Case report : Treatment-resistant schizophrenia with auto-aggressive compulsive behavior—Successful management with cariprazine

The present case report describes a patient with treatment-resistant schizophrenia and auto-aggressive compulsive behavior who was effectively treated with a third-generation antipsychotic medication, cariprazine. The diagnosis was made 12 years ago, and the patient has been hospitalized 14 times and undergone various antipsychotic treatments. Despite receiving both inpatient and outpatient care, the patient's response to treatment has been only partial, and he has been classified as a treatment-resistant case. Therefore, the patient was switched to cariprazine, which led to significant improvements in both positive and negative symptoms, as well as the complete reduction of auto-aggressive compulsive behavior. These improvements contributed to the patient's overall social functioning and the achievement of remission, while also avoiding polypharmacy and eliminating the metabolic side effects associated with previous treatments.publishersversionPeer reviewe

Changes in diagnostic patterns of depression among family physicians in Latvia after participating in the education course on depression developed within the national research programme biomedicine 2014-2017 : Preliminary results

nnually, 7.9% of the general population in Latvia are suffering from depression. According to theofficial statistics, less than 8000 persons a year have been treated for depression in thestate-paid health care services while the National Research Programme (NRP) BIOMEDICINE2014–2017 found that more than 70 000 depressed patients annually are coming to family physi-cians (FPs) in Latvia. Within NRP researchers have developed an algorithm for diagnostics andtreatment of depression and carried out ten educational courses for FPs all over Latvia in 2016.Data on the treatment of depression have been collected from the National Health Service (NHS)database from 01.01.2015 till 30.06.2017. Changes between the trained and control groups havebeen calculated for the time period before intervention — 2015–2016 and six months right after it.The “Depression School” was attended by 210 (15.2%) out of 1382 FPs, in contract with theNHS, who signed in for the course on first-to-come basis. There were no statistically significantdemographic differences between trained and control groups, except, a larger proportion of FPsfrom rural places vs. the capital city attended the courses. Comparing the trained and controlgroups, during the period before the intervention there were on average 0.96 vs. 0.83 depressiveepisodes (F32) and 3.26 vs.1.74 recurrent depressive disorder (F33) episodes in 1/2 year (p<0.001). Statistically significant increase was observed for F33 episodes (+1.42,p< 0.001), andnumeric for F32 episodes (+0.18,p= 0.36) in the trained group of FPs in 2017. In total this gavea statistically significant (p< 0.001) increase by 43.6% of F33 diagnoses following the educationcourse on depression for family physicians. Further analysis of data to access sustainability oftraining effect after 12 and 24 months are underway.publishersversionPeer reviewe

Latvian family physicians' experience and attitude in diagnosing and managing depression

Depression is among the most common mental disorders in primary care. Despite high prevalence rates it remains to be under-diagnosed in primary care settings over the world. This study was aimed to identify Latvian family physicians’ (FPs) experience and attitude in diagnosing and managing depression. It was carried out within the framework of the National Research Programme BIOMEDICINE 2014–2017. After educational seminars on diagnosing and managing depression, FPs were asked to complete a structured questionnaire. In total 216 respondents were recruited. Most of the doctors, or 72.2% (n = 156), agreed with the statement that patients with depression use primary care facilities more often than other patients. More than a half of physicians, or 66.3% (n = 143) quite often asked their patients about their psycho-emotional status and 65.7% (n = 142) of clinicians thought that they can successfully assess a patient’s psychoemotional status and possible mental disorders. The majority, or 91.6 % (n = 198), supposed that routine screening for depression is necessary in Latvia. Despite the fact that a significant number, or 62.6% (n = 135) of FPs thought that their practice was well suitable for the treatment of depressive patients, half of the respondents, or 50.9% (n = 110), assessed their ability to build a trustful contact and to motivate patients for treatment as moderate. Although FPs acknowledged the importance and necessity to treat depression, current knowledge and management approaches were far from optimal. This justifies the need to provide specific training programmes for FPs.Peer reviewe

Clinical Utility of the Parent-Report Version of the Strengths and Difficulties Questionnaire (SDQ) in Latvian Child and Adolescent Psychiatry Practice

