Mental Health Symptomatology and Posttraumatic Growth among Those with Multimorbidity in COVID Pandemic: Cross-Sectional Findings from the STRONG Study in Greece

Background: Individuals with physical or mental health conditions represent a vulnerable population, especially during the COVID-19 pandemic. However, limited information is available concerning posttraumatic growth and common mental health symptoms of this vulnerable health group during COVID-19. Methods: An online cross-sectional study (STRONG study; psychological changes and effects after COVID-19 quarantine in Greece) was conducted from 28 September 2020 (no lockdown restrictions) to 2 November 2020, just before the second lockdown in Greece. Main outcomes were depressive and anxiety symptoms as well as posttraumatic growth. Results: A total of 860 adults participated in the study. A high proportion of participants did not report any pre-existing health condition (61%), while 334 individuals reported one or more physical or mental health conditions. Overall, 20.2% of the participants reported significant depressive symptoms, and 27.9% reported moderate to high posttraumatic growth. The presence of physical and mental health conditions, either as single diagnosis or as a multimorbidity, was significantly associated with the development of depressive symptomatology (either physical or mental health conditions: OR = 1.12; 95% CI, 1.07–1.17, p < 0.001; both physical and mental health conditions: OR = 1.23; 95% CI, 1.14–1.33, p < 0.001). Posttraumatic growth did not differ between those with or without any pre-existing health issue. Conclusions: Although having a physical or/and a mental health condition predicted the development of depressive symptomatology in a post-lockdown period, the presence of pre-existing conditions was not associated with posttraumatic growth development. Clinicians should be aware of depressive symptoms among their multimorbid patients, even after exiting lockdown.

Sexual Dysfunction in Schizophrenia: A Narrative Review of the Mechanisms and Clinical Considerations

Psychiatric disorders, in general, have a high prevalence of sexual problems, whether from the psychopathology of the disorder itself, pre-existing or co-morbid sexual disorder or from side effects of the treatment for mental disorders. Many patients report an already existing sexual dysfunction at the onset of diagnosis. The risk association for developing sexual dysfunction in patients with schizophrenia includes antipsychotic use and resulting hyperprolactinemia, age, gender, and disease severity. Medication side effects lead to nonadherence, and relapses lead to structural changes in the brain, treatment resistance, and worsening of symptoms. Findings in certain studies propose serum prolactin and thyroid-stimulating hormone measurement as a tool for assessing patients with schizophrenia for sexual dysfunction. Regarding specific symptoms, females especially reported decreased desire at baseline and galactorrhea after treatment. The findings of this review, therefore, suggest that sexual dysfunction may be present in patients with schizophrenia before starting antipsychotic treatment and that patients, especially those who are female, are likely to develop hyperprolactinemia with antipsychotic treatment. Aripiprazole may be an emergent treatment for sexual dysfunction in those who use antipsychotics. It is important for patients to consider sexual dysfunction prior to prescribing antipsychotics. Since sexual dysfunction can impact a patient’s quality of life and affect treatment adherence, it is important for physicians to be aware and monitor patients for symptoms.

Analysing the Impacts of Financial Expenditure of Prefectures on Methods of Suicide Completion in Japan

Recently, several studies reported that the governmental financial expenditures play important roles in the prevention of increasing suicide mortalities; however, the specific regional policies, designed dependent on regional cultural, economic, education and welfare backgrounds, affect suicide mortality by a specific suicidal means. Therefore, the present study determined the impacts of the regional governmental expenditure of six major divisions, “public health”, “public works”, “police”, “ambulance/fire services”, “welfare” and “education” on suicide mortalities by five major suicidal means, “hanging”, “poisoning”, “charcoal burning”, “jumping” and “throwing”, across the 47 prefectures in Japan during 2009–2018 using fixed-effect analysis of hierarchal linear regression with robust standard error. The expenditures of “ambulance/fire services” and “education” indicated the negative relation to suicide mortalities by wide-spectrum suicidal means, whereas expenditures of “public works” did not affect suicide mortalities. In the education subdivisions, expenditure of “kindergarten” and “elementary school” indicated the impacts of reduction of suicide mortalities, whereas the expenditures of “special school” for individuals with disabilities unexpectedly contribute to increasing suicide mortalities by poisoning, charcoal burning and throwing of females. Regarding subdivisions of welfare, expenditure of “child welfare” and “social welfare” contributed to a reduction in suicide mortalities, but expenditure of “elderly welfare” surprisingly contributed to increasing suicide mortalities. Furthermore, expenditures of welfare subdivision abolished the negative impacts of the expenditures of educational subdivisions, kindergarten and elementary school, but the positive impact of expenditure of special school on female suicide mortalities was not affected. These results suggest that most Japanese people are struggling to care for children even in the situation of an increasing elderly population with a decreasing birthrate. Therefore, it is important to enhance the investment welfare policy for the future to improve the childcare environment. The results demonstrated by this study suggest that the scientifically evidence-based redistributions of welfare expenditure in regional government, at least partially, provide improvement of Japanese society and welfare systems, under the continuous severe Japanese social concerns associated with increasing elderly population with a decreasing birthrate.

