Definition and epidemiology of treatment resistance in psychiatry

The current chapter discusses different aspects of treatment resistance in mental disorders. We will first describe the prevalence and disease burden of mental disorders, then we will have a closer look at treatment outcomes in psychiatry, and next we will focus on treatment resistance, its impact and strategies for improvement. It will become clear that, despite the rapidly increasing knowledge base for psychiatric treatments, there are still many unknowns and points for improvement. The aim of this chapter is to introduce the major elements of this discussion needed to appreciate the more specific aspects that will be treated in the subsequent chapters that focus on specific disorders.</p

Identification of Ehrlichia spp. and Borrelia burgdorferi in Ixodes Ticks in the Baltic Regions of Russia

The presence and distribution of Ehrlichia spp. and Borrelia burgdorferi sensu lato was demonstrated among ixodid ticks collected in the Baltic regions of Russia, where Lyme borreliosis is endemic. A total of 3,426 Ixodes ricinus and 1,267 Ixodes persulcatus specimens were collected, and dark-field microscopy showed that 265 (11.5%) I. ricinus and 333 (26.3%) I. persulcatus ticks were positive. From these samples, 472 dark-field-positive and 159 dark-field-negative ticks were subjected to PCR and subsequent reverse line blot hybridization. Fifty-four ticks (8.6%) carried Ehrlichia species, and 4 (0.6%) carried ehrlichiae belonging to the Ehrlichia phagocytophila complex, which includes the human granulocytic ehrlichiosis agent. The E. phagocytophila complex and an Ehrlichia-like species were detected only in I. ricinus whereas Ehrlichia muris was found exclusively in I. persulcatus, indicating a possible vector-specific infection. Borrelia garinii was found predominantly in I. persulcatus, but Borrelia afzelii was evenly distributed among the two tick species. Only two I. ricinus ticks carried B. burgdorferi sensu stricto, while Borrelia valaisiana and a newly identified B. afzelii-like species were found in 1.7 and 2.5% of all ticks, respectively. Of the dark-field-positive ticks, only 64.8% yielded a Borrelia PCR product, indicating that dark-field microscopy may detect organisms other than B. burgdorferi sensu lato. These observations show that the agent of human granulocytic ehrlichiosis may be present in ticks in the Baltic regions of Russia and that clinicians should be aware of this agent as a cause of febrile disease

To Paint A New Picture: Into the Lives of Eldest Siblings of Separated Fami-lies During COVID-19

This study emerged to enable humanitarian organizations to provide better services for children in separated families by understanding eldest siblings' lived experiences. Through Husserlian's descriptive phenomenology utilizing Colaizzi's method of data analysis, six participants were interviewed online at the height of the pandemic in 2021-2022 in Cebu City, Philippines. Data were transcribed using data reduction methods and revealed 6 themes: (1) "Having to always be the bigger person": Role Intensification; (2)"Devoting myself to things that weren't supposed to land on me": Adult Difficulties; (3) "Becoming stronger and keeping a soft spot"; Growing in Stature; (4) "True brothers are there for you”: The Support Given to the Supporter; (5) “To be free but mindful:'' Motivation to Persevere; (6) “To paint a better picture of life: ''Setting and Living an Example. The researchers discovered that the eldest siblings were forced to take charge of responsibilities that were not supposed to be theirs; encountered emotional difficulties such as loneliness and anxiety in facing a wide range of familial, developmental, and logistical problems; coped through these challenges with social support, religious devotion, and modern entertainment; and devoted their lives to protecting their siblings and giving them the lives they deserve. From these results, the researchers recommend that counseling is provided for the eldest siblings to enable the development of support structures and meaningful relationships that propel the eldest siblings to persevere