Search Results (36)

Background and Clinical Significance: NMDAR autoimmune encephalitis is a rare but potentially life-threatening autoimmune disorder that can be hard to recognize initially because it has nonspecific symptoms. In the early phase of the disease, clinical presentation is often dominated by psychiatric symptoms, which can be misleading. A diagnosis is established by demonstrating specific anti-NMDA receptor antibodies, with cerebrospinal fluid analysis considered the most reliable diagnostic method. Timely initiation of immunomodulatory therapy, including corticosteroids, intravenous immunoglobulins, and therapeutic plasmapheresis, significantly improves disease outcomes, while second-line therapies are used in refractory cases. Case Presentation: A 21-year-old female patient (M.B.) was admitted to the Psychiatry Clinic at the University Clinical Center of Vojvodina due to the sudden onset of behavioral changes, including social withdrawal, absence of verbal communication, and unusual orofacial grimacing. During hospitalization, the patient was intermittently in a state of severe psychomotor agitation and poorly communicative, with pronounced orofacial dyskinesias and involuntary tongue movements. Anti-NMDA receptor autoantibodies were detected in both serum and cerebrospinal fluid, and the patient was subsequently transferred to the Intensive Care Unit of the Neurology Clinic. Due to the lack of an adequate clinical response to pulse corticosteroid therapy, six cycles of therapeutic plasmapheresis were performed. Following this treatment, significant clinical improvement was observed. Conclusions: Timely recognition of this condition and a multidisciplinary approach allow for early initiation of immunomodulatory therapy and significantly improve treatment outcomes. Full article

Background/Objectives: A psychiatric consultation is a professional evaluation aimed at establishing a diagnosis, a prognosis, and developing a treatment plan. The objective was to assess psychiatric consultations (PCs) at the Community Mental Health Center (CMHC), Emergency Room (ER) and General Hospital (GH) to highlight differences across settings. Methods: With a retrospective design, we examined all PCs performed between 1 January 2024 and 31 December 2024 at the CMHC, ER and GH of Baggiovara in Modena. Descriptive statistical analysis and a multivariate logistic regression were performed. Results: We collected a total of 3174 PCs for 1801 patients, performed in the three settings: 52% in ER, 30% in CMHC and 18% in GH. In ER, PCs were most frequently requested for suicide risk (26%), psychomotor agitation (14%) and substance intoxication (14%). In CMHC, the most common diagnoses were depressive disorders (22%), acute anxiety (20%) and acute psychotic episodes (13%). In GH, consultations mainly addressed psychiatric symptoms associated with medical and eating disorders. The overall rate of psychiatric hospitalization after PCs was 16.2%, reaching 23.4% for consultations in ER. Discontinuation of pharmacological therapy was significantly associated with an increased risk of hospitalization (p < 0.001), which rose to 17% when therapy had been interrupted for more than one year. Conclusions: PCs at ER were the access point for most hospitalizations. Therapeutic discontinuation, acute psychosis and substance use represented the main predictors of hospitalization. Strengthening shared care pathways among CMHC, ER and GH represents an effective model of integration between hospital and community services, ensuring continuity of care. Full article

Stroke survivors with spasticity, an involuntary increase in muscle tone, often struggle to access specialized equipment and medical support for their rehabilitation. Rehabilitation exercises are daily routines requiring patients to perform repetitive movements of their spastic joints. To reduce patient mobilization within hospitals, offering orthoses suitable for use in home settings, outside of clinical environments, is required to limit the involvement of healthcare personnel in the treatment of hemiparesis for patients. Such orthoses must be designed to be portable and be able to tolerate the erratic motions of spasms without breaking or injuring patients. This paper presents the use of magnetorheological actuators to design an elbow orthosis, improving weight, reactivity, and transparence necessary for effective rehabilitation of spastic patients. A prototype is designed, built, and characterized experimentally. Results suggest that the technology is lightweight and highly transparent to erratic motion, and thus well-suited for spastic patients. Full article

