Antenatal screening of depressive and manic symptoms in south Brazilian childbearing women: A transversal study in advance of the pandemic scenario

Background The diagnosis of mood disorders (MD) during pregnancy is challenging and may bring negative consequences to the maternal-fetal binomial. The long waitlist for specialized psychiatric evaluation in Brazil contributes to the treatment omission. Almost 20.0% of women treated with antidepressants have a positive screening for bipolar disorder. Therefore, it has been recommended the investigation of depressive and bipolar disorder during prenatal care. Unfortunately, the screening for mood disorders is not a reality in Brazil and many childbearing women remain undiagnosed. The objective of this study is to observe the frequency of MD and the effectiveness of screening scales for routine use by health professionals during prenatal care in high-risk pregnancies. Methodology/Principal findings This cross-sectional study included 61 childbearing women in their second trimester who were interviewed using the Edinburgh Postnatal Depression Scale (EPDS) and the Mood Disorder Questionnaire (MDQ). The cut-off point was EPDS ≥ 13 and MDQ ≥ 7 and the SCID-5 was the gold standard diagnosis. MD were diagnosed in 24.6% of the high-risk pregnancies. EDPS was positive in 19.7% and the frequency of major depression was 8.2%. 16.4% of the childbearing women were diagnosed with bipolar disorder, while MDQ was positive in 36.1%. 11.5% of the women had EPDS and MDQ positive. EPDS sensitivity was 80.0% and specificity 92.1%, whereas MDQ presented a sensitivity of 70.0% and specificity of 70.6%. Conclusion/Significance There is a high prevalence of MD in high-risk pregnancies. The routine use of EPDS simultaneously to MDQ during antenatal care is effective and plays an important role in early diagnosis, counselling, and promotion of perinatal mental health.

Needle as foreign body in urethra: Successful removal

: Self-inserted foreign bodies in the lower urinary tract are rare among children. The treatment of foreign bodies in the urethra is determined by their type, size, location, shape, and mobility. : We describe here a 10-year-old boy who had self inserted a needle into his urethra. Initial attempts to remove the needle from the urethra by inserting a cystoscope failed. The patient presented to our institution with bleeding per urethra with feeding tube insitu per urethra. As already attempted for urethroscopic removal, direct removal of needle done under general aneathesia done.: Per Rectal examination plays an important role and gives adequate information and timely management of the child leads to uneventful hospital stay Psychiatric evaluation is mandatory to detect an underlying mental disorder.

Liaison Psychiatry During the Peak of the Coronavirus Pandemic: A Description of Referrals and Interventions

Introduction: The novel coronavirus SARS-CoV-2 belongs to the coronavirus family, a group of viruses that can cause upper respiratory infections in humans. Among other symptoms, it can present as an asymptomatic infection or as a more severe disease requiring hospitalization. Neuropsychiatric symptoms have been described in the acute phase of the illness and as long-term repercussions. We describe the characteristics and interventions in those COVID-19 patients referred to our liaison psychiatry service.Materials and Methods: This is a cross-sectional descriptive study. This study was carried out within the Department of Psychiatry of Cruces University Hospital (Basque Country, Spain). Data from each psychiatric consultation within our consultation-liaison service were consecutively obtained for 1 month from March 17 to April 17, 2020. We recruited data regarding clinical and referral characteristics and psychiatric interventions.Results: Of a total of 721 SARS-CoV-2 hospitalizations, 43 (5.6%) patients were referred to our psychiatry liaison service. The median age was 61 years old, and 62.8% were women. The infectious disease department was the most frequent petitioner (37.2%), and the most common reason for referral was patient anxiety (25.6%). A total of 67.4% of patients received psychological counseling and 55.8% received some pharmacological approach, with a median of 3.7 visits/calls per patient. In addition, 20.3% needed a medication switch due to potential interactions between psychotropics and drugs used to treat SARS-CoV-2.Discussion: In our study, up to 5.6% of SARS-CoV-2 hospitalized patients needed a psychiatric evaluation, especially for anxiety and mood symptoms. Psychosocial factors associated with the pandemic, drugs used to treat the infection, or a direct causative effect of the virus may explain our findings.

Psychiatric Evaluation in Chinese Criminal Proceedings:A Legal Perspective

Psychiatric evaluation is widely used in criminal cases to screen people with mental disorder because insanity can either exempt the offender from criminal responsibility or mitigate his/her criminal punishment. The operation of psychiatric evaluation in China used to carry a typical characteristic of civil law tradition, but recent reforms have strengthened the procedural safeguards for psychiatric evaluation and stressed the requirement of its presentation and examination in criminal trials. This article will explore how psychiatric evaluation is conducted, and how the expert opinion is presented and examined as evidence in criminal trials in China. Part I will give a historical overview of psychiatric evaluation in China's criminal cases. Part II will introduce the current legislation on psychiatric evaluation in China. Part III will explore problems with current legislation and practice. In this part, high-profile cases will be cited to illustrate loopholes in the psychiatric evaluation law and practical problems with the operation of evaluation. Potential solutions to these loopholes or problems will also be explored. Part IV will focus on the presentation and examination of psychiatrists’ expert opinion in criminal trials. Although expert witnesses are also required to testify before the court in China, very few of them take the stand in practice. This part will discuss why reforms kept failing and what should be done to bring expert witnesses to court. Psychiatrists are important expert witnesses; the discussion of live psychiatrists will shed light on the appearance of all the expert witnesses in Chinese criminal trials.

