Browsing by Author "Rancans, Elmars"

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    Anxiety Screening among the General Population of Latvia and Associated Factors
    (2022-08-26) Vinogradova, Vineta Viktorija; Kivite-Urtane, Anda; Vrublevska, Jelena; Rancans, Elmars; Department of Psychiatry and Narcology; Institute of Public Health; Department of Public Health and Epidemiology
    Background and Objectives: The aim of this study was to determine the point prevalence of at least mild anxiety symptoms and symptoms of generalized anxiety disorder in the Latvian general population, and to analyze the associated factors. Materials and Methods: A computer-assisted face-to-face survey was conducted in 2019–2020 with a multistage stratified probability sample of the Latvian general adult population (n = 2687). Anxiety was assessed using the 7-item Generalized Anxiety Disorder (GAD-7) scale; a score of ≥5 was defined as indicating the presence of mild symptoms of anxiety, and a score of ≥10 as the cutoff for identifying cases of generalized anxiety disorder. The Patient Health Questionnaire 9 (PHQ-9) and MINI International Neuropsychiatric Interview (M.I.N.I.) modules were used for assessing comorbid conditions. Multinomial logistic regression was conducted. Results: The point prevalence of mild anxiety symptoms was 10.9%. The point prevalence of generalized anxiety disorder symptoms was 3.9%. Higher odds of mild anxiety symptoms were detected in respondents of a young age (vs. 65 y.o. and older, aOR 3.1, p < 0.001), unmarried respondents (vs. married/cohabiting, aOR 1.5, p = 0.02), those living in the capital city (aOR 1.6, p = 0.008) or rural areas (aOR 1.5, p = 0.03) (vs. other towns), respondents with poor self-rated health (vs. good, aOR 2.6, p < 0.001), and diagnosed alcohol use disorder (aOR 1.9, p < 0.001), suicidal behavior (aOR 2.4, p < 0.001), and symptoms of depression (aOR 6.4, p < 0.001) (vs. no such conditions). As for symptoms of generalized anxiety disorder, female sex (vs. males, aOR 2.5, p = 0.003), age below 44 years (vs. 65+, aOR 6.2, p = 0.002), average self-rated health (vs. good, aOR 2.6, p = 0.005), and poor self-rated health (vs. good, aOR 5.3, p < 0.001), together with comorbid suicidal behavior (aOR 6.1, p < 0.001) and symptoms of depression (aOR 43.4, p < 0.001) (vs. no such conditions), increased the odds. Conclusions: Young age, poor self-rated health, and comorbid symptoms of depression and suicidal behavior were significant factors associated with symptoms of both mild anxiety and generalized anxiety disorder. Being unmarried, living in the capital city or rural areas, and alcohol use disorder were associated with mild anxiety symptoms alone. Female sex was associated with generalized anxiety disorder symptoms alone.
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    Assessment and Treatment of Negative Symptoms in Schizophrenia-A Regional Perspective
    (2022-02-04) Bitter, Istvan; Mohr, Pavel; Raspopova, Natalia; Szulc, Agata; Samochowiec, Jerzy; Micluia, Ioana Valentina; Skugarevsky, Oleg; Herold, Róbert; Mihaljevic-Peles, Alma; Okribelashvili, Nino; Dragašek, Jozef; Adomaitiene, Virginija; Rancans, Elmars; Chihai, Jana; Maruta, Natalia; Marić, Nadja P; Milanova, Vihra; Tavčar, Rok; Mosolov, Sergey; Department of Psychiatry and Narcology
    Clinicians and researchers consider that there are a variety of symptoms that constitute negative symptoms in schizophrenia, and they may use different definitions for the same symptoms. These differences are also reflected in a variety of negative symptom rating scales. Both research and clinical work are negatively affected by the lack of consensus regarding the symptoms that constitute negative symptoms in schizophrenia. Leading research groups have investigated ways to reduce heterogeneity in the domain of negative symptoms in schizophrenia; however, little attention has been paid to regional differences in the concepts of negative symptoms in schizophrenia. The objective of this review was to collect and summarize information about the assessment and treatment of negative symptoms of schizophrenia in Central and Eastern Europe (CEE). Nineteen experts from 17 countries in CEE participated in this project. The participants collected information about their countries, including the following: (1) the most important publications about negative symptoms in schizophrenia (irrespective of the time of their publication); (2) the most frequently used negative symptom of schizophrenia in clinical practice; (3) definitions of frequently used negative symptoms; and (4) treatment of negative symptoms in schizophrenia. The participating experts/countries most frequently reported the following five negative symptoms: avolition, blunted affect, alogia, asociality, and anhedonia. Several experts also considered other symptoms as belonging to the negative symptom domain, such as a decrease in energy level and changes in personality. The importance of evaluating the long-term course and the relationship between negative symptoms and other symptom domains was also noted. No noticeable differences were reported in the treatment of negative symptoms compared to currently published guidelines and algorithms. The most frequently reported negative symptoms included those defined by the NIMH-MATRICS consensus statement on negative symptoms and recently endorsed in a guidance paper of the European Psychiatric Association. The main differences in the concepts, names, and definitions of primary negative symptoms, especially those related to personality changes, and to the evaluation of the long-term course and relationship between different symptom domains in CEE compared to the current English language literature deserve the attention of psychiatrists and other professionals in this field.
