The modern psychiatric crisis has become a global epidemic as the prevalence of psychiatric disorders continues to rise. These numbers have only been exacerbated by the COVID-19 pandemic, and the long-term psychological effects resulting from the social isolation and fear of the disease have yet to be seen. Those already suffering from psychiatric disorders have limited options for treatment, as current therapeutic methods for mood, anxiety, and substance use disorders demonstrate high failure rates with many individuals suffering from treatment resistance. Individuals that do respond to modern therapies typically require treatment for several weeks or months, occasionally even years, before experiencing any reductions in their symptoms. Tryptamine psychedelics have been used for millennia by indigenous cultures through highly ritualized religious ceremonies to purge individuals of disease and offer spiritual guidance, however their application within modern medicine did not begin until Albert Hofmann’s discovery of LSD in 1938. The next several decades saw an explosion in clinical studies involving tryptamine psychedelics showcasing their ability to demonstrate immediate treatment after single doses in individuals suffering from diseases such as depression and PTSD, however research and clinical practices came to a halt after the passing of the Controlled Substances Act of 1970. As renewed interest in psychedelic medicine continues to grow, this review details the therapeutic potential of tryptamine psychedelics while exploring their current status within clinical trials.

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The affective disorders (anxiety and depression) are common psychiatric disorders that primarily involve disturbances in mood and represent the second leading source of disease burden world-wide. A wide base of evidence supports a significant genetic contribution to these disorders. Polymorphic variation in the promoter region (5-HTTLPR) of the human serotonin transporter (hSERT) gene, which leads to a life-long alteration in serotonin transporter (SERT) expression and functioning, has been implicated in the aetiology of both anxiety and depression. Despite the strong evidence implicating a role for this polymorphism in affective psychopathology the underlying mechanism by which genetically determined SERT bioavailability influences affective functioning are not understood. In these studies I attempt to elucidate the alterations in cerebral, serotonin (5-HT) system and hypothalamo-pituitary-adrenal (HPA) axis functioning which may relate to the effect of the 5-HTTLPR on affective functioning by characterising these parameters in an animal model of genetically increased SERT expression (hSERT over-expressing mice; hSERT OVR). Furthermore, as gender influences both the likelihood of developing affective disorders and the impact of the 5-HTTLPR on affective functioning, with a greater effect being observed in females than in males, we characterise these parameters in mice of both genders. The data presented in this thesis demonstrate that the life-long increase in SERT bioavailability present in hSERT OVR mice produces profound alterations in cerebral, serotonin system and HPA axis functioning. Furthermore, the influence of increased SERT expression upon cerebral and serotonin system functioning is greater in females than in males. Additionally, a number of sexually dimorphic variations in serotonin system functioning were identified. Thus this thesis extends the currently available information regarding the underlying mechanisms by which gender and a life-long alteration in SERT expression may influence the risk of affective psychopathology.

Objective: According to the Joint Commission (2012), about 80% of serious medical errors are related to miscommunication between healthcare providers. The Joint Commission (2012) recommended the utilization of standardized communication tools to reduce the number of medical errors related to the miscommunication. The Situation-Background-Assessment-Recommendation (SBAR) communication tool is a standardized tool that has been used to improve the effectiveness of communication between healthcare providers. The purpose of this project was to evaluate the effectiveness of using SBAR communication tool for warm handoff between primary care providers and behavioral health providers in order to provide a continuous and complete transition of care for patients with psychiatric disorders or psychosocial issues. Method: A mixed method design was implemented in an integrated primary care clinic at two locations in Phoenix, Arizona. A brief presentation about the SBAR tool and copies of the SBAR tool was provided for the clinic staff. Data were gathered from four participants (two nurse practitioners and two behavioral health workers) using structured observation, pre-and post-test surveys, and structured interviews. Length of study was one month. Results: During the data collection, there were 40 observed warm handoffs, 12 unobserved warm handoffs between primary care nurse practitioners and behavioral health workers. Seventy-five percent of the participants felt that the SBAR helped them in organizing their thoughts and providing/obtaining adequate information during warm handoff. They reported satisfaction when using the SBAR tool. There was no statistically significant difference in the scores of collaboration and satisfaction about care decisions between pre and post-SBAR intervention. Conclusion: The SBAR communication tool has the potential to improve communication between primary care providers and behavioral health workers to improve the quality and safety of care for patients with psychosocial concerns. Utilizing SBAR may increase teamwork and ensures adequate hand-off information on the warm handoff. Multiple PDSA cycles should be conducted to refine the change and make it applicable and sustainable in the integrated care setting.

