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Michelle N Levitan,1,2 Marcelo Papelbaum,2 Mauro G Carta,3 Jose C Appolinario,1 Antonio E Nardi1 1Psychiatry Institute/Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; 2Eating Disorders Department/Sheba Medical Center, Ramat Gan, Israel; 3Dipartimento di Scienze Mediche e Sanità Pubblica, Università Degli Studi di Cagliari, Cagliari, ItalyCorrespondence: Michelle N Levitan Email milevitan@gmail.comAbstract: Binge eating disorder (BED) affects a significant rate of the general population causing a negative impact on their quality of life, weight, and self-esteem. Besides psychological treatments that compose the majority of the studies, pharmaceuticals have contributed to improve a host of clinical parameters, thus being an important component of the treatment. We opted to target the latest results by performing a review of the literature on the pharmacology for BED from the last 5 years. To achieve this goal, the terms: “binge eating disorder” and “treatment” were added to the PubMed database and the website clinicaltrials.gov. At least five drugs were either being tested or had already been recognized to improve BED symptoms – although only lisdexamfetamine is currently approved by the FDA to treat this condition. However, due to a better understanding of BED psychopathology in the last decade, it is notorious that improvement of eating-related symptoms is not the only desired target. Due to the significant comorbidity percentage (30%), weight loss is highly pursued, as well as the amelioration of clinical parameters which highlights the importance of having new agents combining both objectives.Keywords: binge eating disorder, treatment, pharmacological treatment

Background: The acquisition of health information via the internet has emerged as a prevalent approach within the general population and is likely to exert an influence on health decision-making processes. This study aims to evaluate the comprehensive quality of online information about anxiety treatment and management comparing websites in English, which is widely used for international scientific communication, and Italian, a popular local language. It was used a multidimensional methodology that assesses scientific quality of information; readability of the website; the technological quality of the website and the website's popularity ranking., Methods: We conducted a systematic search on four widely used online search engines. Duplicated, unrelated websites, and scientific papers were excluded. The assessment included the use of several criteria and tools: the DISCERN scale, the JAMA benchmark criteria, adherence to the Health on the Net Code; the Nibbler tool; PageRank; and the Flesch Reading Ease test/the Gulpease readability index., Results: 78 websites in Italian and 60 in English were evaluated. Quality of information of the English websites was higher than that of the Italian ones, but only a small percentage of them reported high level information about all treatment types and shared decision-making process. Technological quality was higher in English websites. In general, all websites were difficult to read, requiring reading skills at the high school level or higher., Conclusions: These results can promote future guidelines to improve online health information. Users should be able to find information about all treatment types (pharmacological and psychosocial) in line with the current guidelines for the treatment and the management of anxiety disorders. This would help internet users to achieve a higher level of quality information., Competing Interests: Declaration of competing interest All the authors Paola Melis, Alessandra Perra, Antonio Egidio Nardi, Thurayya Zreik, Antonio Preti, Mauro Giovanni Carta declare: - There are no any relevant conflict of interest at any time and during the 36 months prior to publication; - There are no any patents, wether palenned, pending or issued, broadly, relevant to the work; - There are no other relationships/conditions/circumstances that present a potential conflict of interest; - In general the authors have nothing to disclose., (Copyright © 2024. Published by Elsevier Ltd.)

