Analysis of Psychological and Gut Microbiome Characteristics in Patients With Non-erosive Reflux Disease

Objective: To assess the correlation between the incidence of non-erosive reflux disease (NERD) and psychological factors, especially somatoform disorders. To investigate the characteristics of gut microbiome in NERD patients.Methods: We enrolled 24 NERD patients and 24 healthy controls. All patients were evaluated via GerdQ, SOMS-7, SAS, HAMA, and HAMD. Fecal samples were collected and 16S rRNA sequencing was performed to evaluate the gut microbiome composition.Results: The main symptoms of the NERD patients were regurgitation (87.5%), belching (66.7%), pharyngeal discomfort (50%), and heartburn (37.5%). The average score of GerdQ was 13.42 ± 3.41. In 15 patients (62.5%), the total score of the last two items was <3 points, while the average score of 24 patients was 3.63 ± 2.32. NERD patients with somatoform disorders accounted for 50%. There were 17 patients without anxiety, 6 patients with mild anxiety (25%), 1 patient with moderate anxiety (4.2%), and no patient with severe anxiety. There were 22 patients (91.7%) without depression, 2 patients (8.3%) with mild depression, and no patient with moderate or severe depression. The alpha diversity of NERD group was higher than HC, which showed significant difference (P < 0.05). The beta-diversity was significantly different between HC and NERD patients (P = 0.026), male and female patients (P = 0.009). The beta-diversity was also significantly different between male and female patients (P = 0.009). There were several bacteria with significant differences between HC and NERD group, and NERD patients with or without somatoform disorders, such as Firmicutes, TM7 were enriched in the NERD group compared with the healthy control group, while Bacteroidetes were enriched in the healthy controls.Conclusions: NERD symptoms overlap with somatoform disorders. NERD symptoms have an impact on the daily life quality of patients. Some of them are accompanied by anxiety and depression of different degrees, and the two are significantly correlated. The diversity of gut microbiome in patients with NERD is significantly higher than healthy controls, which has its characteristics. The predominant bacteria in gut microbiome of patients with NERD are similar to the healthy population, with Firmicutes and Bacteroidetes as the main ones. The composition of gut microbiome in NERD patients with or without somatoform disorder is significantly different, which may be related to the interaction of microbiome-brain-gut axis.

A Mental Health Profile of 900 Newly Arrived Refugees in Denmark Using ICD-10 Diagnoses

(1) Background: Recognizing mental health problems in newly arrived refugees poses a challenge. Little is known of the mental health profile of refugees currently arriving in Northern Europe. (2) Method: In total, we included 900 adult (≥18 years old) refugees arriving in Aarhus, Denmark, between 1 January 2014 and 1 January 2020. All participants accepted an offer of a voluntary systematic health assessment from the municipality in Aarhus, including a mental health screening. (3) Results: Within this cohort, 26% (237/900) of the participants were referred to the Department of Psychiatry, Aarhus University Hospital, 24% (212/900) were in contact with the department and 21% (185/900) received ≥1 psychiatric diagnosis. Within the subpopulation referred (n = 237), 64% (152/237) were diagnosed with post-traumatic stress disorder (PTSD) (DF431), 14% (34/237) with neurotic, stress-related and somatoform disorders (F40–F48) and 13% (30/237) with major mood disorders (F30–F39). Among the participants referred to the Department of Psychiatry and participants receiving a diagnosis, we found an overrepresentation of participants originating from the Southern Asian region (Pakistan, Afghanistan and Iran) and with an age above 44 years. (4) Conclusion: We found a high prevalence of both referrals and psychiatric diagnoses in newly arrived refugees. Attention to psychiatric conditions in refugees and systematic health assessments during resettlement are needed.

How effective is laparoscopic redo-antireflux surgery?

Summary Background: The failure-rate after primary antireflux surgery ranges from 3 to 30%. Reasons for failures are multifactorial. The aim of this study is to gain insight into the complex reasons for, and management of, failure after antireflux surgery. Methods: Patients were selected for redo-surgery after a diagnostic workup consisting of history and physical examination, upper gastrointestinal endoscopy, quality-of-life assessment, screening for somatoform disorders, esophageal manometry, 24-hour-pH-impedance monitoring, and selective radiographic studies such as Barium-sandwich for esophageal passage and delayed gastric emptying. Perioperative and follow-up data were compiled between 2004 and 2017. Results: In total, 578 datasets were analyzed. The patient cohort undergoing a first redo-procedure (n = 401) consisted of 36 patients after in-house primary LF and 365 external referrals (mean age: 62.1 years [25–87]; mean BMI 26 [20–34]). The majority of patients underwent a repeated total or partial laparoscopic fundoplication. Major reasons for failure were migration and insufficient mobilization during the primary operation. With each increasing number of required redo-operations, the complexity of the redo-procedure itself increased, follow-up quality-of-life decreased (GIQLI: 106; 101; and 100), and complication rate increased (intraoperative: 6,4–10%; postoperative: 4,5–19%/first to third redo). After three redo-operations, resections were frequently necessary (morbidity: 42%). Conclusions: Providing a careful patient selection, primary redo-antireflux procedures have proven to be highly successful. It is often the final chance for a satisfying result may be achieved upon performing a second redo-procedure. A third revision may solve critical problems, such as severe pain and/or inadequate nutritional intake. When resection is required, quality of life cannot be entirely normalized.

