Insomnia is a serious and widespread public health problem, but is often undetected and patients do not receive needed treatment. Insomnia is often comorbid with other diseases and conditions, such as arterial hypertension, type 2 diabetes mellitus, pain syndromes, anxiety and depressive disorders, etc. A separate problem is drug-induced insomnia, when patients develop symptoms due to other diseases treatments. Insomnia has a negative effect on the prognosis of comorbid diseases, including an increased risk of death, more severe disease, and decreased quality of life. The presence of sleep disorders makes it difficult to effectively treat the underlying disease, so clinical guidelines draft for the evaluation and treatment of insomnia in multimorbid patients is proposed. Diagnostic methods are reviewed and recommendations are given for the treatment of acute and chronic insomnia and features of the treatment of insomnia in multimorbid patients. A clinical algorithm has been proposed to determine treatment tactics in multimorbid patients.
Инсомния является серьезной и широко распространенной проблемой общественного здравоохранения, но часто остается невыявленной, и пациенты не получают необходимого лечения. Инсомния часто коморбидна с артериальной гипертензией, сахарным диабетом 2-го типа, болевыми синдромами, тревожными и депрессивными расстройствами и др. Отдельной проблемой остается развитие инсомнии на фоне приема лекарственных препаратов по поводу других заболеваний. Инсомния оказывает неблагоприятное влияние на прогноз коморбидных заболеваний, включая повышение риска смерти, более тяжелое течение заболеваний и снижение качества жизни. Наличие расстройств сна затрудняет эффективное лечение основного заболевания, поэтому предложен проект клинических рекомендаций по диагностике и лечению инсомнии у полиморбидных пациентов. Рассмотрены современные методы диагностики и даны рекомендации по лечению острой и хронической инсомнии и особенности терапии инсомнии у полиморбидных пациентов. Предложен клинический алгоритм, позволяющий определить тактику лечения у полиморбидных пациентов.

UNASSIGNED: Perinatal depression and anxiety are public health concerns affecting approximately 1 in 10 women in Singapore, with clear evidence of association with various adverse outcomes in mother and child, including low birthweight, preterm birth and negative impact on infant neurodevelopment, temperament and behaviour. A workgroup was formed to develop recommendations to address the perinatal mental health needs of women with depression and anxiety. The approach was broad-based and aimed to incorporate holistic methods that would be readily applicable to the network of care providers supporting childbearing women.
UNASSIGNED: The Grading and Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework was employed to draw these guidelines. Workgroup members-comprising experts in the field of perinatal mental health and obstetric medicine-deliberated on the public health needs of the target population, and reviewed literature published from 2001 to 2022 that were relevant to improve the well-being of women with depression and anxiety during the preconception and perinatal periods.
UNASSIGNED: A consensus meeting was held involving a wider professional network, including family physicians, paediatricians, psychiatrists, social services and the Health Promotion Board in Singapore.
UNASSIGNED: Ten consensus statements were developed, focusing on the overall aim of achieving optimal perinatal mental health for women with depression and anxiety. They relate to awareness and advice on preconception mental health, screening and assessment, optimising care and treatment. Special considerations were recommended for women who suffered severe maternal events, tailoring care for adolescents and women with special needs, and addressing infant mental health needs.

UNASSIGNED: Autism is a neurodevelopmental condition that is increasing in prevalence worldwide. There has been an exponential increase in autism-related research since 2010, when the first Singapore Clinical Practice Guidelines (CPG) on autism was published. Understanding of autism has since evolved to adopt a lifespan approach beyond that of a childhood condition. The aim of this CPG was to provide an updated set of recommendations for children and adolescents to aid clinical practice for professionals.
UNASSIGNED: A multidisciplinary workgroup that comprised representatives from various sectors worked on this CPG. Clinical questions were organised into 10 different sections, each with its own subgroup of members. Seventeen existing international guidelines were evaluated using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE-II) framework, of which 4 met criteria to act as references. Literature review across multiple databases was conducted between January 2011 to 2023; Grading of Recommendations, Assessment, Development and Evaluation (GRADE-like) methodology was used to synthesise evidence. Recommendation statements were derived, following Delphi-style consensus surveys among the workgroup. The draft guidelines underwent external review and public consultation before being formalised.
UNASSIGNED: Recommendation and good practice statements pertaining to care of children and adolescents on the autism spectrum across 10 different sections were developed. Evidence matrices complement these recommendations and detail relevant evidence behind each recommendation statement.
UNASSIGNED: It is intended for these guidelines to promote effective management and healthcare services for children and adolescents on the autism spectrum, by reinforcing good and evidence-based clinical practice within our national context.

