Multidimensional and population-based genetico-epidemiological research in Africa

Objective: Evidence supports that environmental factors contribute to the presentation of psychotic symptoms. Khat leaves contain amphetamine-like alkaloids, and heavy use is frequently associated with psychotic symptoms. We studied how khat use and exposure to traumatic events affect khat-induced psychotic experiences. Methods: At Gilgel Gibe Field Research Center of Jimma University, Ethiopia, we randomly selected a representative cohort of 1,100 men aged 18 to 40 years; 853 (77.5%) agreed to participate. We interviewed participants during the dry season, when khat availability is restricted, and nine months later, just after the rainy season (n = 695; 81.5% of initial sample). We assessed self-reported khat use, khat-induced psychotic experiences, and exposure to potentially traumatic experiences. Khat alkaloids were determined in urine by immunoassay. Significant outcomes: (1) In a large of males from the general population in rural Ethiopia, khat use varies according to seasonal availability and is associated with psychotic experiences. (2) The interaction of several environmental risk factors contributes to explain the prevalence of psychotic experiences, i.e. severe khat use that is more prevalent during rainy season is related to a higher level of khat-induced psychotic experiences among respondents with a severe exposure to traumatic events. (3) Not just lifetime but also recent exposure to traumatic events seems to be a factor that increases the psychotomimetic effects of severe khat use. Conclusions: Our findings support that the interaction of environmental factors might be related to the development of psychotic experiences; this needs to be replicated in larger, longer studies that assess psychotic experiences and symptoms more comprehensively. Systematic studies on long-lasting effects of khat use on mental health in the general population are needed

Multidimensional and population-based genetico-epidemiological research in Africa

Objective: Evidence supports that environmental factors contribute to the presentation of psychotic symptoms. Khat leaves contain amphetamine-like alkaloids, and heavy use is frequently associated with psychotic symptoms. We studied how khat use and exposure to traumatic events affect khat-induced psychotic experiences. Methods: At Gilgel Gibe Field Research Center of Jimma University, Ethiopia, we randomly selected a representative cohort of 1,100 men aged 18 to 40 years; 853 (77.5%) agreed to participate. We interviewed participants during the dry season, when khat availability is restricted, and nine months later, just after the rainy season (n = 695; 81.5% of initial sample). We assessed self-reported khat use, khat-induced psychotic experiences, and exposure to potentially traumatic experiences. Khat alkaloids were determined in urine by immunoassay. Significant outcomes: (1) In a large of males from the general population in rural Ethiopia, khat use varies according to seasonal availability and is associated with psychotic experiences. (2) The interaction of several environmental risk factors contributes to explain the prevalence of psychotic experiences, i.e. severe khat use that is more prevalent during rainy season is related to a higher level of khat-induced psychotic experiences among respondents with a severe exposure to traumatic events. (3) Not just lifetime but also recent exposure to traumatic events seems to be a factor that increases the psychotomimetic effects of severe khat use. Conclusions: Our findings support that the interaction of environmental factors might be related to the development of psychotic experiences; this needs to be replicated in larger, longer studies that assess psychotic experiences and symptoms more comprehensively. Systematic studies on long-lasting effects of khat use on mental health in the general population are needed

A cross-sectional survey of internet use among university students

The last 2~decades have seen an increase in the number of reports of excessive internet use. Therefore, this study aimed to examine internet use among university students to gain more insight into the novel phenomenon of addictive internet use (AIU). Data were collected by the means of an online questionnaire sent to 4391 students. Approximately 10% of the 4391 students could be included in the statistical analysis. Of those 483 students, almost all (99.2%) used the internet, and a quarter (24.8%) showed AIU. The students used the internet mostly for information searches, random browsing, social networking, and online shopping; however, AIU was seen most often in the areas of social networking, random browsing, information searches, gaming, and pornography. One in four of the respondents showed addictive behavior in at least one area of internet use. Students with AIU in the area of random browsing were significantly less far advanced in their studies than those without AIU, and well-being was significantly poorer across AIU groups than in those who did not show AIU. The study confirms the importance of AIU, as reflected in the high prevalence of AIU among the students and the significantly lower level of well-being in those with AIU. Undifferentiated consideration of AIU does not do justice to its various facets, and future research should consider all areas of internet use, with the aim to increase understanding of the underlying mechanisms of AIU and develop more differentiated treatment approaches

EPA-EAN statement on Post-COVID syndrome.