Background: The perception of respect for users' rights is fundamental for organizational well-being in mental health services. This cross-sectional observational study examined the job satisfaction and perception of user rights among nursing staff compared to other health professionals across seven countries in the Mediterranean and Latin American regions. This research measures this perception among nursing staff in different countries, with a particular focus on regional differences and professional roles., Methods: Data were collected from mental health services in four Mediterranean and three Latin American countries via a structured questionnaire (Well-Being at Work and Respect Rights Questionnaire - WWRR), administered both online and on paper. Using multivariable logistic regression, the study analyzed associations between job satisfaction, respect for rights, and various socio-demographic and professional factors., Results: Among 408 nurses and 492 other health professionals, findings revealed significant cross-country variability. Nurses in North Macedonia reported higher job satisfaction and perceived respect for user rights than other professionals ( p <0.0001 in all items of the questionnaire), while Tunisian nurses showed lower organizational satisfaction but higher respect for user rights ( p =0.033 for respect for rights). However, in general, no significant differences were found between nurses and other professionals across all items., Conclusion: The perception of respect for users' rights is fundamental for organizational well-being in mental health services. The study highlights differences in organizational well-being perceptions across various contexts, emphasizing the need for culturally and economically adapted policies to improve mental health service environments globally. The results indicate the variability in the perception of respect for rights and job satisfaction between different geographical and professional contexts. This indicates the need for policies adapted to specific cultural and economic realities to improve organizational well-being in mental health services., Competing Interests: Dr. Mauro Giovanni Carta is the Editor in Chief of the journal Clinical Practice & Epidemiology in Mental Health, Dr. Mehmet Eskin is the Editorial Advisory Board of the journal Clinical Practice & Epidemiology in Mental Health and Dr. Maura Galletta and Dr. Uta Ouali is the Editorial Advisory Board of the journal Clinical Practice & Epidemiology in Mental Health., (© 2024 The Author(s). Published by Bentham Open.)

Background: To date, most large surveys on the mental health of children under 11 years old have relied exclusively on data collected from parents and teachers, with no information from children themselves. However, these children are valuable informants despite their young age., Objective: To evaluate the effects of adding young children's self-evaluation of internalizing disorders to a combined teacher/parent-based algorithm using data from a European survey carried out in Italy, Bulgaria, and in the Netherlands., Method: Comparing concordances with the Development and Well-Being Assessment (DAWBA; considered as the gold standard) of a Strengths and Difficulties Questionnaire's (SDQ) parent/teacher-based predictive algorithm, with and without integrating a child self-evaluation. The child self-evaluation was using the Dominic Interactive (DI), a computerized, pictorial, self-administered questionnaire for young children, which followed DSM 5 diagnoses definitions for internalized disorders. The concordance comparisons concerned 238 children, 5 to 12 years old from out-patient clinics, double evaluated, using kappa concordance test . Subsequent variations in disorder prevalence were evaluated in cross-sectional surveys in the general populations of the three study countries ( n  = 3,442)., Results: Adding self-evaluated child DI-based 'probable' internalizing disorder diagnoses to the SDQ parent/teacher algorithm increased concordance with gold standard: kappa increased from .25 (.14-.37) to .36 (.23-.49). In terms of population-based data, this addition increased the prevalence of 'probable' emotional disorders from 2.00 % (1.56-2.53) to 3.63 % (3.03-4.31) and revealed an expected gender difference., Conclusion: The inclusion of young children's self-reported data on internalizing disorders is a valuable addition to the generally used combined parent/teacher-based SDQ algorithm, and therefore better reflects the true prevalence of these disorders in these children. Further evaluation on larger validation samples is required.

