data is collected using an online survey platform. To investigate the impact of lockdown on the women's mental and physical health, a semi-structured questionnaire comprising a number of open-and closed-ended questions was prepared. Additionally, any mental health disorders and emotional difficulties that developed during lockdown or became worse were enlisted. Another goal was to gauge how much family members understood and were sympathetic to the physical and mental strain the working women were under. Result(s): The study involved 200 women from different states of India. The hours spent in the kitchen and other associated activities increased from 1.5 hours to 5.5 hours when the time between before and during the lockdown was compared. The amount of time spent engaging in physical activity, such as yoga and morning and evening walks, significantly decreased during the lockdown are coming to normal after the lockdown. 68 per cent of those surveyed said that women's behaviour had changed. About 58 per cent of the women suffered physical changes such fatigue, headaches, lower back discomfort, and other issues with women's weight gain. Conclusion(s): Additional research is required to better understand the long-term effects of the COVID-19 pandemic on women's mental health, particularly in regard to the identification of additional variables that may be connected to the pandemic's potentially multiplicative effects on women.Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.

Intra-hospital complications during SARS-CoV2 infection

Introduction: The SARS-CoV2 virus has a respiratory tropism. Although pulmonary complications are most often in the foreground, other complications affecting other organs have been observed and associated with a greater bad prognosis. The aim of this work was to report the various complications observed in patients hospitalized with COVID-19 pneumonia. Method(s): We carried out a retrospective study from the records of patients treated for pneumonia COVID-19 hospitalized between March 2020 and July 2021. Result(s): We collected 578 patients aged between 18 and 98 years old. Thoracic complications were dominated by bronchial superinfection(4.3%), pericarditis(3.3%), pneumomediastinum(1.2%) and pneumothorax(0.8%). Among the thromboembolic complications, we counted 30 pulmonary embolisms(5.2%), 7 acute limb ischemia (1.2%), 2 strokes(0.3%) and 1 venous thrombosis deep(0.1%). Cardiac arrhythmias were observed in 6% of cases. Bradycardia sinusitis was observed in 14 patients (2.4%) and first degree atrioventricular block in 4 patients (0.7%). Acute heart failure occurred in 31 patients (5.3%). Neurological disorders were observed in 23 patients with agitation (4%) and hallucinations (1%). Acute renal failure was the most common metabolic complication (20%) followed by rhabdomyolysis (28%) and cytolysis hepatic (36%). Two patients presented with diabetic ketoacidosis (0.3%). Complications cardiac, neurological and renal were associated with a worse prognosis (p=0.001) and the pulmonary complications with longer hospitalization (p=0.01). Conclusion(s): SARS-CoV2 infection is a polymorphic disease. Identification of the different complications respiratory and extra respiratory is essential for rapid multidisciplinary care.

Possible autoimmune pediatric encephalitis following COVID-19 infection with focal cerebral dysfunction in a young female: A case report

Introduction: Post-COVID-19 autoimmune encephalitis is a rare manifestation following COVID-19. Most cases have not demonstrated solid evidence regarding their pathogenesis. Some believe it to be an immune process. Case presentation: In this case report, we present a case of a young female who presented to our emergency department with visual, auditory, and olfactory hallucinations after successfully treating COVID-19 two weeks prior to this visit. On examination, her vital signs were stable, but she was agitated, distressed, and hallucinating. Neurological examinations were normal. Laboratory investigations, including autoimmune profiles, were all negative. Magnetic resonance imaging of the brain showed non-specific changes in the bilateral frontal area. Electroencephalography (EEG) showed lateralized rhythmic delta activity (LRDA) arising more from the right occipital lobes. Autoimmune psychosis was suspected due to psychosis, abnormal imaging, and abnormal EEG findings. She was given corticosteroids and antipsychotic medication. Her symptoms improved within ten days. On follow-up, she remained well without any return of psychosis. Conclusion(s): Possible autoimmune pediatric encephalitis following COVID-19 is a rare entity that has scarcely been reported. The majority of the cases were reported to have been related to stress following the infection. To establish the correct diagnosis, an extensive workup, including an autoimmune profile, lumbar puncture, magnetic resonance imaging, and electroencephalography, is recommended.Copyright © 2022 The Author(s)