Background/Objectives: Cancer cachexia is a multifactorial syndrome characterized by involuntary weight loss and muscle wasting, leading to impaired quality of life and poor clinical outcomes. Although oral nutritional supplements (ONS) are recommended to support inadequate oral intake during chemotherapy, their effects on underlying metabolic alterations and gut microbiome composition, particularly across different stages of cachexia remain unclear. This single-arm pilot study aimed to evaluate the feasibility and metabolic effects of an 8-week ONS intervention in patients with cancer cachexia undergoing chemotherapy. Methods: This study was conducted at the Chungnam National University Hospital, Daejeon, Republic of Korea between January 2023 and October 2023. The primary endpoints were feasibility outcomes, including adherence, tolerability, attrition rate, and ONS-related adverse events. Secondary outcomes included body composition, physical performance, biochemical markers, quality of life, plasma GDF-15 levels, serum metabolomics, and gut microbiome composition. Assessment of secondary outcomes and multi-omics profiling was performed at baseline and after 8 weeks. Patients were stratified into severe and non-severe cachexia groups and analyzed. Results: A total of 10 patients (median age 65 years, range 42–76) participated. Primary cancer types included cholangiocarcinoma (n = 4), colorectal (n = 4), and gallbladder cancer (n = 2). Adherence was 82%, with excellent tolerability and no ONS-related adverse events. Body composition, quality of life, and gut microbiome showed no significant changes. Hand-grip strength and walking-speed were slightly improved after 8 weeks intervention (p = 0.014 for hand-grip strength; p = 0.021 for walking-speed, Wilcoxon signed-rank test) in overall cohort. Metabolomics identified 10 metabolites, predominantly fatty acids, with significant between-group differential responses (p < 0.05, Mann–Whitney U test). Non-severe cachexia patients showed reductions in circulating fatty acids following ONS, consistent with attenuated lipolysis and reduced endogenous fat mobilization, whereas severe cachexia patients demonstrated increases, suggesting limited metabolic responsiveness to nutritional intervention. Fatty acid metabolism emerged as the predominant discriminatory pathway. Conclusions: This study showed the feasibility of integrating ONS with multi-omics profiling. Our findings suggest that metabolic alterations might precede clinically detectable changes, potentially providing a rationale for early intervention. Specifically, certain fatty acids were identified as candidate biomarkers that warrant further validation in larger cohorts. Full article

Background/Objectives: Mild Encephalopathy with Reversible Splenial Lesion (MERS) is a potential complication of certain viral infections, but adult cases involving influenza are rare in the literature. Here, we report a case of a 31-year-old Chinese gentleman with an atypical presentation of Influenza B-associated mild encephalopathy with reversible splenial lesion (MERS). Methods: This is a case report with a detailed chronology followed by a discussion of pathophysiology. Results: The patient presented acutely to the tertiary hospital with a severe headache and a peculiar automatism pattern of behaviour involving intermittent screaming, involuntary jerking movements of the upper limbs, and incoherent speech, which culminated in an episode of tonic–clonic seizure lasting 3 min. Symptoms started on the day that the patient was diagnosed with Influenza B and given the antiviral Baloxavir by his GP. Clinically, there was high anion gap metabolic acidosis with hyperlactatemia, rhabdomyolysis, hepatitis transaminitis and absolute lymphopenia. Nasopharyngeal swab PCR and immunofluorescence was positive for Influenza B. EEG was normal, but an MRI of the brain showed a cytotoxic lesion of the splenium of the corpus callosum. The patient was started on Oseltamivir and made a complete neurological recovery, with a repeat MRI showing resolution of the splenial lesion at 3 months. MERS is a rare clinic-radiological syndrome characterized by a transient encephalopathy and a reversible lesion in the splenium of the corpus callosum, which has been reported mostly in the pediatric population. Conclusions: This case report of an influenza B-triggered MERS in an adult highlights the importance of maintaining MERS as a differential for acute encephalopathy in adults with a viral prodrome. Full article

