Cannabis use and age of admission to a psychiatric unit for first episode of psychosis

Background: Research has implicated that cannabis has an aetiological role in psychosis, and thus one can hypothesize that the onset of psychosis in patients who use cannabis occurs earlier in life than those who do not use cannabis Aim: The aim of this study is to assess the possible influence of cannabis on the age of onset of patients with first episode of psychotic illness admitted to a psychiatric unit in the Maltese Islands. Methods and sample: This study is a one year prospective study that includes all ICD-10 first episode psychosis patients admitted to a psychiatric hospital in the Maltese Islands. Age of admission to hospital was used as proxy for age of onset of psychosis. Use of cannabis prior to admission was ascertained by urine testing. Results: The mean age of admission to hospital for first onset psychosis for patients whose urine was positive to cannabis was 24.63 years old, and for patients whose urine was negative to cannabis was 44.63 years old. This difference was statistically significant, using the Mann Whitney-U test p=0.001. Conclusion: The results indicate that cannabis use can precipitate an earlier onset of psychotic illness. Considering the widespread use of cannabis, and that earlier age of onset of psychosis is associated with worse prognosis, this issue is of public health concern.peer-reviewe

Socioeconomic status and its impact on the prevalence of severe ADHD in the Maltese Islands

Attention deficit hyperactivity disorder (ADHD) is a common disorder associated with hyperactivity, impulsivity and reduced attention. If left untreated this may possibly lead to various impairments in other areas, such as lack of educational attainment, increased risk of accident-prone behaviour, substance misuse and antisocial behaviours. Although the exact aetiology is still not fully understood, various studies have demonstrated the presence of both a genetic and an environmental component. ADHD is highly hereditable, demonstrating a strong genetic component. Furthermore, increased rates of ADHD have been linked with a low socioeconomic status. The islands of Malta have traditionally been divided for statistical purposes into 6 districts, with certain districts more often being associated with low socioeconomic demographics. The main aim of this study was to assess whether higher prevalence rates of ADHD were present in the districts, which are classically associated with a low socioeconomic status. All persons aged 0 to 18 years attending the governmental clinics, having a documented diagnosis of severe ADHD and therefore being prescribed pharmacotherapy were identified and included in this study. 9 youngsters were living in institutional care and were therefore excluded from the study. A significant difference (p<0.0001) in the point prevalence of ADHD between the 6 Malta districts was found, with higher rates of ADHD occurring in the harbour districts. Though not statistically significant, a positive correlation was demonstrated between the ADHD prevalence and a number of socioeconomic variables, these included; the rate of smoking (p=0.111), number of people classified as at-risk-of-poverty per district (p=0.397), and number of people with no schooling per district (p=0.156). The overall point prevalence for ADHD in Malta obtained was 0.85, a value which is less than the average prevalence noted worldwide. The authors believe this value is an underestimation since the data collection in this study did not include ADHD cases off pharmacological treatment and any ADHD cases assessed and treated in the private sector.peer-reviewe

Lack of leisure time : a cause of psychological distress in international medical graduates

Background: Previous research has shown that migration for a newly graduated doctor is a risk factor for psychological distress. Aims: In this paper we examine the risk factors for psychological distress in a group of international medical graduates. Methods: We studied the potential risk factors of Cultural Distance, gender, uncertainty and lack of leisure time for psychological distress in a group of 30 international medical graduates in Malta undergoing their foundation training. Results: Psychological distress was measured using the General Health Questionnaire. Lack of leisure time was found to be significantly related to psychological distress (B 1.558, S.E. 1.226, Wald 6.677, Sig. 0.010). Cultural Distance, gender and uncertainty were not found to be significantly associated with psychological distress in the group studied. Conclusions: We suggest that helping such doctors having more leisure time is an important part of their coping mechanisms in dealing with the stress of their profession.peer-reviewe

Socio-economic status and population density risk factors for psychosis : prospective incidence study in the Maltese Islands

