Low lung function in Bipolar Disorder and Schizophrenia: a hidden risk.

Introduction: People with serious mental illness (SMI), such as schizophrenia and bipolar disorder, have a higher risk of premature morbidity and mortality. In the general population, impaired lung function is associated with increased morbidity and mortality. We compared lung function between people with and without serious mental illnesses using a cross-sectional study in 9 community mental health units. Methods: Subjects aged 40-70 years with a diagnosis of schizophrenia or bipolar disorder were recruited consecutively. The controls had no psychiatric diagnosis and were not receiving any psychotropics. Spirometry was performed by a trained nurse. We used the 2021 American Thoracic Society/European Respiratory Society standards for the interpretation of the spirometry results. Results: We studied 287 subjects. People with SMI (n = 169) had lower spirometry values than those without a psychiatric diagnosis (n = 118). An abnormal spirometry pattern (36.1% vs 16.9%, p < 0.001), possible restriction or non-specific (Preserved Ratio Impaired Spirometry [PRISm]) pattern (17.8% vs 7.6%, p = 0.014), and pattern of airflow obstruction or possible mixed disorder (18.3% vs 9.3%, p = 0.033) were more frequent in people with SMI. Multivariate analyses showed that the PRISm pattern was associated with abdominal circumference (odds ratio [OR] 1.05, 95%CI 1.03-1.08) and that the pattern of airflow obstruction or possible mixed disorder was associated with smoking behavior (OR 5.15, 95%CI 2.06-15.7). Conclusion: People with SMI have impaired lung function, with up to one-third of them showing an abnormal spirometry pattern. This suggests that regular monitoring of lung function and addressing modifiable risk factors, such as tobacco use and obesity, in this population is of paramount importance.

A Systematic Review on the Association between Schizophrenia and Bipolar Disorder with Chronic Obstructive Pulmonary Disease.

A systematic review aimed to investigate the association between schizophrenia and bipolar disorder and chronic obstructive pulmonary disease (COPD), its prevalence and incidence, potential factors associated with its occurrence and its impact on mortality among these patients. We performed the literature search in PubMed, Scopus and PsycInfo from inception to February 2022 and identified 19 studies: ten cross-sectional, 5 that included cross-sectional and longitudinal analyses, and 4 retrospective cohort studies. The reported prevalence of COPD ranged from 2.6% to 52.7% in patients with schizophrenia and between 3.0% and 12.9% in patients with bipolar disorder. Two studies reported an annual incidence of COPD of 2.21 cases/100 person-years in patients with schizophrenia and 2.03 cases/100 person-years in patients with bipolar disorder. Among the risk factors evaluated in three studies, only advanced age was consistently associated with the presence/occurrence of COPD in patients with schizophrenia and bipolar disorder; the role of tobacco consumption was not investigated in those three studies. According to two studies, the likelihood of mortality from COPD showed an over 3-fold increase in patients with schizophrenia and a 2-fold increase in those with bipolar disorder compared to the overall population; COPD was also associated with increased inpatient mortality. Available data indicate that COPD in patients with schizophrenia and bipolar disorder is a major public health problem. National and international health organizations should strive to specifically address this issue by creating awareness about this health problem and developing specific programs for screening and early intervention aimed to reduce the burden of COPD in these populations.

Smoking cessation opportunities in severe mental illness (tobacco intensive motivational and estimate risk - TIMER-): study protocol for a randomized controlled trial.