OBJECTIVE: The Canadian 24-Hour Movement Guidelines include recommendations for healthy levels of physical activity, sedentary behaviour, and sleep. Meeting these recommendations could help immigrants stay healthy. However, little is known about the movement behaviours of adult immigrants in Canada nor how these differ in relation to non-immigrants or time since immigration. The objectives were to estimate and compare the prevalence of meeting the 24-Hour Movement Guideline recommendations among adult non-immigrants, established immigrants, and recent immigrants in Canada across different sex groups.
METHODS: Self-reported data from the 2017 and 2018 cycles of the Canadian Community Health Survey were used. Meeting the guideline recommendations was based on the following: accumulating ≥ 150 min/week of moderate-to-vigorous physical activity (MVPA), limiting screen time to ≤ 3 h/day, and getting 7-9 h/day of sleep for adults aged 18-64 or 7-8 h/day of sleep for adults aged 65 + . Logistic regression was used to compare guideline adherence according to immigration status while controlling for age, sex, income, marital status, and education.
RESULTS: Among immigrants, 21.5% met all three guideline recommendations, 43.7% met 2 of 3 recommendations, and 28.5% met a single recommendation. The corresponding values for non-immigrants were 26.2%, 42.7%, and 24.6%. Compared to established immigrants, recent immigrants were more likely to meet all three recommendations (OR = 1.27; 95% CI (1.07, 1.50)) and to meet the sleep recommendation (OR = 1.29; 95% CI (1.07, 1.54)) after controlling for confounders.
CONCLUSIONS: Approximately 1 in 5 immigrants in Canada met all three recommendations of the 24-Hour Movement Guidelines. Movement behaviours vary according to immigrant status.
RéSUMé: OBJECTIFS: La conformité aux Directives canadiennes en matière de mouvement sur 24 heures pour les adultes, qui comprennent des recommandations concernant des niveaux sains d’activité physique, de comportement sédentaire et de sommeil, pourrait aider les immigrants à rester en bonne santé. Cependant, on connait peu de choses sur les comportements de mouvement des immigrants adultes au Canada, ni sur la façon dont ces comportements pourraient différer par rapport aux non-immigrants ou par rapport au nombre d’années depuis l’immigration. Les objectifs de cette étude étaient d’estimer et de comparer la prévalence de la conformité aux recommandations en matière de mouvement sur 24 heures chez les non-immigrants, les immigrants établis et les nouveaux immigrants au Canada. MéTHODES: Les données tirées des cycles 2017 et 2018 de l’Enquête sur la santé dans les collectivités canadiennes (ESCC) ont été utilisées. La conformité aux recommandations reposait sur les éléments suivants : accumulation de ≥ 150 min/semaine d’activité physique d’intensité moyenne à élevée, ≤ 3 heures/jour de temps de loisir devant un écran, et 7 à 9 heures/jour de sommeil pour les adultes âgés de 18 à 64 ans ou 7 à 8 heures/jour de sommeil pour les adultes âgés de 65 ans et plus. Les modèles de régression logistique ont été ajustés en ce qui a trait à l’âge, le sexe, le revenu, l’état matrimonial et l’éducation. RéSULTATS: Parmi les immigrants, 21,5 % se conformaient aux trois recommandations, 43,7 % se conformaient à 2 des 3 recommandations, et 28,5 % se conformaient à une seule recommandation. Les valeurs correspondantes pour les non-immigrants étaient de 26,2 %, 42,7 %, et 24,6 %. Comparativement aux immigrants établis, les nouveaux immigrants étaient plus aptes à se conformer aux trois recommandations (RCa = 1,27; IC de 95% (1,07 à 1,50)) et à la recommandation en matière de sommeil (RCa = 1,29; IC de 95% (1,07 à 1,54)). CONCLUSION: Environ un immigrant sur cinq au Canada se conformait aux trois recommandations des Directives canadiennes en matière de mouvement sur 24 heures pour les adultes. Les comportements de mouvement varient selon le statut d’immigré.

UNASSIGNED: The care of people with schizophrenia (PWS) is usually provided in an outpatient setting by community mental health teams. However, PWS frequently require inpatient treatment because of a wide array of clinical, personal and/or social situations. Unfortunately, to our knowledge, there are no guidelines available to help psychiatrists in the decision-making process on hospital discharge for PWS. The aim of this project was to develop an expert consensus on discharge criteria for PWS after their stay in an acute inpatient psychiatric unit.
UNASSIGNED: Using a modified Delphi method a group of 42 psychiatrists throughout Spain evaluated four areas of interest regarding this issue: clinical symptomatology, treatment-related factors, follow-up health care units after discharge, and physical health and monitoring.
UNASSIGNED: After two rounds, among the 64 statements, a consensus was reached for 59 (92.2%) statements. In three (17.7%) of the 17 statements on \'clinical symptomatology\' and 2 (13.3%) of the 15 statements on \'follow-up health care units after discharge\', a consensus was not reached; in contrast, a consensus was reached for all statements concerning \'treatment-related factors\' and those concerning \'physical health and monitoring\'. The consensus results highlight the importance for discharge of the control of symptoms rather than their suppression during admission and of tolerability in the selection of anantipsychotic.
UNASSIGNED: Although there is a lack of relevant data for guiding the discharge of PWS after hospitalization in an acute inpatient psychiatric unit, we expect that this consensus based on expert opinion may help clinicians to take appropriate decisions.

