Drug Repositioning Ketamine as a New Treatment for Bipolar Disorder Using Text Mining

Bipolar Disorder (BD), a chronic mental illness, does not have an ideal treatment, and patients with BD have a higher chance of being diagnosed with alcohol abuse, liver disease, and diabetes. The goal of treatment is to prevent a relapse in BD episodes and find a new treatment. The research here looks at the genetics of BD and ignores environmental factors, as they are subjective. Therapy treats known environmental triggers and stressors and explores methods to reduce them. However, therapy alone cannot fully alleviate the symptoms of BD. My research employs text-mining as a primary strategy to obtain relevant genes and drugs pertaining to BD. The main gene involved is the Brain-Derived Neurotrophic Factor (BDNF). Popular drugs currently used for treatment of BD are Lithium and Carbamazepine. Using CMapPy to look at gene expression data, one sees a relationship between the two drug therapies and BDNF. Lithium fails to treat mania and Carbamazepine fails to treat depression, relatively speaking. When comparing gene expression data of Lithium and Carbamazepine with Ketamine, a newer therapy for BD, Ketamine, raises the BDNF level, keeps it elevated, and effectively controls BD episodes. Ketamine does not have the shortcomings that Lithium and Carbamazepine have. Next steps would include conducting a clinical trial with the hopeful application of Ketamine as a new treatment for BD.

Eventful past, stagnant present, and hopeful future: A time order analysis of experiences of homeless women with chronic mental illness residing in shelter care homes

Background: In developing countries like India, many women with mental illness are residing in shelter care homes (SCHs) without their wish. SCHs are residential facilities provided to the socially and economically backward women for free of cost. These facilities are funded by government or voluntary organizations. Aim: To understand the living experiences of homeless women with chronic mental illness (HWCMI) admitted in SCHs. Method: This article highlights learning from a qualitative study, 17 HWCMI participated in the research. Along with their past experiences, present life, and expectations in the future, other socio-demographic details also recorded. Qualitative data were analyzed using thematic analysis approach with the Atlas ti-8 software. Findings: Three main themes were emerged from the analysis such as ‘Eventful past’, ‘Stagnant present’, and ‘Hopeful future’. The theme ‘Eventful past’ shows clear pathways to homelessness. ‘Stagnant present’ reflects upon trapped present life and their concerns and care-related aspects. The final theme, ‘hopeful future’, depicts strong hope in future and readiness for changing their living situations. The findings are discussed in the background of current trends in psychiatric rehabilitation and what is lacking in the Indian context. Conclusion: This study attempts to unveil the gender-specific and person-centric explanations of experiences associated with the combination of homelessness and mental illness.

Intimate partner violence among reproductive-age women with chronic mental illness attending a psychiatry outpatient department: cross-sectional facility-based study, Addis Ababa, Ethiopia

ObjectiveTo determine the prevalence of intimate partner violence (IPV), and associated factors, in reproductive-aged women attending psychiatric outpatient departments.DesignCross-sectional facility-based study.SettingOutpatient psychiatric clinics of public hospitals in Addis Ababa.ParticipantsReproductive aged women with chronic mental illness (CMI) who attended follow-up in psychiatric outpatient clinics.Primary and secondary outcome measuresThe data were collected using a multi-culturally validated instrument from randomly sampled women with CMI. Multiple logistic regression was used to identify factors independently associated with IPV.ResultFour hundred and twenty-two women who were attending the psychiatric outpatient clinics took part in the study. The majority of participants 62.0% (95% CI 56.1 to 68.8) experienced IPV at least once in their lifetime. The most common form of IPV experienced by women was emotional violence (60%; 95% CI 55.0 to 64.7). One hundred and eighty-six (44.1%; (95% CI 39.3 to 48.8)) respondents experienced physical or sexual violence during the last year. A history of divorce (Adjusted Odds Ratio [AOR]=5.64; 95% CI 2.75 to 11.56) and having a mental illness for more than 5 years (AOR=2.23; 95% CI 1.26 to 3.93) were associated with any form of IPV.ConclusionThe high prevalence of IPV among women attending psychiatric outpatient services highlights the need to routinely inquire about IPV and develop effective strategies to prevent it among this vulnerable group.

