bluuebunny/crossref_metadata_2025 huggingface dataset:
Disintegration of sensorimotor brain networks in schizophrenia
Authors: Kaufmann T. , Skåtun K.C. , Alnæs D. , Brandt C.L. , Doan N.T. , Agartz I. , Melle I.S. , Andreassen O.A. , Westlye L.T.
Published: May 2016

A large body of literature reported widespread structural and functional abnormalities throughout the brain in schizophrenia spectrum disorders (SZ). Corresponding with the typical symptomatology in SZ where sensory dysfunctions contribute to the core social and cognitive impairment, converging evidence suggests a disturbed interplay between higher-order (cognitive) and lower-order (sensory) regions. This talk will discuss the results of several recent studies, investigating brain connectivity in SZ using functional magnetic resonance imaging data from large samples. Within-network sensorimotor as well as sensorimotor-thalamic aberrations in SZ robustly appear among the core findings across studies, both during performance of cognitive tasks and during rest. We utilized machine learning to distinguish SZ from healthy controls based on connectivity profiles. When classifying on sensorimotor connections alone, not only can we reach accuracies largely above chance but also, these accuracies are as good as when incorporating whole brain connectivity in the classification. Whereas the overall accuracy levels in distinguishing SZ from controls are not useful in a clinical context, these results underline the robustness of the sensorimotor findings on the individual subject level. Targeting the sensory and perceptual domains may thus be key for future research to get a better understanding of the heterogeneity of clinical manifestations in severe mental disorders and to map clinical symptoms to imaging phenotypes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A life course perspective on familial and environmental risks for schizophrenia using a western Australian E-cohort
Authors: Morgan V. , Di Prinzio P. , Valuri G. , Croft M. , Shah S. , McNeil T. , Jablensky A.
Published: May 2016

Introduction

Familial risk for psychosis may interact with environmental risk factors.

Objectives

We are studying a large birth cohort of children of mothers with psychotic disorders, themselves at high risk of developing a psychotic illness, to understand the developmental aetiology of psychotic illness.

Aims

Our aim is to examine whether exposure to environmental stressors in childhood, including timing of exposure, is a risk factor for psychotic illness, independent of familial liability. Specificity to maternal schizophrenia is explored.

Methods

We used record-linkage across state-wide registers (midwives, psychiatric, child protection and mortality, among others) to identify 15,486 offspring born in Western Australia 1980–2001 to mothers with a lifetime history of psychotic illness (case children) and compared them with 452,459 offspring born in the same period to mothers with no known psychiatric history (comparison children).

Results

A total of 4.1% of case children had developed a psychotic illness compared to 1.1% of comparison children. Exposure to environmental risk factors including obstetric complications, aboriginality, lower socioeconomic status, discontinuity in parenting and childhood abuse significantly increased risk of psychotic illness in offspring. Length and age at time of discontinuity in parenting impacted on risk. At the same time, case children were also significantly more likely than comparison children to be at risk of experiencing these adverse life events.

Conclusions

Exposure to environmental stressors is associated with psychotic illness, and timing of exposure is important. However, children already at increased familial risk for psychotic illness are also at increased risk of experiencing these environmental stressors.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mental health in context. Impact of economic policies on health services
Authors: Sartorius N.
Published: May 2016

The impact of economic policies on mental health services – and with some differences also on general health services – will be exemplified by an analysis of the current trend of governments’ withdrawal from funding the mental health services it provided until now and the replacement of the government funded services by privately owned services. The analysis will be made on the background of the current worldwide tendency of commoditification, which posits that health care should be considered a commodity and judged using indicators, which have proven their value in commerce and handling of commodities. The analysis leads to the conclusion that the both tendencies – of commoditification and of increasing involvement of private capital in running health care services are likely to lead to a deterioration of care for people with mental illness.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Assessment of people with intellectual disability for the court: What does a psychiatrist need to know?
Authors: Latham R.
Published: May 2016

This presentation will focus on the importance of psychiatrists understanding that they operate at an interface between two very different disciplines; medicine and law. There will be consideration of what and why psychiatrists need to understand the law, the way it operates and the likely implications of their opinions. There will be consideration of an example from England and Wales to illustrate the way in which psychiatry and law might interpret the same information. The aim is that psychiatrists will be better equipped to face the challenges the law presents.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Use of risk assessment tools for people with intellectual disability: The latest evidence
Authors: Morrissey C.
Published: May 2016

A relatively high proportion of people detained in forensic psychiatric hospitals have intellectual disabilities (up to 3000 people in the UK; Royal College of Psychiatrists, 2013), and people with intellectual disability are significantly over-represented among those psychiatric patients with long lengths of hospital stay (CQC, 2013; Vollm, 2015). People with mild to borderline intellectual disabilities are also prevalent in the UK prison system.

