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Consortium Psychiatricum

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Vol 1, No 1 (2020)
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EDITORIAL

3-7 315
Abstract
The current COVID-19 pandemic is associated with fear, insecurity, and perceived social isolation worldwide. In this editorial, we discuss the influence of the COVID-19 pandemic on mental health among the general population and among particularly vulnerable groups (e.g., people with pre-existing mental illness). Additionally, we explore the role of e-mental health options in times of social distancing. Preliminary empirical evidence indicates that a wide range of people have experienced mental health difficulties due to the COVID-19 pandemic and corresponding infection-control measures. E-mental health options are a feasible means of addressing psychological distress and mental illness during the pandemic. Thus, these options should be made available in a timely fashion. Future multidisciplinary research is needed to develop e-mental health strategies that specifically focus on the consequences of social isolation, economic hardship and fear of infection.

Research

8-20 308
Abstract

Background. In 2020, the COVID-19 pandemic evoked a variety of research into the virus and its effects on mental health. A variety of mental health and psychological problems have been reported: stress, anxiety, depressive symptoms, insomnia, denial, stigma, anger and fear.

Objectives. To assess the level of anxiety, depression and distress in the general population during the lockdown in Russia and to reveal factors associated with distress.

Methods. An online survey was carried out from 22–27 April 2020 (the fourth week of lockdown) among the general population (mostly Moscow residents). The survey questions covered general information about people’s social and demographic characteristics, experience of COVID-19, health condition (physical and mental), attitudes and views on the pandemic, and the need for psychological support. The survey included the Hospital Anxiety and Depression Scale (HADS) and evaluation of the preceding week’s subjective distress level using a visual numeric scale (from 0 to 10). We also asked respondents to specify the causes of distress, adopted from the WHO information sheet relating to the major psychological challenges of the COVID-19 pandemic.

Results. In total, 352 responses were collected (men = 74, women = 278; age (M ± SD) = 36.81 ± 11.36 y.o.). Most respondents (n = 225, 63.92%) did not have any personal experience of the coronavirus infection. Normal levels of anxiety and depression scores were prevalent in the sample. Higher than normal levels of HADS anxiety/depression (> 7 scores) were observed in 105 (29.83%) and 59 (16.76%) respondents, respectively; mean (95% CI) scores for HADS anxiety/depression were 6.23 [5.77, 6.68] /4.65 [4.22, 5.08] (women) and 4.20 [3.32, 5.09] /3.46 [2.63, 4.29] (men), respectively.
The leading causes of distress were: 1) the risk of financial problems in the future (n = 267, 76.3%); 2) violation of plans and the disruption to normal life (n = 235, 67.1%; and n = 240, 68.6%, respectively); 3) the health of elderly or chronically diseased relatives (n = 205, 58.6%) and 4) being in self-isolation (n = 186, 53.1%).

Conclusion. The level of anxiety and depression during the COVID-19 pandemic in the study sample did not exceed the norm for the population in non-pandemic conditions. Our assessment of distress levels captured existing emotional problems, and distress levels were found to be connected with the reported need for psychological support.

22-29 169
Abstract

Introduction. The association between schizophrenia and toxoplasmosis has been demonstrated in a number of studies: the prevalence of schizophrenia is significantly higher in toxoplasmosis positive subjects than in those with T.gondii negative status. However, the clinical significance of this association remains poorly understood.

Objectives. To identify clinical phenomena that are typical for toxoplasmosis-associated (T.gondii seropositive) schizophrenia compared to Toxoplasma-seronegative schizophrenia.

Methods. A retrospective database analysis of serum samples from 105 inpatients with schizophrenia (ICD-10 code: F20; including 55 male patients; mean age of 27.4 ± 6.4 years) was carried out. The clinical examination involved a structured interview including ICD-10 and E. Bleuler’s criteria for schizophrenia and psychometric tests (Positive and Negative Scales of PANSS). Serum antibodies (IgG) to T.gondii were identified using ELISA. The statistical significance of any differences were evaluated using the non-parametric Mann-Whitney (U) and χ2 tests.

Results. The proportion of seropositive patients in the sample was 16.2%. Comparing schizophrenia patients, who were seropositive or seronegative for toxoplasmosis, there were no statistically significant differences for the mean total PANSS score, mean PANSS-P, PANSS-N or PANSS-G scores. For the majority of PANSS items, differences were also statistically insignificant, except for G5 and G6—mannerism and posturing. Seropositive patients had a higher score for this item than seronegative patients: 3.5 versus 2.1 points (U=389.5; р=0.001). Depression, on the contrary, was less pronounced in seropositive than seronegative patients: 1.4 versus 2.4 points (U=509.5; р=0.023). In addition, in seropositive patients, the frequency of symptoms such as mutism according to ICD-10 criteria for schizophrenia  was significantly higher (23.5% versus 3.4%, χ2=9.27, р=0.013), and the whole group of catatonic symptoms according to the E. Bleuler’s criteria for schizophrenia was higher (52.9% versus 28.4%, χ2=3.916, p = 0.048).

Conclusion. The association between a positive toxoplasmosis status in patients with schizophrenia and catatonic symptoms has been revealed for the first time and should be verified in larger studies.

