Goldberg Shprintzen Syndrome: The Novel Association with Congenital Unilateral Anorchia (Monorchism)

Background: Goldberg Shprintzen syndrome is a very rare autosomal recessive mental-growth retardation syndrome associated with characteristic facial dysmorphism, Hirschsprung disease, and a variety of neurological abnormalities, and abnormalities on brain imaging studies. However, the association of the syndrome with congenital unilateral absence of the testis (monorchism) has not been reported before. We have previously reported the thirty fourth and thirty fifth cases of the syndrome which occurred in Iraqi brothers, and described a novel therapeutic approach which was used to treat the younger brother. The aim of this paper is to report the novel association of Goldberg Shprintzen syndrome with congenital right monorchism. Patients and methods: T.A.S, the younger of two brothers with Goldberg Shprintzen syndrome was first seen at the age of four years and 10 months at the pediatric neuro-psychiatric clinic on the 29th of August, 2019. He had spastic right hemiparesis and was unable to walk alone, and was not saying any word and had characteristic facial features including hypertelorism, narrow palpebral fissures, open mouth, and laterally lifted ear. He also had neonatal intestinal obstruction which was attributed to Hirschsprung disease, and was treated surgically with resection and colostomy. The boy was treated successfully with novel therapeutic approach and experienced improvement in cognitive abilities, speech, and motor function, and after treatment was able to walk alone. Results: During July, 2021, the family reminded us that the child had single testis in the scrotum, and during early infancy an MRI study failed to find any second testis anywhere. An ultrasound was performed and showed normal left testis. However, the right testis could not found in the right hemi-scrotal sac nor with the right inguinal canal or within the abdomen. Thus, the ultrasound confirmed the earlier MRI findings which suggested congenital absence of the right testis (monorchism). Conclusion: This paper reported the novel association of Goldberg Shprintzen syndrome with monorchism, and this case represented the third case of congenital syndromic monorchism in the world.

Role of Early Brief Psychological Interventions in Substance Use Disorders

Objective: To assess the effects of early brief psychological interventions in patients of substance use disorders. Study Design and Setting: This descriptive prospective study was conducted at main reception centre filter clinic/ Emergency Department of PNS Shifa hospital from 1st July 2020 to 31st March 2021. Methodology: Total n=78 patients were identified after a simple screening question regarding substance abuse which was how many times the patient had used an illegal drug in the last one year. An answer of more than 1 was considered as a positive response and further screening was done with Drug and Alcohol screening test (DAST). Patients who showed low scores on DAST were recommended for brief interventions which were given as weekly sessions for 6 weeks and reassessment was done at 3rd month. The SPSS 20 package program was used for statistical analysis. The descriptive statistics were analyzed for all the variables evaluated in the study. Results: This study revealed that that after 3 months of brief psychological interventions, 43(55.1%) patients remained abstinent from drugs. 18(23%) patients did not report for follow up. 9(11.5%) had reduced their use while 8(10.2%) were still using drugs regularly. Conclusion: This study showed that brief psychological interventions at the level of filter clinics/Emergency departments can help patients of substance use seek early care who fear going to a psychiatric clinic.

Prevalence of mental disorders by sex among Hera General Hospital patients over the past 10 years

Objectives: Mental disorders manifest as social, occupational, or emotional dysfunctions. Many countries struggle to recognize mental disorders and their effects on communities. Mental health awareness in Saudi Arabia has improved in recent years as psychiatric treatment has become more acceptable in Saudi society. The aim of this study was to determine the percentages of mental disorders among a hospital population at Hera General Hospital, Makkah, Saudi Arabia, using the diagnostic criteria of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders and the tenth revision of the International Classification of Diseases. We aimed to determine sex differences and to identify the five most common disorders. Material and Methods: We identified clusters of mental disorders seen at Hera General Hospital psychiatric clinic using the diagnostic criteria of the DSM-IV and ICD-10 and it was a cross-sectional study of patients at a psychiatric outpatient department from July 2009 to June 2019 in Hera General Hospital, Makkah, Saudi Arabia. Results: The most common mental disorders in patients attending the psychiatric clinic of Hera General Hospital were found to be major depressive disorder (41.3%), followed by anxiety disorders (22.1%), substance-induced psychotic disorder (11.4%), schizophrenia (8.9%), and Mental retardation (7.0%). Females were observed to have a higher risk for mood and anxiety disorders, whereas males had a higher risk for substance-induced psychotic disorder and schizophrenia. Conclusion: Major depressive disorder was the most prevalent mental disorder at Hera General Hospital. Most patients with depressive disorder were female.