The aim of the study is to determine the incidence of patients suffering from psychosis and requiring admission to hospital. The study also intended to gain further epidemiological information, specifically in relation to population density and socio-economic status, as well as ethnicity, and to examine any differences between the six districts of the Maltese Islands. Based on the evidence from previous studies, Professionals hypothesized that a higher incidence of psychosis would be found in the lower socio-economic region, the more densely populated regions and among ‘irregular’ migrants.This was a prospective cross-sectional study of the incidence of psychosis in patients requiring admission to hospital. The sample comprised all patients newly admitted, with a diagnosis of psychosis, to a psychiatric ward at any of the three government hospitals between 1 May 2007 and 30 April 2008. There were no exclusion criteria related to age, gender or ethnicity.peer-reviewe

The mental health of newly graduate doctors in Malta

Several studies have shown high rates of psychiatric morbidity in young doctors at various stages of their training (Paice, et al. 2002, Levine et al. 2006). Migration is also known to have an impact on emotional wellbeing (Bhugra 2004). Foreign doctors in Malta now make up over 30% of the junior doctor cohort. This is a new situation for trainers here.This study was carried out in part fulfillment of the requirements for the completion of Specialist Training in Psychiatry in Malta. This article focuses on the first part of the study: the quantitative analysis aimed to answer the following questions: 1. What are the rates of mental health problems amongst recently qualified doctors? 2. What are the factors associated with the increased rates of mental distress? Subjects and methods: A quantitative cross-sectional analysis was carried out by means of self-report questionnaire including demographic details and the General Health Questionnaire-28 (GHQ-28) (Goldberg 1972). This study was approved by the Health Ethics Committee (HEC23/12). Results: 117 (78.5%) of junior doctors participated in this study. 70.9% were Maltese. 49.4% were found to have GHQ-28 scores of more than 6, indicating significant psychological distress. Further analyses revealed that lack of leisure time (p<0.001), uncertainty (p=0.009), migration (p=0.03) and being female (p=0.04) were significantly related to caseness. Conclusion: As trainers and supervisors in medical education, it is important to be aware of the difficulties that young doctors face. These may include psychological distress, significant enough to reach caseness. Lack of leisure time seems to be an important factor which is possibly an area that can be easily tackled.peer-reviewe

THE MENTAL HEALTH OF NEWLY GRADUATE DOCTORS IN MALTA

Background: Several studies have shown high rates of psychiatric morbidity in young doctors at various stages of their training (Paice, et al. 2002, Levine et al. 2006). Migration is also known to have an impact on emotional wellbeing (Bhugra 2004). Foreign doctors in Malta now make up over 30% of the junior doctor cohort. This is a new situation for trainers here.This study was carried out in part fulfillment of the requirements for the completion of Specialist Training in Psychiatry in Malta. This article focuses on the first part of the study: the quantitative analysis aimed to answer the following questions: 1. What are the rates of mental health problems amongst recently qualified doctors? 2. What are the factors associated with the increased rates of mental distress? Subjects and methods: A quantitative cross-sectional analysis was carried out by means of self-report questionnaire including demographic details and the General Health Questionnaire-28 (GHQ-28) (Goldberg 1972). This study was approved by the Health Ethics Committee (HEC23/12). Results: 117 (78.5%) of junior doctors participated in this study. 70.9% were Maltese. 49.4% were found to have GHQ-28 scores of more than 6, indicating significant psychological distress. Further analyses revealed that lack of leisure time (p<0.001), uncertainty (p=0.009), migration (p=0.03) and being female (p=0.04) were significantly related to caseness. Conclusion: As trainers and supervisors in medical education, it is important to be aware of the difficulties that young doctors face. These may include psychological distress, significant enough to reach caseness. Lack of leisure time seems to be an important factor which is possibly an area that can be easily tackled