Introduction: The Russo-Ukrainian War (RUW) poses a significant mental health burden, warranting a scoping review of the evidence to shed light on the unmet needs., Methods: MEDLINE/PubMed and EMBASE databases were inquired from inception until September 1st, 2023, to address the following a-priori-formulated questions: i) "Which psychiatric population has been assessed? How did the conflict affect the functioning of people with established mental health conditions (e.g., treatment adherence, hospitalization rates, and use of illicit substances)?" ii) "Did any psychiatric symptoms or disorders arise because of the RUW? If so, among which groups (e.g., civilians, combatants, refugees, caregivers) and in what geographical regions?", iii) "The impact of the Russo-Ukrainian war: what evidence focused on pre- and post-mental health status?", iv) "Did the conflict affect the rates of suicidal ideation or behaviors (e.g., attempt and death by suicide)? How did the war affect mental status, especially among vulnerable populations?", v) "What psychosocial or medical interventions have been adopted for internally displaced people or refugees complaining of mental health disturbances?", vi) "What rating tools or ad-hoc measures have been developed/adopted?", vii) "How did the existing evidence compare the RUW with other conflicts in different geographical regions or periods?"., Results: Twenty-seven records addressed questions 1-3 and 5-6, with the female gender facing the highest burden. Reliable records about the Russian side of the conflict are needed., Conclusion: Cohort studies across different phases of the RUW and populations are required to deliver effective clinical and public health interventions, especially to at-risk populations., Competing Interests: Declaration of competing interest None of the authors has any conflict of interest whatsoever to disclose in conjunction with the present rereport., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: With the growing older adult population, the European Union emphasizes the need to promote research in healthy aging trough multidisciplinary and innovative approaches, including the integration of advanced technologies like virtual reality (VR) in cognitive rehabilitation. This reflects the increasing awareness of the importance of addressing challenges related to neurodegenerative diseases in the older adult population. Our study aims to present a protocol that will assess the feasibility and provide a preliminary measure of effectiveness for an intervention using immersive CR technology for cognitive remediation (CR) in individuals with Mild Cognitive Impairment (MCI)., Methods: A feasibility randomized controlled clinical study will involve 30 individuals who are over 65 years old, both sex, who meet the diagnostic criteria for MCI from the University Hospital of Cagliari, randomly assigned to either the experimental condition or control group. Both groups will continue to receive standard pharmacological therapy. The experimental group will undergo a 3-months cognitive remediation program using fully immersive VR with two sessions per week. Each session will last a maximum of 60 min and will be supervised by expert health professionals. In contrast, the control group will continue with standard care. The intervention program will be carried out by s psychiatric rehabilitation technicians and speech therapists, emphasizing a comprehensive framework aligned with healthcare needs. Feasibility will be assessed based on tolerability, including dropout rates and acceptability, which considers the proportion of recruited participants among those considered eligible and on side effects and level of satisfaction. The preliminary measures of effectiveness will be evaluated on quality of life, cognitive functions, biological and social rhythms, depressive symptoms and anxiety., Results: The trial findings will be submitted for publication in international peer-reviewed journals and shared at international meetings and conferences., Discussion: This study aiming to assess the feasibility and preliminary effectiveness of a fully immersive VR/CR program for MCI in order to give data for a subsequent confirmatory trial. The results of the pilot RCT are expected to significantly contribute to research on the prevention of neurocognitive degeneration, with a specific emphasis on enhancing the application of technologies. The strengths of this work are the high technological innovation program for mental health treatments for healthy aging and multidisciplinary approach emphasizing a holistic framework aligned with health needs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Perra, Primavera, Leonetti, Montisci, Chessa, Scuteri, Cossu, Nardi, Valmaggia, Galetti, De Lorenzo, Sancassiani and Carta.)

Background: Antibody-mediated rejection is a significant cause of kidney transplant failure. Recent studies have shown that the MHC class I MICA gene influences the transplantation outcome. However, the role of the primary MICA receptor, NKG2D, has yet to be explored., Aim: We aimed to investigate the correlation between recipient/donor MICA allele matching and NKG2D genotype with the risk of antibody-mediated rejection and their potential clinical effects and implications for organ maintenance therapy., Methods: Of the 524 patients who underwent transplantation, 387 were eligible for the study. Complete MICA allele and two functional polymorphisms of NKG2D ( rs1049174C>G and rs2255336G>A ) were analyzed in 148 transplanted patients and 146 controls., Results: Increased recipient/donor MICA allele mismatches correlate with an elevated risk of antibody-mediated rejection (X 2 = 6.95; Log-rank=0.031). Notably, the rs1049174[GG] genotype contributes to a significantly increased risk of antibody-mediated rejection (X 2 = 13.44; Log-rank=0.001 and X 2 = 0.34; Log-rank=0.84). The combined effect of two MICA allele mismatches and rs1049174[GG] genotype shows the highest risk (X 2 = 23.21; Log-rank<0.001). Most importantly, patients with rs1049174[GG] and rs2255336[ AA ] genotypes may respond less to mTOR inhibitor immunosuppressive therapy than Calcineurin inhibitors ( rs1049174[GG]; P=0.035; and rs2255336[AA] ; P=0.002)., Conclusion: Recipient/donor MICA allele mismatches and specific NKG2D variants, as well as their combinations, influence kidney transplant outcomes, providing insights for personalized treatment and enhancing graft survival., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Littera, Mocci, Argiolas, Littarru, Lai, Melis, Sanna, Mereu, Lorrai, Mascia, Angioi, Mascia, Matta, Lepori, Floris, Manieli, Bianco, Onnis, Rassu, Deidda, Carta, Giuressi, Perra, Chessa, Giglio and Pani.)