BACKGROUND: There is an increased risk of premature death in people with severe mental illness (SMI). Respiratory disorders and cardiovascular disease are leading causes of increased mortality rates in these patients, and tobacco consumption remains the most preventable risk factor involved. Developing new tools to motivate patients towards cessation of smoking is a high priority. Information on the motivational value of giving the lung age and prevention opportunities is unknown in this high-risk population. METHODS/DESIGN: This article describes in detail a protocol developed to evaluate an intensive motivational tool, based on the individual risks of pulmonary damage and prevention opportunities. It is designed as a randomized, 12-month, follow-up, multicenter study. A minimum of 204 smokers will be included, aged 40 years and older, all of whom are patients diagnosed with either schizophrenia or bipolar disorder (BD). Chronic obstructive pulmonary disease (COPD) will be evaluated using spirometry, and the diagnosis will then be validated by a pneumologist and the lung age estimated. Based on this value, a motivational message about prevention will be issued for the intervention group, which will be reinforced by individualized text messages over a period of 3 months. The efficacy of the method and the pulmonary damage variables will be evaluated: smoking cessation at the end of follow-up will be confirmed by cooximetry, and the COPD diagnosis and the severity of the staging for disease will be assessed. DISCUSSION: In the context of community care, screening and early detection of lung damage could potentially be used, together with mobile technology, in order to produce a prevention message, which may provide patients with SMI with a better chance of quitting smoking. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03583203 . Registered on 11 July 2018. Trial status: recruitment.

CT diagnosis of appendicitis in children: comparison of orthogonal planes and assessment of contrast opacification of the appendix.

OBJECTIVE: The aim of this study was to determine which plane is best for identification of the appendix and to assess if opacification of the appendix impacts visualization. METHODS: Retrospective review of 218 computed tomography examinations performed for suspected appendicitis was conducted by 2 pediatric radiologists evaluating conspicuity of the appendix depending on orthogonal plane and enteric contrast. RESULTS: Of the 180 cases in which the appendix was visualized, 154 were performed with multiplanar reformations. The best plane for identification of the appendix was coronal in 96, axial in 41, and sagittal in 17. Of the 218 computed tomography examinations, 169 had enteric contrast. The appendix was identified in 180 cases and completely opacified in 62, partially opacified in 26, without opacification in 59, and air filled in 33. Of the 38 cases in which the appendix was not identified, 29 had enteric contrast administration.In 131 of the 218 cases, the appendix was normal, and 58% demonstrated partial or complete opacification of the appendix. In 35 of the 218 cases, appendicitis was found, and there was predominantly no opacification or at most partial opacification of the appendix. CONCLUSIONS: The coronal plane is best to identify the appendix. No enteric contrast is required to visualize appendicitis.

US depiction of the appendix: role of abdominal wall thickness and appendiceal location.

The purpose of the present study was to correlate direct measurements of abdominal wall fat at the site of exam and appendiceal position with ultrasound (US) visualization of the appendix. The study took place at a large, urban pediatric teaching hospital. Demographic and imaging data of all patients who underwent both US and CT examinations within a 72-h period to evaluate for appendicitis were assessed. Two hundred eighteen patients met study criteria. Greater abdominal wall fat (p < 0.001) was observed in the subjects where the appendix was not visualized with ultrasound (17.04 mm, SD ± 13.52) than in subjects where the appendix was visualized with ultrasound (11.75 mm, SD ± 11.81) was significant. Using ROC curve analyses, there was no abdominal fat thickness cutoff threshold above which the appendix was significantly unlikely to be seen using US. Retrocecal location of the appendix was found to impair appendiceal visualization with US for both normal and inflamed appendices. Increased abdominal wall fat thickness was associated with decreased US appendiceal visualization rates, although there was no fat thickness value above which we could predict that the appendix would not be visualized with US. In patients with retrocecal appendices, the difference in visualization rates was significantly worse regardless of whether the appendix was normal or inflamed.

Bilateral tuberculous otomastoiditis in an immmunocompetent 5-year-old child: CT and MRI findings (2009: 3b).

Bilateral tuberculous mastoiditis (TOM) in an immunocompetent child is a very uncommon form of tuberculous infection presentation. This report shows the CT and MR imaging of bilateral tuberculous otomastoiditis consisting of aggressive signs of middle ear and mastoid involvement with bony destruction and periauricular collections with no signs of brain involvement. Differential diagnosis at pediatric age of destructive lesions such as mainly aggressive forms of histiocytosis is underscored. This form of bilateral TOM at this early age has not been described from a radiological perspective.