Publisher Copyright: © 2022 by the authors.Abstract: Background and Objectives: Screening instruments can be crucial in child and adolescent mental healthcare practice by allowing professionals to triage the patient flow in a limited resource setting and help in clinical decision making. Our study aimed to examine whether the Strengths and Difficulties Questionnaire (SDQ), with the application of the original UK-based scoring algorithm, can reliably detect children and adolescents with different mental disorders in a clinical population sample. Materials and Methods: a total of 363 outpatients aged 2 to 17 years from two outpatient child psychiatry centres in Latvia were screened with the parent-report version of the SDQ and assigned clinical psychiatric diagnoses. The ability of the SDQ to predict the clinical diagnosis in major diagnostic groups (emotional, conduct, hyperactivity, and developmental disorders) was assessed. Results: The subscales of the parent-report SDQ showed a significant correlation with the corresponding clinical diagnoses. The sensitivity of the SDQ ranged 65–78%, and the specificity was 57–78%. The discriminative ability of the SDQ, as measured by the diagnostic odds ratio, did not quite reach the level of clinical utility in specialised psychiatric settings. Conclusions: We suggest the SDQ be used in primary healthcare settings, where it can be an essential tool to help family physicians recognise children needing further specialised psychiatric evaluation. There is a need to assess the psychometric properties and validate the SDQ in a larger populational sample in Latvia, determine the population-specific cut-off scores, and reassess the performance of the scale in primary healthcare practice.publishersversionPeer reviewe

Probability of Major Depression Classification Based on the SCID, CIDI, and MINI Diagnostic Interviews : A Synthesis of Three Individual Participant Data Meta-Analyses

Funding Information: This study was funded by the Canadian Institutes of Health Research (KRS-134297, PCG-155468, PJT-162206, KRS-140994, KRS-144045). Drs. Wu and Levis were supported by Fonds de recherche du Québec – Santé (FRQS) Postdoctoral Training Fellowships. Dr. Benedetti was supported by a FRQS researcher salary award. Publisher Copyright: © 2020 Lippincott Williams and Wilkins. All rights reserved. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.INTRODUCTION: Three previous individual participant data meta-analyses (IPDMAs) reported that, compared to the Structured Clinical Interview for the DSM (SCID), alternative reference standards, primarily the Composite International Diagnostic Interview (CIDI) and the Mini International Neuropsychiatric Interview (MINI), tended to misclassify major depression status, when controlling for depression symptom severity. However, there was an important lack of precision in the results. OBJECTIVE: To compare the odds of the major depression classification based on the SCID, CIDI, and MINI. METHODS: We included and standardized data from 3 IPDMA databases. For each IPDMA, separately, we fitted binomial generalized linear mixed models to compare the adjusted odds ratios (aORs) of major depression classification, controlling for symptom severity and characteristics of participants, and the interaction between interview and symptom severity. Next, we synthesized results using a DerSimonian-Laird random-effects meta-analysis. RESULTS: In total, 69,405 participants (7,574 [11%] with major depression) from 212 studies were included. Controlling for symptom severity and participant characteristics, the MINI (74 studies; 25,749 participants) classified major depression more often than the SCID (108 studies; 21,953 participants; aOR 1.46; 95% confidence interval [CI] 1.11-1.92]). Classification odds for the CIDI (30 studies; 21,703 participants) and the SCID did not differ overall (aOR 1.19; 95% CI 0.79-1.75); however, as screening scores increased, the aOR increased less for the CIDI than the SCID (interaction aOR 0.64; 95% CI 0.52-0.80). CONCLUSIONS: Compared to the SCID, the MINI classified major depression more often. The odds of the depression classification with the CIDI increased less as symptom levels increased. Interpretation of research that uses diagnostic interviews to classify depression should consider the interview characteristics.publishersversionPeer reviewe

Accuracy of the Patient Health Questionnaire-9 for screening to detect major depression : updated systematic review and individual participant data meta-analysis