Although the relationship between intelligence and offending is complex, lower intelligence is a known actuarial risk factor for offending behaviour. Studies, which have investigated the prediction of re-offending risk in populations with intellectual disability, have nevertheless found lower rates of recorded re-offending compared to those in mainstream forensic populations (e.g. Gray et al., 2010). The relatively high rate of ‘offending-like’ behaviour, which is not processed through the criminal justice system in people with intellectual disability makes risk prediction a more complex exercise with this group of people. It also makes outcomes measurement more difficult.

This paper will give an overview of the current research evidence and clinical practice in the field of risk assessment, risk management and outcome measurement with offenders with intellectual disability. It will summarise the findings of a recent NIHR funded systematic review by the author, which pertains to this area, and will point to future developments in the field.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Physical comorbidity and consequences for mortality and treatment
Authors: Heun R. , Schoepf D.
Published: May 2016

Introduction

Ageing is related to an increase rate of physical comorbidity. However, the interaction between physical comorbidity and the development of depression in the elderly is not yet clear. Depression may be the cause or consequence of physical morbidity. Both may increase mortality.

Methods

A total of 9604 patients with depression and a control sample of 96040 patients who attended a general hospital were followed-up for up to 12 years. Physical comorbidity and mortality was assessed.

Results

Twenty-nine physical disorders were more prevalent in subjects with depression, but the effect of individual disorders on mortality did not differ significantly in the depressed and control sample.

Conclusions

Patients with depression suffer more physical health problems than control patients that lead to death. The implications for early treatment will be discussed, a preventative approach may be most relevant.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Distinction of dementia and depression in various stages of the disease processes
Authors: Maier W.
Published: May 2016

Old age depression is often difficult to discriminate from dementia (particularly of Alzheimer type) – particularly cross-sectionally. Incident dementia is frequently associated with depressed mood and agitation; depression in the elderly goes together with executive and memory dysfunctions; associated psychotic symptoms and activity-of-daily-life dysfunctions are shared by both conditions as well as major risk factors as vascular and metabolic factors. Frequently both syndromes are “masking” each other; depression may furthermore present as the first clinical sign of Alzheimers disease.

Yet, both clinical syndromes/disorders emerging from quite different are pathogenic neurobiological mechanisms with differentiating neuropsychological, – imaging and – chemical features. Clinical tools can be derived and enable accurate differential diagnosis. Thus, the distinction between both syndromes is a first instance for biomarker supported differential diagnoses in psychiatry.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Clinical and neurobiological effects of aerobic endurance training in multi-episode schizophrenia patients
Authors: Falkai P.
Published: May 2016

Schizophrenia is a severe brain disorder characterised by positive, negative, affective and cognitive symptoms and can be viewed as a disorder of impaired neural plasticity. Aerobic exercise has a profound impact on the plasticity of the brain of both rodents and humans such as inducing the proliferation and differentiation of neural progenitor cells of the hippocampus in mice and rats. Aerobic exercise enhances LTP and leads to a better performance in hippocampus related memory tasks, eventually by increasing metabolic and synaptic plasticity related proteins in the hippocampus. In healthy humans, regular aerobic exercise increases hippocampal volume and seems to diminish processes of ageing like brain atrophy and cognitive decline.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Gender-related differences in the associations between sexual impulsivity, psychiatric disorders and trauma
Authors: Erez G. , Pilver C. , Potenza M.N.
Published: May 2016

Introduction

Sexual impulsivity (SI) has been associated with conditions that have substantial public health costs, such as sexually transmitted infections and unintended pregnancies. However, SI has not been examined systematically with respect to its relationships to psychopathology. The literature regarding associations between SI and history of different types of trauma also scarce.

Aims

We aimed to deepen the understanding of the roots of SI, both through the prism of history of trauma and through the prism of psychopathology as an explanation for SI.

Objectives

We intended to investigate associations between SI and psychopathology, and between SI and personal history of trauma of different types, including gender-related differences.

Methods

We performed a secondary data analysis of Wave-2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national sample of 34,653 adults in the United States. DSM-IV based diagnoses of mood; anxiety, drug and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Scheduled DSM-IV Version.