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Introduction: Whole Exome Sequencing (WES) has emerged as an efficient tool in clinical cancer diagnostics to broaden the scope from panel-based diagnostics to screening of all genes and enabling robust determination of complex biomarkers in a single analysis., Methods: To assess concordance, six formalin-fixed paraffin-embedded (FFPE) tissue specimens and four commercial reference standards were analyzed by WES as matched tumor-normal DNA at 21 NGS centers in Germany, each employing local wet-lab and bioinformatics. Somatic and germline variants, copy-number alterations (CNAs), and complex biomarkers were investigated. Somatic variant calling was performed in 494 diagnostically relevant cancer genes. The raw data were collected and re-analyzed with a central bioinformatic pipeline to separate wet- and dry-lab variability., Results: The mean positive percentage agreement (PPA) of somatic variant calling was 76 % while the positive predictive value (PPV) was 89 % in relation to a consensus list of variants found by at least five centers. Variant filtering was identified as the main cause for divergent variant calls. Adjusting filter criteria and re-analysis increased the PPA to 88 % for all and 97 % for the clinically relevant variants. CNA calls were concordant for 82 % of genomic regions. Homologous recombination deficiency (HRD), tumor mutational burden (TMB), and microsatellite instability (MSI) status were concordant for 94 %, 93 %, and 93 % of calls, respectively. Variability of CNAs and complex biomarkers did not decrease considerably after harmonization of the bioinformatic processing and was hence attributed mainly to wet-lab differences., Conclusion: Continuous optimization of bioinformatic workflows and participating in round robin tests are recommended., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: MMT reports speaker and travel Expenses from Twist. JS reports speaker honoraria from DLS, Molecular Health, AstraZeneca and Biocartis, outside the submitted work. UL reports speaker fees from AstraZeneca, GSK, Novartis, Menarini, advisory board from AstraZeneca and Novartis. DH reports speaker honorary AstraZeneca, adboard BMS, WD speaker honoraries BMS & Novartis. SMB reports speaker honoraria, advisory board fees and research grants from AstraZeneca, Daiichi, Menarini, Novartis, Roche, BMS, Pfizer, Bayer, MSD, Merck, Amgen, Molecular Health, Targos, DLS, Janssen, GSK, QuIP, outside the submitted work. SL reports research grant from BMS, advisory board/speaker invitation from AstraZeneca, Eli Lilly, Roche and Takeda outside of this work. NTG reports research support from Janssen-Cilag and Advisory Boards from Janssen-Cilag, AstraZeneca, Daiichi-Sankyo and BMS outside the submitted work. WW reports research grants from Roche, MSD, BMS and AstraZeneca. Advisory board, lectures and speaker bureau fees from Roche, MSD, BMS, AstraZeneca, Pfizer, Merck, Lilly, Boehringer, Novartis, Takeda, Bayer, Janssen, Amgen, Astellas, Illumina, Eisai, Siemens, Agilent, ADC, GSK und Molecular Health. SO received reimbursement for travel expenses and payment for conference presentations from Illumina Inc. and Oxford Nanopore Technologies. CS reports research funding from BMS Stiftung Immunonkologie and institutional grants from Illumina outside the submitted work. CPS reports an investigator-initiated grant from Illumnia outside of the submitted work. PS reports grants from Inctye, BMS, Gilead, Falk, speakers bureau/advisory board from MSD, BMS, AstraZeneca, Incyte, Astellas, Janssen, Eisai, Amgen, Boehringer Ingelheim. DK reports personal fees for speaker honoraria from AstraZeneca, and Pfizer, personal fees for Advisory Board from Bristol-Myers Squibb, outside the submitted work. NP reports speaker fees from Novartis, Bayer, Roche, AstraZeneca, Illumina, BMS, MSD, PGDX/Labcorp, advisory board from Novartis, Lilly, Roche, Janssen, travel expenses from Novartis, AstraZeneca, Illumina, BMS, MSD, PGDX/Labcorp, Research grants from Illumina. JB reports grants from German Cancer Aid and consulting from MSD, outside the submitted work. AS reports participation in Advisory Board/Speaker’s Bureau for Astra Zeneca, AGCT, Bayer, Bristol-Myers Squibb, Eli Lilly, Illumina, Janssen, MSD, Novartis, Pfizer, Roche, Seattle Genetics, Takeda, and Thermo Fisher, grants from Bayer, Bristol-Myers Squibb, and Chugai, outside the submitted work. All other authors report no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: This