Pattern of Psychiatric Morbidities and Sociodemographic Profiles of Patients Attending Out-Patient Department (OPD) at Iftikhar Psychiatric Hospital, Peshawar

Background: Psychiatric disorders are the major causes of disability worldwide. Due to cultural differences, the patterns of mental disorders vary globally and there is need to study the patterns of psychiatric disorders in our region. Aims and Objectives: The aim of this study is to know the pattern of various psychiatric morbidities as well as socio demographic characteristics of patients attending out-patient department (OPD) at Iftikhar Psychiatric Hospital, Peshawar. Materials and Methods: This descriptive study was conducted at Iftikhar Psychiatric Hospital, Peshawar from 1st June 2020 to 31st January 2021. During this period, a total of 150 patients were recruited through non-probability consecutive sampling technique. Data was collected for variables like gender, age, marital status, urban/rural background, employment status and psychiatric diagnosis. For the variables of continuous type like age, mean and standard deviation were calculated. Diagnosis was made using ICD-10 diagnostic classification system. All the variables were presented as frequencies and %ages. Data was analyzed using SPSS software version 20. Conclusion: Male predominance was observed in the study. Maximum numbers of psychiatric patients were in the age range from 18-40 years. Majority of the study participants were married, employed and belonged to urban background Regarding psychiatric morbidities, the most common were neurotic, stress related and somatoform disorders (38%) followed by mood disorders (28.66 %)., schizophrenia and other psychotic disorders (17.33%) and substance misuse disorders (10%). Keywords: ICD-10; Psychiatric morbidity; out-patient department

Hypochondriac Beliefs and Behavior in Patients with Somatoform Disorders: Relationship to Somatic Complaints and Subjective Well-Being

Background: studies of the psychological mechanisms of perpetuation and quality of life in patients with somatoform disorders are important for identifying targets for psychological interventions and defi ning risk groups. Aim: to reveal specifi c hypochondriac beliefs and behavior in patients with somatoform disorders related to severity of somatic complaints and subjective well-being. Patients and methods: 100 patients with somatoform disorders were assessed by using Screening for Somatoform Symptoms, Toronto Alexithymia Scale, Cognitions About Body And Health Questionnaire, Scale for the Assessment of Illness Behaviour, and Quality of Life Enjoyment and Satisfaction Questionnaire-18. Results: level of somatoform symptoms is higher in patients with a tendency to catastrophize bodily sensations, autonomic disfunction, mental scanning for bodily symptoms, and disturbances in daily activities due to illness. Regardless of somatoform symptoms’ severity, subjective well-being is lower in patients with belief in bodily weakness and somatosensory amplifi cation, autonomic sensations, expression of symptoms, and changes in daily activities due to illness. Conclusions: the results are discussed in the context of possible psychological and behavioral factors in the perpetuation of somatoform disorders. Patients of older age are at risk of perpetuation of somatoform disorders due to a greater tendency to catastrophize bodily sensations and higher belief in bodily weakness.

Characteristics of patients with a lipoprotein(a) assessment – a health insurance claims database analysis