Results

For both women and men, SI was positively associated with most Axis-I and Axis-II psychiatric disorders. Significant gender-related differences (GRD) were observed. Among women as compared to men, SI was more strongly associated with social phobia, alcohol abuse/dependence and most personality disorders. As for trauma, SI was positively associated with any trauma for both women and men. Among women as compared to men, SI was more strongly associated with sexual assault and kidnapping.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychopathology of the self and the altered cortical midline structures in psychiatric disorders – a marriage?
Authors: Northoff G.
Published: May 2016

The self is central in our mental life and disturbances of the self-figure most prominently in psychopathological symptoms. The cortical midline structures (CMS) have been associated with self-related processing and its changes in schizophrenia, depression and other psychiatric disorders. However, the exact neuronal mechanisms underlying self-related processing in CMS and its changes in psychiatric disorders remain unclear. Especially the neural overlap between high resting state activity levels and self-related processing in CMS is rather puzzling. I present recent data on the rest-self overlap in healthy subjects showing that resting state activity in CMS can predict self-relatedness. The implications for psychological symptoms as in depression and schizophrenia are pointed out.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Information and communication technologies for the follow-up of patients
Authors: Baca-Garcia E.
Published: May 2016

Clinical assessment in psychiatry is mostly based on brief, regularly scheduled face-to-face appointments. Although crucial, this approach reduces assessment to cross-sectional observations that often miss critical information about course of disease and risk assessment. Clinicians in-turn make all medical decisions based on this inevitably limited information. We discuss recent technological developments in terms of assessment and information triangulation, analysis of longitudinal data, approaches to enhance medical decision-making and improve communication between patients, caregivers and clinicians.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Emotional instability and adult attention-deficit hyperactivity disorder (ADHD)
Authors: Asherson P.
Published: May 2016

Background

ADHD is defined in DSM-5 by developmentally inappropriate and impairing levels of inattentive and hyperactive-impulsive symptoms. However, emotional dysregulation is considered to be an associated feature of the disorder that supports the diagnosis of ADHD. The common co-occurrence of emotional liability (EL) in ADHD raises the question of whether EL should be viewed as a component of ADHD or reflecting a comorbid condition.

Aims

To address the question of whether EL should be viewed as a third dimension of ADHD.

Method

We investigated the association of EL with ADHD and impairment scores, in a sample of adults with ADHD that had been carefully selected for absence of comorbid conditions that could give rise to EL using both rating scale and experience sampling methods to measure emotional instability. We reviewed the effects of stimulants and atomoxetine on EL and the covariation of EL with ADHD inattention and hyperactivity-impulsivity. We further considered the phenotypic and genetic association of EL with ADHD using population twin data.

Results

From these studies, we found that EL is strongly associated with ADHD even in non-comorbid cases and gives rise to additional impairments after ADHD symptoms are controlled for in the analysis. Stimulants and atomoxetine both improve EL and these improvements are correlated with changes in ADHD symptoms, indicating a shared treatment response. Genetic model fitting suggests a common pathway model, consistent with a single genetic liability for inattention, hyperactivity-impulsivity and EL.

Conclusions

Taken together these findings suggest that EL can be viewed as a third dimension of ADHD. Patients presenting with chronic emotional instability should always be screened for ADHD.

Disclosure of interest

The author has not supplied his declaration of competing interest.
How increasing the effect of rTMS in the treatment of auditory hallucinations in schizophrenia?
Authors: Dollfus S. , Nathou C. , Olivier E.
Published: May 2016

Repetitive transcranial magnetic stimulation (rTMS) shows a high inter-subjects variability in the efficacy of treatment of auditory verbal hallucinations (AVH) in schizophrenia. The aim of this presentation is to demonstrate the involvement of several factors in the efficacy of rTMS such as the frequency of stimulation, the placebo effect and the brain morphology underlying the target of stimulation.

Methods

A meta-analysis was conducted to determine the effect sizes of placebo effect in 21 controlled studies on rTMS in the treatment of AVH in schizophrenia. MRI was also acquired in patients treated by rTMS to evaluate the scalp to cortex distances (SDCs) and the gray matter densities (GMDs) at the target of stimulation. Finally, we evaluated the efficacy of high (20 Hz) frequency stimulation in a controlled placebo study.

Results

Weak or no placebo effect in the control groups led to reveal a superiority of active rTMS over sham rTMS in the treatment of AVH. Clinical efficacy of rTMS was also correlated with the SCD or the GMD at the region of the target stimulation. Finally, we also demonstrated that more responders were observed after 2 weeks in the active group treated by 20 Hz than in the placebo group.