research describes incorporating the principles of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in training students at an Italian university. It also describes the perception of students on the rights of people with disabilities and the quality of services using the questionnaire the Well-Being at Work and Respect Right (WWRR), the objective is to compare the responses of students from the faculty of health sciences and health professionals human rights respect, organizational well-being, and job satisfaction in healthcare environments method: Cross-sectional study the data obtained were analyzed using the ANOVA test and Chi-SQUARE test results: University students have little recognition of the professional roles for the social and labor inclusion of users of health services, which promotes rethinking the type of training they receive conclusions: the findings show the need to incorporate in a more detailed way the principles of the CRPD in university training plans that promote an emphasis on disabilities based on human rights, despite the fact that the perception by students is optimistic in relation to respect for the rights of users in health services where they have done their training or practices, these results indicate a reevaluation of university training that gives a balance between technical skills but with an emphasis on human rights and social inclusion in health services., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: This study aimed to measure differences among informal caregivers, users, and mental healthcare workers (MHW) regarding job/organizational satisfaction and perceptions of respect for rights in the mental health services of one region of Italy., Methods: A sample of 100 caregivers, 240 MHW, and 200 users completed the "Well-Being at Work and Respect for Human Rights Questionnaire" (WWRR) in community mental health centers in Sardinia., Results: Caregivers reported higher satisfaction toward MHW on perceiving respect for human rights among users (5.2 ± 1.0 vs 5.1 ± 1.1, p < 0.0001) and health professionals (5.3 ± 0.8 vs 4.5 ± 1.3, p < 0.0001) and organization well-being (5.1 ± 1.2 vs 3.9 ± 1.3, p < 0.0001); toward users about respect of rights of MHW (5.3 ± 0.8 vs 4.9 ± 1.2, p < 0.0001) and both toward users and MHW on dissatisfaction on resources ( p < 0.0001). Caregivers strongly highlighted insufficient resources for services., Conclusion: Despite caregiver satisfaction, resource deficiencies signal a critical juncture in Italian mental health care. Continued cuts in healthcare spending, especially in mental health, raise concerns for future outcomes., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Long-term deterioration in the mental health of healthcare workers (HCWs) has been reported during and after the COVID-19 pandemic. Determining the impact of COVID-19 incidence and mortality rates on the mental health of HCWs is essential to prepare for potential new pandemics. This study aimed to investigate the association of COVID-19 incidence and mortality rates with depressive symptoms over 2 years among HCWs in 20 countries during and after the COVID-19 pandemic., Methods: This was a multi-country serial cross-sectional study using data from the first and second survey waves of the COVID-19 HEalth caRe wOrkErS (HEROES) global study. The HEROES study prospectively collected data from HCWs at various health facilities. The target population included HCWs with both clinical and non-clinical roles. In most countries, healthcare centers were recruited based on convenience sampling. As an independent variable, daily COVID-19 incidence and mortality rates were calculated using confirmed cases and deaths reported by Johns Hopkins University. These rates represent the average for the 7 days preceding the participants' response date. The primary outcome was depressive symptoms, assessed by the Patient Health Questionnaire-9. A multilevel linear mixed model (LMM) was conducted to investigate the association of depressive symptoms with the average incidence and mortality rates., Results: A total of 32,223 responses from the participants who responded to all measures used in this study on either the first or second survey, and on both the first and second surveys in 20 countries were included in the analysis. The mean age was 40.1 (SD = 11.1), and 23,619 responses (73.3%) were from females. The 9323 responses (28.9%) were nurses and 9119 (28.3%) were physicians. LMM showed that the incidence rate was significantly and positively associated with depressive symptoms (coefficient = 0.008, standard error 0.003, p = 0.003). The mortality rate was significantly and positively associated with depressive symptoms (coefficient = 0.049, se = 0.020, p = 0.017)., Conclusions: This is the first study to show an association between COVID-19 incidence and mortality rates with depressive symptoms among HCWs during the first 2 years of the outbreak in multiple countries. This study's findings indicate that additional mental health support for HCWs was needed when the COVID-19 incidence and mortality rates increase during and after the early phase of the pandemic, and these findings may apply to future pandemics., Trial Registration: Clinicaltrials.gov, NCT04352634., (© 2024. The Author(s).)