UNASSIGNED: Schizophrenia is most times a chronic and often debilitating illness associated with poor mental health outcomes. Early and effective treatment of schizophrenia in the most appropriate setting can make a significant difference in the long-term recovery. The aim of this narrative review was to provide suggestions and recommendations for effectively managing patients with schizophrenia during acute exacerbations and to enhance awareness and skills related to personalized medicine.
UNASSIGNED: A panel of academics and clinicians with experience in the field of psychosis met virtually on July 13th 2023 to narratively review and discuss the research evidence and their clinical experience about the most appropriate acute treatments for patients with schizophrenia. This manuscript represents a synthesis of the panel analysis and discussion.
UNASSIGNED: First contact is very important for service users, as is finding the most adequate treatment setting. If patients present to the emergency department, which may be a traumatic setting for service users, a dedicated environment with adequate space and specialized mental health support, including personnel trained in de-escalation techniques, is recommended. A well-connected continuum of care is strongly recommended, possibly with seamless links between inpatient units, day hospital services, outpatient facilities and rehabilitation services. Ideally, this should be structured as part of a coordinated step-down service line. Treatment challenges include suboptimal response, side effects, and nonadherence, which is reduced by the use of long-acting injectable antipsychotics.
UNASSIGNED: Individual circumstances, including age, gender, and presence of hostility/aggression or self-harm, cognitive impairment and negative symptoms, comorbidities (depression, substance use disorders) or associated symptoms (anxiety, insomnia), should be considered when selecting the most appropriate treatment for the acute phase of schizophrenia. Efficacy and feasibility, as well as acceptability and tolerability of treatments, require joint consideration from the early stages of schizophrenia, thereby enhancing the possibility of improved short- and long-term outcomes.

OBJECTIVE: Clinical practice guidelines (CPGs) are essential for standardising patient care based on evidence-based medicine. However, the presence of financial conflicts of interest (COIs) among CPG authors can undermine their credibility. This study aimed to examine the extent and size of COIs among authors of psychiatry CPGs in Japan.
METHODS: This cross-sectional analysis of disclosed payments from pharmaceutical companies assesses the prevalence and magnitude of personal payments for lecturing, consulting and writing to CPGs for bipolar disorder and major depressive disorder in Japan between 2016 and 2020.
RESULTS: This study found that 93.3% of authors received payments over a 5-year period, with total payments exceeding US$4 million. The median payment per author was US$51 403 (IQR: US$9982-US$111 567), with a notable concentration of payments among a small number of authors, including the CPG chairperson. Despite these extensive financial relationships, only a fraction of authors disclosed their COIs in the CPGs. These large amounts of personal payments were made by pharmaceutical companies manufacturing new antidepressants and sleeping aids listed in the CPGs.
CONCLUSIONS: This study found that more than 93% of authors of CPGs for major depressive disorder and bipolar disorder in Japan received considerable amounts of personal payments from the pharmaceutical industry. The findings highlight deviations from international COI management standards and suggest a need for more stringent COI policies for psychiatry CPGs in Japan.

暂无摘要。

UNASSIGNED: Early childhood is a critical period for growth and development. Adopting healthy lifestyle behaviours during this period forms the foundation for future well-being and offers the best protection against non-communicable diseases. Singapore studies have shown that many young children are not achieving the recommendations on physical activity, sedentary behaviour and sleep. A workgroup was set up to develop recommendations for caregivers of infants, toddlers and preschoolers (aged <7 years) on how to integrate beneficial activities within a daily 24-hour period for optimal development and metabolic health.
UNASSIGNED: The Grading of Recommendations Assessment, Development and Evaluation (GRADE)- ADOLOPMENT approach was employed for adoption, adaption or de novo development of recommendations. International and national guidelines were used as references, and an update of the literature reviews up to September 2021 was conducted through an electronic search of PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases.
UNASSIGNED: Four consensus statements were developed for each age group: infants, toddlers and preschoolers. The statements focus on achieving good metabolic health through regular physical activity, limiting sedentary behaviour, achieving adequate sleep and positive eating habits. The 13th consensus statement recognises that integration of these activities within a 24-hour period can help obtain the best results.
UNASSIGNED: This set of recommendations guides and encourages caregivers of Singapore infants, toddlers and preschoolers to adopt beneficial lifestyle activities within each 24-hour period.

The COVID-19 pandemic wrought significant negative impacts on youth well-being, particularly among Black, Hispanic, American Indian, Alaska Native, and LGBTQ+ (Lesbian, gay, bisexual, transgender, queer or questioning) youth. The pandemic disrupted connections to family, school, and community, which are essential supports for youth mental health. Lessons learned from the pandemic suggest the role of stress and windows of opportunity to build resiliency. Drawing from a policy dialog on the youth mental health crisis conducted by 4 American Academy of Nursing Expert Panels, we present approaches to the current increase in youth mental health problems. Included is emerging literature on building youth resilience, particularly via re-establishing school and community connections. The role of families, schools, and community support is emphasized, particularly by creating a healing school environment and the pivotal role of school nurses. Recommendations include increased support for families, engaging the school nurse role, and developing school-based innovative programs to build connections and youth wellness.