Conclusion

We clearly demonstrated that several factors such as high frequency, the placebo effect, anatomical cortical variations can impact on the efficacy of rTMS. These results fundamentally inform the design and the method of further controlled studies, particularly with respect to studies of rTMS in the treatment of AVH.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Value in mental healthcare: The patient aspect
Authors: Cohen Y.
Published: May 2016

From the patients’ point of view, valued-based mental healthcare is mental healthcare based on a holistic vision of care, according to which patients are actively involved in their treatment to achieve the best possible outcomes. They are invited to collaborate with both mental health care providers such as psychiatrists and primary caregivers to determine what types of treatment are the most effective.

GAMIAN-Europe believes that the best package of care includes the following four elements:

– medication – antipsychotic medication is consensually regarded as first-line treatment for people with mental health problems;

– psychotherapy/counselling – although antipsychotic medications are the mainstay of treatment for mental health problems, pharmacotherapy alone produces only limited improvement in negative symptoms, cognitive function, social functioning and quality of life. Additionally, many patients continue to suffer from persistent positive symptoms and relapses, particularly when they fail to adhere to prescribed medications. These situations emphasize the need for multimodal care, which includes psychosocial therapies as adjuncts to antipsychotic medications in order to alleviate symptoms and to improve social functioning and quality of life;

– psycho-education – the more a patient learns about his/her condition the better placed he/she will be to take control of it. Psycho-education embodies this principle by using a clearly-defined therapeutic programme, in which a trained therapist delivers targeted information designed to reduce both the frequency and the severity of symptoms. Psycho-education increases patients’ knowledge and understanding of their illness and treatment options and helps them cope more effectively. Many people find that they benefit not only from the information they receive during psycho-education, but also from the learning process itself. There are several different ways in which psycho-education can be delivered, including one-to-one sessions with a therapist, sessions aimed specifically at carers and family members, group sessions attended by several people coping with mental illness and mixed group sessions attended by people with mental illnesses and family members;

– self-help – self-help groups offer patients a voice and an audience with the time and inclination to listen to patients’ concerns and reassure them and ease their anxiety. For example, a self-help group may be able to quell anxiety regarding side effects, to reassure the patient, from first-hand experience, that these side effects are transient, normal and non-threatening and will diminish over time. The real experts on living with a mental disorder are those who are already doing so. Therefore, most support groups are full of people who can share information about how they have managed to cope with their illnesses.

Disclosure of interest

The author has not supplied his declaration of competing interest.
The current state of child and adolescent mental health services in Europe: A survey in 28 countries
Authors: de Girolamo G. , Signorini G. , Singh S.P. , Warwick J.
Published: May 2016

Introduction

Transition to adulthood is the period of onset of most serious mental disorders. The current discontinuity of care between Child and Adolescent Mental Health (CAMHS) and Adult Mental Health (AMHS) Services is a major socioeconomic and societal challenge for the EU.

Objectives/aims

In the framework of the MILESTONE project this study aims to map current services and transitional policies across Europe, highlighting current gaps and the need for innovation in care provision.

Methods

An on-line mapping survey has been conducted across all 28 European countries through the administration of two ad-hoc instruments: the Standardized Assessment Tool for Mental Health Transition (SATMEHT) and the European CAMHS Mapping Questionnaire (ECM-Q). The survey systematically collected data about CAMHS organization and characteristics, with a specific focus on actual national transition policies and practice.

Results

Response rate was 100%. Despite up to 49% of CAMHS service users need to continue with specialist AMHS care, written policies for managing the interface between these two services are available only in 4/28 countries and transition support services are reported as missing by half of the respondents. Lack of connection between CAMHS and AMHS is reported as the major (82%) difficulty experienced by young service users.

Conclusion

Preliminary results indicate a marked variability in characteristics of services and in data activity among the 28 European countries, with important missing information at national level about CAMHS and their functioning. All these conclusions warrant an improvement in data collection and service planning and delivery.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Novel psychoactive substances
Authors: Orsolini L. , Papanti D. , Vecchiotti R. , Valchera A. , Corkery J. , Schifano F.
Published: May 2016

Over the last decade, the “traditional” drug scene has been supplemented – but not replaced – by the emergence of a range of novel psychoactive substances (NPS), which are either newly created or existing drugs, including medications, now being used in novel ways. By the end of 2015, in excess of 700 NPS had been reported by a large number of countries in the world. Most recent data show however that synthetic cathinones; synthetic cannabinoids; and psychedelics/phenethylamines; account for the largest number of NPS. Given the vast range of medical and psychopathological issues associated with the molecules here described, it is crucial for health professionals to be aware of the effects and toxicity of NPS. The “Drugs 2.0.” revolution facilitated the birth and growth of an “Online Drug Culture” which finds its main expression in chats/fora/blogs as well as the diffusion of online drug marketplaces (both in the surface and deep web). The web has progressively modified the drug market from a “street” into a “virtual” one, so by increasing the availability of new drugs/NPS/“legal highs” (“legal alternatives” to the traditional illegal drugs). The rapid pace of change in the NPS online market constitutes a major challenge to the provision of current and reliable scientific knowledge on these substances. The present lecture aims at providing an overview of the NPS phenomenon, also giving an overview of the main clinical and pharmacological issues relating to these most popular NPS categories.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Short-term psychotherapeutic interventions in consultation-liaison psychiatry
Authors: Diefenbacher A. , Burian R.
Published: May 2016