Background: Instruments to assess the knowledge about the rights of persons with mental health conditions and psychosocial disabilities, the attitudes toward their role as rights holders, and mental health professionals' practices related to substitute decision-making and coercion are either missing or lack evaluation of their validity and reliability., Aim: The aim of this study is to evaluate the validity and reliability of three instruments developed to fill this gap in the literature, the World Health Organization's QualityRights (WHO QR) Knowledge questionnaire, the WHO QR Attitudes questionnaire, and the WHO QR Practices questionnaire., Methods: A sample of participants was recruited and completed an online survey. Content validity and face validity were assessed for the three questionnaires. Based on the characteristics of the questionnaires, different approaches were used to assess their construct validity (confirmatory factor analysis, known group validity, and convergent and divergent validity). Internal consistency was evaluated using Cronbach's alpha and test re-test reliability using Pearson's and Spearman's r coefficients., Results: The analyses conducted indicate that the three questionnaires are valid and reliable instruments to evaluate the knowledge about the rights of persons with mental health conditions and psychosocial disabilities, the attitudes toward their role as rights holders, and mental health professionals' practices related to substitute decision-making and coercion., Conclusion: This finding lends support to the use of these instruments both within mental health services and in the general population for a better understanding of current knowledge, attitudes, and practices related to a human rights-based approach to mental health in mental health services and the community., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer FS declared a shared affiliation with authors MA, SD’O, and MC to the handling editor at the time of review. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Moro, Gyimah, Susser, Ansong, Kane, Amissah, Gureje, Osei, Norcini Pala, Taylor, Drew, Kofie, Baingana, Ohene, Addico, Fatawu, Atzeni, D’Oca, Carta and Funk.)

Introduction: Dementia, depression, and cardiovascular disease are major public health concerns for older adults, requiring early intervention. This study investigates whether a virtual reality cognitive remediation program (VR-CR) can improve cognitive function and depressive symptoms in older adults, and determines the necessary sample size for future studies. Integrated VR and CR interventions have shown promising outcomes in older adults with neurodegenerative and mental health disorders., Methods: This secondary analysis of a randomized controlled trial involves adults aged 58-75 years with bipolar disorder, excluding those with acute episodes, epilepsy, or severe eye diseases. The experimental group received standard treatment plus VR-CR, while the control group received only standard treatment., Results: No baseline differences were found between the experimental and control groups. No significant improvement was observed in the overall cognitive function test ( p = 0.897) or in depressive symptoms ( p = 0.322). A phase III efficacy study requires a sample size of 28 participants (alpha = 0.05, beta = 0.20)., Conclusions: VR-CR can potentially treat depressive symptoms in adults and older adults, but the results support conducting phase III studies to further investigate these outcomes. However, the improvement in cognitive performance in the elderly is less pronounced than in younger individuals.

