Self-Reported Alcohol, Tobacco, and Cannabis Use during COVID-19 Lockdown Measures: Results from a Web-Based Survey.

BACKGROUND: The outbreak of coronavirus disease 19 (COVID-19) has led to measures of social distancing and quarantine worldwide. This stressful period may lead to psychological problems, including increases in substance use. OBJECTIVE: To investigate changes in alcohol, tobacco, and cannabis consumption before and during COVID-19 lockdown and motives for these changes in substance use. METHOD: A web-based survey was filled out by an unselected population during the social distancing measures of the COVID-19 pandemic in Belgium that assessed changes in alcohol, tobacco, and cannabis consumption in the period before and during the COVID-19 lockdown and also asked about reasons for change. RESULTS: A total of 3,632 respondents (mean age 42.1 ± 14.6 years; 70% female) filled out the survey. Overall, respondents reported consuming more alcohol (d = 0.21) and smoking more cigarettes (d = 0.13) than before the COVID-19 pandemic (both p < 0.001), while no significant changes in the consumption of cannabis were noted. The odds of consuming more alcohol during the lockdown were associated with younger age (OR = 0.981, p < 0.001), more children at home (OR = 1.220, p < 0.001), non-healthcare workers (p < 0.001), and being technically unemployed related to COVID-19 (p = 0.037). The odds of smoking more cigarettes during the lockdown were associated with younger age (OR = 0.988, p = 0.027), current living situation (p < 0.001), lower education (p = 0.015), and working situation related to COVID-19 (p = 0.018). Boredom, lack of social contacts, loss of daily structure, reward after a hard-working day, loneliness, and conviviality were the main reasons for consuming more of the various substances. CONCLUSIONS: During the lockdown, individuals consumed slightly more alcohol and smoked marginally more cigarettes compared to the period before the lockdown. Further research focussing on follow-up of individuals at risk may be useful to provide appropriate care in post-COVID times.

Patient's and general practitioner's perspectives regarding disturbed eating.

OBJECTIVES: We wanted to investigate the patient's expectations on the general practitioner's (GP) responsibilities in screening and follow up of disturbed eating behaviour. Then, we looked for remediation for some of the mentioned shortcomings in family medicine. We also examined if online aid (offered by the non-profit organisation "Eetexpert.be") is already known and used. SUBJECTS AND METHODS: Anonymous patient questionnaires were gathered at 4 treatment centres for eating disorders or were collected with help of the Flemish patients organisation for eating disorders (Vlaamse Vereniging Anorexia Nervosa en Boulimia Nervosa). Later, online enquiries were sent to Flemish GPs. RESULTS: Out of 123 patients responding to the questionnaire, 44 found their GP to have had an important supportive role in their healing process. Active listening and targeted referral were among the most appreciated interventions by those patients. 71 GPs replied the online enquiry. Only 1 out of 5 knew about the free online assistance of "Eetexpert.be". Responders suggested several additional barriers to care. CONCLUSIONS: In Flanders there is a contrast between expectations and needs of patients on one hand compared to the services provided by GPs on the other. Reassuringly, all responding physicians were open to more education and support regarding eating disorder treatment.

Mobile crisis team in the Brussels region: facts and figures.

BACKGROUND: A reformation of psychiatry was set up in Belgium with the establishment of mobile crisis teams. SUBJECTS AND METHODS: We performed a retrospective analysis of the patients referred to the mobile team "Pharos" in the period between December 2013 and December 2018. RESULTS: The number of patients is growing over the years and the most common referral reasons are suicidal thoughts and depressive mood. We have a high percentage of inclusions, maybe because the main referrers are GPs. Alcohol withdrawal at home is feasable and safe. CONCLUSION: Many psychiatric crisis situations can be managed at home with support of mobile teams, but further research is needed to provide evidence on outcome and cost effectiveness.

Intensive HF-rTMS treatment in refractory medication-resistant unipolar depressed patients.

BACKGROUND: Major depression is a worldwide severe mental health problem. Unfortunately, not all depressed patients respond to pharmacotherapy or psychotherapy, even when adhering to treatment guidelines. Even though current guidelines do not in particular advocate repetitive Transcranial Magnetic Stimulation (rTMS) in refractory treatment resistant depression (TRD), using more intensive stimulation parameters might hold promise as a valuable alternative. OBJECTIVE: Consequently, in this randomized sham-controlled crossover study, we wanted to evaluate clinical outcome of intensive HF-rTMS treatment in TRD when applied to the left dorsolateral prefrontal cortex (DLPFC). METHODS: After a 2-week antidepressant washout, 20 unipolar TRD patients, at least stage III, received 20 sham-controlled high-frequency (HF)-rTMS sessions, in a crossover design. Five daily suprathreshold HF-rTMS sessions were spread over four successive days delivering in total 31,200 stimuli. RESULTS: Overall, the procedure resulted in immediate statistical significant decreases in depressive symptoms regardless of order/type of stimulation (real/sham), suggesting possible placebo responses. On the other hand, albeit only 35% (7/20) of the patients showed a 50% reduction of their initial Hamilton Depression rating score at the end of the two-week procedure, all these patients showed a prompt clinical response after real HF-rTMS treatment, not after sham. Furthermore, a shorter duration of the current depressive episode was a predictor for beneficial clinical outcome. Unresponsiveness to former ECT could be indicative for negative clinical outcome in these kinds of patients. LIMITATIONS: Single center setup with relatively small sample size and no follow-up. CONCLUSIONS: Our findings indicate that intensive HF-rTMS treatment might have the potential to result in fast clinical response when confronted with a refractory TRD patient.

Intensive rTMS applications in difficult to treat psychiatric patients: some cases.

Despite adherence to treatment guidelines, some patients are resistant to several psychopharmacological interventions. Guidelines to overcome treatment resistance are scarce and new treatment modalities are needed. When confronted with psychopharmacological failure, repetitive transcranial magnetic stimulation (rTMS) therapy can be considered. In these case series a combative high frequency (HF)-rTMS protocol with frequent stimulations at suprathreshold intensity was applied for treatment-resistant depression (TRD), schizoaffective- and bipolar I disorder, mixed episode. Besides effectiveness, tolerability was closely monitored. All three patients, suffering from different psychiatric conditions were experiencing limited to excellent clinical improvement without serious side effect or adverse events. These very preliminary results suggest, along with research using comparable intensive stimulation parameters for treatment-resistant depression, that 'aggressively' targeting the left DLPFC is well tolerated and safe. Our clinical results suggest a possible beneficial treatment strategy of HF-rTMS protocols following unsuccessful. Larger sham-controlled studies are needed to substantiate our results.

Combative HF-rTMS treatment, for a bipolar I patient, following unsuccessful ECT.

We aimed to Examine the safety and effectiveness of HF-rTMS in a treatment-refractory bipolar I patient in a mixed affective episode. Our case illustrates that "combative" HF-rTMS therapy could be a safe and valid treatment alternative for refractory bipolar I patients in mixed episode, not successfully treated with ECT.

Successful ECT treatment after relapse during VNS therapy.

We present a case of a patient with severe treatment resistant depression who relapsed while being treated with vagus nerve stimulation. We describe that he was safely treated with unilateral ECT concomitantly with the VNS.