Due to a reduction in length of hospital stay of general hospital inpatients, CL-psychiatrists find themselves confronted with the problem of “less time to do more”. This presentation will first outline procedural aspects of CL-psychiatry, delineating its development from the “situational approach” do becoming case managers. Then, short-term supportive interventions will be discussed with regard to their applicability and newer disorder specific techniques, such as ACT and DBT will be demonstrated in their usefulness for the medically ill.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Drugs pharmacokinetics interactions with cardiac and renal disease patients in consultation-liaison psychiatry
Authors: Telles D. , Barbosa A.
Published: May 2016

The prevalence of psychiatric disturbances in patients with cardiovascular disease is elevated. For example the prevalence of major depression can reach 15–20% and of anxiety disturbances 5–20%.

When we treat psychiatric symptoms in cardiovascular disease we must have in mind four particular effects of psychiatric drugs: (1) disturbances of atrial-ventricular conduction; (2) QTc interval prolongation that can lead to torsade de pointes and ventricular fibrillation; (3) hypertension; (4) changes in platelet aggregation.

On the other hand, there is a great prevalence of psychiatric disease in patients with renal disease. For example, about 5–25% of the patients with advanced renal disease have major depression.

Renal disease patients can evidence changes in several pharmacokinetic parameters such as: (1) biodisponibility; (2) distribution; (3) metabolism; (4) excretion. Therefore, when we treat these patients we have to keep in mind the effect of psychiatric drugs over the renal functioning, but also the effect of the deficient renal function in the pharmacokinetics of the drugs.

I this presentation we intend to reveal what are the main concerns when we prescribe psychiatric drugs in patients with cardiovascular and renal disease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A European psychopharmacology curriculum: The young psychiatrist's point of view
Authors: Spies M. , Kasper S.
Published: May 2016

It goes without saying that psychopharmacologic treatment requires extensive knowledge of topics ranging from pharmacodynamics and efficacy, to pharmacokinetics, side-effects, and toxicity. Knowledge should be supplemented with experience regarding applicability in a clinical setting. It is well accepted that comprehensive psychopharmacologic education is essential to convey necessary knowledge and adequately prepare trainees for independent practice [1]. Currently, a psychopharmacologic curriculum, under the umbrella of the European Psychiatric Association, is in preparation in order to emphasize the importance of psychopharmacologic education in the context of psychiatric training and to foster standardization within the European Union. The aim of this presentation is to discuss psychopharmacologic education and prerequisites for an effective curriculum from the trainee's point of view. We will address challenges facing psychiatric trainees [2] and review existing curricula as well as literature in which they are evaluated. Based on evaluation of the model curriculum by the American Society of Clinical Psychopharmacology, one of the most broadly used psychopharmacologic curricula, it has been emphasized that an effective curriculum should be more than a list of topics. It should also convey pedagogic strategies with a focus on up-to-date technology, and provide a process through which teacher and trainee progress can be assessed [3,4]. Reflection on currently available curricula should aid in the development of an effective and timely EU-wide psychopharmacologic curriculum.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Harmonization of European training
Authors: Oude Voshaar R.
Published: May 2016

Mental health disorders, especially dementia, mood- and anxiety disorders, are among the most prevalent diseases in later life. Due to a greying European society, numbers are expected to increase over the next decades. Consequently, there is a pressing need for well-trained specialists in geriatric psychiatry across Europe in order to meet the mental health needs and to deliver a high standard of care to the aging population. In the past decades, some countries have set up specific training programs for specializing in geriatric psychiatry, whereas others did not. In order to stimulate the development of high-quality services, harmonizing specialty training across Europe will be a first step forward.

The EU stresses the need for standardizing qualifications of medical professionals to enable them to work across the EU. This workshop aims to work towards a consensus on the minimum training level required for geriatric psychiatry. We state that being able to work as an old age psychiatrist requires specific training in geriatric psychiatry and old age over and above general training in psychiatry. Therefore, discussion of opportunities to develop minimal criteria for training and practice across Europe is crucial. Taken the differences between countries into account (many countries do not provide specific training in old age psychiatry), we should finally agree on the minimal level of education and supervision, the minimum level of work experience and finally the minimal level of supervision in peer groups as a starting point.

