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Background: Severe Mental Disorders (SMDs) cause mental health worldwide challenges because of several relapses and extensive recovery periods of hospitalization, which put a lot of economic and social burden on families and governments. Therefore, interventions are necessary to decrease the relapse of these disorders. Aim: This study was conducted to investigate the effect of Information Technology Assisted Relapse Prevention Program (ITAREP) on relapse among people who live with SMDs. Method: This study was a randomized clinical trial with intervention and control groups. ITAREP is a remote intervention based on monitoring the Early Warning Signs (EWS) to decrease the number of potential relapses. Using convenience sampling, people with SMDs admitted to Sina Juneqan Psychiatric Hospital and their caregivers were recruited in this study and randomly allocated to the control and intervention groups. Two checklists of the EWS for the patient and the patient's caregiver were used for monitoring the relapse signs. Data were collected at baseline and 90 days after discharge and were analyzed using t-test and Chi-square statistical tests and linear regression in SPSS software. Results: Fifty-two patients who lived with SMDs participated in this study (26 in the intervention group and 26 in the control group). The two groups were homogeneous regarding age, gender, type of mental disorder, and duration of the disorder. Forty-two males and ten females participated in this research. Most of the participants were diagnosed with schizophrenia. The results showed that the number of relapses in the intervention group was significantly lower than in the control group in the post-test. Conclusion: Social workers, as the case managers and a member of the interdisciplinary psychiatric team, can actively perform follow-up measures after discharge using ITAREP, and it can be expected that these interventions will reduce the number of relapses among patients who live with SMDs.

In the statistical calculation of the National Narcotics Board of the Republic of Indonesia or so called BNN, there were 70% of drug offenders with the status of drug relapse in 2019 reached (BNN: 2019). Such condition illustrates that the social rehabilitation mechanism for drug offenders in Indonesia still has the opportunity to present shameless people. Therefore, this study is intended to observe the significance of Lifestyle Related Shaming as an effort to reduce the number of drug relapses in Indonesia. Lifestyle Related Shaming is supported by 3 (three) macro theories, namely reintegrative shaming theory proposed by John Braithwaite, desistance theory proposed by Farral and routine activity theory proposed by Hiddlenlang The literature review method was applied here through the utilization and effort to develop an existing theory (grounded theory) by presenting certain concepts (variables) in accordance with the affordability of study data. In addition to qualitative approach, this research also performed a quantitative approach through survey method among respondents who experienced drugs relapse in Indonesia as well as in-depth interviews with drug relapse residents with various backgrounds and educational levels at the Center for Drug Rehabilitation of the Republic of Indonesia at Lido Bogor. It is expected that this study may provide a broad understanding to the government to prepare the best program for solving the drug relapse phenomenon, especially drug abuse in Indonesia. For the science, this study is expected to be a basis for the implementation of shaming in Indonesia. Furthermore, this study is also expected to be able to provide input in the process of drug relapse management in Indonesia, especially in an effort to prevent residents from falling into a shameless condition.

Drug abuse has been proven to be a mental disorder because of the heavy intake of substances usage controlled by the environment. Environmental factors play a significant role in drug addiction and recovery. However, there is a knowledge gap regarding environmental factors contributing to relapse and hinder motivation for recovery among drug addicts in Malaysia. Therefore, the objective of this research is to find out the impact of the environment on drug relapse and motivation recovery in former addicts. For this purpose, a cross-sectional research design was utilized whereby a self-administered questionnaire was randomly distributed among 50 Malaysian drug addicts. Data were analysed through IBM SPSS software version 25.0, and the partial least squares structural equation modelling (PLS-SEM) approach supported by Smart-PLS 3.3 to analyse the research model. The findings of the study indicated that the environment significantly impacts motivation recovery and relapse. Furthermore, the positive environment influences motivation for recovery in former addicts and pushes the addicts to relapse after rehabilitation. The study will provide insights into the environmental factors that contribute to drug addiction and relapse in Malaysia.

Objective: High relapse rate of patients with schizophrenia has a large impact on patients and their families that can be reviewed from biopsychosocial and spiritual factors. Determining all the potential risk factors of relapse in schizophrenia can help increase awareness of physicians, patients, and families. Physicians are the ones who examine patients and have responsibility to manage and educate them and expect to prevent relaps. This study analyze various biopsychosocial and spiritual factors affecting relapse occurrence in patients with schizophrenia. Methods: Cross sectional observational analytic study on 226 subjects with schizophrenia in three places in East Java, Indonesia, namely Soetomo Academic Hospital Surabaya (33.2%), Menur Hospital Surabaya (32.7%), and Radjiman Wediodiningrat Mental Hospital Lawang (34.1%) that met the inclusion and exclusion criteria. Data collection including 33 biopsychosocial and spiritual factors and were analyzed using bivariate and multivariate logistic regression. Results: Relapse rate within 1 year was 59.73%. There were 12 factors significantly affected the relapse of schizophrenia, namely history of physical disease of mothers during pregnancy ( p < .001; B = 27.31; 95% CI 3.96–188.52), presence of trigger ( p < .000; B = 6.25; 95% CI 2.61–14.96), negative beliefs ( p < .000; B = 4.94; 95% CI 2.10–11.61), hereditary factors ( p < .001; B = 4.84; 95% CI 1.93–12.10), insight ( p < .003; B = 4.27; 95% CI 1.62–11.27), 1-year GAF Scale ( p < .015; B = 3.79; 95% CI 1.30–11.09), response to treatment ( p < .006; B = 3.68; 95% CI 1.45–9.36), family knowledge ( p < .011; B = 3.23; 95% CI 1.31–7.93), history of head trauma ( p < .029; B = 3.13; 95% CI 1.13–8.69), medication side effects ( p < .028; B = 2.92; 95% CI 1.12–7.61), substance use history ( p < .031; B = 2.86; 95% CI 1.10–7.45), and occupation ( p < .040; B = 2.40; 95% CI 1.04–5.52). Conclusions: The 12 factors of biopsychosocial-spiritual are determinant to predict the risk of relapse in patients with schizophrenia. These factors should be emphasized in psychoeducation for patients and their families to enable intervention and relapse prevention.

<b><i>Background:</i></b> The recreational use of gamma hydroxybutyrate (GHB) is associated with frequent overdoses, coma and the risk of developing GHB use disorder (GUD). Several studies suggest negative effects of GHB use or related comas on cognition. Since relapse rates are high in GUD and cognitive impairment has been associated with relapse in other substance use disorders, we aimed to (1) investigate the prevalence of cognitive impairment before and after detoxification, (2) analyse the relationship between GHB use, comas, and cognitive impairment, and (3) explore the association between cognitive impairment and relapse after detoxification in GUD patients. <b><i>Methods:</i></b> In these secondary analyses of a prospective cohort study, a consecutive series of patients with GUD (<i>n</i> = 103) admitted for detoxification were recruited at six addiction care facilities in the Netherlands. The Montreal Cognitive Assessment (MoCA) was used to screen for cognitive impairments before and after detoxification. The follow-up duration for the assessment of relapse in GHB use was 3 months. <b><i>Results:</i></b> A substantial number of patients with GUD screened positive for cognitive impairment before (56.3%) and after (30.6%) detoxification. Impairment on the MoCA memory domain was most frequent (58.8%). Cognitive impairment was not related to the severity of GUD or number of GHB-induced comas. Logistic regression analysis showed that only the memory score independently predicted relapse. <b><i>Discussion:</i></b> Cognitive impairment seems highly prevalent among patients with GUD, possibly related to the risk of relapse. The absence of a relationship between the severity of GUD, level of GHB use, the number of GHB-induced comas, and cognitive impairment suggest that other factors may also contribute to the observed cognitive impairment.

During the 2018-2020 Nord Kivu Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo, an individual who had received the Merck rVSV-ZEBOV vaccine was diagnosed with EVD. His treatment included an Ebola virus-specific monoclonal antibody (mAb114), and he recovered within 14 days but re-presented six months later with severe EVD-like illness and Ebola virus viremia and died. We initiated an epidemiological and genomic investigation that showed the patient had a relapse of acute EVD, which led to a transmission chain that resulted in 91 cases spanning six health zones over four-months.

In statistical calculations, drug abusers with the status of drug relapse in Indonesia reached 70% in 2019 (National Narcotics Agency: 2019). This condition illustrates that the social rehabilitation mechanism for drug abusers in Indonesia still has the opportunity to present shameless. Therefore, this study seeks to see the significance of Lifestyle-related shaming as an important part of the mechanism for implementing shaming for the shameless, especially drug relapse offenders in urban areas. This study was conducted based on the analysis of John Braithwaite's shaming theory which states that the public's response to perpetrators is divided into 2 (two) namely reintegrative shaming which means re-acceptance of the shameless by giving shame to them and stigmatization which means treating the shameless by giving a negative stigma permanently. The method used here was literature review by utilizing and trying to develop existing theories (grounded theory) by presenting concepts (variables) in accordance with the affordability of study data so as to produce new findings regarding the significance of Lifestyle-related shaming in its role for drug relapse offenders. Lifestyle-Related Shaming is part of a combination of reintegrative shaming theory, desistance theory and routine activity theory. In the literature study conducted, the combination of (3) three macro theories produces Lifestyle-related shaming which is closely related to urban lifestyle. It is expected that later, this study will be able to provide a broad understanding to the government to prepare the best program for solving shameless phenomenon, especially drug abuse in Indonesia. Furthermore, it is also useful in science as a basis for the application of shaming in Indonesia.

Abstract

Aim
Resuming drinking is a main contributant to recurrence in alcoholic pancreatitis. We assessed current clinical practice in the Netherlands regarding alcohol in managing patients with a first episode of acute alcoholic pancreatitis.


Methods
A survey was distributed to 35 hospitals affiliated with the Dutch Pancreatitis Study Group. We evaluated current support based on various components of brief interventions, the participation of psychosocial healthcare providers, the cooperation with the primary care physicians and the presence of a protocol and its implementation.


Results
The response rate was 100% (n = 35). Psychoeducation is the most frequently performed intervention in current support treatment (97% of hospitals). In 17% of hospitals, healthcare providers with a psychosocial background routinely participate in current support treatment; 37% of hospitals create an individual treatment plan in which goals regarding alcohol cessation are specified and only 46% of hospitals provide the primary care physician with specific discharge information; 31% of hospitals indicate that the treatment is uniformly performed within their division of Gastroenterology. Protocols are available in 3% of the hospitals surveyed. Opportunities to involve the patient's social network were not given sufficient priority.


Conclusion
Among Dutch hospitals, there is no routine management strategy with regard to enhancing treatment for heavy alcohol use in alcoholic pancreatitis patients. There is a need to test a validated support program in randomized studies. Meanwhile, possible opportunities for effecting change are often missed.

Hana Alahmari,1 Hana Al Daajani,2 Fatimah Alsayed,3 Abdulrhaman Alrashid4 1Rheumatology Unit, Department of Medicine, King Khalid University Hospital, Abha, Saudi Arabia; 2Rheumatology Unit, Department of Medicine, King Fahad Military Medical City, Dammam, Saudi Arabia; 3Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 4Rheumatology Unit, Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi ArabiaCorrespondence: Hana AlahmariRheumatology Unit, Department of Medicine, King Khalid University Hospital, P.O Box 641, Abha, Saudi ArabiaTel +966 72417578Fax +966 7418111Email Drhana.s@hotmail.comBackground: Anti-neutrophil cytoplasm antibodies-associated vasculitis (AAV) is a rare autoimmune condition with high-relapsing rate and incidence of complications, resulting in increased morbidity and mortality. Characters of patients with anti-neutrophil cytoplasm antibodies-associated vasculitis in Saudi Arabia require further exploration.Objective: To evaluate the clinical profile, relapse rate and disease-related complications among patients with AAV at a tertiary hospital in Saudi Arabia. To estimate the role of BVAS score at the time of presentation in predicting relapse during the disease course.Design and Setting: This retrospective cohort study was performed through data collection from patients' records who had AAV, who visited the rheumatology clinic. The collected data involved the demographics of patients and their investigations, medications, and outcomes of treatment. Statistical analysis was executed through SPSS version 26.Results: Fifty-two patients were eligible for inclusion, while 48 patients were analyzed because of missing data. Females represented 60.4%. Half of the patients were more than 50 years old, and 68.8% had comorbidities. As for diagnosis, 62.5% had granulomatosis with polyangiitis, 25% had eosinophilic granulomatosis with polyangiitis, and 12.5% had microscopic polyangiitis. The rate of relapse was 31.3%, while the remission rate was 68.8%. Additionally, 66.7% had lower respiratory involvement, and 43.8% had renal involvement. More than half of the patients had BVAS score below 14.5 points. The study did not explore a positive correlation between the disease relapse and high BVAS at the first presentation.Conclusion: Early prediction of relapse and such intervention is of paramount importance in order to avoid accrual of organ damage with treatments that prevent further relapses. BVAS score was not found to be a potential predictor in our study. Future studies are highly endorsed, with prospective design and large sample size to achieve statistical significance for the incidence of relapses and complications.Keywords: ANCA-associated vasculitis, relapse predictors, BVAS, low complements, rheumatoid factor, relapse criteria

Many firms may successfully navigate an organizational crisis, but may find themselves entangled in another soon after. Building on a resource-dependence perspective, this study evaluates how certain investor characteristics foster organizational resilience during a crisis by preventing a relapse following recovery. Drawing on data from 2014 to 2019, we analyzed 359 firms that faced a crisis in 2015, as indicated by their Altman Z-score values. Our findings reveal that diversity and patience of investors prevent firms from relapsing into upcoming crises; however, the probability of relapse increases when concentrated investors boost the firm's capital during the in-crisis period. We bridge the gap between the resource-dependence theory and literature on organizational resilience and contribute by extending previous analyses on the relevance of investors to recover from a crisis to identify how in-crisis investors' features also state the foundations to avoid future relapses. JEL CLASSIFICATION: D74; D81; G01; G32; P45