bluuebunny/crossref_metadata_2025 huggingface dataset:
DEPRESSION IN OPIATE ADICTION
Authors: Vasiljević M.
Published: August 2023

Introduction

Miroslava Vasiljević psychiatrist employed in Specialist practice of psychiatry Sunce, Belgrade, Serbia.

Objectives: Objectives and aims

Substance abuse is a major public health problem with high morbidity and mortality. Treatment – seeking opioid dependent individuals frequently report mood problems in the form of depression. The aim of this study was to evaluate the depression in patients with substance abuse.

Methods

We evaluated mood problems in the form of depression and health- related quality of life (HRQoL) among patients (20) with diagnosed opiate dependance who entered detoxification program and met the criteria for abstinence in period of one month, and compared with the results of 20 healthy controls consisted of secondary medical staff.

Almost all of the patients had a total PSQI score of 6 or higher, suggestive of depression, compared with control group (PSQI < 5).Patients had problems with a depression, taking antidepressives and problem to keep up enough enthusiasm to get things done (P < 0,05), compared with the control group.

Results

SF-36 scores for psysical functioning, role-physical, bodily pain, social functioning, role-emotional, and mental health were significantly lower mean compared to control group. Patients with disease had a reduced HRQoL, related to control group.

Conclusions

Majority of heroin-dependent patients reported depression and reduced quality of life. These conclusions are limited, because data was collected via questionnares of patients were small. In future we plan to include more substace abuse patients.

Disclosure of Interest

None Declared
Psychological factors associated with bruxism in a sample of university students from the Colombian Caribbean
Authors: Cabas-Hoyos K. , Llinas-Ariza A. , Guerrero-Cantillo C.
Published: August 2023

Introduction

Within the theories that explain tooth grinding are dental factors, skeletal malocclusions, occlusal anomalies and defective reconstructions, however, there would be psychological factors that explain this phenomenon.

Objectives

The aim of the study is to evaluate anxiety, depression and coping responses in university students who self-report clenching or grinding teeth.

Methods

Design: Non-experimental, cross-sectional, and quantitative.

Sample: University students (n=25) aged between 18-25 years (mean: 25.3; SD: 2.39), purposive sampling. Participants completed a self-reported questionnaire reporting teeth clenching/grinding habits.

Instruments: Standardized instruments were used, such as the State Trait Anxiety Inventory (STAI), Beck’s Depression Inventory (BDI) and Coping Strategies Scale Modified (CSS-M).

Procedure: First, the study was disclosed, the participants were informed and signed informed consent. They were asked to complete an instrument on teeth grinding/clenching habits and if it was fulfilled, it was included in the study and the psychological evaluation instruments were administered.

Data analysis: An analysis was made using descriptive statistics.

Results

The STAI results showed a high Anxiety-State in all the participants and the Anxiety-Trait had a prevalence of 92.3%. Regarding the levels of depression, it was evidenced that 7.7% presented moderate depression and 31.6% showed mild symptoms.

The most used coping strategies were problem solving (87.2%), positive reappraisal (74.4%) and religious support (71.8%), while the least used were seeking professional help (92.3%), waiting (76.9%), aggressive reaction (74.4%) and expression of coping difficulty (71.8%).

Conclusions

University students must cope with an academic load that exceeds their capacity to face academic challenges (Wikes et al., 2019). This demand causes significant discomfort that increases emotions with a high negative charge and favors the appearance or intensification of mental health problems, such as chronic stress, anxiety, depression, nervousness and behavioral disorders.

Disclosure of Interest

None Declared
Hetero agressive behavior in bipolar disorder : about 30 cases
Authors: Znaidi F. , Ellini S. , Fekih Romdhane F. , Cheour M. , Damak R.
Published: August 2023

Introduction

The social representations linked to bipolar disorder remain until today marked by unpredictability, danger and aggressiveness.

Objectives

The objectives of this study were to identify clinical and socio-demographic characteristics of a group of patients with bipolar disorder who had committed a heteroaggressive act and to establish the relationship between these characteristics and the risk of recurrence of violence

Methods

We conducted a descriptive and analytical study, including the files of 30 patients with bipolar disorder and hospitalized for heteroaggressive behavior.

We collected the data related to the socio-demographic, anamnestic and clinical characteristics of the patients.