640 Cannabis abuse and syncope

Aims Cannabis (marijuana) is the most consumed drug worldwide, counting roughly 200 million users in 2019 (4% of the global population). Once illegal in most of the world countries, cannabis is now legal for medical and recreational use in several states. During the last 20 years, we have observed a growing decriminalization wave parallel with an increase number of consumers: it is therefore mandatory not only for the cardiologists but for every physician to be aware of marijuana potential cardiovascular adverse health effects. With this paper, we present a case report of cannabis induced 16 s implantable loop recorder (ILR) recorded asystole from hypervagotonia in a 24-year-old heavy marijuana consumer. We focus on the infrequently reported association between syncope and chronic marijuana use and we try to explain the underlying mechanisms against the background of the current literature. Methods and results A 24-year-old presented to the emergency department sent by her cardiologist because of a recent finding of a 16 s asystole on the ILR she implanted 7 months before for recurrent syncopes. She openly declared that she is a heavy marijuana user (at least 5 cannabis-cigarette per day, not mixed up with tobacco, for no less than 12 years). She had a history of at least two spontaneous atypical syncopal episodes and a multitude of pre-syncopal episodes. Before being hospitalized, she underwent several diagnostic tests excluding a neurological etiology and, upon outpatient regimen, she begun a cardiology evaluation which lead to the ILR implantation. While watching TV at late night, the second prodrome-less syncopal episode occurred and a 16-s asystole was found on the ILR. During hospitalization, the patient was closely monitored and we evaluated basic autonomic function tests, carotid sinus massage, echocardiography, exercise stress test, and 24 h telemetry. Following the results of the exams, we considered a heart conduction system anomaly unlikely. Finally, the patient underwent a toxicological and a psychiatric evaluation, where she strongly expressed not wanting to abandon cannabis abuse. After a collective discussion with the heart team, syncope unit, electrophysiologists, and toxicologist, we decided to implant a dual chamber pacemaker with a rate response algorithm due to the high risk of trauma of the syncopal episodes. Conclusions Cannabis cardiovascular effects are not well known; among these we find ischaemic episodes, tachyarrhythmias, symptomatic sinus bradycardia, sinus arrest, and ventricular asystole. In the light of the poor literature, we believe that cannabis may produce opposite adverse effects depending on the duration of the habit. Acute administration increases sympathetic tone and reduces parasympathetic tone; conversely, with chronic intake an opposite effect is observed: repetitive dosing decreases sympathetic activity and increases parasympathetic activity. Physicians should be aware of the effects that cannabis produces upon the cardiovascular system: this could avoid expensive, prolonged hospitalizations, and needless diagnostic tests.

Association of Diabetes Complications With Depression and Suicidality in Hospitalized Patients: a Multicenter Cross-sectional Study

Background: Diabetes mellitus and depression are both considered the most prevalent diseases of the recent century. On the other hand, it is estimated that the rate of depression is nearly doubled in diabetic patients compared with the general population.Method: A total of 89 patients, who were admitted to the hospital because of the complications of the disease, were voluntarily and conveniently participated in the study. The participants were given the questionnaires of Beck Depression Inventory-2nd-edition and Beck Scale for Suicide Ideation. They were divided into two age groups: 18-50 years old and 50-75 years old. Control group, consisting of 89 individuals without any underlying disease, were randomly selected from the patients’ visitors, matched with the participants according to the age group and gender. Statistical analysis was performed between the two groups based on scores obtained. Results: Beck Depression Inventory Scale score was significantly higher, regardless of age, in the patient group compared to the control group. However, there was no significant difference between the scores of Beck Scale for Suicide Ideation between the patient group and the control group. In the patient group, it was found that among the variables, female gender, and diabetic foot were associated with higher severity of depression symptoms. Conclusion: It is vitally essential for diabetic patients to undergo periodic psychiatric evaluation. Early diagnosis of depression could help them to better cope with their mental health issue, and as a result, it will decrease risk of suicidal ideation and other consequences.

Serious Suicide Attempt by Hunting Gun with Severely Infectious Wounds and Facial Deformity during COVID-19 Arena; A Case Report

The etiology of suicide among students around the world revolves issues such as communication, education, family problems and parents’ relationship. We intend to report a case with serious recurrent suicide attempt by gun shot during COVID-19 period. We also present psychiatric and clinical evaluation, cosmetic surgery consultation, as well as microbial assessments in this survey. The seventeen-year-old single male student from southwest of Iran with asymmetric deformed face was observed with the loss of parts of the mouse, nose, chin and mandible region .He had experienced a serious suicide attempt by a threatening plan following rejection. The patient had blurred, hypo phonic and hypotonic speech. Following the shooting, the soft and hard palate, facial, frontal bone and sinus had been destroyed and a foreign body was seen in the frontal sinus. After suicide risk as assessment, It was detected multiple predictive risk factors for recent suicide attempt and the possibility of recurrent suicide in future. Finally, reconstructive surgery was performed. We assessed him via face to face interview in order to identify psychiatric disorders. Also, he was evaluated as probability of committing recurrent suicide. It is emphasized that in families which young children are prone to psychiatric disorders or emotional problems, availability of a dangerous device such as a gun can be harmful and it should be removed as soon as possible. We suggest the need for psychiatric evaluation especially suicide phenomenon in adolescents and their families as various conflicts in family context.