Early clinical predictors and correlates of long-term morbidity in bipolar disorder

OBJECTIVES: Identifying factors predictive of long-term morbidity should improve clinical planning limiting disability and mortality associated with bipolar disorder (BD). METHODS: We analyzed factors associated with total, depressive and mania-related long-term morbidity and their ratio D/M, as %-time ill between a first-lifetime major affective episode and last follow-up of 207 BD subjects. Bivariate comparisons were followed by multivariable linear regression modeling. RESULTS: Total % of months ill during follow-up was greater in 96 BD-II (40.2%) than 111 BD-I subjects (28.4%; P=0.001). Time in depression averaged 26.1% in BD-II and 14.3% in BD-I, whereas mania-related morbidity was similar in both, averaging 13.9%. Their ratio D/M was 3.7-fold greater in BD-II than BD-I (5.74 vs. 1.96; P<0.0001). Predictive factors independently associated with total %-time ill were: [a] BD-II diagnosis, [b] longer prodrome from antecedents to first affective episode, and [c] any psychiatric comorbidity. Associated with %-time depressed were: [a] BD-II diagnosis, [b] any antecedent psychiatric syndrome, [c] psychiatric comorbidity, and [d] agitated/psychotic depressive first affective episode. Associated with %-time in mania-like illness were: [a] fewer years ill and [b] (hypo)manic first affective episode. The long-term D/M morbidity ratio was associated with: [a] anxious temperament, [b] depressive first episode, and [c] BD-II diagnosis. CONCLUSIONS: Long-term depressive greatly exceeded mania-like morbidity in BD patients. BD-II subjects spent 42% more time ill overall, with a 3.7-times greater D/M morbidity ratio, than BD-I. More time depressed was predicted by agitated/psychotic initial depressive episodes, psychiatric comorbidity, and BD-II diagnosis. Longer prodrome and any antecedent psychiatric syndrome were respectively associated with total and depressive morbidity

Deterrence of online child sexual abuse and exploitation

Abstract ‘Cyberspace’ has added a dimension to the ecology of the child and should be a starting point for practitioners (including police) to think about digital media in the context of child sexual abuse. While there is no evidence to suggest that online abuse and exploitation is a more serious offence than crimes occurring offline, the behaviours enabled by social media may present a significant risk factor for some children. This article gives a brief overview of the phenomena and prevalence of online child sexual abuse and exploitation and the role that the Internet may play. This is considered in relation to deterrence, prevention and management of these crimes, and further develops a public health approach to online child abuse and exploitation. Finally, the article critically considers emerging evidence to support this interaction between the individual and the online environment.</jats:p

A systematic review of the evidence on the treatment of rapid cycling bipolar disorder

Fountoulakis KN, Kontis D, Gonda X, Yatham LN. A systematic review of the evidence on the treatment of rapid cycling bipolar disorder. Bipolar Disord 2013: 15: 115-137. (c) 2013 John Wiley & Sons A/S.Published by Blackwell Publishing Ltd. Objective: Rapid cycling is associated with longer illness duration and greater illness severity in bipolar disorder. The aim of the present study was to review the existing published randomized trials investigating the effect of treatment on patients with rapid cycling bipolar disorder. Methods: A MEDLINE search was conducted using combinations of the following key words: bipolar and rapid or rapid-cycling or rapid cycling and randomized. The search was conducted through July 16, 2011, and no conference proceedings were included. Results: The search returned 206 papers and ultimately 25 papers were selected for review. Only six randomized, controlled trials specifically designed to study a rapid cycling population were found. Most data were derived from post hoc analyses of trials that had included rapid cyclers. The literature suggested that: (i) rapid cycling patients perform worse in the follow-up period; (ii) lithium and anticonvulsants have comparable efficacies; (iii) there is inconclusive evidence on the comparative acute or prophylactic efficacy of the combination of anticonvulsants versus anticonvulsant monotherapy; (iv) aripiprazole, olanzapine, and quetiapine are effective against acute bipolar episodes; (v) olanzapine and quetiapine appear to be equally effective to anticonvulsants during acute treatment; (vi) aripiprazole and olanzapine appear promising for the maintenance of response of rapid cyclers; and (vii) there might be an association between antidepressant use and the presence of rapid cycling. Conclusion: The literature examining the pharmacological treatment of rapid cycling is still sparse and therefore there is no clear consensus with respect to its optimal pharmacological management. Clinical trials specifically studying rapid cycling are needed in order to unravel the appropriate management of rapid cycling bipolar disorder

Καταγραφή και αξιολόγηση εκπαιδευτικών αναγκών των πιστοποιημένων εκπαιδευτών του εκπαιδευτικού προγράμματος Pre Hospital Trauma Life Support – PHTLS στην Ελλάδα