Results

The average age of patients was 40.87 years, with extremes ranging from 25 to 62 years. The patients were mostly male (60%), living in urban areas (80%) and single (60%). 66,67% of patients in our sample were professionally active.

Half of the patients in our study were consumers of alcohol or cannabis. The majority of patients were on sodium valproate (66.7%), a long-acting neuroleptic (60%) and a benzodiazepine (56.7%).

Heteroaggressive behavior was in most cases physical (63.3%), having taken place in the patient’s home (66.67%) and directed towards a family member in an impulsive context (53.33%). 63.3% of patients reoffended their act of violence.

We found statistically significant correlations between the recurrence of heteroaggressive behavior and advanced patient age (p=0.01), male sex (p=0.05), illiteracy (p=0 .04) and unemployment (p=0.04).

Our study also showed that the recidivism of violence was significantly correlated with the criminal history of the patients (p=0.04) as well as the consumption of alcohol and cannabis (p=0.01). The number of recurrences was proportionally correlated to the duration of consumption.

Recurrence of violence was also significantly higher in patients with psychiatric comorbidity (p=0.01) and poor treatment compliance (p=0.04).

Finally, the number of recurrences of heteroaggressivity was proportionally correlated to the number of hospitalizations (p= ˂10¯³).

Conclusions

Heteroagressive behavior in patients with bipolar disorder is not only attributable to mental illness but also to the intertwining of several risk factors. The prevention of violence requires the identification and management of these risk factors.

Disclosure of Interest

None Declared
Lithium intoxication due to furosemide interaction – a case report
Authors: Vaz I. , Vitória-Silva J.
Published: August 2023

Introduction

Lithium has been used for the management of psychiatric illnesses over the years and it continues to be the first-line mood stabilizer used in treatment and prevention of bipolar disorder. Due to its narrow therapeutic index, other prescribed medications can increase lithium levels and potentiate its toxic effects. Among the most described drugs, non-steroid anti-inflammatory drugs and diuretics (mainly thiazides and loop diuretics) are the most commonly implicated. Risk factors for developing lithium toxicity include old age, polypharmacy, renal impairment, hyponatremic and hypovolemic conditions. Although there is interindividual susceptibility, older patients are at particularly higher risk.

Objectives

To summarize the latest literature about this field and to present a case report as a basis for discussion.

Methods

A brief review of the latest literature was performed, using PubMed and the keywords “lithium” and “acute renal injury”. Also, a case report about a 73 year-old man who suffer from lithium intoxication due to lithium-furosemide interaction is presented.

Results

In the presented case, Mr. F, 73 years old, independent for activities of daily living, was admitted to the Internal Medicine ward due to acute renal injury and lithium intoxication. Initially he was non-collaborative, sleepy, disoriented in all references and speechless. The creatinine was 1.28 mg/dL, urea 63 mg/dL, unspecific leucocitosis 17000/mm3, C-Reactive Protein 8 mg/dL, lithium 2.22 mEq/L. The psychiatrist was called to approach the psychiatric status, but as the patient awareness was impaired, the mental state examination was not possible. The patient’s daughter was interviewed. The patient had bipolar disorder (BD) type 1 and was diagnosed with mild cognitive impairment (MCI) a year ago. He had been stable for BD and MCI until the last month. He began to present nocturia, so he went to a urologist who prescribed him furosemide 40 mg daily for benign prostatic hyperplasia (BPH). Since that moment, he started being confused and progressively went to the state that was previously described at the admission of internment. Furosemide, quetiapine and lithium were stopped. He got better, to his previous state, and then started quetiapine 200 mg/day and tansulosine 0.4 mg/day.

Conclusions

Initiating diuretics in patients under lithium should be carefully considered and lithium blood levels must be monitored more regularly when new drugs are prescribed. Other medications must be regarded as alternatives but, if it is not possible, they should be used in the lowest dose and shortest duration as possible. With this case report, we highlight the importance of considering patients as a whole, taking both their physical and mental well-being into account. Healthcare professionals are invited to coordinate their efforts to deliver the best standard of care.

Disclosure of Interest

None Declared
Secondary Mania in Older Adults: a case report and review of literature
Authors: El Moussaoui N.
Published: August 2023

Introduction

Although mania is commonly associated with bipolar disorder, it can have many etiologies. Thus, “primary mania” results from bipolar disorder, whereas “secondary mania” results from pharmacological, metabolic, or neurologic causes. Older adults are at risk for secondary mania because of increased medical comorbidities and neurological changes. In one retrospective study of 50 patients with mania who were older than 65 years, it was the first manic episode for 28% of the patients and 71% had a comorbid neurological disorder.