Background Elevated lipoprotein(a) [Lp(a)] has been established as marker of cardiovascular [CV] risk, however, it is not commonly assessed. Purpose The aim of the study was to characterize patients who underwent their first Lp(a) testing regarding sociodemographic characteristics and clinical outcomes. Methods A retrospective analysis was performed on data from 4 million individual patients in a local database that provides complete, longitudinal, anonymized claims data. The data are representative of the German population in terms of age and gender. Lp(a) billing codes documented in the ambulatory setting were used to identify adult patients in 2015 to 2018 (index quarter defined as the first Lp(a) test in the respective year). These patients must not have had any Lp(a) test in the year prior to the index quarter. Patient data needed to be available for at least 1 year before and 1 year after the Lp(a) test or until death, whichever came first. Patients were followed for a maximum of four years. Results Within the four-year period, 36.609 patients (0.83% of the analysis set) had an Lp(a) test, of whom the majority (58%) were women. 50% of the women (median age 49 years) and 32% of the men (median age 56 years) were younger than 50 years. The most prevalent comorbidities (based on International Classification of Diseases, version 10, German modification) at index were: dyslipidemia (E78) 46%, essential hypertension (I10) 46%, dorsalgia (M54) 25%, overweight/obesity (E66) 18%, chronic ischemic heart disease (I25) 16%, type 2 diabetes mellitus (E11) 15%, other coagulation defects (D68) 14%, depressive episodes (F32) 14%; disorders of refraction and accommodation (H52) 13%, somatoform disorders (F45) 13%, other non-toxic goiter (E04) 13%, other hypothyroidism (E03) 13%, and chronic kidney disease (N18) 11%. The rates of cardiovascular events and procedures are listed in the table below. Conclusions Lp(a) tests are rarely performed in Germany. Women are more often tested than men, and in women this is done at a younger age. The data suggest that CV events/ CV hospitalizations frequently trigger the first Lp(a) assessment. The population tested displayed a high prevalence of cardiovascular comorbidities. The data identify an opportunity to better characterize the CV risk by testing Lp(a) once in a lifetime independent of prior CV events as recommended by current European Society of Cardiology/European Atherosclerosis Society guidelines. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): The analysis has been funded by Novartis Pharma GmbH, Nuremberg.

The assessment of capacity limitations in psychiatric work disability evaluations by the social functioning scale Mini-ICF-APP

Objective Insurers frequently commission medical experts to estimate the degree of the remaining work capacity (RWC) in claimants for disability benefits. The social functioning scale Mini-ICF-APP allows for a rating of activity and participation limitations in thirteen capacity domains, considered as particularly relevant for work ability. The current study sought to evaluate the role of the Mini-ICF-APP ratings in psychiatric work disability evaluations, by examining how the capacity limitation ratings varied with the claimants’ primary psychiatric diagnoses and how the ratings were related to RWC estimates. Methods Medical experts estimated the RWC of 946 claimants with mental disorders and rated their activity and participation limitations using the Mini-ICF-APP, with higher ratings reflecting more severe limitations. The ratings were compared between claimants with different psychiatric diagnoses by analyses of variance. The mean Mini-ICF-APP rating across all capacity domains as well as all capacity-specific ratings were entered in simple or multiple regression models to predict the RWC in an alternative job. Results The Mini-ICF-APP capacity limitation ratings in all domains but mobility were higher for claimants with personality and behavior disorders as compared to those with mood disorders or with neurotic, stress-related and somatoform disorders. The largest differences were observed in social capacities (e.g. group integration: F 2, 847 = 78.300, P < 0.001). In claimants with depression, all ratings increased with the severity of the diagnosis (all Fs 2, 203 > 16.393, all Ps < 0.001). In the overall sample, the mean Mini-ICF-APP rating showed a strong negative correlation with the estimated RWC (r = −.720, P < 0.001). Adding the capacity-specific ratings to the prediction model improved this prediction only marginally. Discussion The Mini-ICF-APP allows for documenting claimants’ activity and participation limitations, which is likely to increase the transparency of medical experts’ RWC estimates and enables them to check the plausibility of such estimates. However, our study showed that despite the strong association between RWC and Mini-ICF-APP ratings, half of the RWC variance was unrelated to the capacity limitations documented in the Mini-ICF-APP.

Psychiatric comorbidities in dermatitis artefacta: A systematic review and meta-analysis

Dermatitis artefacta, also known as factitious or factitial dermatitis, is a rare and difficult-to-treat condition characterized by self-inflicted skin lesions. Despite the well-documented psychological disturbances that characterize this condition, little is known about the relative frequency of specific psychiatric disorders in this patient group. The current systematic review was undertaken to address this gap in our knowledge and was conducted in accordance with PRISMA guidelines. The PubMed and Scopus databases were searched using the terms “dermatitis artefacta,” “factitious dermatitis,” and “factitial dermatitis” in combination with “psychiatry,” “psychiatric diagnosis,” “psychiatric disorder,” “mental illness,” “depression,” and “anxiety.” After screening a total of 215 citations, a total of 11 papers were included in the final review. All the included studies were of low to very low quality as per the GRADE guidelines, and there was substantial heterogeneity among them (I2 = 50.4). It was observed that 46.2% of patients (95% CI: 35.4–57.4%) with dermatitis artefacta had a comorbid psychiatric disorder, with the most common diagnoses being depression, somatoform disorders, anxiety disorders, substance use disorder, and intellectual disability. About 20.1% of patients refused a psychiatric evaluation, while 40.9% reported a significant stressful life event. These results suggest that a significant proportion of patients with dermatitis artefacta suffer from psychiatric disorders, which may be related to their self-infliction of lesions either biologically or psychologically. Treatment of these disorders may lead to a partial or complete improvement in their dermatological condition. A sensitive, non-confrontational approach is essential when evaluating these patients to minimize the chances of refusal and improve patient compliance.