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVE: To update a previous individual participant data meta-analysis and determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9), the most commonly used depression screening tool in general practice, for detecting major depression overall and by study or participant subgroups. DESIGN: Systematic review and individual participant data meta-analysis. DATA SOURCES: Medline, Medline In-Process, and Other Non-Indexed Citations via Ovid, PsycINFO, Web of Science searched through 9 May 2018. REVIEW METHODS: Eligible studies administered the PHQ-9 and classified current major depression status using a validated semistructured diagnostic interview (designed for clinician administration), fully structured interview (designed for lay administration), or the Mini International Neuropsychiatric Interview (MINI; a brief interview designed for lay administration). A bivariate random effects meta-analytic model was used to obtain point and interval estimates of pooled PHQ-9 sensitivity and specificity at cut-off values 5-15, separately, among studies that used semistructured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual), fully structured interviews (eg, Composite International Diagnostic Interview), and the MINI. Meta-regression was used to investigate whether PHQ-9 accuracy correlated with reference standard categories and participant characteristics. RESULTS: Data from 44 503 total participants (27 146 additional from the update) were obtained from 100 of 127 eligible studies (42 additional studies; 79% eligible studies; 86% eligible participants). Among studies with a semistructured interview reference standard, pooled PHQ-9 sensitivity and specificity (95% confidence interval) at the standard cut-off value of ≥10, which maximised combined sensitivity and specificity, were 0.85 (0.79 to 0.89) and 0.85 (0.82 to 0.87), respectively. Specificity was similar across reference standards, but sensitivity in studies with semistructured interviews was 7-24% (median 21%) higher than with fully structured reference standards and 2-14% (median 11%) higher than with the MINI across cut-off values. Across reference standards and cut-off values, specificity was 0-10% (median 3%) higher for men and 0-12 (median 5%) higher for people aged 60 or older. CONCLUSIONS: Researchers and clinicians could use results to determine outcomes, such as total number of positive screens and false positive screens, at different PHQ-9 cut-off values for different clinical settings using the knowledge translation tool at www.depressionscreening100.com/phq. STUDY REGISTRATION: PROSPERO CRD42014010673.publishersversionPeer reviewe

EFFECT OF THE COVID-19 EMERGENCY STATE IN THE LATVIAN GENERAL POPULATION WITH DEPRESSION AND DISTRESS ON CHANGES OF PATTERNS OF SMOKING AND PSYCHOACTIVE SUBSTANCE USE

Publisher Copyright: © 2024 Sciendo. All rights reserved.The World Health Organisation warned that the COVID-19 pandemic could have psychiatric consequences, such as elevated levels of depression and increased alcohol and psychoactive substance use. On 12 March 2020, Latvia declared a state of emergency, which was repealed on 10 June 2020. A nationwide representative online study in the general population of Latvia was conducted from 7 to 27 July 2020. The Centre for Epidemiologic Studies Depression Scale was used to determine the presence of distress/depression. A structured questionnaire was used to determine psychoactive substance use. The study sample included 2608 respondents. In the study population, prevalence of depression and distress was estimated to be 5.7% (95% CI 4.92-6.71) and 7.82% (95% CI 6.85-8.91), respectively. Patients with depression and distress smoked more tobacco than respondents without distress/depression. During the state of emergency, there were changes in smoking habits in patients with depression, in contrast with respondents without reported depressive symptoms, with a tendency to smoke either more (28% vs. 7.4%) or less (22% vs. 9.7%). Patients with distress smoked more than healthy patients (30.9% vs. 7.4%). Patients with depression and distress were significantly more likely to consume more alcohol during an emergency (14.0% and 17.7%). Patients with depression were more likely to use less alcohol during an emergency than healthy respondents (18.0% vs. 10.6%). There was no statistically significant difference in the use of other psychoactive substances among those who were depressed or in distress. Participants with depression were more likely to change their smoking habits during the state of emergency and to consume smaller alcohol amounts compared to participants without symptoms. Participants with distress smoked more and consumed larger alcohol amounts compared to healthy participants.Peer reviewe

CRITERION-BASED VALIDITY OF THE DEPRESSION SCALE OF LATVIAN CLINICAL PERSONALITY INVENTORY

The main aim of this study was to evaluate the criterion validity and to estimate the cut-off score of the Depression scale (DS) and short Depression scale (DSs) for a new self-report measure – Latvian Clinical Personality Inventory (LCPI). Usefulness of DS and DSs for identifying patients with major depression were analysed based on psychometric analysis of data acquired from psychiatric inpatient sample with depressive disorder (n = 37) in comparison to randomised stratified community subsample (n = 176) selected from the overall test development sample (N = 888). The present study was carried within the framework of the National Research Program (BIOMEDICINE) 2014 – 2017 (sub-project Nr.5.8.2.). It was shown that all 24 item of DS show good to excellent discrimination power. Cronbach’s alpha was 0.97 for DS and 0.95 for DSs in test development sample. For DS, the optimal cut-off score was 26 points (sensitivity 95%, specificity 91%, and positive predicted value of 69%). For DSs, the optimal cut-off was 12 points (sensitivity 92%, specificity 89%, and positive predicted value 63%). DS and DSs of LCPI is proved to have good criterion validity in detecting depression and to be a reliable and valid instrument for assessment of depression symptoms in patients with depression and in general population. Subjects scoring at least 26 on DS or 12 points on DSs constitute a target group for further diagnostic assessment in order to determine appropriate treatment

