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Violence risk is a major challenge among acute psychiatric inpatients. The study aimed to predict violent behavior risk in an acute psychiatric ward using video recordings from the emergency department. 69 videos of the emergency department recording the first ten minutes following patients' arrivals were included. Psychiatrists watched the videos, completed relevant Brief Psychiatric Rating Scale items and answered intuitive questions about each patient's risk of violence. Demographic and clinical data were also collected. Motoric mannerisms as rated in the BPRS significantly differed between violent and non-violent patients (p < 0.05). Additionally, we found a significant correlation between intuitive prediction of violence and actual violence (p = 0.008). Violent behavior was predicted in 42.1% of the cases by the intuitive evaluation compared to 11.5% mistakenly evaluated patients. Logistic regression revealed that the intuitive question and the BPRS items regarding tension and motoric mannerism created a successful model for predicting violence with 88.2% sensitivity and 72.5% specificity. We sought to define the factors that most accurately predict violence in the acute psychiatric ward, based solely on behavior in the emergency department. Intuitive impressions of clinicians and motoric mannerisms should be considered when evaluating patients for potential violent behavior., Competing Interests: Declarations Ethics approval and consent to participate The study was approved by the IRB Committee of Lev Hasharon Mental Health Center on 9th December 2020 (Trial number LH13/2020). Due to the retrospective design of the study, the IRB Committee of Lev Hasharon Mental Health Center waived the participants from signature on informed consent. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

The role of the endocannabinoid system (ECS) in depression and suicidality has recently emerged. The purpose of the study was to identify changes in plasma endocannabinoid concentrations of several endocannabinoids and correlate them with depressive symptoms and suicidality in patients with severe major depression undergoing electroconvulsive therapy (ECT). The study included 17 patients that were evaluated in four visits at different stages of therapy. At each visit depression, anxiety and suicidality symptoms were assessed and blood samples collected. Several endocannabinoid concentrations increased following six sessions of ECT, as 2-AG (p < 0.05) and LEA (p < 0.01), and following twelve sessions of ECT, as 2-AG (p < 0.05), AEA (p < 0.05), LEA (p < 0.05) and DH-Gly (p < 0.05). Endocannabinoids also correlated with symptoms of depression, anxiety and suicidality at baseline and at the sixth ECT session. Finally, we found one endocannabinoid, l-Gly, that differentiated between remitted and not-remitted patients at the seventh and thirteenth ECT sessions (p < 0.05). Our findings suggest that depression is markedly related to imbalance of the endocannabinoid system, and further regulated by ECT. Plasma endocannabinoids could be promising biomarkers for detection of depression response and remission., Competing Interests: Declaration of competing interest None of the authors reports any financial or other conflict of interest with regard to this study. The authors furthermore confirm that this manuscript or parts thereof have not been published and are not under consideration for publication elsewhere. They also confirm that all of them contributed significantly to the study. They furthermore, confirm giving their approval to all statements and declarations included in this submission., (Copyright © 2024. Published by Elsevier B.V.)

Aims: To find clinical and immunological signatures of the SARS-CoV-2 and the COVID-19 pandemic on children newly diagnosed with type 1 diabetes (T1D)., Methods: A single-centre, retrospective, observational study comparing the clinical and immunological characteristics of children diagnosed with T1D the year before and during the first 2 years of the COVID-19 pandemic. Data extracted from the medical records included clinical and demographic parameters, COVID-19 PCR results and the presence of anti-islet, thyroid and celiac-related antibodies. Also obtained from the medical records was a family history of T1D, celiac disease and autoimmune thyroid disease in a first-degree family member., Results: A total of 376 children were diagnosed with T1D during the study period. A total of 132 in the pre-COVID era and 246 in the first 2 years of the pandemic. At diagnosis, the pH in children with DKA was lower, and HbA1c tended to be higher in the COVID-19 group compared to the pre-COVID-19 group (7.30 [7.18, 7.35] vs 7.33 [7.19, 7.36], p = 0.046) and (110.9 [86.9, 129.5] vs 100 [80.3, 129.5], p = 0.067]) respectively. Multiple islet antibodies (IA) were significantly more common among patients in the pre-COVID-19 group compared to the COVID-19 group (72% vs 61%, p = 0.032). Tissue transglutaminase antibodies were more common among children diagnosed in the COVID-19 compared to the pre-COVID group (16.6% vs 7.9%, p = 0.022)., Conclusions: Our findings suggest that SARS-CoV-2 and the environmental alterations caused by the pandemic affected the clinical characteristics and the immunological profile of children diagnosed with T1D. It is, therefore, plausible that the virus plays a role in the autoimmune process causing T1D., (© 2023 Diabetes UK.)