Σε μια εποχή όπου η εξειδικευμένη γνώση βελτιώνει σημαντικά το προσδοκώμενο αποτέλεσμα, η στοχευμένη εκπαίδευση κατέχει σημαντική θέση στον σχεδιασμό μοντέλων εκπαίδευσης. Σκοπός της παρούσας μελέτης αποτελεί η καταγραφή και η αξιολόγηση των πιστοποιημένων εκπαιδευτών του Pre Hospital Trauma Life Support – PHTLS ως πιστοποιημένου εκπαιδευτικού προγράμματος της National Association of Emergency Medical Technician – NAEMT στην Ελλάδα. Αρχικά θα διεξαχθεί μια αδρή περιγραφή της προ – νοσοκομειακής φροντίδας και της αναγκαιότητας δημιουργίας στοχευμένων πιστοποιημένων εκπαιδευτικών προγραμμάτων, ανατρέχοντας στην διεθνή βιβλιογραφία, αναλύοντας και προβάλλοντας τις ανάγκες, όπως αυτές έχουν πλέον διαμορφωθεί. Στην συνέχεια περιγράφοντας τον τρόπο υλοποίησης του εκπαιδευτικού προγράμματος PHTLS καθώς και της διαδικασίας επιλογής των νέων εκπαιδευτών, θα αναλυθεί η πρόοδος και η εξέλιξη της διαδικασίας στοχεύοντας στην βελτίωση τους ποσοστού επιβίωσης των κρίσιμων αιφνιδίως ασθενών μέσω της τεχνογνωσίας που αποκομίζετε από την πιστοποιημένη εκπαίδευση. Στα πλαίσια της διπλωματικής αυτής διαμορφώθηκε ένα ερωτηματολόγιο, το οποίο σχεδιάστηκε εξ’ ολοκλήρου και αποκλειστικά για τους εν ενεργεία πιστοποιημένους εκπαιδευτές του PHTLS στην Ελλάδα, προκειμένου να χαρτογραφηθεί το εκπαιδευτικό και επαγγελματικό τους προφίλ. Στη συνέχεια με έναν ερευνητικό συσχετισμό ποιοτικών και ποσοτικών δεικτών, θα τεκμηριωθεί αφ’ ενός πως μπορεί η στοχευμένη εκπαιδευτική δραστηριότητα του PHTLS να βελτιώσει το επίπεδο γνώσεων των πιστοποιημένων εκπαιδευτών και αφ’ ετέρου πως αυτή η ενέργεια θα επηρεάσει την βελτίωση της παροχής προ – νοσοκομειακής φροντίδας στην Ελλάδα. Απώτερος σκοπός της παρούσας διπλωματικής εργασίας είναι η συμβολή της στην βελτίωση του σχεδιασμού των νεότερων εκπαιδευτικών προγραμμάτων που θα επηρεάσουν σημαντικά την ποιότητα παροχής υπηρεσιών προ – νοσοκομειακής φροντίδας σε βαρέως πάσχοντες ασθενείς.At a time when specialized knowledge is significantly improving the expected result, targeted education holds an important place in the design of educational models. The purpose of this study is to record and evaluate certified trainers of Pre Hospital Trauma Life Support - PHTLS as a certified training program of the National Association of Emergency Medical Technician - NAEMT in Greece. Initially, a rough description of pre-hospital care and the need to create targeted certified educational programs will be conducted, looking back at the international literature, analyzing and projecting the needs as they have now been shaped. Then, describing the implementation of the PHTLS training program and the process of selecting new trainers, the progress and development of the process will be analyzed, aiming to improve the survival rate of critical sudden patients through the know-how you gain from certified training. In the framework of this diploma, a questionnaire was developed, which was designed entirely and exclusively for the currently certified PHTLS instructors in Greece, in order to map their educational and professional profile. Then, with a research correlation between qualitative and quantitative indicators, it will be documented on the one hand that the targeted educational activity of PHTLS can improve the level of knowledge of certified trainers and on the other hand that this action will improve the provision of pre-hospital care. in GREECE. The ultimate goal of this dissertation is to improve the design of newer educational programs that will significantly affect the quality of pre-hospital care services for critically ill patients

Accessibility in digital health : virtual conversational agents and mental health services