Objectives

The etiology of mania is important because although acute symptomatic treatment of both primary and secondary mania may be similar, appropriate treatment of secondary mania includes addressing the cause. We present here two case histories of secondary mania in older adults, discuss their presentations and differential diagnosis in turn, and discuss treatment.

Methods

We will present a clinical case of a patient. Ms. A, a 63-year-old divorced woman with no prior medical or psychiatric history, was seen for an acute manic episode with mixed features. She was in her usual state of health until 2 weeks before admission, when she presented with a status epilepticus requiring a one-week hospitalization in the neurology département and treated by Carbamazepine. She then developed an abnormally excited and labile mood, motor excitability accompanied by rapid thoughts, with a total loss of desire and pleasure and thoughts of death.

Results

In our study, the patient presented a manic episode with mixed characteristics secondary to a status epilepticus.

The patient was treated both somatically and psychologically, and the evolution was positive. The patient was stabilised after being put on an antiepileptic drug associated with an antipsychotic drug.

In our study, the patient presented with a manic attack with mixed characteristics secondary to a status epilepticus.The patient was treated both somatically and psychologically, and the evolution was favourable. The patient was stabilised after being put on an antiepileptic drug associated with an antipsychotic drug.

Conclusions

Late onset psychiatric disorders often represent a challenge for the psychiatrists as far as the diagnosis and management issues are concerned. The elderly patients have generally been reported to have associated medical, especially neurological illnesses and are also prone to side effects of various psychotropic medications.

Disclosure of Interest

None Declared
Evaluation of the executive dysfunction in patients with bipolar disorder
Authors: Vasiliu O.
Published: August 2023

Introduction

Bipolar disorders (BD) associate impairments in cognitive functioning not restricted to acute mood episodes. The functional impact of these cognitive dysfunctions is significant in many cases, therefore, an extensive evaluation is granted for BD patients from this perspective. Executive dysfunction in BD has been reported, especially during mania and was associated with formal thought disorder, but multiple cognitive deficits may reflect an underlying pathologic process related to the mood disorder itself.

Objectives

To assess the level of executive dysfunction in a sample of patients with type I BD (BDI) using structured measurement methods.

Methods

Five patients diagnosed with BDI (two patients during manic episodes, one during the euthymic phase, and 2 during depressive episodes) were evaluated for working memory (n-back test), verbal fluency (Controlled Oral Word Association Test, COWAT) and verbal learning (Verbal Learning and Memory test, VLMT). All patients were adults, mean age of 35.5 years, and all were undergoing psychotropic treatment with antipsychotics and/or mood stabilizers. Also, five normal healthy controls, matched for age, were evaluated using the same test battery.

Results

All five BDI patients presented dysfunctions (three at a trend level, and one at a significant level, p<0. 01) in at least one cognitive domain, with three patients presenting modifications in all three tests that were administered vs. normal controls. The most affected domain was verbal learning, followed by working memory and verbal fluency. No individual in the control group had significant cognitive deterioration, on any outcome assessed.

Conclusions

Cognitive domains are altered in BDI patients, therefore, a test battery destined to quantify executive dysfunctions, independent of the presence of an acute mood episode or during the euthymic phase, may be useful for case management.

Disclosure of Interest

None Declared
Does mentalizing moderate the relationship between psychopathology and quality of life?
Authors: Szabó B. , Miklósi M. , Sharp C. , Futó J.
Published: August 2023

Introduction

Most previous research focused on the association between mentalizing and specific mental disorders, while less is known about the relationship between mentalizing and quality of life among adolescents.

Objectives

This study aimed to validate The Reflective Function Questionnaire for Youth in the Hungarian language and evaluate the moderating influence of mentalizing on the relationship between psychopathology and quality of life.

Methods

A community sample of 384 youths of 12–18 years (72.7% females) completed the following questionnaires: The Reflective Function Questionnaire for Youth (RFQY), The Measure of Quality of Life for Children and Adolescents and The Strengths and Difficulties Questionnaire. First, we tested the different factor structures of the RFQY: the two-factor, the eight-item, and the five-item versions. We conducted a series of moderation analyses with quality of life as the dependent variable, higher-order symptom categories (internalizing or externalizing symptoms separately) as the independent variable, and mentalization as the moderator.