Background: Despite the exposure to a wide combination of risk factors, evidence concerning risk of suicide among refugees is mixed., Aims: We aimed to establish more precise estimates of suicide and suicidal behavior in refugees and asylum seekers, investigate the role of somatic and psychiatric comorbidities, and the effectiveness of preventative interventions., Methods: We searched PubMed/Medline, EMBASE, CINAHL, and PsycInfo without time limitations from inception until June 5, 2024. Studies were included if systematic reviews or meta-analyses reporting data on suicide or suicidal behavior in refugees or asylum seekers, or detailing the results of preventive interventions. Quality was assessed using the National Institutes of Health Quality Assessment Tool for Systematic Reviews and Meta-Analyses., Results: Out of 49 papers, 10 systematic reviews and meta-analyses were included. Refugees showed significantly higher suicide death rates and suicidal ideation, suicide plan and suicide attempt prevalence compared to people living in the host countries. Refugees who arrived in low-income and lower-middle-income countries displayed lower suicidal ideation, but higher suicide death rates and suicide attempt prevalence compared to refugees who arrived in high-income and upper-middle-income countries. However, no review provided data regarding somatic comorbidity, psychiatric comorbidity, or the effectiveness of treatments, and evidence on specific categories of refugees is scarce., Conclusion: Refugees have been proven to be at risk for suicide and suicidal behavior. More research is required to identify the targets and procedures of intervention., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: It is difficult to quantify the impact of the COVID-19 pandemic on mental health as many community surveys have limited quality, rely on screening tests to measure mental health conditions and distress, and often use convenience samples. Moreover, robust surveys come mainly from high-income countries., Aim: To measure the prevalence of depressive disorders with onset during the pandemic in a community of a Lower-Middle-income country (LMIC)-Tunisia., Methods: Clinical semi-structured face-to-face interviews were carried out during the pandemic (September-December 2021) by medical doctors among a representative sample of the general population in the governorate of La Manouba, Tunisia. Psychiatric diagnoses were established according to DSM-IV., Results: The prevalence of Major Depressive Disorder (MDD) started or recurred after the pandemic was 5.66%. The factors associated with MDD were loss of job and considerably diminished income due to the pandemic (OR = 2.1, 95% CI [1.5, 2.9]) and the perception of having the family's financial situation below the Tunisian average (OR = 2.3, 95% CI [1.7, 3.2]). Female sex, marital status as separated/divorced, and having a COVID-19 infection were associated with MDD only in the overall sample and urban areas, but not in rural areas. Age and having loved ones who passed away due to COVID-19 were not associated with MDD., Conclusion: In Tunisia, the pandemic seems to have increased the risk of depression in people experiencing a precarious financial situation, also due to the pre-existing economic crisis. Specific local level factors, such as not establishing a rigid lockdown for an extended period, may have protected young people and allowed for better mourning in families suffering the loss of a loved one.

Background/Objectives : Sleep disturbances often accompany mood disorders and persistent insomnia after mood symptoms have resolved may be a marker of poor outcome. The association between sleep symptoms and mood disorders seems to change with age and sex. This study aims to assess the frequency of depressive episodes and sleep disorders in the general population through an agile screening questionnaire and to evaluate the association of depressive episodes and sleep symptoms by sex and age categories. Methods : 774 women and 728 men from Sardinia aged > 16 years old were enrolled. The Patient Health Questionnaire (PHQ-9) was administered through a computer-assisted telephonic interview. Results : The frequency of depressive episodes was double in women (10.6% vs. 4.4%; p < 0.0001), with the highest values in women > 75 yo (17.4%). The frequency of sleep dysregulation was double in women (18.7% vs. 9.6%; p < 0.0001), with the highest values in women > 75 yo (35.9%) and the lowest in the group of men > 75 yo. The group of young males showed the lowest frequency of depressive episodes (1.4%) and a frequency of sleep dysregulation (9.1%) similar to that of the other groups of age and sex. Sleep dysregulation without depressive episodes presented a higher distribution in the elderly, both in males (20.7%) and in females (18.5%). No significative differences were found across sex and age groups in the distribution of depressive episodes without sleep dysregulation. Conclusions : The use of an agile screener such as PHQ9 in the general population and/or in populations at risk can be a valuable tool in finding those individuals in whom sleep dysregulation may represent an early warning signal, one that may be thoroughly evaluated to identify and treat possible sleep disorders early.