Introduction: Chloral hydrate (CH), a medication dating back to 1832, is tranquilizer and sleep promoter still used today. It remains an option for short-term insomnia therapy and sedation before medical procedures, despite its controversial safety profile., Methods: This study investigated the potential benefits of chloral hydrate addition for increasing sleep duration and reducing agitation and violence in inpatients with treatment-resistant schizophrenia (TRS). A retrospective, observational case series design was utilized, analyzing data from fourteen patients diagnosed with TRS disorders., Results: CH addition increased the rate of full night sleep and decreased the rates of agitation and verbal and physical violence events. Notably, no adverse events including falls were reported during CH addition., Discussion: CH shows some short-term benefits in improving sleep disorders and reducing violent and agitated behavior in patients with TRS. Our study has limitations due to its small sample size, retrospective design and lack of a control group. A large-scale, double-blind, randomized trial is needed to further explore the efficacy and safety of CH in psychiatric populations with TRS accompanied by agitation, violence and disturbed sleep., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Shelef, Alaa, Bloemhof-Bris, Halperin, Weizman and Stryjer.)

Adherence to prescription medications is critical for both remission from schizophrenia and control of physical comorbidities. While schizophrenia with comorbid hypothyroidism is common, there is little research on adherence to hypothyroidism treatment in this population. The current study used a retrospective, matched case-control design. The cohort included 1,252 patients diagnosed with schizophrenia according to ICD-10 and 3,756 controls matched for gender, age, socioeconomic status and ethnicity without diagnosis of schizophrenia. All data were retrieved from the electronic medical database of a large health maintenance organization. Retrieved data included demographics, thyroid functionality test results and prescribed medications. Measures of adherence to therapy were used for analyses as were data from follow-ups of patients with hypothyroidism. A diagnosis of hypothyroidism was found in 299 patients, 115 of whom were also diagnosed with schizophrenia. The 184 without schizophrenia constituted the control group. No statistically significant differences were found between the two groups regarding prescriptions for L-thyroxin and TSH levels and number of TSH tests. Adherence of patients with schizophrenia to hypothyroidism treatment was found to be as good as that of individuals without a schizophrenia diagnosis., Competing Interests: The authors declare no competing interests exist., (© The Author(s) 2023.)

Objectives: The mechanism of inflammation of the immune system, for example, such circulatory markers as the neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV), has been shown in many studies to be associated with schizophrenia. In addition, it has been shown that the cannabidiol component reduces the activation of the acquired immune system. This study examined the differences in the levels of NLR and MPV among schizophrenia patients with cannabis use versus those without., Methods: In 2019 to 2020, a retrospective cross-sectional study was conducted based on digital medical records. Demographic, clinical, and complete blood cell count data were collected from records of rehospitalization of active psychotic schizophrenia inpatients. Data on NLR, MPV values, and demographic and clinical characteristics were compared between the groups and according to the degree of prevalence of cannabis use., Results: No differences were found in the NLR and MPV values between the groups., Conclusion: The results were contrary to our expectations. These results may be explained by the presentation of a "pseudo-balanced" picture created when multiple processes affect inflammatory indices., Competing Interests: Conflicts of Interest and Source of Funding: The authors have no conflicts of interest to declare., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

In 2021, overdose deaths surpassed the 100,000 mark for the first time in the United States' history, and alcohol-related deaths continue to surpass 140,000 each year. Regulatory and societal barriers to effective treatment and prevention of substance use disorder (SUD) persist. Innovative strategies and approaches to support long-term recovery can help re-duce morbidity and mortality associated with SUD. Improving access to quality treatment and the availability of a broad range of policies and programs to support recovery and address social determinants of health, including employment supports, are key to curbing the overdose epidemic and rebuilding stronger communities. This article outlines the role Recovery Ready Workplaces can play in reducing overdoses and helping individuals sustain recovery from SUD, as well as in strengthening communities. This article describes how congressional and state legisla-tive action, Americans with Disabilities Act (ADA) enforcement and expansion, and other programmatic and fiscal policy changes at the state and federal levels will accelerate the adoption of Recovery Ready Workplaces as an element of a comprehensive response to SUD. The article also identifies existing state models and proposes specific federal- and state-level solutions to address some of the current limitations. Recovery Ready Workplaces benefit employees, employers, and the nation's economy. Recovery Ready Workplaces are a supportive tool and policy strategy to help those with SUD thrive in recovery and to bolster communities and the econ-omy as a whole.