Attention Deficit Hyperactivity Disorder and Bipolar Disorder: Diagnosis, Treatments, and Clinical Considerations: A Narrative Review

Attention-deficit Hyperactivity Disorder is one of the most common childhood mental health disorders, affecting about 5.6% of the population worldwide. Several studies have specifically shown a high prevalence of comorbid mood disorders, such as depression and bipolar disorder (BD), in those diagnosed with ADHD. Several common symptoms of ADHD are also found in BD, which are characterized by alternating periods of euthymia and mood disturbances. The inattention and impulsivity of ADHD can be seen in manic and hypomanic episodes of BD. Over the past decade, there has been an increased interest in research between the correlation of ADHD and pediatric bipolar disorder (PBD) in children. Some experts hypothesize that more children are comorbidly diagnosed with ADHD and PBD because of how many clinicians treat children with ADHD. Other factors, which may affect the dual diagnoses of ADHD and PBD, are overlapping diagnostic criteria for the two disorders, the inevitable biases seen when one disorder is diagnosed without the other, and related risk factors leading to prodromal relationships. By examining clinical trials, a better understanding of whether ADHD and PBD have a stepwise progression or if other factors influence these comorbidities, such as blurred lines of diagnostic criteria. Those with ADHD are also at an increased risk of impairment at work and in social settings. This manuscript explores both progression of this disease and its clinical connections to other disorders.

Causes and Risk Factor of Post-Traumatic Stress Disorder in Adult Asylum Seekers and Refugees

Objectives: To assess the causes and risk factors of post-traumatic stress disorder (PTSD) in adult asylum seekers and refugees. To explore whether the causes and risk factors of PTSD between male and female adult refugees/asylum seekers are different. Study design: Systematic review of current literature. Data Sources: PubMed, Web of Science, Scopus and Google Scholar up until February 2019. Method: A structured, systematic search was conducted of the relevant databases. Papers were excluded if they failed to meet the inclusion and exclusion criteria. Afterwards, a qualitative assessment was performed on the selected papers. Results: 12 Studies were included for the final analysis. All papers were either case studies/reports or cross-sectional studies. Traumatic events experienced by refugees/asylum seekers are the most frequently reported pre-migration causes of PTSD development, while acculturative stress is the most common post-migration stressor. There were mixed reports regarding the causes of PTSD between both genders of refugees/asylum seekers. Conclusions: This review’s findings have potential clinical application in terms of helping clinicians to risk stratify refugees/asylum seekers for PTSD development and thus aid in embarking on earlier intervention measures. However, more rigorous research similar to this study is needed for it to be implemented into clinical practice.

COVID-19 Pandemic and the Burden of Internet Addiction in the United States

Despite the extensive usage of the internet, little is known about internet addiction among Americans during the pandemic. A valid and reliable questionnaire was deployed online via MTurk to recruit a national sample of adult Americans to understand the nature and extent of internet addiction. A total of 1305 individuals participated in the study where the majority were males (64%), whites (78%), non-Hispanic (70%), married (72%), 18–35 years old (57%), employed full time (86%), and with a Bachelor’s degree or higher (83%). The prevalence of internet addiction was distributed as no addiction (45%), probable addiction or risk of addiction (41%), and definite or severe addiction (14%). More than a fourth of the population had depression (28%) or anxiety (25%). Despite adjusting for sociodemographic characteristics, definite/severe internet addiction was strongly predictive of depression, anxiety, and psychological distress in multiple regression analyses. Those who were probably addicted or at risk of addiction were also more likely to have depression or anxiety. Compared to estimates before the pandemic, this study suggests an increase in internet addiction among U.S. adults during the COVID-19 pandemic. Population-based interventions and mental health promotion strategies should focus on a reduction in internet consumption and screen time.