Counseling of Patients with Severe Psychiatric Conditions and Referral to Smoking Cessations Programs

Background: Cigarette smoking and Nicotine dependence are highly prevalent in patients with severe and chronic mental illness. Psychiatric patients consume more cigarettes than general population. Smokers with chronic mental illness can quit smoking with appropriate intervention by smoking cessations programs. These patients can benefit from pharmacotherapy, but consideration should be given for possible interaction with patients’ psychiatric medications. Tobacco use and dependence need to be formally documents on electronic medical records and be offered a referral to smoking cessations programs. Method: All patients in a community rehabilitation service ward in Northwest London were interviewed to identify the type, quantity, and duration of their tobacco. Their electronic clinical records were reviewed to confirm their age, ICD 10 Primary Diagnosis, ICD10 Tobacco dependence diagnosis, medications they take, record of ECG tests and presence of cardiopulmonary problems. Then their records were checked if they were given advice regarding their smoking habit, desire to quit smoking and agreement to be referred to a smoking cessation program. Results and Discussion: Half of the total number of patients in the community psychiatric rehabilitation were cigarette smokers. Majority of the smokers had history of polysubstance abuse. Recording of current smoking status were not regularly update. Patients who had recorded status of being a smoker were all referred to a smoking cessation program and majority had counseling by the healthcare professionals in their unit. Attending the smoking cessation program in those patients have as good outcomes as general population. Conclusions: A substantial number of patients in psychiatric rehabilitation units smoke cigarettes. If their smoking status is accurately documented, they would be referred to a formal smoking cessation program.

Vocational rehabilitation for mental health service users with chronic mental illness in low-income to upper-middle-income countries: a scoping review protocol

IntroductionWork is integral to the occupations of human beings and accounts for up to a third of time spent in an average adult life. Occupational therapists play a role in vocational rehabilitation of mental health service users (MHSUs) with the aim of optimising their work participation. It is advisable that occupational therapists providing vocational rehabilitation to MHSUs with chronic mental illness in mental healthcare settings are guided by a practice framework developed for that particular context. This scoping review aims to summarise existing evidence on vocational rehabilitation for MHSUs in low-income to upper-middle-income countries. The findings will inform subsequent phases of research undertaken to formulate a vocational rehabilitation practice framework for MHSUs in Namibia.Methods and analysisThe scoping review will employ the five stage methodological framework proposed by Arksey and O’Malley. This will be used in conjunction with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISM-ScR) and Joanna Briggs scoping review guidelines. MESH terms, Boolean operators and truncation strategies will be employed for a comprehensive article search in electronic scholarly databases. These databases will include PsycINFO, EBSCOhost, HINARI, Google scholar, Medline, CINAHL, PubMed, Cochrane Library, Scopus, Science Direct and Wiley Online Library. Mendeley and Rayyan, both open source platforms, will be used for title, abstract and full-text screening, as well as data extraction. Data will be sifted and sorted by key categories and themes using a data charting form.Ethics and disseminationThe scoping review findings will be published in a peer-reviewed journal and presented at local and international conferences. Ethical clearance for this study will not be required as secondary data will be utilised and there are no patients involved.

