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Introduction: Suicidal behavior is prevalent among individuals with mental disorders and constitutes a major global, clinical, and public health concern. It is generally accepted that the majority of persons who die by suicide are suffering from psychiatric disorders in most cases and that affective disorders make up the single commonest group. Suicide risk is highest during the years immediately following the onset of affective disorders; therefore, identifying risk factors and successful treatment of initially non-suicidal individuals with affective disorders can prevent developing suicidal behavior, help detecting, and predict it. Clarifying risk factors for individual types of major affective disorders could enhance earlier identification of suicidal risk, support preventive interventions and improve the treatment and prognosis of individuals at risk. We have developed a study protocol with the aim to address the complex interaction of endocrine parameters, lithium trace concentrations and cognitive functions with affective disorders and risk of suicidal behavior. Method: A cross-sectional study will be done among individuals hospitalized after a suicidal attempt for treatment of affective disorders (group 1), hospitalized for the treatment of affective disorders without life time history of suicidal behavior (group 2), and control group individuals without life time history of mental disorders or suicidal behavior (group 3). Based on this study design we calculated the appropriate study sample size (N = 210). Venous blood samples of study participants will be collected for the evaluation of endocrine parameters, serum lithium concentrations, liver and kidney function. Data on sociodemographic factors, cognitive functions, history of mental disorders, and suicidality risk will be evaluated using validated questionnaires and instruments. Associations of endocrine parameters, serum lithium concentrations, cognitive functions, and suicidality risk will be analyzed using descriptive and inferential statistics, including linear and logistic regression. Based on this study design we calculated the appropriate study sample size (N = 210). Power analysis has shown that this sample size is appropriate for detection of significant differences between the groups. Conclusion: The findings of the potential influence of the associations between serum lithium trace concentrations, endocrine parameters, and cognitive functions on suicidality risk in individuals with affective disorders may help clinicians effectively plan suicide prevention and timely implement actions for treatment. [ABSTRACT FROM AUTHOR]

Introduction: It is known that symptoms of major depressive disorder (MDD) are associated with neurodegeneration, that lipopolysaccharide (LPS) can induce symptoms of MDD, and that blood LPS levels are elevated in neurodegeneration. However, it is not known whether blood LPS and cytokine levels correlate with MDD, cognition and brain structure, and this is tested in this study. Methods and analysis: This cross-sectional study includes individuals with MDD (n = 100) and a control group of individuals with no one-year history of a mental disorder (n = 50). A comprehensive evaluation is performed, including the collection of basic sociodemographic information, data on smoking status, body mass index, course of MDD, past treatment, comorbid diseases, and current use of medications. Diagnosis of MDD is performed according to the WHO's [2019] International Classification of Diseases and related health problems by psychiatrist and severity of MDD is evaluated using the Montgomery–Åsberg Depression Scale. The Cambridge Neuropsychological Test Automated Battery is used to evaluate cognitive functioning. Venous blood samples are taken to measure genetic and inflammatory markers, and multiparametric brain magnetic resonance imaging is performed to evaluate for blood-brain barrier permeability, structural and neurometabolic brain changes. Descriptive and inferential statistics, including linear and logistic regression, will be used to analyse relationships between blood plasma LPS and inflammatory cytokine concentrations in MDD patients and controls. The proposed sample sizes are suitable for identifying significant differences between the groups, according to a power analysis. Administrative information: Trial registration: Clinicaltrials.gov NCT06203015. [ABSTRACT FROM AUTHOR]

The high rates of comorbidity with substance use disorders in general psychiatry patients demand enhanced competences from psychiatry residents in addiction medicine. The aim of this article is to improve knowledge, skills and attitudes in psychiatric residents in treating patients with comorbid substance-related disorders (SUD). Four seminars with all residents on relevant and actual knowledge on substance-related disorders and a small group experience of five sessions on improving skills and attitudes in dealing with patients are described and evaluated quantitatively and qualitatively. Both quantitative evaluations show that seminars and small group experiences are highly appreciated. Concerning the seminar, residents appreciated, in particular, to study and present selected up-to-date literature and the positive learning environment. The small group experience resulted in sharing feelings and thoughts about patients with SUD and mutual support. The results show that the goals of these two methods of education have been met. This means that these two methods can be integrated in the training of residents in psychiatry to increase knowledge, skills and attitudes concerning addiction.