REVIEW

30-46 366
Abstract

Background. Virtual reality (VR) has been effectively used in the treatment of many mental health disorders. However, significant gaps exist in the literature. There is no treatment framework for researchers to use when developing new VR treatments. One recommended treatment across a range of diagnoses, which may be suitable for use in VR treatments, is Cognitive Behavioural Therapy (CBT). The aim of this systematic review is to investigate CBT treatment methods that utilize VR to treat mental health disorders.

Objectives. To investigate how CBT has been used in VR to treat mental health disorders and to report on the treatment characteristics (number of sessions, duration, and frequency) that are linked to effective and ineffective trials.

Methods. Studies were included if patients had a mental health diagnosis and their treatment included immersive VR technology and CBT principles. Data were extracted in relation to treatment characteristics and outcomes, and analysed using narrative synthesis.

Results. Ninety-three studies were analysed. Exposure-based VR treatments were mainly used to treat  anxietyrelated disorders. Treatments generally consisted of eight sessions, once a week for approximately one hour. VR treatments were commonly equal to or more effective than ‘traditional’ face-to-face methods. No specific treatment characteristics were linked to this effectiveness.

Conclusion. The number, frequency and duration of the VR treatment sessions identified in this review, could be used as a treatment framework by researchers and clinicians. This could potentially save researchers time and money when developing new interventions.

Commentary

Special article

49-59 406
Abstract
The mental health system in Portugal evolved from an institutional-centred system to a community-based system, a process which began in 1998 and has gathered pace since 2006.
The approval and implementation of the Portuguese Mental Health Law and the Portuguese National Mental Health Care Plan has contributed to the implementation of institutions and regulations aimed at decentralized, local and less restrictive models of care. The implementation and evolution process has been steady and gradual, introducing many of the envisioned changes whilst adapting existing mental health institutions and services.
The current article describes this transition process, attempting to identify the strengths and weaknesses of the Portuguese Mental Health System from a community-centred perspective.
60-70 252
Abstract

Introduction. The shift from the hospital-based model of care to community-based mental health services began three decades ago and is still an ongoing process in Brazil.

Objectives. To update data on the development of the community mental health services network in Brazil in relation to service availability and structure, manpower, pattern of service use, financing, epidemiological studies and the burden of mental disorders, research and national mental health policy.

Methods. Searches were constructed to collect data on indexed databases (Medline, Scielo), as well as governmental, NGOs and medical council sources, reports and the grey literature up until 30th March, 2019.

Results. Community mental health services are unevenly distributed in the country. Brazil leads the world in terms of the prevalence of anxiety disorders, ranking fifth for depression prevalence. Violence and suicide rates are two growing factors which exacerbate the prevalence of mental disorders prevalence. An increased reduction of the number of psychiatric beds in the country, in addition to the unbalanced growth of services in the community, has resulted in treatment gaps and the underutilization of services and barriers to treating people with the most severe psychosis. Investment in mental healthcare is still scarce. However, mental health funding is not addressed according to the population´s needs and scientific evidence, resulting in a waste of resources and inefficiency. Programmes and service interruptions are common according to each government mandate.

Conclusion. Successive changes in ideological perspectives have led to the introduction of policies which have caused fragmentation in the mental health system and services. A lack of evaluation and transparency of services and costs are the main barriers to integrating multiple services and planning long-term developmental phases.

71-77 204
Abstract
Lebanon is a medium-income country in the Eastern Mediterranean which has seen a surge in interest in mental health over the past two decades following years of stagnation. The mental health needs of the country at primary care level and for severe psychiatric disorders are underserved. Political instability, chronic underfunding and widespread stigma have all contributed to maintaining a traditional model of private clinics affiliated with inpatient and long-stay psychiatric units. A number of initiatives have recently been launched to cater for patients with psychotic disorders and also to offer partial hospitalization for others with mood-related conditions. In parallel, the Ministry of Public Health, with international funding, has been instrumental in its efforts to standardize care at a national level, particularly for early detection and treatment in primary care settings. The priorities of the national mental health programme are consistent with the global trend in shifting services to the community. Hurdles remain, in line with those facing countries with similar socio-demographics and resources. These include limited third-party coverage of mental health, absence of training opportunities in multidisciplinary community settings and some clinicians’ reluctance to update their ways of working. Development of a local workforce, familiar with evidence-based models of care and dedicated to providing a patient-centred approach in the least restrictive settings, is essential for consolidating community care in Lebanon. This would be reinforced by (overdue) legislation and implementation of a mental health law.

Special view

78-84 458
Abstract
Asia is the largest and the most populous continent on earth. South Asia has a population of around 1.8 billion, thus constituting about one fourth of humanity. India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan, the Maldives and Afghanistan are the countries in South Asia and many of them are Muslim-majority nations. Although India is predominantly a Hindu nation with a total population of 1.4 billion, there are more Muslims in India than in Pakistan and other South Asian nations. Hindus, Muslims, Christians, Sikhs and followers of other religions have lived peacefully in South Asia for centuries. However, certain incidents of communal violence and other untoward occurrences in South Asia suggest that Islamophobia is present here too. The authors discuss demography, cultures and the possible effect of Islamophobia on the mental health of the people of South Asia.



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ISSN 2712-7672 (Print)