Diabetes Prevalence and Risk Factors in Patients With Chronic Mental Illness on Second-Generation Antipsychotics

The rates of obesity and type 2 diabetes (T2D) are much higher in patients with chronic mental illness compared to the general population1. Second-generation antipsychotic medications (SGA) are clearly contributory to these adverse metabolic phenotypes2. Thus, annual monitoring of fasting plasma glucose (FPG) levels is recommended to screen for T2D in patients on SGA3. Of note, FPG, and also HbA1c, have poor sensitivities in detecting T2D early, with nearly 50% of cases being missed using either of the above tests when compared to oral Glucose Tolerance Testing (oGTT,4). We thus screened patients with schizophrenia, schizoaffective or bipolar disorder on SGA per oGTT. We hypothesized that we would identify more patients with T2D per oGTT compared to FPG or HbA1c testing alone. To identify risk factors for T2D, we also assessed BMI, waist/hip ratio, blood pressure, dietary habits (UKDDQ = UK Diabetes and Diet Questionnaire), physical activity records (3d pedometer records), measures of psychopathology, cognition (PHQ-9 = Patient Health Questionnaire, SLUMS = Saint Louis University Mental Status exam) as well as HOMA IR (Homeostatic Model Assessment of Insulin Resistance), Matsuda index and lipid profile. Data were analyzed using SPSS, comparing normal and prediabetic patients to patients with T2D (per oGTT criteria). Thus far, we screened 22 patients per oGTT and newly identified 5 patients with T2D (23%), only one patient had T2D per HbA1c criterion, 4 were identified per elevated FPG, 3 patients had elevated 2h plasma glucose levels. Patients with T2D had significantly lower Matsuda indices (p<0.0001); trends towards higher HOMA IR and waist/hip ratios were observed in diabetic compared to non-diabetic patients (p=0.08). Patients with T2D tended to be heavier, had worse dietary habits (higher UKDDQ scores), and surprisingly were less depressed (lower PHQ-9 scores) than non-diabetic patients (p<0.25). In conclusion, oGTT is more sensitive in identifying patients with T2D early compared to FPG or HbA1c alone. Matsuda indices, HOMA IR and waist/hip ratios may serve as additional markers to distinguish non-diabetic from diabetic patients. Since metabolic syndrome and diabetes are all risk factors for an increased cardiovascular mortality in patients with chronic mental illness, identifying and treating T2D early and aggressively should be primary goals of care in this high-risk patient population. References:1 Lean ME, Pajonk FG. Diabetes Care. 2003 May;26(5):1597–605.2 Allison DB, Mentore JL, Heo M, et al. Am J Psychiatry 1999 Nov;156(11):1686–1696.3 American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity. Diabetes Care. 2004 Feb;27(2):596–601.4 Cowie CC, Rust KF, Byrd-Holt DD, et al. Diabetes Care 2010 Mar;33(3):562–568.

Lithium and Atypical Antipsychotics: The Possible WNT/β Pathway Target in Glaucoma

Glaucoma is a progressive neurodegenerative disease that represents the major cause of irreversible blindness. Recent findings have shown which oxidative stress, inflammation, and glutamatergic pathway have main roles in the causes of glaucoma. Lithium is the major commonly used drug for the therapy of chronic mental illness. Lithium therapeutic mechanisms remain complex, including several pathways and gene expression, such as neurotransmitter and receptors, circadian modulation, ion transport, and signal transduction processes. Recent studies have shown that the benefits of lithium extend beyond just the therapy of mood. Neuroprotection against excitotoxicity or brain damages are other actions of lithium. Moreover, recent findings have investigated the role of lithium in glaucoma. The combination of lithium and atypical antipsychotics (AAPs) has been the main common choice for the treatment of bipolar disorder. Due to the possible side effects gradually introduced in therapy. Currently, no studies have focused on the possible actions of AAPs in glaucoma. Recent studies have shown a down regulation of the WNT/β-catenin pathway in glaucoma, associated with the overactivation of the GSK-3β signaling. The WNT/β-catenin pathway is mainly associated with oxidative stress, inflammation and glutamatergic pathway. Lithium is correlated with upregulation the WNT/β-catenin pathway and downregulation of the GSK-3β activity. Thus, this review focuses on the possible actions of lithium and AAPs, as possible therapeutic strategies, on glaucoma and some of the presumed mechanisms by which these drugs provide their possible benefit properties through the WNT/β-catenin pathway.