Purpose: While the pivotal role of pharmacotherapy in psychiatry is universal, significant regional differences exist in drug use patterns. Herewith we compare the use of ATC psychotropic drugs (N05, psycholeptics and N06A, antidepressants) in 2010–2015 in the three Baltic Countries with reference to the Nordic Countries. Methods: Data were obtained from the national authorities on medicines as expressed in DDD per 1000 inhabitants per day. A semi-structured questionnaire was used for expert statements on the rationale of current use of medicines. Results: During the observation period the use of antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants steadily increased, while the growth in use of anxiolytics stagnated in the more recent years. Antipsychotic use was the largest in Lithuania and the lowest in Estonia. The use on anxiolytics in Lithuania was more than twice of that in Estonia and Latvia. Conversely, the use of hypnotics and sedatives was about three times higher in Estonia than in Latvia or Lithuania. Antidepressant use was dominated by the selective serotonin reuptake inhibitors in all three countries, but overall was much lower in Latvia as compared to Lithuania and Estonia. As compared to the Nordic Countries in 2015, antidepressants are used at much lower level throughout Baltics, probably reflecting underdiagnostics of depression and anxiety disorders. Conclusion: While the health-care expenditures in Estonia, Latvia and Lithuania are largely similar, as is the cultural and recent political background of these EU member countries, the extent and the pattern of psychotropic drug use is remarkably variable. [ABSTRACT FROM AUTHOR]

Aims Alcohol consumption is a well-established risk factor in suicidal behaviour, but there is still discussion about which factor might imply greater suicide risk—acute alcohol intoxication or being a problems drinkers. The aim of this study was to analyse the association between a suicide attempt and the drinking pattern and to evaluate the risk factors for suicide attempt among problem drinkers versus non-problem drinkers. Short summary We found that problem drinking (CAGE ≥2) is an important issue in suicide attempts. Factors predicting suicide attempt among problem drinkers were male gender, younger age, being married or in a partnership status, low education and acute alcohol intoxication prior a suicide attempt. Methods A cohort study was performed including all cases of patients (n = 425) hospitalized in the Lithuanian University of Health Sciences after a suicide attempt. Participants completed a self-administered questionnaire that included questions on sociodemographic characteristics, the nature of the suicide attempt, the question of alcohol consumption prior to the suicide attempt and a CAGE questionnaire screening for problem drinking (CAGE ≥ 2). Results Two-thirds (70.9%) of male and 43.2% of female suicide attempters were problem drinkers. Problem drinking versus non-problem drinking increased the risk of suicide attempt especially according to gender (3.2 times for male), age (1.08 times for younger age), marital status (among married or in a partnership—1.58 times), education level (among < 12 years—2.04 times) and acute alcohol intoxication prior a suicide attempt (8.15 times—among intoxicated). Conclusions Our results highlight that being a problem drinker as well as the use of alcohol at the time of the event is an important issue in suicide attempt,. [ABSTRACT FROM AUTHOR]

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Introduction. Glucocorticoids are a commonly prescribed class of medication used to suppress the immune system and decrease inflammation. Since their introduction they became widely used to effectively treat a wide range of illnesses - allergies, connective tissue, skin, lung diseases, cancer and to prevent transplant rejection. However, they have many adverse effects, which range from diabetes mellitus, osteoporosis and arterial hypertension to mental disorders. Case report. For a 49 year old man, after 1 year of chronic glomerulonephritis caused renal insufficiency, renal transplantation was scheduled. Illness was complicated with secondary third grade hypertension. There was no history of mental disorders and use of psychotropic drugs. Before the transplantation standard induction of imunosupression was given: intravenous methylprednisolone 250mg and mycophenolate mofetil 500 mg oral administration. After operation transplanted kidney started to function immediately. Standard postoperative imunosupressive treatment according to the kidney transplantation protocol: calcineurin inhibitors (cyclosporine 4mg/kg/ day, later in accordance to its concentration in blood), mycophenolate mofetil 1g two times per day and methylprednisolone 1mg per kilo (70mg), then gradually reducing the dose and in 2-3 weeks reaching maintenance dose (8mg per day). On the eighth day after kidney transplantation patient became psychomotorically agitated, visual hallucinations appeared, persecutory delusions, became disoriented in time, cooperation process has been difficult, thinking viscous, nonproductive. Differential diagnosis was carried out: subarachnoid haemorrhage and hypertensive crisis induced encephalopathy was rejected after the head CT scan. After psychiatrist's consultation delirium syndrome was diagnosed. 5 mg of haloperidol was prescribed intramuscular injection for treatment. Since the psychiatric symptoms have not been improving, the dosage was increased up to maximum 18 mg/d., methylprednisolone dose was further reduced according to the protocol. In continuing treatment with antipsychotics and decreasing glucocorticoid dosage, psychomotoric agitation, disorientation and delusions has been reduced. Conclusions. To patients that had no previous psychiatric symptoms before kidney transplantation, even when using glucocorticoids according to standard immunosuppression scheme, delirium syndrome might occur. Therefore it is essential to monitor all patients for this adverse effect and teach them and their family members to recognize the symptoms of mental disorders and explain that they should inform their physician about this. [ABSTRACT FROM AUTHOR]