Rationale and Objective: At the beginning of vaccination against coronavirus disease 2019 (COVID-19), information about the effects of the vaccine was not known and hesitancy was observed among the population. The mental health staff members in our center in Israel had to decide whether to get vaccinated or not. The objective of this study was to evaluate the differences in demographic characteristics of vaccinated and nonvaccinated mental health care workers (HCWs), and to identify their reasons for or against vaccination., Method: Data on characteristics of 357 staff members at a mental health center (MHCS) in Israel and their attitudes regarding COVID-19 vaccination, those who were nonvaccinated, were collected via anonymous questionnaires, from 1 January to 10 January 2021. The groups were then compared using χ 2 , Fisher's exact tests, t test or Mann-Whitney nonparametric test as appropriate. A logistic regression was then performed using the significant variables and odd ratios presented., Results: Eighty-one per cent of the sample received at least the first dose of the vaccine. Results indicated differences in seniority (p < 0.001), profession (p < 0.001), department (p < 0.001), risk groups (p < 0.05), religion (p < 0.001), religiosity (p < 0.001), previous care for COVID-19 patients (p < 0.05) and level of interaction with patients (p < 0.01), between the vaccinated and nonvaccinated staff. The factor that was found to be most influential regarding vaccination and which convinced those originally against the vaccine to become vaccinated was the level of scientific knowledge about the vaccine., Conclusion: Efforts and resources should focus on the dissemination of reliable scientific data about the vaccine, to increase vaccination rates among mental HCWs., (© 2022 John Wiley & Sons Ltd.)

Background: Risk factors for severe coronavirus disease-2019 (COVID-19) infection include old age, chronic illness, and neurological conditions. In contrast, high vitamin D levels are known to augment immune activity and to reduce the severity of viral infections. Recently, a possible association between the likelihood of COVID-19 infection, COVID-19 severity, and vitamin D blood levels was reported., Objectives: To assess the possible association between vitamin D long-term supplementation and COVID-19 symptomatic severity and complications of COVID-19 infection in elderly psychiatric inpatients, a high at-risk group., Methods: We conducted a retrospective case series study. Data of 14 elderly COVID-19 positive inpatients, presenting with dementia or schizophrenia and other medical conditions were extracted from medical records. All patients maintained a 800 IU daily dose of vitamin D prior to the infection., Results: Most of the inpatients were asymptomatic or presented very few symptoms. No need for intensive care unit intervention or deaths were reported. Cognitive functioning of the patients remained unchanged., Conclusions: Pre-existing vitamin D supplementation may reinforce immunity and reduce COVID-19 severity in elderly psychiatric inpatients.

Many psychotic patients are treated with antipsychotic medications during acute agitation and aggressive behavior episodes in an attempt to achieve a rapid calming effect. Those medications include olanzapine, zuclopenthixol acetate, and haloperidol intramuscular administration. This study compared the effectiveness of these injections in reducing the need for restraint during agitated-psychotic episodes that include aggression. Sociodemographical and clinical data were retrieved from the electronic medical records of 179 patients who needed rapid calming while hospitalized in a mental health center with acute psychosis. The treatments administered were olanzapine intramuscular, zuclopenthixol acetate intramuscular, and haloperidol intramuscular. The assessed outcomes were rate of restraint and violent behavior. Olanzapine was found significantly more effective in reducing the need for restraint compared to zuclopenthixol acetate. No significant differences were found between haloperidol and the other two with regard to restraint. Neither were other significant differences found between the groups with regard to violent or self-harming behaviors. No significant differences were found in the rate of violent behavior and antipsychotic dosage at discharge. In conclusion, in inpatients with acute agitated psychosis, olanzapine intramuscular shows better efficacy in reducing the need for restraint, at least as compared to zuclopenthixol acetate intramuscular., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)