Recent advances in Artificial Intelligence have led changes to the operation, the capabilities and the performance of a number of industries. Provision of Mental Health Services is expected to experience a paradigm shift, with the introduction of Artificial Intelligence-driven Virtual Conversational Agents (VCAs). This is a conceptual paper, focusing on the use of Personalised Anthropomorphic VCAs (PAVCAs), which we introduce as a term. We suggest the use of PAVCAs to support people suffering from Prolonged Grief Disorder (PGD). For such an application to be able to drive meaningful change for the users and to deliver economic value and utility, we argue that the PAVCAs are configured to the known and public characteristics (e.g. personal linguistic peculiarities, moral principles, stated tastes and preferences across a range of themes) of the users beloved deceased ones. Such digital services aim to offer to service users solace, comfort and companion. We explore the options of having such applications personalized pre-mortem or post-mortem, and the source for information being affected by data limitations. Using two models, we suggest that the use of these platforms can comprise a reactive approach to the diagnosis of PGD; as well as a proactive approach, dealing with grief before PDG is manifested

Artificial Intelligence and Regulation : Total Quality Management for Mental Health Services

Artificial Intelligence becomes increasingly embedded in various forms in organizational processes and business activities, transforming the structures that support organizations and industries at global scale. The advance of Artificial Intelligence is expected to shift paradigms in several sectors. Technological innovations bring the need for regulatory institutions and frameworks to be introduced to monitor and control Artificial Intelligence applications, such as ChatGPT and other similar platforms in their current and future forms. This paper contributes to the literature on regulation of the services of Artificial Intelligence platforms. Through a Multivocal Literature review, the paper argues for the need for such regulations. We suggest that Artificial Intelligence needs to be regulated, and that this will be beneficial for the development of the quality of the services. Through direction of the regulatory institution, proper implementation of Artificial Intelligence in mental health services leads to business performance effects for the mental health providers and to health improvement outcomes for the patients, and eventually to the transformation of the paradigm of this sector’s services. We propose directions for the implementation of a TQM model, normalized in the standards of Industry 5.0, and adapted for the Mental Health Services sector. Through the EFQM Model, the paper argues for the approach that can be implemented in regulating the Artificial Intelligence industry to ensure high performance and quality assurance. We suggest that results can be affected by stakeholder’s perceptions, and we focus on the challenge of fast-moving Artificial Intelligence mental health services platforms coexisting as stakeholders with slow-moving medical bodies which establish practices and protocols. Medical bodies are identified as key stakeholders restrained by their commitment to uphold deontological ethics

Brain Chip Implants and Superego Functions : The case of China's Social Credit System

This paper explores theoretical dimensions of Brain Chip Implant (BCI) technology and how superego-type ethical and moral compasses can be embedded in its functionalities. A case study of the Social Credit System applied in China serves as context for developing the arguments made. We consider how specific elements of BCI applications, as implemented by Neuralink, can directly affect users’ behaviours. The analysis contextualizes Neuralink’s existing publicly known projects as the most advanced stage of the spectrum of commercial digital technologies, and considers the servitization elements that can be implemented through Neuralink’s BCIs. In the case study, we propose that China’s Social Credit System can be implemented through BCI technology, customized for the state-determined norms and standards, adding an explicit servitization element to this technology. We note that having this technology drive parts of the paradigms in the economy suggest the study of relevant technological economics considerations. Ethical dimensions of such an application are also introduced in the paper, covering human aspects and societal perspectives. This paper contributes to the relatively new emerging literature on applications of BCI and other similar technologies, which are anticipated to be disruptive technologies at the forefront of Industry 5.0 and Society 5.0

Mood instability and irritability as core symptoms of major depression : an exploration using Rasch analysis

Background: Mood instability (MI) and irritability are related to depression but are not considered core symptoms. Instruments typically code clusters of symptoms that are used to define syndromic depression, but the place of MI and irritability has been under-investigated. Whether they are core symptoms can be examined using Rasch analysis. Method: We used the UK Psychiatric Morbidity Survey 2000 data (n = 8,338) to determine whether the nine ICD/DSM symptoms, plus MI and irritability, constitute a valid depression scale. Rasch analysis was used, a method concerned with ensuring that items constitute a robust scale and tests whether the count of symptoms reflects an underlying interval-level measure. Two random samples of 500 were drawn, serving as calibration and validation samples. As part of the analysis, we examined whether the candidate symptoms were unidimensional, followed a Guttman pattern, were locally independent, invariant with respect to age and sex, and reliably distinguished different levels of depression severity. Results: A subset of five symptoms (sad, no interest, sleep, cognition, suicidal ideas) together with mood instability and irritability satisfactorily fits the Rasch model. However, these seven symptoms do not separate clinically depressed persons from the rest of the population with adequate reliability (Cronbach α = 0.58; Person Separation Index = 0.35), but could serve as a basis for scale development. Likewise, the original nine DSM depression symptoms failed to achieve satisfactory reliability (Cronbach α = 0.67; Person Separation Index = 0.51). Limitations: The time frame over which symptoms were experienced varied, and some required recall over the last year. Symptoms other than those examined here might also be core depression symptoms. Conclusion: Mood instability and irritability are candidate core symptoms of the depressive syndrome and should be part of its clinical assessment