This article presents data on the phenomenology of delusions of persecution and poisoning in patients with schizophrenia and determines parallels between sociodemographic status and personal religiosity and this type of delusions. We have studied the content of delusions in patients with schizophrenia looking for persecution and poisoning themes using Fragebogen fuer psychotische Symptome (FPS). A total of 295 patients suffering from schizophrenia participated in this study; 74.7% reported delusions of persecution. The proportion of female patients (81.9%) who felt persecuted was almost one-third higher than the proportion of male patients (66.9%). The prevalence of delusions of persecution was lower in the group of persons for whom their faith was personally important (73.4%) than in the atheistic group (86.7%). Delusions of persecution and poisoning were strongly intercorrelated. Delusions of poisoning were reported by 57.8% of respondents: 54.8% by male and 60.6% by female patients. In multivariate analysis, delusions of persecution were more prevalent in women compared to men; in those with a chronic course of illness compared to those with periodic course; in those with small size of family compared to those with large family. The presence of delusions of being poisoned was related to older age of the patient, higher than secondary education, chronic course of schizophrenia, and younger parental age. Personal importance of the faith was not associated with prevalence of delusions of persecution and poisoning in patients with schizophrenia.

Mirtazapine is an established antidepressant with well-documented efficacy demonstrated in controlled clinical trials. However, the gap between the results obtained in controlled clinical trials and everyday clinical practice exists. Therefore, the importance of naturalistic studies in psychiatry is becoming recognized. The aim of present naturalistic study was to acquire data on efficacy, safety, and preference of mirtazapine orally disintegrating tablets during a 17-week treatment of depression. This prospective, open-label, multicenter study in patients with mild to severe depression was conducted at 47 mental health centers of Lithuania by 78 psychiatrists. Patients were initially given 15 mg or 30 mg of mirtazapine orally disintegrating tablets; the maximum allowed dose was 45 mg per day. The primary efficacy measure was the total score on the Hamilton Depression Rating Scale-17 (HAMD-17), the Clinical Global Impression-Severity (CGI-S), and Clinical Global Impression-Improvement (CGI-I) scales. Tolerability was primarily measured by assessing the incidence of treatment-emergent adverse events. Patients were evaluated at baseline, at weeks 1, 5, 9, 13, and 17. A total of 779 patients (595 women [76.4%] with a mean [SD] age of 50.2 [13.65] and 184 men [23.6%] with a mean [SD] age of 52.4 [14.6] years) were enrolled into the study; 687 (88.2%) patients completed the study. The mean (SD) daily dose of mirtazapine orally disintegrating tablets was 29.0 (3.8) mg. The mean total (SD) HAMD-17 score improved significantly from 25.7 (4.6) to 7.3 (4.3) (P<0.005). At each visit, the mean HAMD-17 score was significantly lower than that at the preceding visit. At week 17, remission (HAMD-17 score < or =7) was observed in 436 (56%) patients. The mean (SD) CGI-S score improved significantly from 4.9 (1.0) at baseline to 1.5 (0.6) at endpoint (P<0.001). According to the CGI-I assessments, 621 patients (89.4%) improved and improved very much. The vast majority of patients (80%) preferred the new formulation of mirtazapine - mirtazapine orally disintegrating tablet. Treatment-emergent adverse events occurred in 106 patients (13.6%). The most frequent adverse events were weight gain, sedation, dizziness, and dry mouth. In this study conducted in Lithuania with depressed patients, a significant improvement was shown in all efficacy measures. In addition, mirtazapine orally disintegrating tablet was a well-tolerated and preferable formulation for the treatment of depressed patients.

Unlabelled: The aim of this study was to study and compare externalizing and internalizing difficulties, clinical problems of adolescent girls who attempted a suicide and delinquent girls. A total of 100 adolescent girls aged 11-18 years have participated in this study: 50 of them were suicide attempters, and the other 50 girls had problems of delinquent behavior. In this study, the questionnaire ASEBA YSR 11-18 was used. To compare averages, Student's t and Mann-Whitney's U tests were applied with a 0.05 level of statistical significance. For adolescent girls who attempted a suicide, more prominent internal difficulties were identified. They were more depressive/anxious, presented more somatic complains, and were more closed/anxious. Those girls felt more anxiety and presented more affective problems. The difference in the average scores of scales of the both groups was statistically significant (P<0.05). Externalizing problems of adolescent suicide attempters did not significantly differ from ones of the girls with delinquent behavior. The average scores of scales on braking of rules and aggression were not significantly different. Girls with delinquent behavior had a higher social competency, and the girls who attempted a suicide more often presented significant social difficulties, though there was no statistically significant difference in the scores on the activity competence scale., Conclusions: The adolescent girls who attempted a suicide have more evident internal difficulties than delinquent girls do, though externalizing behavior difficulties of the suicide attempters are similar to those of girls with delinquent behavior. The girls who attempted a suicide experience more social difficulties, and their social competency is lower when comparing to delinquent girls of the same age.