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    Association of depression and anxiety with the 10-year risk of cardiovascular mortality in a primary care population of Latvia using the SCORE system
    (2018-06) Ivanovs, Rolands; Kivite, Anda; Ziedonis, Douglas; Mintale, Iveta; Vrublevska, Jelena; Rancans, Elmars; Department of Psychiatry and Narcology; Department of Public Health and Epidemiology
    Background: Depression and anxiety have been recognized as independent risk factors for both the development and prognosis of cardiovascular (CV) diseases (CVD). The Systematic Coronary Risk Evaluation (SCORE) function measures the 10-year risk of a fatal CVD and is a crucial tool for guiding CV patient management. This study is the first in Latvia to investigate the association of depression and anxiety with the 10-year CV mortality risk in a primary care population. Methods: This cross-sectional study was conducted at 24 primary care facilities. During a 1-week period in 2015, all consecutive adult patients were invited to complete a nine-item Patient Health Questionnaire (PHQ-9) and a seven-item Generalized Anxiety Disorder scale (GAD-7) followed by sociodemographic questionnaire and physical measurements. The diagnostic Mini International Neuropsychiatric Interview (M.I.N.I.) was administered by telephone in the period of 2 weeks after the first contact at the primary care facility. A hierarchical multivariate analysis was performed. Results: The study population consisted of 1,569 subjects. Depressive symptoms (PHQ-9 ≥ 10) were associated with a 1.57 (95% confidence interval (CI): 1.06-2.33) times higher odds of a very high CV mortality risk (SCORE ≥ 10%), but current anxiety disorder (M.I.N.I.) reduced the CV mortality risk with an odds ratio of 0.58 (95% CI: 0.38-0.90). Conclusions: Our findings suggest that individuals with SCORE ≥ 10% should be screened and treated for depression to potentially delay the development and improve the prognosis of CVD. Anxiety could possibly have a protective influence on CV prognosis.
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    Beliefs in Conspiracy Theories and Mental Health in the Student Community of Latvia During the COVID-19 Outbreak
    (2023-10) Vorobjova, Julija; Pilaga, Sindija Mairita; Mikelsone, Madara; Rancans, Elmars; Smirnova, Daria; Fountoulakis, Konstantinos N; Vrubļevska, Jeļena; Statistics Unit; Department of Psychiatry and Narcology
    BACKGROUND: The objective of this study was to investigate self-reported changes in mental health and their association with various sociodemographic factors and beliefs in conspiracy theories among university and college students in Latvia during the second state of emergency caused by COVID-19. SUBJECTS AND METHODS: This cross-sectional study was conducted as part of an international research project, where university and college students were anonymously asked to complete an online self-report questionnaire. Changes in anxiety and depression were assessed using self-rated questions. Statistical analysis involved Pearson's chi-square test and univariate binary logistic regression.ression. RESULTS: The study comprised 1047 students, with 828 females (79.08% aged 21.71±0.09). Worsening in self-reported anxiety was more prevalent among females (69.3%, p<0.001), unemployed respondents (70.0%, p=0.003), individuals who were were not working during the lockdown (70.3%, p<0.001), those experiencing deterioration in general health condition (93.0%, p<0.001), and those belonging to or having knowledge of someone in a vulnerable group (69.5%, p=0.004). Worsening self-reported depression was more prevalent in respondents who did not work during the lockdown (63.9%, p=0.014) and those with deteriorating general health conditions (93.0%, p<0.001). Increased odds ratios (OR) for experiencing changes in anxiety and depression were associated with beliefs in the following conspiracy theories: 'Recommended measures are an attempt to restrict human rights' (OR=1.49, p=0.019 and OR=2.40, p<0.001, respectively). Furthermore, increased OR for experiencing changes in depression were associated with beliefs in the following conspiracy theories: 'The COVID-19 vaccine was ready before the virus spread' (OR=3.11, p=0.007), 'COVID-19 has a lower mortality rate" (OR=1.85, p<0.001)', 'Recommended measures are an attempt to restrict human rights' (OR=2.40, p<0.001), and 'The COVID-19 outbreak is the creation of world leaders' (OR=2.17, p=0.003). CONCLUSIONS: Self-reported changes in depression and anxiety were associated with certain beliefs in specific conspiracy theories.
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    CRITERION-BASED VALIDITY OF THE DEPRESSION SCALE OF LATVIAN CLINICAL PERSONALITY INVENTORY
    (Rēzeknes Tehnoloģiju akadēmija, 2017) Perepjolkina, Viktorija; Kolesnikova, Jelena; Martinsone, Kristine; Stepens, Ainars; Rancans, Elmars; Lubkina, Velta; Zvaigzne, Anda; Rīga Stradiņš University
    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.