Point prevalence and sex-specific associated factors of depression in Latvian general population

Funding Information: The data collection was financed by the European Social Fund and Ministry of Health of the Republic of Latvia in the frame of the “Study on the prevalence of mental disorders and suicidal behavior in the adult population of Latvia” within the project “Integrated measures for health promotion and disease prevention” (Nr.9.2.4.1/16/I/001). The analysis, interpretation of data, language editing procedures, writing of the manuscript, and publication were financed by the European Social Fund and Latvian state budget within the project no. 8.2.2.0/20/I/004 “Support for involving doctoral students in scientific research and studies” at Rīga Stradiņš University. Publisher Copyright: Copyright © 2023 Vinogradova, Kivite-Urtane, Vrublevska and Rancans.Background: This cross-sectional study aimed to determine the current prevalence of depression, and analyze sex-specific associated socio-demographic and health-related factors for depression in a representative sample of the general adult population of Latvia. Methods: Specially trained professional interviewers conducted computerassisted face-to-face interviews with a multistage stratified probability sample from the general Latvian adult population (n = 2,687). A 9-item Patient Health Questionnaire (PHQ) was used for assessment of depression. Respondents were interviewed using the specially developed questionnaire about sociodemographic factors as well as the alcohol use disorder module of the Mini International Neuropsychiatric Interview. Binary logistic regression was used to calculate the odds ratios (OR) for the univariate and multivariate logistic analyses. Results: The point prevalence of depression according to the PHQ-9 was 6.4% (95% CI 5.8–7.6). After adjustment for all independent variables analyzed, being divorced, widowed, or living separately increased the odds of depression [aOR 2.6 (95% CI, 1.2–5.8), p = 0.02] in males. For females, unfinished primary education [aOR 5.2 (95% CI 2.0–13.6), p = 0.001] and economically inactive status [aOR 2.0 (95% CI, 1.1–3.6), p = 0.03] were strongly associated with depression. Limitations: The cross-sectional design of the study did not allow us to draw conclusions about causality. Patients with bipolar, organic, and symptomatic depression states were not excluded. Conclusion: The prevalence of depression in the general adult population is 6.4%, with the most significant sex-specific factors associated with depression for males – being divorced, widowed, or living separately, and for females it was poor education and economic inactivity.publishersversionPeer reviewe

Clinical and Sociodemographic Characteristics in First-Episode Psychosis Patients in a Rural Region of Latvia

The first psychosis is a crucial point for further development of mental disorders. Previous evidence has demonstrated that psychotic disorders, including schizophrenia, are associated with a large number of years living with the disability. It is a global aim to improve prognosis of psychotic disorders, especially in rural regions, where mental health care possibly is not so easily accessible for patients. The aim of this study was to investigate clinical and sociodemographic determinants in association with patient and illness related factors to improve knowledge and understanding of first time psychosis patients in a rural region. This is a descriptive, cohort-based study of all consecutive first episode psychosis (F20, F23, ICD 10) patients admitted in the Daugavpils Psychoneurological Hospital (DPNH) between January 2016 and December 2017. Of the 94 first-time patients hospitalised in DPNH with symptoms of psychosis, 69 met the inclusion criteria. Our results showed that median age of patients was 33 years (IQR 27.5-42.0), median duration of untreated illness (DUI) was 30 months (IQR 11.0-60.0), and median duration of untreated psychosis (DUP) was 8 weeks (IQR 4.0-48.0). The results showed that 55.1% of first psychosis patients had not seen any health care specialist before being admitted to the psychiatric hospital. We found statistically significant differences between some sociodemographic aspects in DUI/DUP. Patients who lived with relatives had the longest DUI - 36 months, compared with 12 months for those who had established their own family. Unemployed patients had longer DUI - 36 months, compared with 12 months for employed patients. Similar findings were shown for associations with DUP. To our knowledge this study adds several important findings that help to better understand first psychosis patients.Peer reviewe