Bipolar disorder in adolescents is a serious mental illness with problematic diagnosis that adversely affects social, academic, emotional, and family functioning. The objective of this study was to analyze features of premorbid and clinical symptoms, comorbidity, and course of bipolar disorder in adolescence. Data for analysis were collected from all case histories (N=6) of 14-18-year-old patients, hospitalized with diagnosis of bipolar disorder in the Unit of Children's and Adolescents' Psychiatry, Department of Psychiatry, Hospital of Kaunas University of Medicine, during the period from 2000 to 2005. Analysis of bipolar disorder course showed that five patients previously had been diagnosed with an episode of depression. The most frequent symptoms typical to bipolar disorder were disobedience and impulsive behavior, rapid changes of mood. The most common premorbid features were frequent changes of mood, being active in communication, hyperactive behavior. Adolescence-onset bipolar disorder was frequently comorbid with emotionally instable personality disorder, borderline type. Findings of the study confirm the notion that oppositional or impulsive behavior, rapid changes of mood without any reason, dysphoric mood and euphoric mood episodes with increased energy were cardinal symptoms of bipolar disorder with mania in adolescents. Most frequent premorbid features of these patients were quite similar to attention-deficit/hyperactivity disorder making differential diagnosis problematic.

Objective: To study the correlation between adolescents' psychical disorders and their difficulties of psychosocial adaptation., Methods and Materials: There were 63 adolescent participants in our study (47 girls and 16 boys) who were hospitalized in Department of Children and Adolescent Psychiatry, Kaunas University of Medicine Hospital (Lithuania) during the period from September to December, 2005. Twenty-seven adolescents (19 girls and 8 boys) had suicidal and self-harming behavior. Psychical disorders were diagnosed according to ICD-10 diagnostic criterions. We used Strengths and Difficulties Questionnaire SDQ-lit adapted for Lithuania., Results: While comparing the mean scores in both sexes of adolescents with diagnoses of depressive, behavioral and adaptation disturbances, we found a statistically significant difference only in emotionally disturbance scale results (p=0.016). Analyzing groups of girls and boys separately, girls showed to be worse psychosocially adapted and had more emotional problems. Girls who tried to commit suicide had more emotional (p=0.006) and psychosocial problems (p<0.001). Girls who were diagnosed with affective disorders had more expressed emotional (p<0.001) and general adaptation (p=0.031) difficulties. Parents noted that those who committed a suicide and had behavior disturbances had more expressed emotional (p=0.007) and general adaptation (p=0.053) problems., Conclusions: 1. Adolescent girls who were diagnosed depressive illnesses had more emotional and general adaptation problems than girls who were diagnosed behavior or adaptation disorders. 2. Adolescent girls who tried to commit suicide had more expressed behavior problems and difficulties of emotional, general adaptation. 3. Most expressed difficulties of emotional and general adaptation were typical to girls who were diagnosed with depression and who tried to commit a suicide.

As many as 60% of the patients do not follow the therapy recommended by their physicians. An important factor that can influence patient's compliance is the physician's opinion about the tolerability and safety of prescribed medication. However, the efforts of both parties, not only physician but also patient, have benefits on the outcome of treatment. Patient's opinion on choosing the form of medication is appropriate way ensuring better compliance. The aim of the survey was to ascertain the opinion of depressed patients towards a new formulation of antidepressant drug, mirtazapine - orally disintegrating tablet Remeron SolTab. The study was approved by Lithuanian State Medicines Control Agency and local Ethics Committee. A total of 453 depressed patients were included in the survey. Most of the patients used a 30-mg dose of Remeron SolTab (n=344, 75.88%). Most of the patients (n=189, 41.81%) had a positive opinion about the taste of medication ("very pleasant"). According to the results of the survey, 281 (61.95%) used Remeron SolTab regularly. However, 129 (28.54%) patients noted that the new drug formulation had no influence on the regularity of use. Statistically significantly more patients (81.86%) noted that they would choose Remeron SolTab compared to the patients who would prefer conventional form of the medication (2.21%). In 184 (40.71%) patients, a significant mood improvement was noted. Most of the patients (n=246, 54.20%) indicated that mood improved. Based on the results of the survey it can be concluded that patient will prefer the drug (or its new formulation) he/she liked and thus will follow physician's instructions and cooperate with physician more closely. A limitation of this study relates to the study design and questionnaire itself, since it was not validated in appropriate way. However, the results of the survey are in line with the results of the similar surveys from other countries and reflect the general tendencies towards antidepressant use.