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    Determinants of Anxiety in the General Latvian Population During the COVID-19 State of Emergency
    (2022) Vrublevska, Jelena; Perepjolkina, Viktorija; Martinsone, Kristine; Kolesnikova, Jelena; Krone, Ilona; Smirnova, Daria; Fountoulakis, Konstantinos N.; Rancans, Elmars; Department of Psychiatry and Narcology; Institute of Public Health; Komunikācijas fakultāte; Department of Health Psychology and Paedagogy
    Background: The COVID-19 pandemic and its restrictive public health measures have seriously affected mental health of society. Social, psychological, and health-related factors have been linked to anxiety in the general population. Aim: We investigate the association of various sociopsychological and health-related determinants of anxiety and identify the predicting factors for anxiety in the general population during the COVID-19 state of emergency from in Latvia. Methods: We conducted an online survey using a randomized stratified sample of the general adult population in July 2020 for 3 weeks. Anxiety symptoms were measured using the State-Trait Anxiety Inventory (STAI-S). Sociodemographic, health-related, sociopsychological characteristics and suicidality were identified using the structured questionnaire. The statistical analysis included Pearson's chi-square test, post hoc analysis, and binomial logistic regression. Results: The weighted study sample included 2,608 participants. The mean STAY-S score of the total sample was 22.88 ± 12.25. In the total sample, 15.2% (n = 398) of participants were classified as having anxiety. The odds ratio (OR) of having anxiety was higher in females (OR = 2.44; 95% CI 1.75–3.33) and people who had experienced mental health problems in the past (OR = 1.45; 95% CI 1.03–2.04), had suicide attempt in the past (OR = 1.68; 95% CI 1.08–2.59), were worried about their health status due to COVID-19 (OR = 1.64; 95% CI 1.36–1.16), were worried about stigmatization from others if infected with COVID-19 (OR = 1.18; 95% CI 1.03–1.35), were worried about information regarding COVID-19 from the Internet (OR = 1.24; 95% CI 1.08–1.43), persons who were lonely (OR = 1.90; 95% CI 1.54–2.34), and persons with negative problem orientation (OR = 1.26; 95% CI 1.06–1.51). Protective factors were identified as having good self-rated general health (OR = 0.68, 95 % CI 0.58–0.81), maintaining a daily routine (OR = 0.74, 95 % CI 0.61–0.90), having financial stability (OR = 0.66, 95 % CI 0.55–0.79), and having good psychological resilience (OR = 0.90, 95 % CI 0.87–0.94). Conclusions: This is the first study to report a prevalence of anxiety in the general population of Latvia. Certain factors that predict anxiety, as well as protective factors were identified.
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    Domu par pašnāvību saistība ar depresijas simptomu izteiktības pakāpi un personības iezīmēm senioriem : pilotpētījuma rezultāti
    (Rēzeknes Tehnoloģiju akadēmija, 2018) Lubenko, Jelena; Perepjolkina, Viktorija; Martinsone, Kristine; Rancans, Elmars; Stepens, Ainars; Lubkina, Velta; Šneidere, Kristīne; Ušča, Svetlana; Rīga Stradiņš University
    Healthy aging and the research on the related factors is one of the World Health Organization's priorities for the 2020-2030 years. Depression and suicidal ideation can adversely affect an individual's aging experience. Personality traits are important factors that allow to predict the individual's behavior in different situations, as well as the accurance of emotional difficulties. The aim of the study was to investigate the relationship between symptoms of depression, suicidal ideation and personality traits in elderly, and to determine whether the relationship between personality traits and suicidal ideation remains statistically significant after controlling the severity of depression symptoms. Thirty nine respondents aged 65 and over were included in the pilot study (M = 71.23; SD = 4.95). The Latvian Clinical Personality Inventory (LCPI) was used for data collection. The results indicate a statistically significant relationship between several personality traits, depression symptoms and suicidal ideation for elderly. Controlling the severity of depression symptoms, statistically significant correlations were found between suicidal ideation and personality traits such as distrust, social withdrawal, self-harm, dissociation proneness on facet level and introversion on domain level. The results of the pilot study largely coincide with the results of previous studies and indicate that certain personality traits, irrespective of the degree of severity of depression symptoms, can explain an additional variation in suicidal thoughts and, hence, the risk of suicide for elderly. It would be important to conduct a study with similar variables in a larger sample.
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    Dosing Cariprazine Within and Beyond Clinical Trials : Recommendations for the Treatment of Schizophrenia
    (2022-01-05) Rancans, Elmars; Dombi, Zsófia Borbála; Barabássy, Ágota; Department of Psychiatry and Narcology
    Although the optimal dosing of an antipsychotic medication is known to be essential in the long-term management of schizophrenia, in case of novel drugs such as cariprazine, determining the right dosing strategy is not that simple. Without decades of experience with a particular compound, evidence regarding dosing and titration comes primarily from double-blind, placebo controlled clinical trials that are not necessarily mirroring the real-life experiences of doctors. Via summarizing data from both clinical data (n = 3275) and real-world evidence (observational study n = 116, case studies n = 29), this perspective paper aims to shed a light on the appropriate dosing strategies of cariprazine from treatment initiation through switching strategies to concomitant medications.