Introduction Patients with serious psychiatric disorders have an increased morbidity and mortality in somatic diseases and elevated prevalence of both diabetes and prediabetes. This increased frequency of somatic diseases is believed to be associated with life style choices and side effects of the antipsychotic medication. Aim In our study we investigated the prevalence of diabetes and prediabetes and compared metabolic risk factors and treatments between patients with and without serious psychiatric disorders in patients with diabetes in Region Örebro County (RÖC). Material and methods The prevalence of diabetes and prediabetes was determined in 944 patients identified from psychiatric outpatient clinics in RÖC. Information about risk factors and treatments were acquired by retrospective examination of medical records. Results Diabetes was identified in 113 patients and prediabetes in 42 patients. In patients with diabetes and serious psychiatric disorders men had significantly higher levels of HbA1c (p<0.01) and creatinine (p<0.01) compared to women, whereas women had higher BMI (p<0.05). No significant differences in HbA1c and BMI were found between patients with psychiatric disorders and all patients in RÖC with diabetes. Patients with psychiatric disorders did however have a significantly higher number of current smokers and a lower prescription of antihypertensive medication. Conclusions The prevalence of diabetes and prediabetes were 12.0% and 4.4%, respectively, in patients with serious psychiatric disorders. Our study indicates no difference in glycaemic control between psychiatric and non-psychiatric patients with diabetes, but there are differences in certain risk factors connected to diabetes.

Introdução: Transtornos psiquiátricos são comuns em pacientes com doenças pulmonares obstrutivas. Portadores de asma de difícil controle manifestam estes transtornos com freqüência superior àqueles com asma controlada. Entre os pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) os sintomas de depressão podem estar relacionados à incapacidade progressiva e as limitações das atividades de vida diária. O objetivo do estudo foi verificar a presença de sintomas de ansiedade e depressão entre os portadores de asma e DPOC. Método: Foram avaliados os instrumentos específicos de quantificação de sintomas de ansiedade e depressão, IDATE e BDI respectivamente, respondidos por pacientes do ambulatório de asma e DPOC. A população constitui-se de 189 pacientes selecionados de três grupos de estudo com objetivos terapêuticos diferentes, sendo 140 asmáticos e 49 portadores de DPOC. Entre as variáveis destes estudos constavam sintomas de ansiedade e depressão como parte da metodologia. Os dados obtidos foram comparados levando-se em consideração aspectos demográficos, funcionais e de gravidade. Resultados: Entre os pacientes asmáticos foi significativamente maior a prevalência de ansiedade moderada e grave quando comparados com aqueles com DPOC (p<0,05). Em relação a depressão, o grupo de asma não controlada apresentou resultados significativamente maiores quando comparado ao grupo de asma controlada (p<0,05). Conclusão: Entre os pacientes asmáticos a freqüência de sintomas de ansiedade e depressão foi maior que entre aqueles com DPOC, o que pode dificultar o controle clínico / Introduction: Psychiatric disorders appear to be common in obstructive pulmonary disease patients. Difficult to control asthmatics show higher frequency of these disorders than controlled asthmatics. In Chronic Obstructive Pulmonary Disease (COPD) patients the depression symptoms may be related to progressive disability and limitations in daily living activities. Our objective was to verify the presence of anxiety and depression symptoms between asthmatic and COPD patients. Methods: Evaluation of anxiety and depression symptoms questionnaires, STAI and BDI respectively, from asthmatics and COPD outpatients clinics. It was a comparative study with 189 patients, 140 asthmatics and 49 with COPD. These patients were enrolled in three different treatment protocols: controlled asthmatics, not controlled asthmatics and stable COPD; all studies measured anxiety and depression symptoms in methodology. Data among groups were analyzed and correlated through demographic, functional and gravity aspects. Results: Moderate and severe anxiety symptoms in asthmatics were significantly higher when compared with COPD group (p<0,05). Not controlled asthmatics showed depression values significantly higher when compared with asthma controlled group (p<0,05). Conclusion: This study showed that anxiety and depression symptoms frequency is higher between asthmatics when compared to COPD patients, which may prevent a good clinical control