Disclosure of interest

The author has not supplied his declaration of competing interest.
New research in outcome management using apps and DSM-5 measures. Preliminary results
Authors: Buwalda V.J.A.
Published: May 2016

The presentation is about the use of outcome measurements in combination of a newly developed app that enables psychiatrists and patients track the progress of their treatment process and adjust it if needed in an shared decision fashion.

In 2013 the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was introduced. Around the same time there was the start of a paradigm shift in healthcare which increased the focus on patient involvement in individual health care decision-making and on measuring and improving outcomes of care (Sederer et al., 1997; Sperry, 1997; Hermann, 2005). If outcome measures are psychometrically sound and able to measure clinical change, treatment progress can be made transparent for both patients and clinicians.

In this presentation the presenter will update the audience on a research project were the DSM-5 Field Trials, patient-reported dimensional measures and the World Health Organization Disability Assessment Schedule (WHODAS) (Clarke et al., 2013; Narrow et al., 2013; Mościcki et al., 2013) are secured and placed in a newly developed app.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Relationships between neurocognition, social cognition and functional outcome in schizophrenia
Authors: Mucci A. , Galderisi S. , Rossi A. , Rocca P. , Bertolino A. , Bucci P. , Maj M.
Published: May 2016

Introduction

The inter-relationships of neurocognition, social cognition, residual psychopathology and real-life functioning are poorly understood. A large multicenter study was carried out by the Italian Network for Research on Psychoses to model relationships between neurocognitive deficits, psychopathology and real-life functioning, taking into account the role of functional capacity and social cognition.

Methods

A structural equation model was used to investigate direct and indirect effects of neurocognition and psychopathology on real-life functioning. Social cognition and functional capacity were modeled as mediators.

Results

In 921 patients with schizophrenia, neurocognition had both direct and indirect effects, through functional capacity and social cognition, on real-life functioning. Neurocognition predicted to a large extent social cognition on which depression and disorganization had a modest effect. Social cognition showed a significant direct impact on real-life functioning.

Conclusion

Our results support a strong link between neurocognition and functional outcome, independent of psychopathology. Social cognition accounted for unique incremental variance in real-life functioning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Assessment of negative symptoms beyond schizophrenia
Authors: Kaiser S.
Published: May 2016

Introduction

Negative symptoms have long been recognized as a hallmark of schizophrenia. Newer evidence suggests that negative symptoms can be observed in persons with other disorders or even in non-clinical populations. However, most negative symptom scales are designed to identify clinically relevant symptoms, which might lead to underappreciation of subclinical symptom expression.

Objectives

The aim of the present study was to establish distributional properties of well-established negative symptom scales in comparison with the newly developed Zurich Negative Symptom Scale, which employs a fully dimensional and continuous approach.

Methods

We included participants with established schizophrenia (n = 65), first-episode psychosis (n = 25), schizotypal personality traits (n = 29) and remitted bipolar disorder (n = 20). Assessment of negative symptoms was conducted with the Zurich Negative Symptom Scale and compared to establish rating scales.

Results

In this broad sample, measurement of negative symptoms with established negative symptom scales lead to a highly skewed distribution. In other words, established negative symptom scales were able to identify negative symptoms in some participants in the non-schizophrenia spectrum, but a differentiation of negative symptom severity in the subclinical range was not possible. In contrast, the distribution of negative symptoms measured with the Zurich Negative Symptom scale approached normality.

Conclusions

Negative symptoms can be observed outside the schizophrenia diagnosis. However, in order to fully explore the continuity of negative symptoms, measurement instruments need to be designed to cover the full range of symptomatology starting at a subclinical level. We propose the newly developed Zurich Negative Symptom Scale as a useful tool in this respect.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Efficacy of nalmefene in a sample of patients with alcohol dependence
Authors: Aguado Mañas J.A. , Segurado O.
Published: May 2016

Introduction

It is well known the high rate of alcohol abuse and dependence in Spain. Specifically, in Castilla and Léon as a wine region, the risk of developing alcoholism is 1 of 10 men and 1 of 15 women [1].

Objective

The aim of the study is to assess the efficacy of nalmefene in reducing alcohol consumption and its complications, in a sample of patients with alcoholism.

Materials and methods

It is an open, naturalistic, observational and descriptive study in a sample of 18 patients with alcohol dependence diagnosis.

We collected standard demographic variables, but also living alone, social support and work.

In addition, clinical variables as SD (standard drinks) per day, time of illness, concomitant diseases, number of admissions, periods of abstinence, abstinence longer duration, nalmefene doses and other treatments were collected. These variables were reassessed at first, 3th and 6th month.