Anesthetic management of toxic epidermal necrolysis: a report of two cases

Toxic epidermal necrolysis (TEN), is an acute, life-threatening emergent disease involving the skin and mucous membranes with serious systemic complications. It is characterized by widespread epidermal sloughing. Drugs are the most common triggers of TEN, but infection, vaccination, radiation therapy and malignant neoplasms can all induce it in susceptible patients. We report two cases in whom a hair dye and a COVID-19 vaccine (BioNTech, Pfizer) were believed to be the causative agents. These patients have to undergo repeated debridements of the necrotic tissue. In this manuscript the anesthetic management of TEN patients is discussed. Detailed preoperative evaluation, aggressive fluid and electrolyte replacement, avoidance of hypothermia during debridement, minimizing anesthetic agents and limiting traumatic procedures are key points in the management.Copyright © 2023 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.

Health Care Workers: The Most Blown Away in the COVID-19 Pandemic Hurricane

Objective: We conducted a questionnaire to reveal the stress, anxiety and burnout that health professionals have experienced during the pandemic period, and the social, economic and work-related problems encountered. Material and Method: A total of 416 healthcare professionals participated in the study. They were reached via an electronic questionnaire form through social media groups and given detailed information abıut the study. They were asked 8 sociodemographic questions, 6 questions for health status of HCW, 8 questions about the changes in working and economic conditions, 11 questions for social and psychological changes of HCW. Results: Ninetyfive percent of the employees felt burnout along with tension, anxiety and restlessness. Despite this, 88% did not receive any psychological support. There have also been changes in the family and social arrangements of the majority of the HCW (94%). Nearly 90% of the HCW worked under pressure. Only 18% of the health professionals who participated in our study did not hesitate to continue their current profession. There is a significant relationship between the participants' decreased willingness to choose the same profession again and their tension/anxiety and burnout (p <0.05). Conclusion: HCW are effected socially, economically and psychological with the rapid spread of COVID-19 pandemic. They experienced stres, anxiety and burnout besides fatigue. This may lead to problems such as taking care of patients and quality in health care even collapses in the health sector. We suggest that providing and sustaining psychological, economical, social and behavioral support for HCW and health sector. (English) [ABSTRACT FROM AUTHOR] Amaç: Pandemi döneminde sağlık çalışanlarının yaşadığı stres, kaygı ve tükenmişlik ile karşılaştıkları sosyal, ekonomik ve işle ilgili sorunları ortaya çıkarmak için bir anket gerçekleştirdik. Gereç ve Yöntem: Çalışmaya toplam 416 sağlık çalışanı katılmıştır. Sosyal medya grupları aracılığıyla elektronik anket formu kullanılarak kendilerine ulaşılmış ve çalışma hakkında detaylı bilgi verilmiştir. Katılımcılara 8 sosyodemografik soru, sağlık durumları ile ilgili 6 soru, çalışma ve ekonomik koşullardaki değişikliklerle ilgili 8 soru, sosyal ve psikolojik değişiklikleri ile ilgili 11 soru sorulmuştur. Bulgular: Çalışanların %95'i gerginlik, kaygı ve huzursuzluk ile birlikte tükenmişlik hissettiğini belirtmiştir. Buna rağmen %88'i herhangi bir psikolojik destek almamıştır. Sağlık çalışanlarının çoğunluğunun (%94) aile ve sosyal düzenlemelerinde de değişiklikler olmuştur. Sağlık çalışanlarının yaklaşık %90'ı baskı altında çalıştığını söylemiştir. Çalışmamıza katılan sağlık çalışanlarının sadece %18'i mevcut mesleğine devam etmekten çekinmemiştir. Katılımcıların aynı mesleği tekrar seçme isteklerinin azalması ile gerginlik/kaygı ve tükenmişlik durumları arasında anlamlı bir ilişki vardır (p <0.05). Sonuç: COVID-19 pandemisinin hızla yayılması ile sağlık çalışanları sosyal, ekonomik ve psikolojik olarak etkilenmişlerdir. Yorgunluğun yanı sıra stres, kaygı ve tükenmişlik yaşamışlardır. Bu durum sağlık sektöründe hasta bakımı ve sağlıkta kalite gibi sorunlara yol açabilmekte, hatta sağlık sektöründe çökmelere neden olabilmektedir. Bu sıkıntıları önlemek için psikolojik, ekonomik, sosyal ve davranışsal desteğin sağlanması ve sürdürülmesinin sağlık sektörü ve sağlık çalışanları için faydalı olacağını düşünüyoruz. (Turkish) [ABSTRACT FROM AUTHOR] Copyright of Firat Tip Dergisi is the property of Firat University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Post-traumatic stress disorder, suicide risk, feeling of loneliness and life satisfaction in the general population during the COVID-19 pandemic.