Results

The confirmatory factor analysis supported the five-item version of the RFQY (Cronbach’s alpha .61) and resulted in a new, 10-item version of The Reflective Function Questionnaire for Youth on the Hungarian sample (Cronbach’s alpha .76). Mentalization had a moderator effect on the relationship between internalizing and externalizing symptoms and quality of life.

Conclusions

Our study provides the first psychometric support for the Hungarian version of the RFQY and underlines the importance of assessing the complex relationships between mentalization, quality of life and symptomatology. Targeting mentalization to improve the quality of life among adolescents might be a key factor.

Disclosure of Interest

None Declared
Autism spectrum disorders - gender differences and the diagnosis dilemma
Authors: Moura J. D. C. , Leal J. , Cunha J. F. , Seabra D. , Torres S. , Rocha T. , Lopes I. , Barata B.
Published: August 2023

Introduction

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by social and communication deficits and restricted and repetitive or stereotyped behaviours. The prevalence of ASD has been thought to be higher in men, which may reflect aspects of the own aetiology of the disorder. Still, it may also be associated with misdiagnosis or missed diagnosis of females with autism due to specific phenotypic traits.

Objectives

To explore the differences between sex/gender in autism’s clinical presentation.

Methods

Non-systematic literature review using the most relevant papers found on PubMed and Google Scholar using the following keywords: “autism spectrum disorder”, “gender differences”, and “autistic women”.

Results

Autistic women seem to have a “camouflage” phenomenon, characterized by a high level of functioning, less unusual play or restricted interests, better socio-emotional reciprocity and coping behaviours. Therefore, women with ASD commonly have an anteriority of multiple diagnoses, which delays their access to the support and care they need.

Conclusions

Professionals must be aware of the sex/gender clinical differences to prevent the misdiagnosis or missed diagnosis of females with autism. Moreover, the current clinical criteria used to diagnose ASD may underserve the female population and deserve to be reviewed.

Disclosure of Interest

None Declared
Parental Alienation Syndrome (PAS). Psychological and legal implications
Authors: Arrieta Pey M. , Rubio Corgo S. , Álvarez Astorga A. , Delgado Campos A. M. , Díaz Gordillo C. , Castro Ibáñez A. C. , Álvarez de Mon González M. Á.
Published: August 2023

Introduction

The first definition of PAS, enunciated by Richard Gardner in 1985, refers to a disorder originating in the context of legal conflicts related to child custody. Its main characteristic would be a smear campaign by the child towards a parent, in the absence of plausible arguments. In this context, the child would experience an oppositional and dichotomous feeling towards his or her parents. In recent years, the presence of PAS has become increasingly important, both in the legal and health fields, largely due to the controversy and debate surrounding its approval and recognition, and there is currently no consensus on the matter.

Objectives

The main objective of this work is to examine the current state of PAS in depth in the different fields in which it is emerging: the medical-scientific and legal spheres. The current controversies and debate, both scientific and legal, will be developed. Research will be carried out on the origin of the concept and its evolution, its symptomatic presentation, the neuropsychological consequences in minors, the role and legal value of expert reports, as well as the existing evaluation methods for the assessment of PAS.

Methods

An extensive literature review was carried out on the subject in question, extracting information mainly from scientific articles, but also from legislative documents, manuals and books.

Results

There are currently no specific laws regulating PAS in European countries. According to Article 10.2 of the Spanish Constitution, norms related to fundamental rights shall be interpreted according to the Universal Declaration of Human Rights. As a direct consequence of the chronic psychological stresses experienced by children, adaptive disorders may appear, often characterised by symptoms of anxiety and depression. In addition, a multitude of neuropsychological consequences have been observed not only in the affected child, but also in the adult he or she will become.

Conclusions

Currently, there is a fervent debate about the validity and recognition of PAS as a diagnostic entity, spanning different disciplines, ranging from health to social and legal. In Europe, professionals in the scientific field have not reached an agreement regarding the approval of PAS. On the one hand, there are those for whom PAS is a verified phenomenon; on the other hand, there are those who flatly reject the existence of this phenomenon. The latter consider PAS an unscientific construct, referring to it as “court syndrome” or “patriarchal alienation syndrome”.