Results

In our sample the average profile is a man (75%) with an age of 46, who lives alone (68%), in urban area and with poor social support.

Average SD consumed at the beginning was 53, one month later was 26, after three months was 14 and 6 months later was 5, with a total abstinence rate of 65% at the end of the period. Logically there was also a dramatic reduction in somatic and social complications.

Conclusions

Nalmefene is demonstrated as a useful drug in reducing alcohol consumption and its complications.

Nalmefene also proves to be effective for achieving complete alcohol abstinence starting with a reduction plan.

Reference not available.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Prevalence rate, demographic and clinical predictors of substance use disorders in emergency room psychiatric patients of a tertiary hospital in Canada
Authors: Agyapong V. , Juhas M.
Published: May 2016

Background

There is only a limited body of literature which has examined the factors which can predict the presence of substance use disorders (SUD) in psychiatric patients seeking emergency room (ER) treatment.

Objective

To examine the factors that can predict the likelihood that a patient presenting to the emergency room and referred to the liaison psychiatric team will suffer from a SUD.

Methods

Nineteen independent demographic and clinical factors from data assessment tools for 477 patients assessed by the liaison psychiatric team in the ER over 12 months were compiled and analysed using univariate analyses and logistic regression in SPSS (version 20).

Results

The 12-month prevalence rate of all SUDs in our clinical sample was 24.7%. Patients who presented to the ER with a chief alcohol and/or drug related complaint (withdrawal or intoxication) were 142 times more likely to fulfill the diagnostic criteria for SUD compared to those who presented with non-SUD related complaints. Male patients or patients with forensic history were both three times more likely to suffer from SUD than female patients or patients with no forensic history, respectively.

Conclusion

There is a high prevalence of SUDs among psychiatric patients assessed in the ER. In addition to targeting patients who present to the ER with an alcohol or drug withdrawal/intoxication for brief psycho-educational interventions and referrals to addiction treatment services, patients with forensic history and male patients should be targeted for SUD screening.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Methamphetamine as a risk factor for myopathy
Authors: Azhari A.
Published: May 2016

Introduction

Cardiotoxic effects of methamphetamine have been proposed in many investigations, but the risk of striated muscles involvement among methamphetamine abusers is unknown.

Methods

A case-control study has begun in our teaching hospital to examine the association between methamphetamine abuse and myopathy. The study population are adult clients who admit in the electrodiagnostic medicine clinic since January 2015 with complains of weakness. For each subject with myopathy, 2 controls without myopathy are randomly selected from the same population. Self-reported history of methamphetamine abuse is acceptable in both groups.

Results

A total of 56 persons with myopathy and 112 controls have been identified, of whom 5 (9 percent) and 3 (3 percent) had history of methamphetamine abuse, respectively. Persons with history of methamphetamine abuse have about three times greater chance to develop myopathy (95% CI: 1.5–5.1) as compared with controls.

Conclusion

There is a misconception among some workers that some illicit drugs such as psycho stimulants can improve their ability to work. In contrast, this study demonstrates that due to harmful effect on the muscles, methamphetamine could diminish the ability to work in long time.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Toxic role in schizophrenia: A review by a clinical case
Authors: Canseco Navarro M. , Peña Serrano A. , Hernández Sánchez J.M. , Canccino Botello M. , Molina López F. , Machado Vera M.
Published: May 2016

Introduction

Often find it difficult diagnostic approach to patients with symptoms that could correspond to several clinical entities. This requires making a correct differential diagnosis to enable a better understanding and addressing the disease in an individualized way.

Objective

Describe pathogenetic factors of paranoid schizophrenia highlighting their relationship with drug consumption.

Methods

Review of the clinical history of a patient admitted to acute ward of the Hospital General Universitario of Valencia.

Results

A case of a 30-year-old man, whose income is motivated by persistent and structured autolytic ideation occurs. It presents positive symptoms for several years and amotivational syndrome ago. It has a history of cannabis, cocaine and alcohol since he was thirteen and remains abstinent for more than six months ago. Differential diagnosis arises between amotivational toxic syndrome, reactive depressive symptoms to the disease and negative symptoms for chronic psychotic process. Finally diagnosed with paranoid schizophrenia and is included in the program of first psychotic episodes.

Today the productive symptoms disappeared and remain negative though with less intensity achieving an improvement in overall activity.