Introduction: The outbreak of the COVID-19 pandemic is an extremely uncommon global epidemic crisis. The study aimed to identify changes in the severity of PTSD symptoms, suicide risk, loneliness and subjective life satisfaction level in the general population, regarding the gender differences, during the first two waves of the COVID-19 pandemic. Material(s) and Method(s): The study group included 303 general population subjects aged 16-84 (50.2% females and 49.8% males). The research was conducted in two phases. The first stage included 150 subjects, the second 153. The following diagnostic tools were used: Impact of Event Scale (IES-R), the De Jong Gierveld Loneliness Scale (DJGLS), Suicide Behavior Questionnaire-Revised (SBQ-R), the Cantril Self-Anchoring Striving Scale (CSASS) and the demographic-descriptive questionnaire. The study was conducted via the Internet. Result(s): In both waves of the COVID-19 pandemic, there was a positive correlation between the feeling of loneliness and the suicide risk, as well as the general level and symptoms intensity of PTSD (intrusion and agitation). In women we observed an increased PTSD level and higher level of intrusion and avoidance symptoms. Having children was a suicide protective factor in women in both waves of the pandemic, and only during the second wave in men. The difference in the declared life satisfaction in both waves was significantly higher in the second study phase only in terms a life satisfaction before the pandemic. Conclusion(s): It is a mental health prevention priority to implement proper crisis interventions and long-term risk assessments in terms of people exposed to the COVID-19 virus and those in social isolation.Copyright © 2022 Via Medica. All rights reserved.

Finding the Rhythm Trough Words. An Experience of a Psychoanalytic Psychotherapy Training in a High-Care Psychiatric Community