Pharmacologic and Clinical Considerations of Nalmefene, a Long Duration Opioid Antagonist, in Opioid Overdose

Opioid use disorder is a well-established and growing problem in the United States. It is responsible for both psychosocial and physical damage to the affected individuals with a significant mortality rate. Given both the medical and non-medical consequences of this epidemic, it is important to understand the current treatments and approaches to opioid use disorder and acute opioid overdose. Naloxone is a competitive mu-opioid receptor antagonist that is used for the reversal of opioid intoxication. When given intravenously, naloxone has an onset of action of approximately 2 min with a duration of action of 60–90 min. Related to its empirical dosing and short duration of action, frequent monitoring of the patient is required so that the effects of opioid toxicity, namely respiratory depression, do not return to wreak havoc. Nalmefene is a pure opioid antagonist structurally similar to naltrexone that can serve as an alternative antidote for reversing respiratory depression associated with acute opioid overdose. Nalmefene is also known as 6-methylene naltrexone. Its main features of interest are its prolonged duration of action that surpasses most opioids and its ability to serve as an antidote for acute opioid overdose. This can be pivotal in reducing healthcare costs, increasing patient satisfaction, and redistributing the time that healthcare staff spend monitoring opioid overdose patients given naloxone.

Model Driven Causal Factors of Panic Buying and Their Implications for Prevention: A Systematic Review

Panic buying is a commonly observed response to disasters, and has been widely observed during the COVID-19 pandemic. However, little is known about the variables influencing this behavior. This review summarizes the existing research in this field and examines its implications for the prevention and control of panic buying. Methodology: All papers published prior to or during the pandemic, providing an empirically tested model of panic buying behavior (Group A) or a theoretical model supported by literature (Group B), were retrieved through a literature search. For papers in Group A, specific risk or protective factors were extracted and tabulated. Overlaps between Group A and Group B models were identified. Study results were analyzed to identify potential strategies which could limit panic buying behavior. Results: It was found that a wide variety of primary (crisis/disease-related), secondary (psychological, informational and sociopolitical), and tertiary (supply chain-related) factors were significantly associated with panic buying, while a single variable–reflective functioning was identified as protective. Conclusions: These results provide valuable leads for strategies aimed at preventing or reducing panic buying, particularly in countries still affected by the pandemic. It is hoped that these findings will be useful from both health administration and academic perspectives.

Clozapine and Constipation: A Review of Clinical Considerations and Treatment Options

Psychosis, a break in reality which is manifested as hallucinations, delusions or the disruption in thought process, is the hallmark of schizophrenia. Despite novel pharmacotherapy advancements of antipsychotic medications that have resulted in some patients having the ability to return to social settings and thereby decreasing psychotic symptoms and reducing hospital admissions, there is still a sub-population of patients who remain symptomatic. Treatment-resistant schizophrenia is defined as failure of treatment with at least two different antipsychotics with the proper length of treatment and titration. Clozapine has been heralded as a drug to resolve the puzzle of treatment-resistant schizophrenia. Clozapine has one side effect that is well known, being the development of agranulocytosis. However, there is another side effect that can limit clozapine’s use and can also be life-threatening. Recently, at the end of January 2020, the FDA issued a communications statement which “[strengthened] an existing warning that constipation caused by the schizophrenia medicine clozapine can, uncommonly, progress to serious bowel complications.” After identifying ten cases of constipation from between 2006 to 2016 that progressed to hospitalization, surgery, and even death, the FDA focused their attention on this often overlooked, common side effect, especially when considering the strong anticholinergic effects of clozapine. Although patients are screened by their physicians for agranulocytosis by weekly lab monitoring, constipation is also a complication that needs to be identified and treated. Much like opioid-induced constipation, constipation can also be reduced with the use of laxatives and reduction in the co-prescribing of anticholinergic therapies with clozapine.

Prevention of Depression in Children, Adolescents, and Young Adults: The Role of Teachers and Parents

Major depressive disorder (MDD) and other affective disorders may surreptitiously arise in children and adolescents during their school period and impair their social and educational functioning. Besides the social and personal burden, which are increased during the SARS-CoV-2 pandemic, the onset of depression may compromise the future of the growing person with chronicity and recurrence. In this context, educators’ training is essential to detect early the onset of a depressive disorder, to spare later consequences through the timely establishment of adequate treatment. The educational staff should receive adequate training to be able to work closely with healthcare providers and parents, thus directing the young person with an affective disorder to the right psychological and pharmacological treatment provider, i.e., a specialized psychologist or psychiatrist. The first approach should be to establish a trustful relationship with the adolescent and his/her classmates, to reduce social and self-stigma and inform about mental illness. If symptoms do not subside and the suffering child or adolescent fails to reintegrate within his/her school environment, cognitive–behavioral interventions are recommended that are individual, group, or computer-based. When needed, these should be implemented with individualized pharmacotherapy.