We aimed to determine the role of the European Psychiatric Association (EPA) and the European Academy of Neurology (EAN) in the management of post-COVID conditions. This is a joint statement from the EAN and the EPA on post-COVID. It is published in the official journals of the two associations, the European Journal of Neurology and European Psychiatry

Substance use disorders and adherence to antituberculosis medications in Southwest Ethiopia: a prospective cohort study

Objectives .In Ethiopia, little is known about the association between substance use disorders and adherence to antituberculosis (anti-TB) medications. Therefore, the objective of this study was to assess the effect of substance use disorders on adherence to anti-TB medications in Southwest Ethiopia. Design. Prospective cohort study. Settings. Patients were recruited from 22 health centres and four hospitals in Southwest Ethiopia. Participants. This study was conducted among 268 patients with TB, aged 18–80 in Southwest Ethiopia between October 2017 and October 2018. At baseline, patients who were exposed substance use disorders (134 patients) and unexposed to substance use disorders (134 patients) were recruited. Patients were followed for 6 months, and data were collected on three occasions. Main outcome measure. Adherence to anti-TB medications. Results. Patients with substance use disorders had consistently higher prevalence of non-adherence than those without, 16.4% versus 3.0% at baseline, 41.7% versus 14.4% at 2-month follow-up and 45.7% versus 10.8% at 6-month follow-up assessments. Patients with khat use disorder were 3.8 times more likely to be non-adherent to anti-TB medications than patients without khat use disorder (Adjusted odds ratio (aOR)=3.8, 95% CI 1.8 to 8.0). Patients who had alcohol use disorder (AUD) were also 3.2 times likely to have poor adherence compared with their counterparts (aOR=3.2, 95% CI 1.6 to 6.6). In addition, being educated (aOR=4.4, 95% CI 1.7 to 11.3), and being merchant (aOR=6.1, 95% CI 1.2 to 30.8) were associated with non-adherence to anti-TB medications. Conclusion. Khat and AUDs predict greater likelihood of non-adherence to anti-TB medication. This implies the need to integrate the management for substance use disorders into the existing TB treatment services

Traumatic Encephalopathy Syndrome and Tauopathy in a 19-Year-Old With Child Abuse

The majority of traumatic encephalopathy syndrome (TES) cases have been reported in former contact sport athletes. This is the first case with TES in a 19-year-old male patient with progressive cognitive decline after daily domestic physical violence through repeated hits to the head for 15 years. The patient presented with a moderate depressive episode and progressive cognitive decline. Tau positron emission tomography (PET) with 220 MBq of [18F]PI-2620 revealed increased focal signal at the frontal and parietal white/gray matter border. Brain magnetic resonance imaging (MRI) showed a cavum septum pellucidum, reduced left-sided hippocampal volume, and a left midbrain lesion. Cerebrospinal fluid results showed elevated total and p-tau. Neurocognitive testing at admission showed memory deficits clearly below average, and hampered dysfunctions according to the slow processing speed with a low mistake rate, indicating the acquired, thus secondary, attentional deficits. We diagnosed the patient with a TES suggestive of chronic traumatic encephalopathy and classified him as having subtle/mild functional limitation with a most likely transition to mild dementia within the TES criteria. This report underlines child abuse as a relevant criterion in diagnosing TES in cases with repetitive hits to the head. In addition to clinical markers, we show the relevance of fluid tau biomarkers and tau-PET to support the diagnosis of TES according to the recently published diagnosis criteria for TES

The COVID-19 Pandemic Mental Health Questionnaire (CoPaQ): psychometric evaluation and compliance with countermeasures in psychiatric inpatients and non-clinical individuals