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    The effect of different degrees of lockdown and self-identified gender on anxiety, depression and suicidality during the COVID-19 pandemic : Data from the international COMET-G study
    (2022-09) Fountoulakis, Konstantinos N; Karakatsoulis, Grigorios N; Abraham, Seri; Rancans, Elmars; Vrubļevska, Jeļena; COMET-G collaboration; Department of Psychiatry and Narcology; Institute of Public Health
    Introduction: During the COVID-19 pandemic various degrees of lockdown were applied by countries around the world. It is considered that such measures have an adverse effect on mental health but the relationship of measure intensity with the mental health effect has not been thoroughly studied. Here we report data from the larger COMET-G study pertaining to this question. Material and Methods: During the COVID-19 pandemic, data were gathered with an online questionnaire from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Anxiety was measured with the STAI, depression with the CES-D and suicidality with the RASS. Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. Statistical Analysis: It included the calculation of Relative Risk (RR), Factorial ANOVA and Multiple backwards stepwise linear regression analysis Results: Approximately two-thirds were currently living under significant restrictions due to lockdown. For both males and females the risk to develop clinical depression correlated significantly with each and every level of increasing lockdown degree (RR 1.72 and 1.90 respectively). The combined lockdown and psychiatric history increased RR to 6.88 The overall relationship of lockdown with severity of depression, though significant was small. Conclusions: The current study is the first which reports an almost linear relationship between lockdown degree and effect in mental health.
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    Effectiveness of self-help groups and psychotherapy : Self-assessment of patients with substance use disorders
    (2012) Sudraba, Velga; Millere, Inga; Rancans, Elmars; Rīga Stradiņš University; Department of Nursing and Obstetric Care; Department of Psychiatry and Narcology
    Background and Objective. The basis of substance use disorders (SUD) is formed withregard to biopsychosocial aspects. By following the SUD biological model exclusively, the effectiveness of treatment is limited since all the formation aspects of SUD are not taken into account. By using the psychosocial model, however, the understanding and treatment of a substance use illness becomes enhanced and is more effective. A key role in this model is played by self-help groups and psychotherapy. The aim of this study was to determine the viewpoint of patients with substance use disorders in terms of the number of visits, duration of treatment, efficacy of self-help groups, and individual and group psychotherapy in different treatment methods. Material and Methods. The participants were approached by researchers at two drug and alcohol services in Latvia. In total, 587 patients received questionnaires developed by the authors of the study. Results. All the 587 questionnaires of both outpatient respondents (n=200, 34.1%) and inpatient respondents (n=387, 65.9%) were analyzed. Of all the outpatient department respondents, 41.5% (n=83) attended self-help groups, 28.5% (n=57) individual psychotherapy, and 14.5% (n=29) group psychotherapy; the inpatient department respondents were 2 to 4 times less often involved in the measures. Conclusions. The outpatient respondents were more frequently employed. They attended selfhelp groups and psychotherapy and obtained longer remission comparing with inpatient respondents. This study has shown that patients had a greater success rate in staying in remission, maintaining outpatient care and shedding the need of inpatient care.
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    Examining the synergistic effects of a cognitive control video game and a home-based, self-administered non-invasive brain stimulation on alleviating depression : the DiSCoVeR trial protocol
    (2023-02) Dechantsreiter, Esther; Padberg, Frank; Morash, Alon; Kumpf, Ulrike; Nguyen, Arthur; Menestrina, Zeno; Windel, Fabienne; Burkhardt, Gerrit; Goerigk, Stephan; Morishita, Takuya; Soldini, Aldo; Ahissar, Shira; Cohen, Tamar; Pasqualotto, Angela; Rubene, Linda; Konosonoka, Liene; Keeser, Daniel; Zill, Peter; Assi, Razan; Gardier, Rémy; Viñals, Roser; Thiran, Jean-Philippe; Segman, Ronen; Benjamini, Yuval; Bonne, Omer; Hummel, Friedhelm Christoph; Bavelier, Daphne; Rancans, Elmars; Nahum, Mor; Department of Psychiatry and Narcology
    Enhanced behavioral interventions are gaining increasing interest as innovative treatment strategies for major depressive disorder (MDD). In this study protocol, we propose to examine the synergistic effects of a self-administered home-treatment, encompassing transcranial direct current stimulation (tDCS) along with a video game based training of attentional control. The study is designed as a two-arm, double-blind, randomized and placebo-controlled multi-center trial (ClinicalTrials.gov: NCT04953208). At three study sites (Israel, Latvia, and Germany), 114 patients with a primary diagnosis of MDD undergo 6 weeks of intervention (30 × 30 min sessions). Patients assigned to the intervention group receive active tDCS (anode F3 and cathode F4; 2 mA intensity) and an action-like video game, while those assigned to the control group receive sham tDCS along with a control video game. An electrode-positioning algorithm is used to standardize tDCS electrode positioning. Participants perform their designated treatment at the clinical center (sessions 1-5) and continue treatment at home under remote supervision (sessions 6-30). The endpoints are feasibility (primary) and safety, treatment efficacy (secondary, i.e., change of Montgomery-Åsberg Depression Rating Scale (MADRS) scores at week six from baseline, clinical response and remission, measures of social, occupational, and psychological functioning, quality of life, and cognitive control (tertiary). Demonstrating the feasibility, safety, and efficacy of this novel combined intervention could expand the range of available treatments for MDD to neuromodulation enhanced interventions providing cost-effective, easily accessible, and low-risk treatment options.ClinicalTrials.gov: NCT04953208.