Disclosure of Interest

None Declared
The place of EMDR in children: a review of the literature
Authors: Raissouni M. , Benhammou S. , Belbachir S.
Published: August 2023

Introduction

EMDR therapy is a brief form of trauma-focused therapy for PTSD. This therapeutic technique was first used by Francine Shapiro in the United States in 1987. EMDR combines exposure imagination, cognitive and psychoanalytical techniques. Designed to treat psychological trauma, emotional shock and grief, EMDR can also be used to treat neurotic problems such as phobias, anxiety and depression.

EMDR therapy can be used at any age and can be adapted to children, adolescents, adults and the elderly unless contraindicated.

In the pediatric population, several studies have shown that EMDR therapy has a remarkable effectiveness on several pathologies and particularly on PTSD.

Translated with www.DeepL.com/Translator (free version)

EMDR therapy is a brief form of trauma-focused therapy for PTSD. This therapeutic technique was first used by Francine Shapiro in the United States in 1987. EMDR combines exposure imagination, cognitive and psychoanalytical techniques. Designed to treat psychological trauma, emotional shock and grief, EMDR can also be used to treat neurotic problems such as phobias, anxiety and depression. EMDR therapy can be used at any age and can be adapted to children, adolescents, adults and the elderly unless contraindicated.In the pediatric population, several studies have shown that EMDR therapy has a remarkable effectiveness on several pathologies and particularly on PTSD. Translated with www.DeepL.com/Translator (free version)

Objectives

Present the indications of EMDR therapy in children and demonstrated its effectiveness in the management of psychiatric disorders in this population.

Methods

This is a systematic review of the literature. The databases used are “PubMed” and “Google Scholar”. No language restrictions were applied.

The following keywords were entered: EMDR, Child. Recent articles published in English or “systematic reviews, meta-analyses or reviews” were included.

Results

From this review of the literature, we note that:

EMDR is a psychotherapy that has been shown to be effective in improving the symptoms of various pathologies in children, including PTSD, major depressive disorders, intellectual disability, anxiety disorders, as well as behavioral disorders

However, the studies are still few in number and also have methodological limitations: they were exploratory studies of relatively small samples.

Conclusions

EMDR therapy is mentioned in the described guidelines as “promising”, as the fact that it yields positive results in a short period of time and that these results continue in follow-up studies has increased the interest in using EMDR in children.

Nevertheless, larger sample sizes are recommended in future studies to better establish the effectiveness of EMDR therapy in children.

Disclosure of Interest

None Declared
Lisdexamfetamine in combination with guanfacine as an effective treatment in the management of behavioral disturbances in patients with Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). Case report
Authors: Del Sol Calderon P. , Izquierdo de la Puente A. , García Moreno M. , Fernández Fernandez R.
Published: August 2023

Introduction

We often find it challenging to manage hyperactivity, low frustration tolerance and angry outbursts in patients with ASD and comorbid ADHD. Fewer drugs are approved for these disorders and these patients are more likely to develop adverse effects.

Objectives

The aim of this case is to show how the combination of lisdexamfetamine together with guanfacine has very positive effects on anger outbursts and boundary heteroaggressiveness in patients with ASD and ADHD.

Methods

Case report and literature review

Results

This is a 14-year-old minor admitted to the psychiatric unit after physical aggression against his family due to anger after removal of video games, requiring police intervention. He has been diagnosed since he was 11 years old with ADHD and Autism Spectrum Disorder. He was being treated with methylphenidate 54 mg and aripiprazole 10 mg. Since the beginning of the admission, the following pharmacological adjustment has been made: Methylphenidate is substituted by lisdexamfetamine up to 50 mg per day. Guanfacine has been started up to 4 mg per day and the dose of aripiprazole has been maintained. The patient had no adverse effects with adequate tolerance without sedation, hyporexia or hypotension. With this adjustment, improvement was found in the levels of restlessness and hyperactivity. The patient expressed a subjective improvement in the levels of restlessness and with a notable improvement in attention in the hospital classroom. An improvement in emotional regulation was also observed, with more tolerance to the imposition of limits, without an explosion of anger in the face of any rule during admission

Conclusions

The management of hyperactivity and episodes of low frustration tolerance in patients with ASD and ADHD is complex. Many studies point out the time-limited use of some antipsychotics such as risperidone or aripiprazole. This work aims to show guanfacine in combination with lisdexamfetamine as an excellent combination for the management of agitation and rage explosion in these patients. In addition, the profile of adverse effects at metabolic level is much better than that of atypical antipsychotics.