Base teórica e objetivo: Cefaléia tensional crônica e enxaqueca têm incidências de 22,63% e 17,89%, respectivamente, entre estudantes universitários. Neste estudo foram analisados fatores associados ao impacto da cefaléia crônica na vida diária de estudantes universitários, especialmente a influência de um screening positivo para rastreamento de transtornos psiquiátricos menores. Métodos: Este estudo transversal incluiu 372 estudantes universitários. Os instrumentos de avaliação foram: um questionário com perguntas sóciodemográficas, um questionário com perguntas para estabelecer o diagnóstico da cefaléia, de acordo com a Sociedade Internacional de Cefaléia (IHS), o Short- Form Headache Impact Test (HIT-6) , uma escala visual analógica, a escala de sonolência Epworth , o Alcohol Use Disorders Identification Test (AUDIT) , e o WHO Self-Reporting Questionnaire-20 . Regressão multivariada foi utilizada para determinar fatores independentes associados ao impacto da cefaléia crônica. Resultados: As razões de prevalência (RP) da associação entre o impacto severo da cefaléia crônica sobre a vida diária e transtornos psiquiátricos menores foi de 2,78, na análise que incluiu com todos os estudantes. Porém, quando foi analisado o subgrupo com cefaléia crônica, esta RP aumentou para 4,04. Enxaqueca e cefaléia crônica tensional tiveram RP de 3,41 e 10,09, respectivamente. Outros co-fatores independentes associados à severidade do impacto da cefaléia foram: sexo feminino (RP =2,01), sonolência diurna (RP =2,37), menor desempenho acadêmico (RP =2,14) e mãe com menos anos de escolaridade (RP=1,07). Conclusão: A identificação de uma associação entre transtornos psiquiátricos menores e o grau de incapacidade determinado pela cefaléia crônica entre estudantes universitários pode ser útil para investigações mais aprofundadas de uma relação causal entre o impacto negativo da cefaléia na qualidade de vida, transtornos psiquiátricas maiores, desempenhos acadêmico e profissional. / Background: Chronic tension headache and migraine have incidences of 22.63% and 17.89% among university students. This study assessed factors associated with the impact of chronic headache on everyday life, especially the influence of a positive screening for minor psychiatric disorders. Methods: This cross-sectional study included 372 university students. Assessment instruments were a questionnaire with socio-demographic questions and the diagnosis of headache according to the International Headache Society (IHS), Short-Form Headache Impact Test (HIT-6), a visual analog scale, Epworth Sleepiness Scale, Alcohol Use Disorders Identification Test (AUDIT), and the WHO Self-Reporting Questionnaire-20. Multivariate conditional regression modeling was used to determine independent predictors of impact of chronic headache. Results: The prevalence odds ratio (OR) of association between severe impact of chronic headache on everyday life and minor psychiatric disorders was of 2.78 in the analysis with all students. However, when analyzed the subgroup with chronic headache, this OR increased to 4.04. Migraine and chronic tension headache had an OR of 3.41 and 10.09, respectively. Other independent cofactors associated with the severity of the impact of headache were female gender (OR =2.01), daytime sleepiness (OR=2.37), lower scholastic performance (OR=2.14) and mother with fewer years of schooling (OR=1.07). Conclusions: The identification of an association between minor psychiatric disorders and the severity of the disability of chronic headache among university students may be useful towards opening up possibilities for further investigation of a causal relation between the negative impact of headache and quality of life, major psychiatric disorders, and academic and professional performance.