Conclusions

Consumption of toxic influences the development of a chronic psychotic process that may appear years later, becoming a etiological and maintainer factor, not only if its consumption continue, but other effects that occur long term amotivational syndrome and worsening prognosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Compulsiveness dimension in a case of pathological gambling
Authors: Chiappini S. , Testa R. , Maisto F. , Leone B. , Di Paolo M. , Pascucci M. , Polidori P. , Grandinetti P. , Conte G.
Published: May 2016

Introduction

Pathological gambling (PG) is currently included among Addictive Disorders (DSM-5). However, its phenomenology resembles features of Obsessive Compulsive Disorder. Several models of addiction conceptualize a progression from impulsivity to compulsivity transitioning from initial positive reinforcement motivations to later negative reinforcement and less pleasurable and automaticity mechanisms.

Clinical presentation

A 34-year-old male, since diagnosed with PG in 2013 and prescribed a group rehabilitation therapy, presented in 2015 complaining of intrusive thoughts and depression symptoms. During the psychiatric examination emerged: low mental concentration; dysphoria; hyporexia; irritability; insomnia; persistent ideas and excessive preoccupations to be betrayed by his girlfriend; and behaviours of hyper control on her life. He has been evaluated using MMPI-2 (obsessivity Tscore 70, depression Tscore 67) and BIS-11 (high score of non-planning impulsiveness).

Treatment

It appeared there was a shift from ego-syntonic novelty driven/impulsive behaviours focused primarily on gambling to ego-dystonic habit driven/compulsive behaviours focused on her girlfriend. He started an individual psychodynamic psychotherapy centred on dysfunctional beliefs and behavioural strategies for treating the compulsive features. As thought content was the most relevant aspect, he was prescribed olanzapine, not a SSRI (normally indicated for OCD), up to 10 mg/die. After a month obsessions and compulsions reduced, and he seemed to reach a good level of personal functioning, despite a rigid anankastic personality trait.

Conclusions

As the management of compulsive behaviours is complex, physician should better assess and recognize psychological personality aspect, collecting patients’ complete history, also testing them psychometrically, and paying more attention to an eventual treatment (both psychological and pharmacological).

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A theory of actor-network for cyber-security
Authors: Balzacq Thierry , Cavelty Myriam Dunn
Published: May 2016

This article argues that some core tenets of Actor-Network Theory (ANT) can serve as heuristics for a better understanding of what the stakes of cyber-security are, how it operates, and how it fails. Despite the centrality of cyber-incidents in the cyber-security discourse, researchers have yet to understand their link to, and affects on politics. We close this gap by combining ANT insights with an empirical examination of a prominent cyber-incident (Stuxnet). We demonstrate that the disruptive practices of cyber-security caused by malicious software (malware), lie in their ability to actively perform three kinds of space (regions, networks, and fluids), each activating different types of political interventions. The article posits that the fluidity of malware challenges the consistency of networks and the sovereign boundaries set by regions, and paradoxically, leads to a forceful re-enactment of them. In this respect, the conceptualisation of fluidity as an overarching threat accounts for multiple policy responses and practices in cyber-security as well as attempts to (re-)establish territoriality and borders in the virtual realm. While this article concentrates on cyber-security, its underlying ambition is to indicate concretely how scholars can profitably engage ANT’s concepts and methodologies.
Weak Gibbs measures: speed of convergence to entropy, topological and geometrical aspects
Authors: VARANDAS PAULO , ZHAO YUN
Published: May 2016

In this paper we obtain exponential large-deviation bounds in the Shannon–McMillan–Breiman convergence formula for entropy in the case of weak Gibbs measures and topologically mixing subshifts of finite type. We also prove almost sure estimates for the error term in the convergence to entropy given by the Shannon–McMillan–Breiman formula for both uniformly and non-uniformly expanding shifts. Finally, we establish a topological characterization of large-deviation bounds for Gibbs measures and deduce some of their topological and geometrical aspects: the local entropy is zero and the topological pressure of positive measure sets is total. Some applications include large-deviation estimates for Lyapunov exponents, pointwise dimension and slow return times.
Renewal theory for random walks on surface groups
Authors: HAÏSSINSKY PETER , MATHIEU PIERRE , MÜLLER SEBASTIAN
Published: May 2016

We construct a renewal structure for random walks on surface groups. The renewal times are defined as times when the random walks enter a particular type of cone and never leave it again. As a consequence, the trajectory of the random walk can be expressed as analigned unionof independent and identically distributed trajectories between the renewal times. Once having established this renewal structure, we prove a central limit theorem for the distance to the origin under exponential moment conditions. Analyticity of the speed and of the asymptotic variance are natural consequences of our approach. Furthermore, our method applies to groups with infinitely many ends and therefore generalizes classic results on central limit theorems on free groups.