Reference

-

Extended-Release Guanfacine for Hyperactivity in Children With Autism Spectrum Disorder. Lawrence Scahill et al. Am J Psychiatry. 2015 Dec.

Disclosure of Interest

None Declared
Utilisation and acceptability of formal and informal support for adolescents following self-harm before and during the first COVID-19 lockdown: results from a large-scale English schools survey
Authors: Borschmann R. , Geulayov G. , Mansfield K. , Moran P. A. , Hawton K. , Fazel M.
Published: August 2023

Introduction

Little is known about the perceived acceptability and usefulness of supports that adolescents have accessed following self-harm, especially since the onset of the COVID-19 pandemic.

Objectives

We aimed to examine the utilisation and acceptability of formal, informal, and online support accessed by adolescents following self-harm before and during the pandemic.

Methods

Cross-sectional survey (OxWell) of 10,560 secondary school students aged 12-18 years in the south of England. Information on self-harm, support(s) accessed after self-harm, and satisfaction with support received were obtained via a structured, self-report questionnaire. No tests for significance were conducted.

Results

1,457 (12.5%) students reported having ever self-harmed and 789 (6.7%) reported self-harming during the first national lockdown. Informal sources of support were accessed by the greatest proportion of respondents (friends: 35.9%; parents: 25.0%). Formal sources of support were accessed by considerably fewer respondents (Child and Adolescent Mental Health Services: 12.1%; psychologist/ psychiatrist: 10.2%; general practitioner: 7.4%). Online support was accessed by 8.6% of respondents, and 38.3% reported accessing no support at all. Informal sources of support were rated as most helpful, followed by formal sources, and online support. Of the respondents who sought no support, 11.3% reported this as being helpful.

Conclusions

More than a third of secondary school students in this sample did not seek any help following self-harm. The majority of those not seeking help did not find this to be a helpful way of coping. Further work needs to determine effective ways of overcoming barriers to help-seeking among adolescents who self-harm and improving perceived helpfulness of the supports accessed.

Disclosure of Interest

None Declared
A systematic review on the association of birth intervals and risk of autism spectrum and attention deficit hyperactivity disorders
Authors: Kelishadi R.
Published: August 2023

Introduction

Pregnancy interval may have various impacts on psychiatric and psychologic disorders of the offspring.

Objectives

This systematic review aimed to assess the relationship of short and long inter-pregnancy intervals (IPIs) with the risk of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD).

Methods

We performed a systematic search on electronic databases including Pubmed, Web of Science, Scopus, and Embase. We included observational studies that evaluated the association between IPIs and the risk of ASD and ADHD. Two reviewers independently screened and then extracted data on study characteristics, IPIs/ birth intervals, and outcome measures. The methodological quality of the included studies was evaluated following the Joanna Briggs Institute (JBI) critical appraisal checklist.

Results

At the final step, 19 out of 161 studies were included in our systematic review. Among them, 16 and 5 studies assessed the association between IPI and the risk of ASD and ADHD, respectively. In 9 studies, findings supported the association between short intervals and an increased risk of ASD. In addition, 7 studies reported significant association between both short and long intervals and an increased risk of ASD. Moreover, 3 studies demonstrated an association between short intervals and ADHD risk, while long birth interval was merely assessed in 2 studies with conflicting results.

Conclusions

This systematic review strongly confirmed the association of short and long birth intervals with ASD and ADHD. Future studies should investigate the mechanisms underlying these associations and the possible modifiers to decrease the risk of such disorders.

Disclosure of Interest

None Declared
How to implement evidence-based practice to prevent and reduce coercion in psychiatry
Authors: Sartorius N.
Published: August 2023

The UN Convention on the rights of people with disabilities (UN CRPD) raised awareness of the need to find alternatives to coercion in the process of care for people with mental illness and/or mental impairment. In order to promote the application of the CRPD the World Psychiatric Association (WPA) has undertaken to produce a document listing possible alternatives to coercion and proposed to the General Assembly of the WPA to support the recommendations of that document by a WPA Position Statement on the matter.

The presentation will discuss the suggestions included in the Position Statement and in the review of options to reduce coercion in the WPA materials.