This review focuses on nicotine comorbidity in schizophrenia, and the insight into this problem provided by rodent models of schizophrenia. A particular focus is on age differences in the response to

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Actually, there is a strong incidence of psychiatric diseases, representing a 13% of total burden diseases and 450 million of people affected. The etiology of psychiatric diseases remains unknown. However, scientific evidences suggest a maldevelopment of nervous system (NS). The diagnosis is inaccurate, and international manuals (ICD-10 and DSM-IV) identify pathologies according to a list of symptoms but no underlying biological cause of disease. The aim of the thesis is to identify potential biomarkers -related to the development of NS- in peripheral blood of psychiatric patients diagnosed as different mental diseases, such as autism spectrum disorders (ASD), schizophrenia and bipolar disorders. It is intended to contribute with the improvement of diagnostic, prognostic and treatment of subjects. The thesis is divided into 4 chapters: 1) study of neurotrophins in ASD, where the results show the relationship of this family of molecules with the disease, 2) study of Latrophilin-3 (LPHN3) in the TEA, which was obtained in association with lower cognitive level of ASD, 3) study of the Eph-receptor A4 in the pathology of schizophrenia and bipolar disorder, results of which show no association, and finally 4) study of Ankyrin-3 (ANK3) in schizophrenia and bipolar disorder, which shown a relationship with bipolar disorder but not with schizophrenia. / Actualment, hi ha una forta incidència de les patologies psiquiàtriques, representant un 13% del total de les malalties i 450 milions de persones afectades. L’etiologia de les patologies psiquiàtriques és desconeguda. Tot i així, evidències científiques suggereixen un mal desenvolupament del sistema nerviós (SN). El diagnòstic és poc precís, i els manuals internacionals (ICD-10 i DSM-IV) identifiquen les patologies d’acord a un llistat de símptomes, però sense cap causa biològica subjacent de la patologia. L’objectiu de la tesi és la identificació de biomarcadors potencials –relacionats en el desenvolupament del SN- en sang perifèrica de pacients diagnosticats amb diferents patologies mentals, com ara els trastorns de l’espectre autista (TEA), esquizofrènia i desordres bipolars. És pretén contribuir amb la millora del diagnòstic, el pronòstic i el tractament de les persones que les pateixen. La tesi s’estructura en 4 capítols: 1) estudi de les neurotrofines en els TEA, on els resultats evidencien la relació d’aquesta família de molècules amb la patologia, 2) estudi de la Latrofilina-3 (LPHN3) en els TEA, on s’ha obtingut associació amb el nivell cognitiu més baix dels TEA, 3) estudi del receptor EPH A4 en les patologies d’esquizofrènia i desordres bipolars, resultats del qual no mostren associació i, per últim 4) estudi de la Ankirina-3 (ANK3) en l’esquizofrènia i els desordres bipolars, en el qual si que es troba una relació amb els desordres bipolars, però no amb l’esquizofrènia. / Actualmente, hay una fuerte incidencia de las patologías psiquiátricas, representando un 13% del total de las enfermedades y 450 millones de personas afectadas. La etiología de las patologías psiquiátricas es desconocida. Aún así, evidencias científicas sugieren un mal desarrollo del sistema nervioso (NS). El diagnóstico es poco preciso, y los manuales internacionales (ICD-10 y DSM-IV) identifican las patologías de acuerdo a un listado de síntomas, pero sin ninguna causa biológica subyacente de la patología. El objetivo de la tesis es la identificación de biomarcadores potenciales –relacionados con el desarrollo del SN- en sangre periférica de pacientes diagnosticados con diferentes patologías mentales, como son los trastornos del espectro autista (TEA), esquizofrenia y desordenes bipolares. Se pretende contribuir en la mejora del diagnóstico, el pronóstico i el tratamiento de las personas que las padecen. La tesis se estructura en 4 capítulos: 1) estudio de las neurotrofinas en los trastornos del espectro autista (TEA), en el cual los resultados evidencian la relación de esta familia de moléculas con la patología, 2) estudio de la Latrofilina-3 (LPHN3) en los TEA, donde se ha obtenido una asociación con el nivel cognitivo más bajo de los TEA, 3) estudio del receptor EPH A4 en las patologías de la esquizofrenia y los desordenes bipolares, resultados del cual no muestran asociación y, por último 4) estudio de la Ankirina-3 (ANK3) en la esquizofrenia y los desordenes bipolares, en el cual si que se ha encontrado una relación con los desordenes bipolares, pero no con la esquizofrenia.