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    Factors Related to COVID-19 Preventive Behaviors : A Structural Equation Model
    (2021-07-05) Šuriņa, Sanita; Martinsone, Kristine; Perepjolkina, Viktorija; Kolesnikova, Jelena; Vainik, Uku; Ruža, Aleksejs; Vrublevska, Jelena; Smirnova, Daria; Fountoulakis, Konstantinos N.; Rancans, Elmars; Department of Health Psychology and Paedagogy; Komunikācijas fakultāte; Department of Psychiatry and Narcology; Institute of Public Health
    Background: While COVID-19 has rapidly spread around the world, and vaccines are not widely available to the general population, the World Health Organization outlines preventive behavior as the most effective way to limit the rapid spread of the virus. Preventive behavior is associated with a number of factors that both encourage and discourage prevention. Aim: The aim of this research was to study COVID-19 threat appraisal, fear of COVID-19, trust in COVID-19 information sources, COVID-19 conspiracy beliefs and the relationship of socio-demographic variables (gender, age, level of education, place of residence, and employment status) to COVID-19 preventive behavior. Methods: The data originate from a national cross-sectional online survey (N = 2,608) undertaken in July 2020. The data were analyzed using structural equation modeling. Results: COVID-19 threat appraisal, trust in COVID-19 information sources, and fear of COVID-19 are all significant predictors of COVID-19 preventive behaviors. Together they explain 26.7% of the variance of this variable. COVID-19 conspiracy beliefs significantly negatively predict COVID-19 threat appraisal (R2 = 0.206) and trust in COVID-19 information sources (R2 = 0.190). COVID-19 threat appraisal contributes significantly and directly to the explanation of the fear of COVID-19 (R2 = 0.134). Directly, as well as mediated by COVID-19 conspiracy beliefs, threat appraisal predicts trust in COVID-19 information sources (R2 = 0.190). The relationship between COVID-19 threat appraisal and COVID-19 preventive behaviors is partially mediated by fear of COVID-19 (indirect effect 28.6%) and trust in information sources (15.8%). Socio-demographic variables add very little in prediction of COVID-19 preventive behavior. Conclusions: The study results demonstrate that COVID-19 threat appraisal is the most important factor associated with COVID-19 preventive behavior. Those Latvian residents with higher COVID-19 threat appraisal, experienced higher levels of fear of COVID-19, had more trust in COVID-19 information sources, and were more actively involved in following COVID-19 preventive behaviors. COVID-19 conspiracy beliefs negatively predict COVID-19 threat appraisal and trust in COVID-19 information sources, but not the COVID-19 preventive behaviors. Socio-demographic factors do not play an important role here.
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    Implementing the Latvian Early Intervention Program (LAT-EIP) for Patients With Schizophrenia Spectrum First-Episode Psychosis : Study Protocol
    (2019-11-13) Berze, Liene; Civcisa, Sandra; Krone, Ilona; Kvartalovs, Dmitrijs; Kikuste, Sarmite; Sapele, Inna; Lazovika, Jelena; Rancans, Elmars; Department of Psychiatry and Narcology
    Background: Patients with first-episode psychosis are mainly young people in the active phase of their social and professional lives, and psychosis is a serious disruption of normal life with high risk of disability. Integrated biopsychosocial early intervention treatment is crucial for patients with first-time psychosis episode. The purpose of this trial is to adapt the first early intervention program for patients with first-time non-affective psychosis in Latvia, and to investigate whether it is possible to integrate this kind of treatment approach in the frame of existing services and whether it provides better outcomes for patients than existing services. Design/Methods: The study has a nonrandomized controlled design in a real-life environment. Participants are all consecutive patients presenting in the psychiatric emergency room with first-time non-affective schizophrenia spectrum psychosis episode (ICD criteria F23, F20) from a catchment area of 262,541 inhabitants, with urban and rural regions. The Latvian Early Intervention Program is a 6-month program developed from existing treatment guidelines and recommendations and adapted to a low-resource environment, integrated in an existing outpatient unit. This study aimed to test the hypothesis that the patients who received intervention have milder symptoms, higher functioning, and better adherence to outpatient treatment. The study primary aims are: 1) to establish and examine in practice the adapted early intervention for patients with first schizophrenia spectrum psychosis; 2) compare clinical and functional outcomes (including occupation, housing, and social relationships) between intervention treatment and standard treatment; and 3) compare the number of rehospitalizations, adherence to outpatient treatment, and assigned disability. Secondary aims are: 1) to compare full recovery status in both treatment groups at 12 months follow-up and 2) to develop recommendations for establishing early intervention programs in limited resource settings. Discussion/Conclusions: Across the world, there is wide inequality in the availably and accessibility to early intervention treatment. This study will increase our knowledge in early intervention treatment approach and outcomes for patients with schizophrenia spectrum first psychosis episode in real-life working clinical practices. We hope to provide theoretical and practical aspects to develop strategies for early intervention service implementation in limited resource mental healthcare settings.
