Attitudes toward mental disorder among medical students

Background: People with mental disorders are among the most stigmatized and vulnerable members of society. Our research study intended to determine the medical students’ attitude toward mental disorders, the presence of stigma, and whether either changed throughout their six-year medical education. Methods: The sample included 200 medical students of the University of Maribor. Empirical data were collected using the CAMI scale (Community Attitudes Towards the Mentally Ill), the Comparison of Attitudes of Patients and Students in Slovenia questionnaire, and additional questions regarding specific mental disorders. The results were processed using the SPSS 25 program. Descriptive statistics methods were applied, including the ANOVA test. Statistically, significant correlations and differences were checked at a 5% risk level. Results: The students strongly agreed with the positive statements and disagreed with the negative statements on the CAMI scale (MV=3.93; SD=0.34; p=0.046). No significant discrepancies between individual undergraduate years were observed; the sixth-year students expressed the most positive attitude among all students. The mean value of all statements was 3.9 (Y1-Y6 SD=0.5), indicating a low presence of stigma. Conclusion: The students expressed a positive attitude toward mental disorders. In sixth-year students, the least stigma, and better knowledge and attitude towards mental disorders were observed. Education, clerkship, and hearing personal confessions about experiencing a mental disorder are needed as they improve attitudes toward them

Aggressive behaviour in children and adolescents as a possible symptom of different mental disorders

Causes of aggressive behaviour in children and adolescents are manifold with exogenous and endogenous factors such as personality traits, temperament, family, socio-cultural, economic and financial factors closely intertwined. Aggressive behaviour, however, can also be associated with mental disorders and this is the topic discussed by the present article. Isolated and occasional outbursts of anger, aggressiveness and rage in children and adolescents can often be confused with conduct disorder. However, conduct disorder is characterised by a stable aggressive behavioural pattern, recurrently violating either the basic rights of the others or of the generally accepted social norms. Aggressive behaviour can also be present in Oppositional Defiant Disorder (ODD), Attention Deficit Hyperkinetic Disorder (ADHD), affective and psychotic disorders, autistic spectrum disorders and in some other developmental neurological disorders including intellectual disability ‒ but only as a possible and not a typical symptom. Child and adolescent psychiatrist can mainly help with aggressive behaviour associated with mental disorders. In all other possible causes of aggressive behaviour, child and adolescent psychiatry has neither the possibility/capacity nor the authority to intervene.  </p

ALTERED PAIN PERCEPTION IN SELF-INJURIOUS BEHAVIOR AND THE ASSOCIATION OF PSYCHOLOGICAL ELEMENTS WITH PAIN PERCEPTION MEASURES: A SYSTEMATIC REVIEW

Background: The pathophysiology of non-suicidal self-injury (NSSI) is controversial. There is growing evidence of altered pain perception in people engaging in NSSI. Some hypotheses have been made on addictive aspects of this behavior. Pain and addictive behavior are modulated by the opioid system, which makes the endogenous opioids one of the candidate neurotransmitters related to NSSI. This article explains the theoretical background on NSSI as an addictive behavior, endogenous opioids involvement and pain perception changes in NSSI and updates the latest findings in this field. The main aim of this paper is a comprehensive review of published studies on pain perception in NSSI and an evaluation of the impact of NSSI functions and other psychological elements on pain perception measures. Subjects and methods: We have reviewed six studies of pain perception in participants with NSSI compared with controls. The participants of these studies were not mentally disabled or autistic and did not have a diagnosed personality disorder. Results: The reviewed studies have demonstrated a higher pain threshold and longer pain tolerance or endurance in five of six studies. Emotional dysregulation was significantly associated with all pain perception variables in one study. Neuroticism, selfcriticism and painful and provocative experiences revealed correlated with pain endurance or pain tolerance. No correlation between pain perception measures and dissociation, hopelessness or locus of control was found. Conclusions: Pain perception was altered in participants with NSSI. Pain perception was associated to emotional dysregulation, self-criticism, neuroticism and painful and provocative experiences. Because of the small number of studies reviewed, results should be seen as guidelines for further studies. They should be replicated on a bigger sample of studies. Further research should focus on pain perception measures in participants with NSSI and an excluded personality disorder

Specific behavioural phenotype and secondary cognitive decline as a result of an 8.6 Mb deletion of 2q32.2q33.1

Chromosomal abnormalities involving 2q32q33 deletions are very rare and present with a specific phenotype. This case report describes a 37-year-old female patient with 2q32q33 microdeletion syndrome presenting with the characteristic features, but with the addition of secondary cognitive decline. Molecular karyotyping was performed on the patient and her parents. It revealed an 8.6 megabase deletion with the proximal breakpoint in the chromosome band 2q32.2 and the distal breakpoint in 2q33.1. The deletion encompassed 22 known genes, including the GLS, MYO1B, TMEFF2, PGAP1 and SATB2 genes. The observed deletion was confirmed using a paralogue ratio test. This case report provides further evidence that the SATB2 gene, together with GLS, MYO1B, TMEFF2 and possibly PGAP1, is a crucial gene in 2q32q33 microdeletion syndrome. The SATB2 gene seems to be crucial for the behavioural problems noted in our case, but deletion of the GLS, MYO1B and TMEFF2 genes presumably contributed to the more complex behavioural characteristics observed. Our patient is also, to our knowledge, the only patient with 2q32q33 microdeletion syndrome with secondary cognitive decline

Incidence, Severity and Characteristics of Patients’ Aggression in Acute Psychiatric Wards: Data from a Slovenian National Survey

To evaluate the incidence, severity and characteristics of aggressive behaviour in patients hospitalized in acute psychiatric wards, as well as the association between patient characteristics and the incidence of recurrent aggressive behaviour

Effectiveness of de-escalation in reducing aggression and coercion in acute psychiatric units

Objective: Most guidelines for the management of aggressive behavior in acute psychiatric patients describe the use of de-escalation as the first-choice method, but the evidence for its effectiveness is inconsistent. The aim of the study was to assess the effect of verbal and non-verbal de-escalation on the incidence and severity of aggression and the use of physical restraints in acute psychiatric wards. Methods: A multi-center cluster randomized study was conducted in the acute wards of all psychiatric hospitals in Slovenia. The research was carried out in two phases, a baseline period of five consecutive months and an intervention period of the same five consecutive months in the following year. The intervention was implemented after the baseline period and included training in verbal and non-verbal de-escalation techniques for the staff teams on experimental wards. Results: In the baseline study period, there were no significant differences in the incidence of aggressive behavior and physical restraints between the experimental and control groups. The incidence rates of aggressive events, severe aggressive events, and physical restraints per 100 treatment days decreased significantly after the intervention. Compared to the control group, the incidence rate of aggressive events was 73% lower in the experimental group (IRR = 0.268, 95% CI [0.2210.342]), while the rate of severe events was 86% lower (IRR = 0.142, 95% CI [0.1070.189]). During the intervention period, the incidence rate of physical restraints due to aggression in the experimental group decreased to 30% of the rate in the control group (IRR = 0.304, 95% CI [0.2380.386]). No reduction in the incidence of restraint used for reasons unrelated to aggression was observed. After the intervention, a statistically significant decrease in the severity of aggressive incidents (p < 0.001) was observed, while the average duration of restraint episodes did not decrease. Conclusion: De-escalation training is effective in reducing the incidence and severity of aggression and the use of physical restraints in acute psychiatric units