Education of Caregivers and Veterans to Improve the Care of the Geriatric Psychiatric Patient

The geriatric psychiatry outpatient clinic provides assessment of the elderly Veteran with mental illness and behavioral and psychological symptoms of dementia. I will describe strategies developed and implemented in this setting to provide education to the caregiver (family) to improve early identification of delirium, depression and cognitive impairment. This education proved to reduce the number of pharmacological treatment and increase the use of nonpharmacological interventions based on "what matters to the patient" and following the BEERS criteria guidelines. One of the most important outcomes of the education and evaluation in the geriatric psychiatric clinic was a decrease in number of emergency room visits of elderly, specifically those with dementia.

Prevalence Of Drug Abuse Among Patients Attending Psychatric Clinic At Federal Medical Centre, Makurdi

ABSTRACTDrug abuse constitutes a global health and social problems and cut across socioeconomic, cultural, religious and ethnic boundaries with conditions and problems that vary locally. Many communities are affected by drug abuse directly or indirectly. While the right use of drug is paramount to health, its abuse brings about detrimental effects. The pattern of drug abuse varies from a region to another. The knowledge of the prevalence of drug abuse and establishing the pattern peculiar to a region will help alleviate its burden on the society.The study was carried out among patients attending psychiatric clinic in Federal Medical Centre, Makurdi, Benue State to determine the prevalence of drug abuse in the population. A cross-sectional retrospective study in which a structured proforma was used to extract the socio-demographic, clinical and drug-related data from the medical folders of 127 patients that attended the clinic. Data analysis was done with statistical package for social sciences (SPSS) version 25.The prevalence of drug abuse was 25.2% and high among ages 20-39 years. Common drugs of abuse were Cannabis 68.8%, Alcohol 65.6%, Tramadol 46.9%, Cigarette 40.6%, Codeine 12.5%, Cocaine 3.1%, Gum 3.1% and Ecstasy 3.1%. Cannabis and alcohol were the substance abused most. The age at onset of substance abuse was between 14 and 19 years. 68.8% used more than one substance. The common physical and behavioral signs at presentation were physical aggression 59.4%, restlessness 56.3%, violence 53.1% and poor sleep 46.9%.The prevalence of drug abuse is high among adolescents and young adult.Recommendations include; strategic education of adolescents to increase awareness about harmful effects of substance abuse, empowerment and redirection of youth towards upright living, strict enforcement of laws and regulation of drug use.

Self-Schema, Attachment Style, and Treatment Outcome of Patients in an Opiate Maintenance Treatment Unit

The aim of this study was to explore self-schemas and attachment style among patients in a methadone or buprenorphine maintenance treatment program of opiate dependence, in relation to treatment outcome (relapse in substance use). The study included 84 patients (21 women and 63 men) in a psychiatric clinic in Malmö, Sweden, providing maintenance treatment of opiate dependence. Three self-report instruments were employed, Young Schema Questionnaire Short version (YSQ-S) and Young Parenting Inventory (YPI) for studying self-schemas and Experiences in Close Relationships–Relationship Structures questionnaire (ECR-RS) for studying attachment style. Demographical data and relapse in substance abuse were registered. The study demonstrated, unsurprisingly, that an insecure attachment style was more common in the group of patients compared to available general population reference data. Significant correlations were found between attachment style and core beliefs about the self (self-schemas). Memories of parenting experiences from childhood (YPI) showed correlations with ongoing self-schemas (YSQ-S). Treatment outcome, defined as relapses in substance abuse, was associated to a minor degree with self-schemas but showed no correlation with attachment style. Patients who did not work or study had more maladaptive self-schemas and insecure attachment style, and a higher incidence of relapse in abuse than patients who were working or studying.

Cancellation of outpatient appointments in patients with attention-deficit/hyperactivity disorder