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    Intramuscular long-acting paliperidone palmitate in acute patients with schizophrenia unsuccessfully treated with oral antipsychotics
    (2015-04-03) Hargarter, Ludger; Cherubin, Pierre; Bergmans, Paul; Keim, Sofia; Rancans, Elmars; Bez, Yasin; Parellada, Eduard; Carpiniello, Bernardo; Vidailhet, Pierre; Schreiner, Andreas; Department of Psychiatry and Narcology
    In this prospective multicentre, open-label, 6-month study (Paliperidone Palmitate Flexible Dosing in Schizophrenia [PALMFlexS]), tolerability, safety and treatment response with paliperidone palmitate (PP) were explored in patients with acute symptoms of schizophrenia following switching from previously unsuccessful treatment with oral antipsychotics. This pragmatic study was conducted in a large, more representative sample of the general schizophrenia population compared to randomized controlled pivotal trials, to specifically mimic real-world clinical situations. After initiation on Day 1 and Day 8, patients received PP once monthly at flexible doses (50-150 mg eq.) intramuscularly. The primary efficacy outcome was defined as the percentage of patients achieving ≤ 30% improvement in PANSS total score from baseline (BL) to last-observation-carried-forward (LOCF) endpoint (EP). Safety and tolerability assessments included Extrapyramidal Symptom Rating Scale (ESRS) total score and treatment-emergent adverse events (TEAEs). Overall, 212 patients received PP at least once after switching from oral antipsychotics, primarily due to lack of efficacy (45.8%). Significant improvements from BL in mean (SD) PANSS total score were observed from Day 8 onwards (BL to LOCF EP: -. 31.0 [29.0]; p. < 0.0001). At endpoint, two-thirds (66.7%) and 43.5% of patients achieved a ≤ 30% and ≤ 50% improvement in mean PANSS total score, respectively. PP was associated with significant improvements across secondary measures of symptom severity, subjective well-being, medication satisfaction, illness-related disorders of activity and participation, and patient functioning (p. < 0.0001; BL to LOCF EP). PP was generally well tolerated, with significant reductions in ESRS total score (p < 0.0001) and mainly mild-to-moderate TEAEs. TEAEs reported in ≤ 5% of patients were injection-site pain (13.7%), insomnia (10.8%), psychotic disorder (10.4%), headache and anxiety (both 6.1%). The PALMFlexS study findings provide valuable pragmatic clinical data on PP treatment in patients with acute schizophrenia previously unsuccessfully treated with oral antipsychotics.
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    Intravenous vortioxetine to accelerate onset of effect in major depressive disorder: a 7-day randomized, double-blind, placebo-controlled exploratory study
    (2020-11) Rancans, Elmars; Zambori, Janos; Dalsgaard, Mads; Baayen, Corine; Areberg, Johan; Ettrup, Anders; Florea, Ioana; Department of Psychiatry and Narcology
    This 7-day randomized, double-blind, placebo-controlled fixed-dose study (NCT03766867) explored the potential for accelerating the onset of antidepressant efficacy of single-dose intravenous (IV) vortioxetine at oral vortioxetine treatment initiation. Patients (ages 18-65 years) hospitalized per standard-of-care with major depressive disorder, who were currently treated with a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor for a major depressive episode [Montgomery-Åsberg Depression Rating Scale (MADRS) total score ≥ 30], received one dose of single-blind IV placebo (1-day placebo lead-in period) before being randomly switched to either single-dose IV vortioxetine 25 mg plus daily oral vortioxetine 10 mg (n = 39), or IV placebo plus daily oral placebo (n = 41). In the placebo lead-in period, patients improved slightly by 0.6 MADRS-6 point; however, at day 1 after randomization, both treatment groups had improved by approximately 3 MADRS-6 points (mean difference =-0.8; P = 0.263), the study thus not meeting its primary endpoint. Similar results were seen for other outcomes except a numerically larger improvement in anxiety symptoms with vortioxetine vs placebo. Pharmacokinetic data confirmed that IV vortioxetine facilitated reaching steady-state plasma concentration within 24 h. IV plus oral vortioxetine was well tolerated, with low levels of nausea as the most common adverse event.