Involuntary urinary leakage due to stress urinary incontinence in women represents a widespread health condition that reduces quality of life. Background: Treatment with tension-free vaginal tape (TVT) remains the most used procedure, although its impact on quality of life, specifically regarding sexual function effects, has not been thoroughly investigated. The aim of our study is to achieve a broader understanding of the full range of outcomes after surgery, emotional well-being, and sexual function. Materials and Methods: The present prospective cohort study was conducted between 15 July 2023 and 15 June 2024 in the Emergency County Clinical Hospital Targu Mures, Department of Obstetrics and Gynecology. This is an investigation of TVT surgery and its impact on urinary incontinence, conducted by evaluating bladder dysfunction and sexual function before and after surgical intervention, as well as considering physical and psychological outcomes using specific questionnaires. Results: There was a 91.7% objective cure rate for incontinence, while urinary symptoms, sexual function, and emotional health significantly improved, urine leakage associated with strong urgency (p = 0.0002), urine leakage associated with coughing, sneezing, or laughing (p ≤ 0.0001), and patient sexual activity and emotional health also improved after surgery (p ≤ 0.0001). Furthermore, colorectal symptoms improved. Conclusions: This study emphasizes that for the best recovery of sexual and emotional health post-surgery, complete symptom removal is a requirement. Additionally, the significance of combined questionnaires in assessing treatment efficacy is highlighted. A larger sample size of patients and a longer follow-up are required before recommending this procedure as a standard treatment. Full article

Objective: The aim of the study was to assess the effectiveness and safety of long-acting injectable anti-psychotic treatment (LAIA) amongst children and adolescents. Given the difficulty of performing an randomized controlled trial (RCT), we suggested comparing children and adolescents to young adults who were treated with LAIAs, and extrapolating data regarding efficacy and safety. Method: We compared data from medical files of adult inpatients treated with LAIAs to children and adolescent inpatients treated with LAIAs, between January 2014 and April 2021. Results: clinical global impression (CGI) scale score and rate of side effects (79% vs. 92%, p-value = 0.106) were not different between children and adolescents and young adults treated with LAIAs. There were no significant differences found between the groups in most demographic and clinical parameters such as gender distribution, legal status (voluntary or involuntary hospitalization), first hospitalizations and subsequent hospitalizations. Significant differences were found in duration of hospitalizations (144 days vs.50 days, p-value < 0.001), the indication for recommending LAIA treatment, diagnosis, the distribution of specific LAIAs and the rates of patients treated for side effects of anti-psychotic treatment. Conclusions: Results suggest that LAIA treatment may be as effective amongst children and adolescents as it is for adults. More research should be done to assess safety and efficacy of LAIA treatment in children and adolescents in the short and long term. Full article

Introduction: This study aimed to explore the clinical and psychosocial characteristics associated with functional non-remission in young adults involuntarily hospitalized for a first episode of psychosis (FEP), focusing on the role of duration of untreated psychosis (DUP) and contextual vulnerabilities. Material and method: We conducted a retrospective monocentric study including 123 patients aged 18–30 who were involuntarily admitted between 2013 and 2023 for a first psychotic episode. Sociodemographic, clinical, and care-related data were extracted from medical records. Functional remission was defined as a Global Assessment of Functioning (GAF) score ≥70 at discharge. Univariate and multivariate logistic regressions were used to identify predictors of functional non-remission. Results: Only 48.8% of patients achieved functional remission at discharge. Social isolation, low socioeconomic status, unemployment, lack of structured activities, and a DUP ≥ 4 weeks were significantly associated with functional non-remission. After multivariate logistic regressions, DUP ≥ 4 weeks remained an independent predictor of functional non-remission. Conclusions: Involuntary admission per se was not a direct predictor of poor outcome. Our findings highlight the critical role of prolonged DUP and psychosocial vulnerability in the trajectory of early psychosis. Early detection strategies, psychosocial support integration, and individualized care planning are essential to improve outcomes among young people experiencing FEP under compulsory admission. Full article