Introduction: MC is a 57-year-old man, who arrived in the actual community in 2017 and has been hospitalized in psychiatric facilities for over twenty years, with a diagnosis of paranoid schizophrenia since the age of 17. He went through several discharges in other communities, which often after a short time dismissed him because of the the difficulties in managing his: "Disruptive behaviour". There are several hospitalizations which have occurred over the years, due to strong agitation, worsening hypomanic mood, severe logorrhea, verbal aggression and destructiveness towards objects. MC had little awareness of his condition and a suspicious attitude towards the community team. He asked to return living with his parents, a request impossible to comply with, due to the severity of the psychopathological frame and the old age of the parents. This framework raised the question to the care team of how to create the conditions for the patient to be engaged in a care path that would take his words into account. Method(s): From 2019 to 2020, during the bimonthly meetings with his parents he was supported by the presence of an assistant. After each meeting he was offered a space where to talk with the psychologist, who is under psychoanalytic psychotherapy training with a Lacanian orientation, in a visa- vis setting. From 2020 to the present day, due to the Covid-19 pandemic and the worsening health conditions of the parents, meetings with the family have been suspended, but the patient maintained the therapy on a weekly basis, and the talking therapy was integrated with the support of writing as an expressive method. This case is based on medical records, the therapist's notes taken at the end of each session (January 2019-July 2022) and from the patient's writings, analyzed via textual analysis. Result(s):The case shows how the initial therapeutic engagement was able to take place on the basis of the patient's own words: "relationship with the parents" was the recurrent theme of his speeches at the beginning of the treatment and offered the clue on why he considered the therapist as 'the one who was helping him with his parents', thus giving the therapist a place. In the progression of the sessions, when the writing was introduced while addressing himself as an "author" not only to the therapist (who helped writing the text under dictation) but also to the readers, the patient used new signifiers, placing them in a "before" and a "now" and being able to find new words to say something about his suffering. In the work on the patient's text extrapolated from his "Theory on the History of Rock Music," emerges the narrative of his first crisis that occurred at the age of 15 following a school rejection. The patient situates his own individual crisis by extending it to the "Crisis of '68", "student Revolts," and the "conflicts between musical genres.", and at the same time including (indirectly) himself as one of the main characters of his theory as one of the so-called "conscripts of '64" and explicitly connecting this to the onset of his paranoia to the therapist too. The patient not only narrates the crisis but also how he tried to "overcome" it, again placing this transition at an extended level through the musical evolution that led to the birth of "punk" music in the 1980s, musical genre in which he could have "recognized himself" because Punk allowed "people who suffered this type of depression" for "artistic expression of paranoia". The writing of this 'theory of the history of rock music' took a long time for the patient to work out, arriving at about ten pages over the course of about 2 years of work, implying the rhythm and logical time set by the patient himself. Conclusion(s): The reference of an aim such as "work" ("Helping with his parents", or "Being his collaborator on writing the text") might have been helpful to the therapist in appearing less persecutory and establishing a climate of trust. When, with the arrival of the pandemic, the outings with the parents were suspended, it was necessary to find new wor ing conditions in the therapeutic process because the patient showed disorientation and difficulty in relating even to the therapist in a calm manner. Also in this case, after a period of suspension, it was the patient who again sought a space to talk, through the theme of music. Working on what the patient offers and support the patient's writing of his "Theory on the history of rock music" allowed the therapist to resume working in a more calm and non-persecutory atmosphere. Writing was a support through which, with the help of the therapist, the patient could construct an elaboration of his illness and suffering and find a way to express something otherwise impossible to say. The work is still in progress;so far, supporting MC in his relationship with his parents through a multidisciplinary intervention and working on his own writing had the effect of allowing the patient to invest more in the community relations and activities, to be more satisfied and to have a greater degree of separation in his relationship with his parents, theme that now does not occupy all of the patient's speech, leaving a space to something new to say.

Investigating the impact of music therapy on two in-patient psychiatric wards for people living with dementia: retrospective observational study.

BACKGROUND: Music therapy can lift mood and reduce agitation for people living with dementia (PwD) in community and residential care settings, potentially reducing the prevalence of distress behaviours. However, less is known about the impact of music therapy on in-patient psychiatric wards for PwD. AIMS: To investigate the impact of music therapy on two in-patient psychiatric wards for PwD. METHOD: A mixed-methods design was used. Statistical analysis was conducted on incidents involving behaviours reported as 'disruptive and aggressive' in 2020, when music therapy delivery varied because of the COVID-19 pandemic. Semi-structured interviews conducted online with three music therapists and eight ward-based staff were analysed using reflexive thematic analysis. RESULTS: Quantitative findings showed a significant reduction in the frequency of behaviours reported as disruptive and aggressive on days with in-person music therapy (every 14 days) than on the same weekday with no or online music therapy (every 3.3 or 3.1 days, respectively). Qualitative findings support this, with music therapy reported by music therapists and staff members to be accessible and meaningful, lifting mood and reducing agitation, with benefits potentially lasting throughout the day and affecting the ward environment. CONCLUSIONS: We identified a significant reduction in the occurrence of distress behaviours on days with in-person music therapy when compared with no music therapy. Music therapy was reported to be a valuable intervention, supporting patient mood and reducing agitation. Interventional studies are needed to investigate the impact of music therapy and its optimum mode of delivery.