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    Prevalence and associated factors of mental disorders in the nationwide primary care population in Latvia : a cross-sectional study
    (2020-04-07) Rancans, Elmars; Renemane, Lubova; Kivite-Urtane, Anda; Ziedonis, Douglas; Department of Psychiatry and Narcology; Department of Public Health and Epidemiology
    Background: Mental disorders are common amongst patients in primary care. There are no published studies on the prevalence of mental disorders in primary care patients in Latvia. The purpose of the study was to evaluate the current prevalence of mental disorders in the nationwide Latvian primary care population and to study possible associated factors and comorbidity of mental disorders. Methods: A cross-sectional study within the framework of the National Research Program BIOMEDICINE 2014-2017 was performed at 24 primary care settings across Latvia. Adult patients seen over a 1-week time period at each facility were invited to participate in the study. Sociodemographic variables (age, sex, education, employment and marital status, place of residence, and ethnicity) were assessed onsite. A Mini-International Neuropsychiatric Interview assessment was conducted over the telephone within 2 weeks after the visit to the general practitioner (GP). Results: Overall, 1485 individuals completed the interview. The current prevalence of any mental disorder was 37.2% and was significantly greater in women. Mood disorders (18.4%), suicidality (18.6%) and anxiety disorders (15.8%) were the most frequent diagnostic categories. The current prevalence of any mood disorder was associated with being 50-64 years of age, female sex, economically inactive status, divorced or widowed marital status and urban place of residence, whilst any current anxiety disorder was associated with female sex, lower education, and single marital status; however, being of Russian ethnicity and residing in a small city were protective factors. Suicidality was associated with female sex, lower education, unemployment or economically inactive status, being divorced or widowed and residing in a small city. The comorbidity rates between mental disorders varied from 2.9 to 53.3%. Conclusions: High prevalence rates of mental disorders, comorbidity and certain associated socio-demographic factors were found in primary care settings in Latvia. This highlights the importance of screening for depression and anxiety disorders and suicidal risk assessment by GPs. The results are fundamentally important for integrative medicine, monitoring and promotion of mental healthcare at the primary care level, as well as for healthcare policy and development of strategic plans in Latvia.
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    Prevalence of Distress and Depression and Related Health and Behavioural Factors in the Student Population of Latvia during the COVID-19 Outbreak
    (2023-02-01) Vorobjova, Julija; Pilaga, Sindija Mairita; Gustsone, Beatrise Elizabete; Rancans, Elmars; Smirnova, Daria; Fountoulakis, Konstantinos N.; Vrublevska, Jelena; Department of Psychiatry and Narcology; Institute of Public Health
    The COVID-19 pandemic, which has spread across the world, has made an impact on every student's ordinary life and mental health, from studying conditions, internship, employment to freedom of movement. This was a cross-sectional study where Latvian university and college students were asked to fill the self-report online questionnaire developed as part of an international study. The objective of the study was to investigate the effects of COVID-19 pandemic and investigate clinical depression, distress and identify the predicting factors. Depression and distress were determined using the Center for Epidemiologic Studies Depression Scale (CES-D) with a previously developed algorithm and cut-off scores. The statistical analysis included the Pearson's chi-square test and binomial logistic regression. The study included 1047 students. The prevalence of distress was 18% (n =188) and prevalence of depression was 33.8% (n = 354). Depression was more common among women-35.9 % (n = 298). Risk factors for depression were poor quality of sleep (OR = 8.31), unemployment (OR = 1.42), excessive internet usage (OR = 7.17), thoughts about death (OR = 12.14), and suicidal behaviour (OR = 4.99). Physical activities operated as a protective measure to prevent depression. This study potentially could help to develop a plan in the future for dealing with psychological support for the student population.
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    A prospective flexible-dose study of paliperidone palmitate in nonacute but symptomatic patients with schizophrenia previously unsuccessfully treated with oral antipsychotic agents
    (2014-11-10) Schreiner, Andreas; Bergmans, Paul; Cherubin, Pierre; Keim, Sofia; Rancans, Elmars; Bez, Yasin; Parellada, Eduard; Carpiniello, Bernardo; Vidailhet, Pierre; Hargarter, Ludger; Department of Psychiatry and Narcology
    Implications The PALMFlexS study is a pragmatic interventional study compared with randomized controlled trials, conducted in a large, more representative sample of patients with schizophrenia, and designed specifically to mimic real-world clinical situations. The findings support the results from randomized controlled studies. The findings support results from randomized controlled studies. They also demonstrate that a clinically relevant treatment response is possible in patients who are considered to be clinically stable by their physician, supporting the use of flexibly dosed PP in such patients. Clinical trials.gov number: NCT01281527. Purpose The goal of this study was to explore the tolerability, safety, and treatment response of flexible doses of once-monthly paliperidone palmitate (PP) in the subset of nonacute but symptomatic adult patients with schizophrenia previously unsuccessfully treated with oral antipsychotic agents in the PALMFlexS (Paliperidone Palmitate Flexible Dosing in Schizophrenia) study. Methods This was an interventional, single-arm, international, multicenter, unblinded, 6-month study performed in patients with schizophrenia. Patients were categorized according to reasons for switching. In patients switching because of lack of efficacy or for other reasons, primary efficacy outcomes were the proportion achieving treatment response (defined as ≥20% improvement in Positive and Negative Syndrome Scale [PANSS] total score from baseline to last-observation-carried-forward end point) and maintained efficacy (defined as noninferiority in the change in PANSS total score at end point versus baseline [Schuirmann's test]), respectively. Findings A total of 593 patients (intention-to-treat population) were enrolled: 63.1% were male; their mean (SD) age was 38.4 (11.8) years; and 78.6% had paranoid schizophrenia. The main reasons for transition to PP were patient's wish (n = 259 [43.7%]), lack of efficacy (n = 144 [24.3%]), lack of compliance (n = 138 [23.3%]), and lack of tolerability (n = 52 [8.8%]) with the previous oral antipsychotic medication. The recommended PP initiation regimen (150 milligram equivalents [mg eq] day 1 and 100 mg eq day 8) was administered in 93.9% of patients. Mean PANSS total score decreased from 71.5 (14.6) at baseline to 59.7 (18.1) at end point (mean change, -11.7 [15.9]; 95% CI, -13.0 to -10.5; P < 0.0001). Sixty-four percent of patients showed an improvement of ≥20% in PANSS total score, and the percentage of patients rated mildly ill or less in Clinical Global Impression-Severity increased from 31.8% to 63.2%. Mean personal and social performance total score (SD) increased (ie, improved) significantly for all patients from baseline to end point (58.1 [13.4] to 66.1 [15.7]; P < 0.0001).