BACKGROUND The COVID-19 pandemic has greatly impacted people's lives across a broad spectrum of psychosocial domains. We report the development and psychometric evaluation of the self-report COVID-19 Pandemic Mental Health Questionnaire (CoPaQ), which assesses COVID-19 contamination anxiety, countermeasure necessity and compliance, mental health impact, stressor impact, social media usage, interpersonal conflicts, paranoid ideations, institutional & political trust, conspiracy beliefs, and social cohesion. Further, we illustrate the questionnaire's utility in an applied example investigating if higher SARS-Cov-2 infection rates in psychiatric patients could be explained by reduced compliance with preventive countermeasures. METHODS A group of 511 non-clinical individuals completed an initial pool of 111 CoPaQ items (Open Science Framework: https://osf.io/3evn9/ ) and additional scales measuring psychological distress, well-being, and paranoia to assess construct validity and lifetime mental health diagnosis for criterion validity. Factor structure was determined by exploratory factor analyses and validated by conducting confirmatory factor analysis in the accompanying longitudinal sample (n~= 318) and an independent psychiatric inpatient sample primarily admitted for major depressive-, substance abuse-, personality-, and anxiety disorders (n~= 113). Internal consistency was assessed by Cronbach's Alpha and McDonald's Omega. For the applied research example, Welch t-tests and correlational analyses were conducted. RESULTS Twelve out of 16 extracted subscales were retained in the final questionnaire version, which provided preliminary evidence for adequate psychometric properties in terms of factor structure, internal consistency, and construct and criterion validity. Our applied research example showed that patients exhibited greater support for COVID-19 countermeasures than non-clinical individuals. However, this requires replication in future studies. CONCLUSIONS We demonstrate that the CoPaQ is a comprehensive and valid measure of the psychosocial impact of the pandemic and could allow to a degree to disentangle the complex psychosocial phenomena of the pandemic as exemplified by our applied analyses

Magnitude and predictors of khat use among patients with tuberculosis in Southwest Ethiopia: A longitudinal study

INTRODUCTION Tuberculosis (TB) is a leading cause of morbidity and mortality in low and middle-income countries. Substance use negatively affects TB treatment outcomes. Our recent study has found that khat use predicted poorer adherence to anti-TB medications. However, there is scarce longitudinal study on predictors of khat use among outpatients with TB, and this study aimed at addressing this research gap. METHODS From October 2017 to October 2018, 268 outpatients with tuberculosis on DOTs were enrolled in a longitudinal study from 26 health institutions in Southwest Ethiopia. Structured questionnaires translated into local languages (Afaan Oromoo and Amharic) were used to assess khat use. Patients were followed for six months, and data were collected on three occasions during the follow-up. A generalized linear mixed model was used to identify the relation between khat use and predictors. Model fitness was checked using the Bayesian Information Criterion (BIC). Odds ratio (OR) and 95% CI were used to describe the strength of association between the outcome variable and predictors. RESULTS The overall prevalence of khat use at baseline and first follow up was 39.2% while it was 37.3% at second follow up. Of this, 77.1% and 96.2% of them believed that khat use reduces the side effects of anti-TB medications and symptoms of tuberculosis respectively. In the final model, being male (aOR = 7.0, p-value = 0.001), being government employee (aOR = 0.03, p-value≤0.001) and presence of alcohol use disorders (AUD) (aOR = 2.0, p-value≤0.001) predicted khat use among outpatients with tuberculosis. CONCLUSION A considerable proportion of patients with TB used khat throughout DOTs and wrongly perceived that it had health benefits. The finding implies that all patients diagnosed with TB should be screened for khat use, and a particular emphasis should be given to males and individuals with a history of alcohol use. Moreover, further studies are needed to assess patients' beliefs regarding the benefits of khat use so that interventions can be developed

COVID-19 Vaccination Intent, Barriers and Facilitators in Healthcare Workers: Insights from a Cross-Sectional Study on 2500 Employees at LMU University Hospital in Munich, Germany

Considering the role of healthcare workers (HCW) in promoting vaccine uptake and previously recorded hesitancy among HCW, we aim to examine the COVID-19 vaccination intent and status of HCW through a cross-sectional anonymous online survey at LMU University Hospital in Munich. Data collection was informed by the Health Belief Model (HBM) and focused on vaccination intent, status and on potential factors affecting the decision-making process. In total, 2555 employees completed the questionnaire. Our data showed that an approving attitude towards recommended vaccines and having received an influenza vaccine in the previous winter were strongly associated with COVID-19 vaccination intent. Further, a positive COVID-19 vaccination status was associated with a higher likelihood of approving the extension of the validity of non-pharmaceutical interventions at the workplace. Our HBM-analysis demonstrated strong associations between the perceived benefits and barriers and COVID-19 vaccination intent. Unchanged or low perceived susceptibility and severity were associated with refusal or indecisiveness. Our findings highlight the factors associated with the decision regarding a COVID-19 vaccine and indicate a pattern-like behavior in the acceptance of novel vaccines by HCW. These insights can help inform the communication aims of vaccination campaigns among HCW within similar organizational contexts or in future outbreaks