"Mãos de Conforto" (Hands of Comfort): A novel non-pharmacological intervention to ease agitation in elderly persons with dementia.

Behavioral symptoms associated with dementia, such as agitation, are frequent and associated with well-known negative consequences for patients, their carers, and their environment. Pharmacological treatments for agitation using sedatives and antipsychotics are known to have several undesirable side effects and modest efficacy. Non-pharmacological alternatives are recommended as first-line options for agitation in persons with dementia with few side effects, but there is limited evidence of efficacy. We developed a novel and simple non-pharmacological alternative for agitation in dementia residents based on a Brazilian intervention using warm water surgical gloves used in patients with COVID-19 in intensive care units during the pandemic. We coined it "Mãos de Conforto" - Hands of Comfort. We report a series of 7 cases in 3 residents with dementia who whore Hands of Comfort.

Fenofibrate and Statins in Patients with COVID-19

Statins, which are widely used to treat hypercholesterolemia, have anti-inflammatory and antioxidant effects, upregulate angiotensin-converting enzyme 2 (ACE2) receptors, which happen to be SARS-CoV-2's gateway into cells. This study aims to analyse the effects of Fenofibrate in comparison to Statins and a control group in patients with COVID-19. This is a retrospective open blind observational study of cohort of 300 patients experienced COVID-19 (symptoms' severity varied between patients). The participants were divided into three cohorts;a control group received standard COVID-19 treatment (n=100);a second group (n=100) of patients who were on Statins, in addition they received the standard treatment;and a third cohort for patients who were already taking Fenofibrate (TRICOR) as a medication to treat hyperlipidemia (n=100). Most symptoms (including cough, exertional dyspnoea, SOB, sore throat, sneezing, headache, tiredness, agitation, diarrhoea, joint pain, insomnia, myalgia, and fatigue) were less prevalent for patients who administered antihyperlipidemic drugs compared to the control group. Patients who were already taking Cholesterol-lowering medication presented with symptoms varied between mild to severe. Patients on Statins or Fenofibrate also showed less tachycardia and tachypnoea compared to those who were not on antihyperlipidemic drugs, and also the need for oxygen and ICU admission were less frequent. The length of stay in hospital was shorter in patients who were already on Statins or Fenofibrate. Both Statins and Fenofibrate have improved the outcome and the severity of symptoms for patients with Covid 19 infection. Copyright © RJPT All right reserved.

The Impact of Covid-19 on Physical and Mental Health of Children: A Descriptive Study

Background and Aim: The World Health Organization (WHO) acknowledged coronavirus epidemic as a pandemic and declared the outbreak as a public health emergency of international concern. Emerging research has suggested that these various restrictions, as well as the fear of the virus itself, may have caused children to experience negative mental health consequences. Due to increased amounts of time spent at home the parents need to be aware about the changes in the mental and physical health of the children. This study, thus aimed to survey the effects of the COVID-19 pandemic lockdown on physical and mental health of school-going children. Material(s) and Method(s): A cross sectional survey was designed to analyse the impact of COVID-19 on the physical and mental health of children. The data is collected with the use of online survey platform. A semi structured questionnaire was developed with several open and close ended questions to examine the effect of lockdown on the mental and physical health of the children from parent-reported changes. Any mental health issues and emotional problems newly emerged or aggravated during lockdown were also enlisted. Another objective was to determine the level of awareness amongst parents about the importance of PA for the child. Result(s): A total of 200 children were included in the study. When the comparison was done in time from before and after lockdown, it was found that the hours spent on mobile were increased from 2 hours to 5 hours. There was significant decrease in the time spend for physical activity. A total of 65% of the respondents reported that there was change in the behaviour of the children. Around 58% of the children had shown the physical changes like eyestrain, fatigue, neck pain, head ache, lower back pain and major problem with increase in weight of children. Conclusion(s): More research is needed to improve our understanding of the long-term impacts of the COVID-19 pandemic on children's mental health, especially with regards to the identification of protective factors found in children who may have been less affected by the pandemic. Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.