THE MENTAL HEALTH OF NEWLY GRADUATE DOCTORS IN MALTA

Background: Several studies have shown high rates of psychiatric morbidity in young doctors at various stages of their training (Paice, et al. 2002, Levine et al. 2006). Migration is also known to have an impact on emotional wellbeing (Bhugra 2004). Foreign doctors in Malta now make up over 30% of the junior doctor cohort. This is a new situation for trainers here.This study was carried out in part fulfillment of the requirements for the completion of Specialist Training in Psychiatry in Malta. This article focuses on the first part of the study: the quantitative analysis aimed to answer the following questions: 1. What are the rates of mental health problems amongst recently qualified doctors? 2. What are the factors associated with the increased rates of mental distress? Subjects and methods: A quantitative cross-sectional analysis was carried out by means of self-report questionnaire including demographic details and the General Health Questionnaire-28 (GHQ-28) (Goldberg 1972). This study was approved by the Health Ethics Committee (HEC23/12). Results: 117 (78.5%) of junior doctors participated in this study. 70.9% were Maltese. 49.4% were found to have GHQ-28 scores of more than 6, indicating significant psychological distress. Further analyses revealed that lack of leisure time (p<0.001), uncertainty (p=0.009), migration (p=0.03) and being female (p=0.04) were significantly related to caseness. Conclusion: As trainers and supervisors in medical education, it is important to be aware of the difficulties that young doctors face. These may include psychological distress, significant enough to reach caseness. Lack of leisure time seems to be an important factor which is possibly an area that can be easily tackled

Serum prolactin monitoring in patients on risperidone admitted to the acute wards at Mount Carmel hospital

First-generation antipsychotics have been shown to increase prolactin levels in the body. Atypical antipsychotics have a lower tendency to produce hyperprolactinaemia due to a weaker and transient dopamine antagonistic effect. Despite being an atypical antipsychotic, Risperidone, tends to cause a higher increase in prolactin due to a stronger and more prolonged blockade on dopamine receptors. The purpose of this audit is to assess current practices at Mount Carmel Hospital (MCH) with regards to serum prolactin monitoring in patients taking Risperidone when compared to Maudsley Prescribing Guidelines in Psychiatry, 14th Edition (2021). The audit was based on patients acutely admitted between June and December 2021. Focus was placed on prolactin levels checked during admission in patients previously on Risperidone, prolactin levels checked in the preceding six months if no prolactin level was checked during admission and the appropriate action taken in cases where the serum Prolactin was noted to be high. From this audit it was concluded that there is inadequate monitoring of serum prolactin levels in patients prescribed Risperidone at MCH. Increased awareness of Risperidoneinduced hyperprolactinemia and associated guidelines are required to improve clinical practice. The recommendations suggested from this audit were to increase awareness of serum prolactin monitoring guidelines amongst all medical and nursing staff at MCH and to create a simple flow-chart outlining the appropriate serum prolactin monitoring guidelines and distribute this to MCH wards.peer-reviewe

Genomic–transcriptomic evolution in lung cancer and metastasis

Intratumour heterogeneity (ITH) fuels lung cancer evolution, which leads to immune evasion and resistance to therapy. Here, using paired whole-exome and RNA sequencing data, we investigate intratumour transcriptomic diversity in 354 non-small cell lung cancer tumours from 347 out of the first 421 patients prospectively recruited into the TRACERx study. Analyses of 947 tumour regions, representing both primary and metastatic disease, alongside 96 tumour-adjacent normal tissue samples implicate the transcriptome as a major source of phenotypic variation. Gene expression levels and ITH relate to patterns of positive and negative selection during tumour evolution. We observe frequent copy number-independent allele-specific expression that is linked to epigenomic dysfunction. Allele-specific expression can also result in genomic–transcriptomic parallel evolution, which converges on cancer gene disruption. We extract signatures of RNA single-base substitutions and link their aetiology to the activity of the RNA-editing enzymes ADAR and APOBEC3A, thereby revealing otherwise undetected ongoing APOBEC activity in tumours. Characterizing the transcriptomes of primary–metastatic tumour pairs, we combine multiple machine-learning approaches that leverage genomic and transcriptomic variables to link metastasis-seeding potential to the evolutionary context of mutations and increased proliferation within primary tumour regions. These results highlight the interplay between the genome and transcriptome in influencing ITH, lung cancer evolution and metastasis

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden