bluuebunny/crossref_metadata_2025 huggingface dataset:
The acceptability of web-care for patients with major depressive disorder
Authors: Ladea M. , Bran M.
Published: May 2016

Introduction

With the extraordinary rate of development of E-health and widespread internet access in Romania, Inomedica decided to create a platform dedicated primarily to the patients and their families: depresiv.ro. According to Internet Live Stats there were 11,178,477 Internet users in Romania (representing 51.66% of the population) in 2014. Inomedica is a non-governmental organization founded by a multidisciplinary team (psychiatrists, sociologists, IT specialists).

The platforms provide rigorous and quality online information about depression as well as self-assessment tools and Q&A section.

The presentation will explore the development and effects of the first 16 months of operation of a web platform about depression.

Methods

The depresiv.ro platform design is simple and user friendly. Mental health specialists contributed to the development of the content, which is easy to access and understand.

The platform also provides access to a self-evaluation tool, the Hospital Anxiety and Depression Scale (HADS), and thus helps the users identify possible problems and encourage them to seek professional help. The web application also included a demographic questionnaire, and a medical history questionnaire. A native iOS version of the application is available to download free on AppStore. The platform is supported by a Google grant program.

Results

The platform traffic increased from a few users per day at launch to more than 1000 unique visitors per day. Since 1st January 2015, about 178,000 unique visitors accessed the platform. All the metrics improved significantly during the last months: bounce rate (66.3%), average session duration (02:17 minutes), number of pages per session (2.4).

About 25,000 users accessed the HADS application since its release, from August 2014 until September 2015, showing the increasing need for free online self-evaluation tools.

The Q&A section is one of the most visited on the platform since many users try to find answers for their questions regarding depressive or anxiety symptoms.

Conclusions

As new technologies are introduced and become more accessible, mental health specialists are developing new ways of providing services and collecting data. The traffic data/usage for both the depresiv.ro platform and the app are evidence for the widespread acceptability of web-based delivery methods.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Papageno program: When learners collaborate for a safer coverage of suicide
Authors: Notredame C.E.
Published: May 2016

Media coverage of suicide has been repeatedly shown to influence suicide rates. The Werther Effect (WE) qualifies the propensity of suicide stories to prompt imitative behaviors. By contrast, the Papageno effect (PE) was more recently identified as a way for journalists to contribute to suicide prevention through their productions. Crucially, both WE and PE depend on the quantitative (audience, redundancies, size of articles, etc.) and qualitative (type of story, editorial style, content, etc.) properties of the coverage.

In order to promote the PE and limit the WE, the World Health Organization (WHO) have edited a guideline for media professionals. For instance, journalists are advised to prohibit sensationalism, avoid pictures or details about the suicide method, and show due respect to the bereaved relatives. However, it is now clear that the only chance for these recommendations to be applied is to integrate their diffusion into a more general effort toward collaboration with journalists.

Papageno is a French national suicide prevention program that fully relies on learners to rise awareness about suicide and its coverage. It mainly consists in pair-meetings between psychiatry trainees and journalism students. Such an innovative formula breaks with the old top-down knowledge transmission model in order to foster personalized and sustainable sensitization. It aims at growing up a new generation of journalists who would be more aware of their responsibility concerning suicide and would more spontaneously resort to the WHO guidelines. Ultimately, the Papageno program strives for the creation of a new culture where journalists and psychiatrist would collaborate for a safer media coverage of suicide.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Longitudinal study of methylome profiles in subjects with psychosis and/or schizophrenia
Authors: Kebir O. , Chaumette B. , Krebs M.O.
Published: May 2016

Background

Schizophrenia is a complex disorder involving both genetic and environmental factors. Epigenetic is a growing theory to explain these interactions at a molecular level. It is well-known that schizophrenia begins with prodromal symptoms and patients undergoing subthreshold symptoms are named ultra-high risk (UHR) subjects. Therapeutic and prognostic attitude remain challenging for this population. According to the model of the gene-environment interactions, the psychotic transition in adolescence could be related to epigenetic changes during the psychotic transition.

Methods

We designed and performed the first longitudinal study about whole-genome DNA methylation changes. Thirty-nine UHR patients were recruited in specialized center C’JAAD - Centre Hospitalier Ste Anne - Paris (France). During follow-up, 14 of them became psychotic (converters) according to the validated scale CAARMS. Initial and final methylation were investigated by Infinium Human Methylation450 BeadChip for 450,000 CpG after bisulfite conversion.

Results

The psychotic transition was not associated with global methylation changes. Linear models failed to identify CpG and genes significantly associated with psychotic transition after Bonferroni correction. Analyses of the top results provided a cluster, which could classify perfectly converters and non-converters. These genes of interest are over-represented in biological pathways with relevance for psychotic physiopathology. Individual analyses highlighted the biological heterogeneity of the psychotic transition.

Conclusion

Improving physiopathological understanding of psychotic transition is a current challenge to identify biomarkers and to develop targeted preventive interventions available in clinical practice for UHR subjects. The epigenetic processes and in particular DNA methylation could be interesting factors.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Smartphone based treatment in bipolar disorder
Authors: Faurholt-Jepsen M. , Frost M. , Bardram J.E. , Kessing L.V.
Published: May 2016

E-mental health technologies are under great development and the use is of these technologies is increasing rapidly.

During this symposium, results from a randomized controlled trial investigating the effect of smartphone based electronic self-monitoring on the severity of depressive and manic symptoms will be presented and discussed.

Further, we will present and discuss the use of automatically generated objective smartphone data on behavioral activities (e.g. social activities, mobility and physical activity) as electronic biomarkers of illness activity in bipolar disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Overview of the EPA guidance paper
Authors: Carrasco M.M.
Published: May 2016

After several decades of Market Faith in Western societies and the most severe financial crash several generations has known, there has not really been a serious re-examination of the role of markets and money in our society. A market economy may be a valuable and effective tool for organizing productive activity. The problem is whether we have become a “market society”. That is, if the economic values have been transplanted to the whole of society – not only economic life – and we have become a monetized society: a society where just about everything is up for sale. That's to say, a way of life where market relations and market incentives and market values come to dominate all aspects of life. Paradoxically, it is possible that the economic crisis has only increased this trend. Administrations at different levels – European, States, Local… – have demanded tremendous sacrifices from the population intended to save the financial system, but on the way sacrificing a Welfare state that took decades to build. In this presentation, we will review the mental health consequences of the current economic crisis. Also it examines how the change in social values and sweeping assertion of economic values can affect the way we think about Mental Health and Psychiatric Care.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Promoting stigma coping and empowerment: Results from the multi-center clinical trial STEM
Authors: Gaebel W.
Published: May 2016

Introduction

The stigma of mental illness is still a major challenge for psychiatry. For patients, stigma experiences and self-stigma are associated with reduced quality of life and increased vulnerability to a more chronicle illness course. Nevertheless, there is a scarcity of validated therapeutic approaches addressing strategies for coping with stigma.

Objectives and aims

A manualized psycho-educational group therapy for stigma coping and empowerment (STEM) should be tested for efficacy in patients with depression and schizophrenia. The study was funded by a research grant of the Federal Ministry of Education and Research.

Methods

A cluster-randomized RCT with two arms including 30 mental health care services (psychiatric inpatient services, day-units, and outpatient services, as well as inpatient psychiatric rehabilitation services) was conducted. The intervention consisted of 8 sessions regular psycho-education group therapy and 3 sessions addressing stigma coping and empowerment. Controls received 11 sessions regular psycho-education. Primary outcome variable was quality of life (WHO-QOL). Assessments were conducted directly before and after the intervention, and at 3, 6 and 12 months follow-ups.

Results

A total of 469 patients participated and more than 300 participants (approx. 65%) completed the 12-month follow-up. First results of the analysis will be presented at the conference.

Conclusions

Since the statistical analysis is currently in progress, no conclusions concerning the efficacy of the tested therapeutic approach can be done by now. Nevertheless there is a strong need for supporting patients in developing positive stigma coping strategies. STEM is the first therapeutic approach to our knowledge tested for efficacy in a RCT.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Phenomenology of emotions
Authors: Stanghellini G. , Aragona M. , Doerr-Zegers O. , Musalek M. , Madeira L.
Published: May 2016

This symposium analyses the psychopathological phenomenon “anxiety”, a classical concept, which has returned to be central in the recent psychiatric debate. Some of the most important international phenomenologists will discuss anxiety in the context of major psychopathological areas. Clinical and research insight will be presented in the context of a philosophically deep understanding of the fundamental qualitative features of the psychopathology of anxiety.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Sex and gender differences in schizophrenic psychoses
Authors: Riecher-Rössler A.
Published: May 2016

Introduction

Sex and gender differences in schizophrenic psychoses have often been described but treatment approaches so far have hardly taken them into account.

Objectives

To describe the most important sex and gender differences in schizophrenic psychoses with clinical implications.

Methods

Review.

Results

Schizophrenic disorders show a later age of onset in women and a slightly better course, especially in young women. As to pathogenesis, there is some evidence that the age difference might be at least partly due to the female sex hormone estradiol being a protective factor. Differences in course might also have to do with this biological factor, but at the same time with the psychosocial advantages of a higher age of onset and other psychosocial factors.

These gender differences have important implications for assessment and therapy. Thus, we have to consider gender differences in coping behaviour as well as psychosocial burdens and needs deriving from differing roles in partnership, family, household and profession, from dependent relationships, potential abuse and violence. Furthermore, there are specific biological risks such as gonadal dysfunction we have to deal with in both sexes differently. Thus, e.g. women with psychosis can also have very special needs regarding fertility, pregnancy and motherhood. Also, around menopause we have to consider special measures such as replacement of physiological 17-b-estradiol.

Conclusions

Women, but also men, with schizophrenic psychoses should get a gender-sensitive assessment and treatment.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Menopause and psychosis
Authors: Usall J. , Huerta-Ramos E.
Published: May 2016

There has been little research into the effects of menopause on symptoms, social and cognitive functioning in women with schizophrenia, and the results are controversial. The most replicated finding is that late-onset schizophrenia is more prevalent in women than in men and that this fact appears to be related to the diminution of estrogen levels during menopause.

Estrogens have a known protective effect on CNS. Animal research has shown that estrogen has a modulating effect on the dopaminergic, glutamatergic and serotonergic systems.

There are concerns about long-term use of sexual hormone therapy in postmenopausal women with regard to breast cancer risk, and the use of the selective estrogen receptor modulators (SERMS's) can be a better option.

Raloxifene is a SERM that is used in the preventive treatment of postmenopausal osteoporosis and has no effect in the breast and uterus. A number of studies seem to indicate that raloxifene acts on brain dopamine and serotonin systems in a similar way to conjugated estrogens.

In this presentation, I will show the results of some clinical trials that have studied the efficacy of raloxifene as a coadjuvant treatment of patients with schizophrenia. Our team has done two clinical trials that studied the efficacy of 60 mg of raloxifene for the treatment of negative symptoms in postmenopausal women with schizophrenia. Our results showed that raloxifene improved the negative symptoms better than placebo. We concluded that raloxifene seems to be a promising option to treat some patients with schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Oxytocin in social anxiety: An overview
Authors: Iancu I.
Published: May 2016

Oxytocin is a neuropeptide that is synthesized in the hypothalamus. It acts as a central neurotransmitter, as well as a peripheral hormone. It is called also trust hormone or love hormone. Because of its anxiolytic, pro-social and social cognitive enhancing effects, oxytocin has been suggested as a promising novel treatment for patients with social anxiety disorder. However, controlled research is small and the studies’ results are inconclusive. I will present the results of several studies with several recommendations about the role of oxytocin in social anxiety disorder. Whereas oxytocin shows some promising effects in resistant cases, of course the preferred agents are SSRIs, SNRIs and CBT.

Disclosure of interest

The author has not supplied his declaration of competing interest.
A neurosciences based – semiology of suicidal behavior
Authors: Courtet P.
Published: May 2016

The epidemiology, risk factors and biological basis of suicidal behaviors have been the object of an ever-increasing research in the last three decades. During this period, researchers all over the world have identified potential biomarkers of risk and developed several theories about the mechanisms leading to suicidal behavior. However, the lack of common terminology, instruments and cooperation has been a major deterrent. Today, the community has established the bases for this collaboration and evidence coming from neuroscientific studies can already be applied to the field of suicidology. We present here a potential semiology based on current evidence coming from biological, clinical and neuroimaging studies. Besides suicidal ideation and warning signs, the clinical features related to suicide risk and revealed by neuroscientific studies include notably: impulsive-aggression and hopelessness as well as high web consumption, sedentary behaviors and reduced sleep time, an enhanced sensibility to social exclusion and loneliness, a decreased sensitivity to detect social support, interpersonal problems related to decision-making impairments, difficulties to regulate negative emotional states, a propensity to perceive psychic and also physical pain and to receive opiates treatments. Improving the assessment will also open new targets for suicide prevention. In the short-term, some of these targets await us: standard protocols for evaluation of risk, healthcare continuity, implication of the family/caregivers, mitigation of social or psychological pain.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Follow-up and chain of care in the prevention of suicide recurrence
Authors: Sáiz Martinez P.A.
Published: May 2016

Suicide constitutes one of the most important problems in global public health. However, assessment as well as corresponding verification of suicide risk, either in case histories or clinical reports, is handled poorly in several clinical settings. Aspects as important as the existence of a personal history of suicidal tendencies are frequently omitted, despite this being one of the risk factors that most clearly predict the possibility of a complete suicide in the future. During this presentation, I would like to refer specific interventions in at-risk populations, with special emphasis on individuals who have made previous suicide attempts. Suicidal behaviour is a very complex phenomenon, making a specific treatment for it difficult to produce. Consequently, when the most appropriate therapeutic approach for an at-risk population is raised, the following fact is mentioned: in approximately 90% of suicide cases, there is an underlying psychiatric disorder. This makes psychopharmacological treatment of the base pathology the most adequate. Still totally in agreement with that affirmation, we want to point out that we often forget there is proven evidence of the preventative utility of non-pharmacological interventions designed to increase clinical follow-up and adherence to post-attempt outpatient treatment. It is important to indicate that these interventions are not aimed at specific disorders or population groups, but rather they are of a more universal character and are thus more easily generalised. During this presentation, some of these approaches will be addressed and discussed.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Emotional instability and autism and intellectual disability
Authors: McCarthy J.
Published: May 2016

Aim

To explore if emotional instability is a useful construct in adults with autism spectrum disorder (ASD) and intellectual disability (ID).

Method/approach

The current diagnostic criteria for ASD and ID will be outlined and related to any relevant literature on emotional instability in those with ASD or ID. Recent cross-sectional studies in a clinic and a prison of adults with ASD and/or ID using standardised screening and diagnostic tools will be described.

Findings

Current literature indicates there is little research on emotional instability in adults with ASD and ID. Studies across clinic and forensic settings indicate high levels of comorbidity such as attention-deficit hyperactive disorder (ADHD) and mood disorders in adults with ASD and ID.

Conclusion

At present emotional instability as a construct may not have validity for adults with ASD and ID but may do in the context of other comorbid conditions such as ADHD.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Phenomenology and neural correlates of formal thought disorder
Authors: Kircher T.
Published: May 2016

Speech and language disorders, such as concretism and formal thought disorder (FTD) are core symptoms of Schizophrenia, but do occur to a similar extent in other diagnoses such as bipolar disorder and major depression. We will review clinical rating scales of FTD and introduce a new, validated scale, the TALD. Further, structural and functional brain imaging data will be reviewed and own novel findings presented, relating speech and language dysfunctions to neural networks, within schizophrenia and across the “functional psychoses”. The impact of genetic variance and NNDA receptor blockage on brain function will be addressed with a particular focus on speech and language (dys-) function. We demonstrate, from the genetic to the brain structural and functional level, that particular aspects of the neural language system are disrupted in patients with FTD across traditional diagnoses.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Language, psychosis and the brain: Novel insights from a dimensional approach
Authors: Strik W.
Published: May 2016

The brain mechanisms related to formal thought disorders (FTD) and auditory verbal hallucinations (AVH) appear to be closely linked to structural and functional abnormalities of the language system.

In particular, functional imaging data indicate that several components of the language system are involved in the generation of both, FTD and AVH. Co-activation of the primary auditory cortex (Heschl's gyrus) during verbal thoughts appears to be crucial for the subjective perception of an externally generated voice, and DTI studies indicated that the intrahemispheric fronto-temporal connectivity of the language system is specifically increased in hallucinating patients. On the other hand, FTD are significantly correlated to a gray matter reduction in Wernicke's region along with a hyperactivation of frontal and temporal components of the language system.

AVH are intimately related to a dysfunction of the left hemispheric language system, including the primary auditory cortex and the fronto-temporal fibre tracts connecting Broca's and Wernicke's regions. Co-activation of the primary auditory cortex during verbal thoughts appears to be the basis of the pathological network dynamics during AVH, while FTD are linked to a pathological hyperactivity of central components of the language system. Both phenomena are related to functional imbalances of the language system, and phenomenological differences may depend on the different contributions of the system components.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Treating adult ADHD and comorbid substance-related disorders
Authors: Ramos-Quiroga J.A.
Published: May 2016

Attention-deficit/hyperactivity disorder (ADHD) is a complex, and multifactorial and chronic neurodevelopmental disorder. Comorbid psychiatric disorders are highly prevalent in individuals with a diagnosis of ADHD. There is a solid overlap between ADHD and substance use disorders (SUD). Prevalence of SUD is high among patients with ADHD, so that SUD are approximately double as common among individuals with ADHD than in general population, and individuals with SUD have much higher rates than expected of a comorbid ADHD. Studies shown that treatment during childhood of attention-deficit/hyperactivity disorder with stimulant medication neither protects nor increases the risk of later substance use disorders. Nevertheless, recent studies found that patients with ADHD and SUD can reduce ADHD symptoms and SUD with stimulants and cognitive-behavioral therapy. Treatment of ADHD in patients with SUD requires a comprehensive diagnostic assessment. It is recommendable to stabilize the addiction prior to treating the ADHD. In this talk, the recent literature for the treatment of adults with co-occurring ADHD and SUD will be reviewed.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Developing and measuring transition-related decision-making in Europe
Authors: Santosh P.
Published: May 2016

The MILESTONE project developed the Transition Readiness and Appropriateness Measure (TRAM) and the Transition-Related Outcome Measure (TROM) on the HealthTracker™ platform, each prepared in versions for young people, parents/carers and clinicians. Together these instruments aim to support and then evaluate clinician decision-making with respect to transition. The suite of measures were developed on and hosted on the HealthTracker™ Platform. FDA approved protocols were evoked in scale development and validation. A comprehensive list of items potentially significant in transition decision-making was generated from a thorough literature review and discussion with experts. Focus groups were conducted with young people, parents/carers and clinicians centring on the themes of “who should transition” and “identifying successful transition”. In open discussion, further items considered important in transition decision-making were elicited, and the importance of listed items was rated. Analysis of the data allowed items to be removed, kept or amalgamated. Domains considered universally important in transition decision-making emerged; these included diagnosis, impairment, risk, life changes, barriers to a successful transition and transition success markers. A beta version of the scale was tested for comprehension and usability by transition experts, young people and parents/carers. Following pilot testing, qualitative interviews were conducted with some participants to identify further issues. Scales were translated from English into French, Italian, German, Croatian and Dutch and translations uploaded to the HealthTracker™ online platform. Validation of the scales required completion of the TRAM and TROM alongside a series of proxy “gold-standard” measures to assess psychometric validity, test-retest validity and sensitivity to change.

Disclosure of interest

The author has not supplied his declaration of competing interest.
The magic list of everyday problems in consultation-liaison psychiatry (and hints for solving them)
Authors: Ferrari S. , Mattei G. , Galeazzi G.M. , Rigatelli M.
Published: May 2016

Introduction

Consultation-liaison psychiatry (CLP) deals with clinical, research and training activities at the interface between psychiatry and the rest of medicine. The main clinical competencies of CLP include medical-psychiatric comorbidity (co-existing psychiatric and non-psychiatric disorders affecting reciprocally); medically unexplained physical symptoms, “somatization” and functional disorders; and liaison activities, addressed to medical workers and teams.

Objectives/aims

To describe and discuss typical clinical scenarios that CL psychiatrists have to work in, and suggest effective, evidence-based solutions.

Methods

Long-standing everyday clinical experience of the authors combined to evidence derived from international literature consented to create a list of the most common and complex problems or difficulties typical of the CLP clinical context, and related possible solutions.

Results

Most common/complex problems include the following: stigma and prejudice (of patients, relatives, colleagues, and own); excessive technicality of language; short/unpredictable duration of hospital stay of patients, and more in general pressure in clinical practice due to shortness of time and resources; tendency of colleagues from other disciplines to disregard setting features related to time and space (inadequate rooms, e.g. too busy or noisy); limited time for face-to-face discussion of cases or problems; conflicts with patients/relatives/colleagues, and fear of reciprocal manipulation.

Discussion

Moving on the interface between psychiatry and the somatic disciplines, CL specialists need to develop special skills, not only those strictly technical, but also those “soft skills” including relational abilities and flexibility. Understanding the systemic aspects of referrals in the relationship between physician, staff and patients is usually essential in the process of consultation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The present situation of psychopharmacology teaching suggests the need for a European curriculum
Authors: Baumann P. , Laux G.
Published: May 2016

Introduction

In most European countries postgraduate training for specialization in psychiatry and psychotherapy is acquired over the course of 4–6-year programs. In the European Union, qualification in one country is recognized within other countries of the Union.

Objectives and aims

To analyze the present situation of psychopharmacology-pharmacopsychiatry postgraduate teaching in Europe and to present the needs and preliminary instruments for improving the situation by harmonization of the programs.

Methods

Analysis of the data available from national psychiatric societies and from the literature; development of a consensus among experts in this field.

Results

Despite efforts to standardize post-graduate training, the curricula in different European countries vary greatly. This variability limits comparability between countries and international exchange while carrying consequences in the breadth and quality of education that trainees receive. Literature and curricula mainly published in USA as well as a recently published curriculum and learning catalogue in Germany [1] offer useful tools for the development of a curriculum at a European level.

Conclusions

There is clearly a need for standardization of psychopharmacology-pharmacopsychiatry teaching at the European level. This can be achieved by the introduction of a curriculum and learning catalogue developed by European experts and based on tools already available.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychopharmacology during residents’ training: The role of scientific societies
Authors: Llorca P.M.
Published: May 2016

In France, psychopharmacology is supposed to be one of the bases of the training during the first year of residency. But there is no standardization in the content of the psychopharmacology courses for residents from one region to another. There is also a debate around the way psychopharmacology has to be learned by young professionals, with the development a narrative approach that seems to have a pedagogic relevance, opposed to a more academic approach. In this context, the French Society for Biological Psychiatry and neuropsychopharmacology developed a program of specific psychopharmacology workshops for residents. These workshops combine a fundamental pharmacologic approach, with a more clinical evidence-based one, trying to take into account the discrepancy that residents may experienced between knowledge and every day practice, around specific topics (e.g. polypharmacotherapy). This program highlights different issues in the domain of the psychopharmacology courses for residents around the format (e.g. on-line courses versus face-to-face courses), the topics and the content of the courses (e.g. categorical approach of prescription versus dimensional approach). It underlines the need for a clear definition of what has to be known by residents in this field but also how this initiative can be implemented for a large number of residents using numeric tools and what is the role of scientific societies and their interactions with academic teaching. The funding of such programs has also to be defined and clarified.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Addiction component walk along working towards a new app
Authors: Krausz M.
Published: May 2016

Only a very small percentage of adolescents and young adults with mental challenges is able to access specialized care. Access is limited due to a lack of capacity but also internal hurdles and stigma especially among young males. The web creates a new environment for them, which is defining a new culture of communication and interaction. The majority is using smart phones to access the internet and make that their main communication device. Walkalong is a web-based platform, which aims to provide a range of opportunities and tools for youth with especially mood challenges. These tools include screening and assessment, online resources and all kind of orientation and interaction for informed decision making. We are working on that to develop a framework for better online-based mental health care including useful tools beyond crisis based on the principles of empowerment and strength based approaches.

Disclosure of interest

The author has not supplied his declaration of competing interest.
A common mental health disorder. This topic choice ground of Pakistan and try clear the women and my country with others
Authors: Akhtar M.N.
Published: May 2016

Depression: is a mood disorder that causes a persistent feeling of sadness and loss of interest.

Signs and symptoms of depression include:

– depression and women: rates of depression in women are twice as high as they are in men;

– depression in Pakistan: globally depression affects 20% of people while in Pakistan;

– helping a depressed person: if you know someone who is depressed, it affects you too;

– to help your friend or relative.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Cognitive functioning in alcoholic patients and efficiency of their correction with use of individualized therapy
Authors: Bokhan N. , Mandel A. , Abolonin A. , Peshkovskaya A. , Nazarova I. , Belokrylov I.
Published: May 2016

Objective

To assess severity of cognitive disturbances during use of individualized therapy.

Materials and methods

Study sample included 40 men with diagnosis of alcohol dependence in the period of remission formation. Methods of pictograms, “ten words”, techniques “analogs”, “number square”, “index of functional flexibility of nervous processes” were applied. Measurement was conducted before and after individualized therapy. Depending on structure of cognitive disturbances the individualized therapy included the following: pharmacotherapy, audiovisual, vibrotactile, oxygen-hyperthermic, resonance-acoustic and psychotherapeutic interventions.

Results

Assessment of drawings of the method of pictograms before and after individualized therapy testifies to increase of number of adequate associations in 36.4% of cases, decrease of inadequate symbolic in average from 1.91 scores to 1.77. After therapy part of graphic phenomena-indicators of organic diseases (in 63.64% of patients) and index of severity of organic graphic symptom complex (from 2.14 ± 1.04 to 1.43 ± 0.98, differences are reliable at Р < 0.05) decreased. A set of associations was widened, number of abstractions of high level increased in 31.82% of cases. It was revealed that abilities to generalize and abstract did not change after therapy. Average productivity of mediated remembering after therapy increased from 58,08% to 71.67%. Increase of volume of attention and its switchover capability, increase of average index of functional flexibility of nervous processes from 1.19 ± 0.26 to 1.62 ± 0.16 (differences are reliable at Р < 0.05) were revealed.

Thus, administered with account for structure of disorders individualized therapy allows significant improvement of cognitive functions of alcoholic patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cannabis and cyclical vomiting
Authors: Canseco Navarro M. , Canccino Botello M. , Machado Vera M.M. , Hernández Sánchez J.M. , Molina López F.
Published: May 2016

Introduction

Traditionally, cannabis is associated with antiemetic action after acute consumption. However, in 2004 the cannabinoid hyperemesis as paradoxical effect of chronic users, after years of exposure described.

Objectives

Description of the cannabinoid hyperemesis.

Method

OLOGYA case is presented.

Results

Clinical case of a woman who repeatedly comes to the emergency service because of abdominal, nausea and vomiting pain.

This is cyclical and hardly controllable. The gastroenterology service studied in depth with negative results. She was followed up by mental health borderline personality disorder and she consumed cannabis at an early age, 20–30 joints daily.

When she reaches abstinence in short periods, ceases digestive discomfort. However, aprece digestive symptoms with each relapse. The present case showed improvement with cessation of cannabis so it probably was the cannabinoid hyperemesis syndrome.

Conclusions

The cannabinoid hyperemesis is characterized by recurrent episodes of nausea, vomiting, abdominal pain, and chronic cannabis use. Temporary relief is achieved with hot baths. Ceases when abstinence is achieved. It is a clinical entity that does not have much information and requires further study.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clinical features of kinesthetic hallucinations in cocaine-dependent patients
Authors: Roncero C. , Rodriguez-Cintas L. , Grau-López L. , Ros-Cucurull E. , Perez-Pazos J. , Barral C. , Palma-Alvarez F. , Barrau V. , Herrrero-Fernandez A. , Vela N. , Romero D. , Sorribes M. , Casas M. , Egido A. , Alvaros J. , Daigre C.
Published: May 2016

Introduction

Legal and illegal drugs can cause psychotic symptoms, in cocaine-dependent patients the prevalence of these symptoms may reach 86% (Vorspan, 2012). It is estimated that 13–32% of cocaine-dependent patients have kinaesthetic hallucinations (Siegel, 1978; Mahoney, 2008; Roncero, 2012).

Objectives

To compare the prevalence of substance-induced psychotic symptoms and compare the use of welfare/social resources and social adjustment among cocaine-dependent patients (CD) and other substances dependences (OtherD).

Methods

Two hundred and six patients seeking treatment at the Addictions and Dual Diagnosis Unit of the Vall d’Hebron. Patients were assessed by ad hoc questionnaire designed to collect demographic data and psychotic symptoms associated with consumption, a record of the care/social resources used by the patient and the scale of social adaptation (SASS). A descriptive and bivariate analysis of the data was performed.

Results

CD were 47.1% vs. 52.9% OtherD (66.1% alcohol, 17.4% cannabis, 8.3% opioid, 8.3% benzodiazepines/other drugs). Of cocaine dependent-patients, 65.6% present psychotic symptoms vs. 32.1% for the OtherD. Different exhibiting psychotic symptoms are: self-referential (69.7% vs. 30.7%), delusions of persecution (43.4% vs. 12.2%), hallucinations (49.4% vs. 14.3%), auditory hallucinations (43.5% vs. 11.4%), visual hallucinations (30.4% vs. 5.7%) and kinaesthetic hallucinations (7.2% vs. 2.9%).

Cocaine-dependent patients significantly use more health care resources in reference addiction unit (76.3% vs. 62.4%, P:.035) and infectious diseases (22.7% vs. 5.5%, P:.000) and justice-related (50.5% vs. 26 resources 0.6%; P:1.001) and less resources and mental health (25.8% vs. 43.1%; P:.013).

Regarding social adaptation, no differences were found in the SASS. Kinaesthetic hallucinations do not appear to be related to a greater use of resources and in social adaptation.

References not available.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cherry flow: physical measures and perturbation theory
Authors: YANG JIAGANG
Published: May 2016

In this article we consider Cherry flows on the torus which have two singularities, a source and a saddle, and no periodic orbits. We show that every Cherry flow admits a unique physical measure, whose basin has full volume. This proves a conjecture given by Saghin and Vargas [Invariant measures for Cherry flows.Comm. Math. Phys.317(1) (2013), 55–67]. We also show that the perturbation of Cherry flows depends on the divergence at the saddle: when the divergence is negative, this flow admits a neighborhood, such that any flow in this neighborhood belongs to one of the following three cases: it has a saddle connection; it is a Cherry flow; it is a Morse–Smale flow whose non-wandering set consists of two singularities and one periodic sink. In contrast, when the divergence is non-negative, this flow can be approximated by a non-hyperbolic flow with an arbitrarily large number of periodic sinks.
When are all closed subsets recurrent?
Authors: LI JIE , OPROCHA PIOTR , YE XIANGDONG , ZHANG RUIFENG
Published: May 2016

In the paper we study relations of rigidity, equicontinuity and pointwise recurrence between an invertible topological dynamical system (t.d.s.)$(X,T)$and the t.d.s. $(K(X),T_{K})$induced on the hyperspace$K(X)$of all compact subsets of$X$, and provide some characterizations. Among other examples, we construct a minimal, non-equicontinuous, distal and uniformly rigid t.d.s. and a weakly mixing t.d.s. which induces dense periodic points on the hyperspace$K(X)$but itself does not have dense distal points, solving in that way a few open questions from earlier articles by Dong, and Li, Yan and Ye.
Quasistatic dynamical systems
Authors: DOBBS NEIL , STENLUND MIKKO
Published: May 2016

We introduce the notion of a quasistatic dynamical system, which generalizes that of an ordinary dynamical system. Quasistatic dynamical systems are inspired by the namesake processes in thermodynamics, which are idealized processes where the observed system transforms (infinitesimally) slowly due to external influence, tracing out a continuous path of thermodynamic equilibria over an (infinitely) long time span. Time evolution of states under a quasistatic dynamical system is entirely deterministic, but choosing the initial state randomly renders the process a stochastic one. In the prototypical setting where the time evolution is specified by strongly chaotic maps on the circle, we obtain a description of the statistical behavior as a stochastic diffusion process, under surprisingly mild conditions on the initial distribution, by solving a well-posed martingale problem. We also consider various admissible ways of centering the process, with the curious conclusion that the ‘obvious’ centering suggested by the initial distribution sometimes fails to yield the expected diffusion.
Fruit and vegetable consumption in Vietnam, and the use of a ‘standard serving’ size to measure intake
Authors: Bui Tan Van , Blizzard Christopher L. , Luong Khue Ngoc , Truong Ngoc Le Van , Tran Bao Quoc , Otahal Petr , Srikanth Velandai , Nelson Mark R. , Au Thuy Bich , Ha Son Thai , Phung Hai Ngoc , Tran Mai Hoang , Callisaya Michele , Smith Kylie , Gall Seana
Published: May 2016

The aims of the present study were to provide nationally representative data on fruit and vegetable consumption in Vietnam, and to assess the accuracy of the reported numbers of ‘standard servings’ consumed. Data analysed were from a multi-stage stratified cluster survey of 14 706 participants (46·5 % males, response proportion 64·1 %) aged 25−64 years in Vietnam. Measurements were made in accordance with the WHO STEPwise approach to surveillance of non-communicable diseases (STEPS) protocols. Approximately 80 % of Vietnamese people reported having less than five servings of fruit and vegetables daily in a typical week. Fruit and vegetable intake reported in ‘standard serving’ sizes was positively correlated with levels of education completed and household income (P<0·001 for trend). The correlations between summary values for each province reflect some known demographic, geographical and climatic characteristics of the country. For example, provinces at higher latitude had higher mean servings of vegetables (r 0·90), and provinces with higher proportions of urban population had higher mean servings of fruit (r 0·40). In conclusion, about eight in ten Vietnamese people aged 25–64 years did not meet WHO recommendations for daily consumption of at least five servings of fruit and vegetables. On the basis of the consistency of the data collected with other estimates and with physical and demographic characteristics of the country, the WHO STEPS instrument has construct validity for measuring fruit and vegetable intake, but with two issues identified. The issues were seasonal variation in reporting and a limitation on the usefulness of the information for associative analyses.
Introduction to the United Kingdom National Multidisciplinary Guidelines for Head and Neck Cancer
Authors: Paleri V , Roland N
Published: May 2016

This is the 5th edition of the UK Multi-Disciplinary Guidelines for Head and Neck Cancer, endorsed by seven national specialty associations involved in head and neck cancer care. Our aim is to provide a document can be used as a ready reference for multidisciplinary teams and a concise easy read for trainees. All evidence based recommendations in this edition are indicated by ‘(R)’ and where the multidisciplinary team of authors consider a recommendation to be based on clinical experience, it is denoted by ‘(G)’ as a good practice point.
Aetiology and risk factors for head and neck cancer: United Kingdom National Multidisciplinary Guidelines
Authors: Shaw R , Beasley N
Published: May 2016

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It discusses the aetiology and risk factors for head and neck cancer and the recommended interventions appropriate for each risk factor.

Recommendations

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Recent evidence synthesis from National Institute for Health and Care Excellence suggests that the following brief interventions for smoking cessation work should be used:

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Ask smokers how interested they are in quitting (R)

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If they want to stop, refer them to an intensive support service such as National Health Service Stop Smoking Services (R)

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If they are unwilling or unable to accept a referral, offer a stop smoking aid, e.g. pharmacotherapy. (R)

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Brief interventions are effective for hazardous and harmful drinking. (R)

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Specialist interventions are effective in people with alcohol dependence. (R)

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Most people with alcohol dependence can undergo medically assisted withdrawal safely at home, after risk assessment. (R)

•

Management of leukoplakia is not informed by high-level evidence but consensus supports targeted use of biopsy and histopathological assessment. (R)

•

The management of biopsy proven dysplastic lesions favours:

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advice to reduce known environmental carcinogens such as tobacco and alcohol (R)

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surgical excision when the size of the lesions and the patient's function allows (R)

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long-term surveillance. (R)

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Fanconi anaemia patients should:

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be followed up in a multidisciplinary specialist Fanconi anaemia clinic (G)

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have quarterly screening for head and neck squamous cell carcinoma and an aggressive biopsy policy (G)

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receive prophylactic vaccination against high risk human papilloma virus (G)

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receive treatment for head and neck squamous cell carcinoma with surgery alone where possible. (G)