Background/Objectives: In Belgium, involuntary psychiatric hospitalization is authorized in the presence of certain criteria governed by the law relating to the protection of the mentally ill. The number of involuntary hospitalizations has been increasing continuously in recent years. Since personality disorders are frequent comorbidities in involuntarily hospitalized patients, the aim of this study was to investigate the potential role played by comorbid personality disorders in the decisions about involuntary hospitalization made during urgent forensic assessment. Methods: A total of 565 individuals were retrospectively recruited from the database of urgent forensic assessment carried out in the Psychiatric Emergency Department. Logistic regression analyses were performed to investigate the risk of involuntary hospitalization associated with comorbid personality disorders in patients referred for urgent forensic assessment. Results: 66.7% of urgent forensic assessments resulted in involuntary hospitalization. In addition, comorbid personality disorders (especially borderline personality disorder) were associated with a lower risk of involuntary hospitalization in patients referred for urgent forensic assessment. Conclusions: In this study, we demonstrated that urgent forensic assessments frequently result in involuntary hospitalizations. Furthermore, this study highlighted that comorbid personality disorders (especially borderline personality disorder) appeared to have a major impact on the decision not to involuntarily hospitalize patients referred for urgent forensic assessment. These elements therefore justify the establishment of adequate clinical reflection to avoid the stigmatization related to these frequent comorbidities in patients at risk of involuntary hospitalization. Full article

This study describes and explores the application of no-restraint policies in General Hospital Psychiatric Units (GHPUs) in Italy, a country pioneering in deinstitutionalization and psychiatric reform. The research aims to assess the organizational characteristics and effectiveness of no-restraint practices, contributing to the global discourse on humane psychiatric care. Following a purposive sampling approach, a nationwide descriptive study was conducted involving a detailed online survey distributed to 24 GHPUs actively engaged in or aspiring toward no-restraint practices. The survey, comprising 60 items across seven sections, gathered comprehensive data on the structural, organizational, and operational dimensions of the units, along with the prevalence and management of restraint episodes. Results reveal a significant commitment to no-restraint policies, with 14 GHPUs reporting zero restraint incidents in 2022. Despite variations in infrastructure and staffing, a common thread was the implementation of systematic procedures and risk management training aimed at reducing coercive practices. The study identified a correlation between the use of exclusive garden spaces and an increased incidence of restraints, suggesting nuanced factors influencing restraint practices. The findings underscore the viability and ethical alignment of no-restraint practices within psychiatric care, highlighting the crucial role of organizational protocols and training. This research adds empirical weight to the advocacy for restraint-free environments in mental health settings, signaling a paradigm shift toward more humane and rights-respecting psychiatric care. Full article

Nocturnal enuresis (NE) is involuntary bedwetting during sleep, typically appearing in young children. Despite the potential benefits of the long-term home monitoring of NE patients for research and treatment enhancement, this area remains underexplored. To address this, we propose NEcare, an in-home monitoring system that utilizes wearable devices and machine learning techniques. NEcare collects sensor data from an electrocardiogram, body impedance (BI), a three-axis accelerometer, and a three-axis gyroscope to examine bladder volume (BV), heart rate (HR), and periodic limb movements in sleep (PLMS). Additionally, it analyzes the collected NE patient data and supports NE moment estimation using heuristic rules and deep learning techniques. To demonstrate the feasibility of in-home monitoring for NE patients using our wearable system, we used our datasets from 30 in-hospital patients and 4 in-home patients. The results show that NEcare captures expected trends associated with NE occurrences, including BV increase, HR increase, and PLMS appearance. In addition, we studied the machine learning-based NE moment estimation, which could help relieve the burdens of NE patients and their families. Finally, we address the limitations and outline future research directions for the development of wearable systems for NE patients Full article

Background: Modified Assertive Community Treatment (ACT) in rural settings may be effective in the care of patients with severe mental illness (SMI) that are difficult to engage in community care. The objective of the present study was to explore the impact of the care by a hybrid ACT team on SMI patients’ hospitalizations, length of hospital stay, symptomatology and functioning in a rural community treatment setting in Greece. Methods: The hybrid ACT team is an expansion of the services of the well-established generic Mobile Mental Health Unit in a rural area of Northwest Greece, and delivers home-based care for patients with SMI. This was a 3-year prospective, mirror image, pre-post observational study. Patients’ symptomatology, functioning and general outcome were measured with the use of the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning Scale (GAF), and the Health of the Nation Outcome Scale (HοNOS). Results: The mean age of the 23 enrolled patients was 52.4 years and the mean age of disease onset was 23.5 years, with a mean number of hospitalizations 10.74. Over the 16-month follow-up patients’ hospitalizations, both voluntary and involuntary, had been significantly reduced by almost 80%. Length of hospital stay had been significantly reduced by 87%, whereas patients’ functioning and symptomatology had been significantly improved, by 17% and 14.5%, respectively. Conclusions: The model of hybrid ACT in rural areas in Greece may be effective in the treatment of difficult-to-engage patients with SMI and may improve patients’ outcomes. Full article