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    A prospective follow-up study of first-episode acute transient psychotic disorder in Latvia
    (2014-02-06) Rusaka, Marija; Rancans, Elmars
    Background: Acute and transient psychotic disorder (ATPD) has been described as an acute psychosis with brief onset and polymorphous symptomatology (WHO, 1993). The study of ATPD is growing increasingly relevant as scientists start an active discussion of the possibility of changing the ATPD classification in the next International Classification of Diseases (ICD-11). The aims of this study were to describe the clinical features of the index episode of ATPD in patients in Latvia, to analyse the stability and longitudinal changes of the diagnosis, to explore potential correlations between the sociodemographic and disease characteristics and to describe stressful life events before the first ATPD episode.Methods: A prospective follow-up study of all first-time admitted patients from the Riga Centre of Psychiatry and Addiction Disorders who fulfilled the ICD-10 criteria for ATPD (WHO, 1993) during the 15-month period from 9 January 2010 to 30 March 2011 and followed up until 31 October 2012. Stressful life events, demographics and clinical features during the index episode were assessed.Results: One hundred two patients were admitted with first-episode ATPD. The majority were females (60.7%). Over an average 26.5-month follow-up period, 59.8% of the patients were not readmitted. The overall stability rate of ATPD diagnosis in our sample was 67.4% (p = 0.0001). In the subgroup of patients who were readmitted, 70.7% had their diagnosis converted to schizophrenia in subsequent visits. Stressful life events before the first episode were found in 49.0% of first-episode ATPD patients. Thought disorder was found to be the strongest statistically significant predictor of ATPD diagnosis conversation to schizophrenia (odds ratio 4.3), with high Wald's criterion (9.435) in binary logistic regression.Conclusions: ATPD is prevalent in Latvia, with rather high overall stability rate. Combining these data from first-episode ATPD patients in Latvia with data from other countries may help predict the development of the disease and provide a basis for potential changes to ICD-11.
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    Relationship of suicide rates to economic variables in Europe : 2000-2011
    (2014-12-01) Fountoulakis, Konstantinos N.; Kawohl, Wolfram; Theodorakis, Pavlos N.; Kerkhof, Ad J.F.M.; Navickas, Alvydas; Höschl, Cyril; Lecic-Tosevski, Dusica; Sorel, Eliot; Rancans, Elmars; Palova, Eva; Juckel, Georg; Isacsson, Goran; Korosec Jagodic, Helena; Botezat-Antonescu, Ileana; Warnke, Ingeborg; Rybakowski, Janusz; Azorin, Jean Michel; Cookson, John; Waddington, John; Pregelj, Peter; Demyttenaere, Koen; Hranov, Luchezar G.; Injac Stevovic, Lidija; Pezawas, Lucas; Adida, Marc; Figuera, Maria Luisa; Pompili, Maurizio; Jakovljević, Miro; Vichi, Monica; Perugi, Giulio; Andrasen, Ole; Vukovic, Olivera; Mavrogiorgou, Paraskevi; Varnik, Peeter; Bech, Per; Dome, Peter; Winkler, Petr; Salokangas, Raimo K.R.; From, Tiina; Danileviciute, Vita; Gonda, Xenia; Rihmer, Zoltan; Forsman Benhalima, Jonas; Grady, Anne; Kloster Leadholm, Anne Katrine; Soendergaard, Susan; Nordt, Carlos; Lopez-Ibor, Juan; Department of Psychiatry and Narcology
    Background: It is unclear whether there is a direct link between economic crises and changes in suicide rates. Aims: The Lopez-Ibor Foundation launched an initiative to study the possible impact of the economic crisis on European suicide rates. Method: Data was gathered and analysed from 29 European countries and included the number of deaths by suicide in men and women, the unemployment rate, the gross domestic product (GDP) per capita, the annual economic growth rate and inflation. Results: There was a strong correlation between suicide rates and all economic indices except GPD per capita in men but only a correlation with unemployment in women. However, the increase in suicide rates occurred several months before the economic crisis emerged. Conclusions: Overall, this study confirms a general relationship between the economic environment and suicide rates; however, it does not support there being a clear causal relationship between the current economic crisis and an increase in the suicide rate.