Background: Bipolar disorder (BD) is a severe psychiatric illness characterized by a chronic course and recurrent episodes, including residual depressive symptoms even during euthymic phases. These symptoms, although not meeting criteria for a depressive episode, are linked to relapse risk and impaired social functioning. This study aims to assess whether Virtual Reality Cognitive Remediation Training reduces depressive symptoms below the clinical threshold in individuals with BD. Methods: This post hoc analysis focuses on the secondary outcome (PHQ9) of a randomized-controlled trial. Participants were recruited from the Center of Liaison Psychiatry and Psychosomatics in Italy. The experimental group received Virtual Reality Cognitive Remediation, while the control group received standard treatment Results: Data from 39 individuals in the experimental group and 25 in the control group were analyzed. A greater reduction in PHQ-9 scores (>9) was observed in the experimental group (71.8% to 48.7%) compared to the control group. Significant improvements in total PHQ-9 scores and specific symptoms were noted in the experimental group compared to the control group. Conclusions: The study highlights the significant impact of virtual reality intervention on reducing depressive symptoms in bipolar disorder. This promising outcome underscores the potential preventive role of cognitive stimulation in relapse prevention. The intervention could offer valuable benefits for both treatment and prevention strategies in bipolar disorder.

Introduction: This study explores the issue of paper-and-pencil screening tests for bipolar disorder, often leading to false positives. It discusses hypotheses that connect MDQ positivity with sleep disorders, a decline in health-related quality of life, and the impact of the COVID-19 pandemic on mood disorders. The study proposes that MDQ identifies a "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS), indicating a stress-related condition. It aims to investigate the association between MDQ positivity and systemic lupus erythematosus (SLE) in comparison to other chronic disorders., Methods: This case-control study, conducted from April 2019 to February 2020, investigated MDQ positivity in patients with SLE. Ethical approvals were obtained, and statistical analysis was used for data assessment., Results: This is a case-controlled study where MDQ positivity was significantly higher in systemic lupus erythematosus cases than controls. The analysis compared gender, age, and the presence of depressive episodes between MDQ-positive and MDQ-negative cases, revealing some differences but no significant variations. Interestingly, no association with high prednisone or biologics use was observed. The frequency of MDQ positivity in systemic lupus erythematosus was compared to other chronic pathologies, revealing varying associations with each condition., Conclusion: This study reveals a high rate of (MDQ) positivity in systemic lupus erythematosus (SLE), associated with the risk of bipolar disorder in SLE. Notable discrepancies in MDQ positivity risk factors between SLE and bipolar disorder are observed. The study emphasizes the ability of MDQ to identify a distinct syndrome characterized by rhythm dysregulation, posing a risk for bipolar disorder and other disorders., Competing Interests: Federica Sancassiani, Michele Fornaro, Giuseppe Carrà, and Antonio Egidio Nardi are the Editorial Advisory Board members, and Mauro Giovanni Carta is the Editor in Chief of the journal Clinical Practice & Epidemiology in Mental Health., (© 2024 The Author(s). Published by Bentham Open.)

Background: The community treatment order (CTO) is designed to deliver mental healthcare in the community and has been introduced in around 75 jurisdictions worldwide. It constitutes a legal obligation in which individuals with severe mental illness must adhere to out-of-hospital treatment plans. Despite intense criticism and the debated nature of published evidence, it has emerged as a clinical and policy response to frequent hospital readmissions and to enhance adherence in cases where there is refusal of pharmacological treatments. This systematic review outlines findings on CTO long-term adherence, after mandatory outpatient treatment has ended, in studies that include people with psychiatric disorders., Method: Following PRISMA guidelines, we performed a review of published articles from PubMed, PsycINFO, EMBASE, and CINAHL up to January 15, 2023. We included studies that assessed adherence after CTO ends. The study is registered with PROSPERO number CRD42022360879., Results: Six independent studies analyzing the main indicators of long adherence: engagement with services and medication adherence, were included. The average methodological quality of the studies included is fair. Long-term adherence was assessed over a period ranging from 11 to 28 months. Only two studies reported a statistically significant improvement. Regarding the remaining studies, no positive correlation was observed, except for certain subgroup samples, while in one study, medication adherence decreased., Conclusion: Scientific evidence supporting the hypothesis that CTO has a positive role on long-term adherence post-obligation is currently not sufficient. Given the importance of modern recovery-oriented approaches and the coercive nature of compulsory outpatient treatment, it is necessary that future studies ensure the role of CTO in effectively promoting adherence., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)