In mental health and psychiatric care, the use of involuntary psychiatric treatment for people with mental disorders is still a central and contentious issue. The main objective of this scoping review was to map and systematize the literature on ethical issues in clinical decision-making about involuntary psychiatric treatment. Five databases (Embase, PsycINFO, CINAHL, Medline, and Scopus) were searched for articles on this topic. Out of a total of 342 articles found, 35 studies from 14 countries were included based on the selection criteria. The articles were analyzed using the inductive content analysis approach. The following main categories were identified: (1) ethical foundations that guide clinical decision-making; (2) criteria for involuntary psychiatric treatment; (3) gaps, barriers, and risks associated with involuntary psychiatric treatment; (4) strategies used to reduce, replace, and improve the negative impact of involuntary treatment; and (5) evidence-based recommendations. Most of the selected articles discuss the logic underlying involuntary treatment of the mentally ill, exploring ethical principles such as autonomy, beneficence, non-maleficence, or justice, as well as how these should be properly balanced. During the process of involuntary psychiatric admission, there was a notable absence of effective communication and a significant power imbalance that disenfranchised those seeking services. This disparity was further intensified by professionals who often use coercive measures without a clear decision-making rationale and by family members who strongly depend on hospital admission. Due to the pluralistic and polarized nature of opinions regarding legal capacity and the complexity and nuance of involuntary admission, further studies should be context-specific and based on co-production and participatory research. Full article

Background: Children and adolescents with psychiatric disorders frequently experience hospital treatment as coercive. In particular, for patients with severe anorexia nervosa (AN), clinical and ethical challenges often arise if they do not voluntarily agree to hospital admission, often due to the ego-syntonic nature of the disorder. In these cases, involuntary treatment (IVT) might be life-saving. However, coercion can cause patients to experience excruciating feelings of pressure and guilt and might have long-term consequences. Methods: This narrative review aimed to summarize the current empirical findings regarding IVT for child and adolescent AN. Furthermore, it aimed to present alternative treatment programs to find a collaborative method of treatment for young AN patients and their families. Results: Empirical data on IVT show that even though no inferiority of IVT has been reported regarding treatment outcomes, involuntary hospital treatment takes longer, and IVT patients seem to struggle significantly more with weight restoration. We argue that more patient- and family-oriented treatment options, such as home treatment, might offer a promising approach to shorten or even avoid involuntary hospital admissions and further IVT. Different home treatment approaches, either aiming at preventing hospitalization or at shortening hospital stays, and the results of pilot studies are summarized in this article. Full article

Despite their controversiality, involuntary admissions in psychiatric departments remain a central issue in mental health care. The present study aims to identify demographic and clinical factors possibly associated with emergency involuntary psychiatric assessment and its outcome in Greece. This study was carried out in the psychiatric department of the University General Hospital of Alexandroupolis (UGHA) from 1 March 2018 to 28 February 2019. The sample included 191 individuals who had been psychiatrically assessed without their consent following a prosecutorial order. The majority of the involuntary assessments resulted in hospitalization (71%), with 51% of them resulting in involuntary hospitalization. Almost all patients diagnosed with “F20–29 schizophrenia, schizotypal and delusional disorders” were subsequently admitted to the psychiatric department of the UGHA (77 of 81, 66 of them involuntarily). Higher admission rates were recorded among those who had been referred from the Prosecutor’s Office of regions that are located far from the psychiatric department of UGHA (Fisher’s exact test, p-value = 0.045). In multivariate logistic regression, prior contact with psychiatric services and having an “F20–29 schizophrenia, schizotypal and delusional disorders” diagnosis was statistically significant with admission to the hospital as an outcome variable. Our study suggests an increased risk of involuntary admission among patients with psychosis, patients who had visited a psychiatric service prior to their assessment as well as those living further away from the main psychiatric services of the hospital. Better organization of community psychiatric services in remote places from hospital central services may lead to fewer prosecutorial referrals and coercive measures. Full article