Background Regular visit to psychiatric clinic is essential for successful treatment of any psychiatric condition including attention-deficit/hyperactivity disorder (AD/HD). However, cancellation of outpatient appointments in patients with AD/HD, which represents a significant medical loss, has not been systematically investigated to our knowledge. Methods A systematic chart review was conducted for patients visiting the Shimada Ryoiku medical Center for Challenged Children in Japan at the age of ≤15 years from January to December 2013. The primary outcome measure was the cancellation rate, defined as the number of missed visits divided by the number of scheduled visits. The cancellation rates during 24 months after the first visit were compared between outpatients with AD/HD and other psychiatric disorders, including pervasive developmental disorders (PDD), and developmental coordination disorders and/or communication disorders (DCD-CD). A generalized linear model with binomial distribution was used to examine factors associated with cancellation rates exclusively in the AD/HD group. Results We included 589 patients (mean ± SD age, 5.6 ± 3.4 years; 432 males) in the analysis. The cancellation rate in patients with AD/HD was 12.3% (95% confidence interval [CI]: 10.0–15.1), which was significantly higher than in those with PDD (5.6%, 95% CI: 3.8–8.3) and DCD-CD (5.3%, 95% CI: 3.6–7.8). Prescriptions of osmotic-release oral system-methylphenidate (OROS-MPH) and antipsychotics were associated with fewer cancellations in AD/HD patients (odds ratios: 0.61, 95% CI: 0.39–0.95 and 0.49, 95% CI: 0.25–0.95, respectively), although these significances did not find in the subgroup analysis including only patients with ≥ 6 years old. Conclusions Patients with AD/HD were more likely to miss appointments compared to those with other psychiatric disorders. The impact of AD/HD medications as well as potential psychiatric symptoms of their parents or caregivers on appointment cancellations needs to be evaluated in more detail in future investigations.

Female Sexual Dysfunction in Patients Treated with Antidepressants: A Comparison between Agomelatine and Escitalopram

Aim: This study aims to determine and compare the prevalence of Female Sexual Dysfunction (FSD) between patients on escitalopram and agomelatine, as well as to investigate possible factors associated with their usage. Study Design: Cross-sectional. Place and Duration of Study: Psychiatric Day Care Clinic, Department of Psychological Medicine, University Malaya Medical Centre (UMMC), Malaysia, between November 1, 2020 until February 1, 2021. Methodology: This study is a cross-sectional study involving 66 women with depression from the outpatient psychiatric clinic of a university hospital; 35 of whom were prescribed with escitalopram and 31 with agomelatine. The subjects were in remission and had no significant signs or symptoms of depression for at least 2 months. The prevalence of FSD between the two groups were compared after adjusting for underlying depression severity. Results: This study showed that the overall prevalence rate of FSD was 33.3%, with the prevalence being higher for those on escitalopram (42.9%) than those on agomelatine (22.6%), but did not achieve statistical significance (P=0.081). Out of the six domains of FSD, multivariate analyses revealed that there was a significant reduction of 69% in sexual desire disorder (95% CI:0.110, 0.855), P=0.022 for those on agomelatine compared to escitalopram. Controlling for drug dosage and depression severity (as measured using Montgomery-Asberg Depression Rating Scale), the odds for patients on agomelatine developing sexual desire disorder was 0.267 (95% CI:0.091, 0.783), P=0.016. Conclusion: There was no significant difference in FSD risk between patients on agomelatine and those on escitalopram. Patients on agomelatine were however less likely to develop sexual desire disorder, which demonstrates a slightly better sexual acceptability profile of agomelatine in women in this respect compared to escitalopram.

Mortality in association with antipsychotic medication use and clinical outcomes among geriatric psychiatry outpatients with COVID-19

Objectives Older adults are particularly vulnerable to the negative consequences of antipsychotic exposure and are disproportionally affected by higher mortality from coronavirus disease 2019 (COVID-19). Our goal was to determine whether concurrent antipsychotic medication use was associated with increased COVID-19 mortality in older patients with preexisting behavioral health problems. We also report on findings from post-COVID follow-ups. Design Retrospective observational study. Participants Outpatients at a geriatric psychiatric clinic in New York City. Measurements Demographic and clinical data including medication, diagnosis and Clinical Global Impression Severity (CGI-S) scales on outpatients who had COVID-19 between February 28th and October 1st 2020 were extracted from the electronic health records (EHR) from the hospital. Results A total of 56 patients were diagnosed with COVID-19 (mean age 76 years; median age 75 years) and 13 (23.2%) died. We found an increased mortality risk for patients who were prescribed at least one antipsychotic medication at the time of COVID-19 infection (Fisher’s exact test P = 0.009, OR = 11.1, 95% confidence interval: 1.4–96.0). This result remains significant after adjusting for age, gender, housing context and dementia (Logistic regression P = 0.035, Beta = 2.4). Furthermore, we found that most patients who survived COVID-19 (88.4%) recovered to pre-COVID baseline in terms of psychiatric symptoms. Comparison of pre- and post-COVID assessments of CGI-S for 33 patients who recovered from COVID-19 were not significantly different. Conclusion We observed a higher COVID-19 mortality associated with concurrent antipsychotics use in older patients receiving behavioral health services. The majority of patients in our geriatric clinic who recovered from COVID-19 appeared to return to their pre-COVID psychiatric function. More precise estimates of the risk associated with antipsychotic treatment in older patients with COVID-19 and other underlying factors will come from larger datasets and meta-analyses.