Disclosure of Interest

None Declared
Big data networks: Dynamic Time Warping as a statistical tool for network analysis using Ecological Momentary Assessment data
Authors: van der Does F. , van Eeden W. , Lamers F. , Penninx B. , Riese H. , Vermetten E. , Wardenaar K. , van der Wee N. , Giltay E.
Published: August 2023

Introduction

In recent research, psychological disorders have been increasingly defined as complex dynamic systems in which symptoms are interconnected and influence each other, thereby forming symptom networks. This paradigm shift calls for the analysis and interpretation of relationships between symptoms that are complex, potentially non-linear, and dynamic. Dynamic Time Warping (DTW) is used to measure similarity in temporal sequences, and has recently been found effective in modelling psychopathology symptom networks.

Objectives

We aim to demonstrate that DTW could also be used to model the network structure in Ecological Momentary Assessment (EMA) data.

Methods

355 participants of the Netherlands Study of Depression and Anxiety (NESDA), of which 100 with and 255 without current disorder, completed EMA assessments of 20 symptoms (e.g., feeling sad, tired, satisfied) five times a day for two weeks. DTW analysis was performed on the group level, comparing participants suffering from mood disorders to healthy controls. DTW distances were visualized as an undirected symptom network, in which we adjusted for the average symptom severity per item per person.

Results

DTW analysis of close to half a million symptom scores yielded six symptom dimensions based on their aggregated similarity of changes over time within the participants. Surprisingly, negative affect symptom networks were found to be less strongly connected in those currently suffering from mood disorders than in controls, whereas the network density of (reverse-coded) positive affect symptoms was more closely connected in this group. This is contrary to the results of previous studies, where negative affect-related symptom networks of those with mood disorders were found to be more strongly interconnected.

Conclusions

DTW is a promising new technique for analyzing EMA data and modeling dynamic symptom networks at both the individual and group levels. Using EMA data, symptom networks and dimensions can be modeled with great structural and temporal detail. Incorporating the temporal symptom dynamics may highlight the importance of the independent trajectories of negative mood symptoms.

Disclosure of Interest

None Declared
Alcohol consumption and cardiovascular risk: a descriptive study in a psychiatric short stay unit
Authors: González Navarro C. , Alonso Salas I. , Morado San segundo L. , López Fariña A. , Bilbao Idarraga A. , López Puentes U. , Samsó Martínez B. , Lopez Brokate R. F. , Ruiz de Azua Aspizua T. , Garnica de Cos E. M. , Ortega Pozas U.
Published: August 2023

Introduction

Patients with mental disorders have a decreased life expectancy, being the main reason the cardiovascular disease. An important proportion of patients present a comorbid drug consumption. Amongst drugs, alcohol is the most frequent, and it is associated with a higher cardiovascular risk. The metabolic syndrome is one of the most employed tools to assess cardiovascular risk.

Objectives

- To describe the demographic characteristics of the patients with an active alcohol consumption that were admitted to the hospital during the period of study.

-

To describe the prevalence of metabolic syndrome in the sample, according to the Adult Treatment Panel III (ATP-III) criteria.

Methods

Retrospective observational study of three months duration. Data was collected from all patients admitted to the hospital during the period of study, with no specific exclusion criteria. Descriptive statistics were performed.

Results

During the period of study 172 patients were admitted to the hospital (56.4% women and 43.6% men). A 44.8% presented alcohol consumption (25% sporadically, 6.4% weekly and 13.4% daily). Amongst women, 1% presented daily and 1% weekly consumption. Amongst men, 21.3% presented daily and 5.3% weekly consumption.

The prevalence of metabolic syndrome in the study sample was 29.11%. In the alcohol consumption group, the prevalence was 24.7% and differed according to the pattern of consumption: 43.5% in the daily consumption group, 27.3% in the weekly and 14% in the sporadically consumption group.

Conclusions

On the one hand, in the sample of study a higher percentage of men present an active alcohol consumption, compared to women. It is remarkable the high percentage of daily alcohol consumption amongst men in our sample.

On the other hand, the prevalence of metabolic syndrome in our sample is similar to the one found in scientific literature regarding patients with mental disorders. It is noteworthy in our sample the increased prevalence of metabolic syndrome found in patients with a daily alcohol consumption, and a decreased prevalence in those with a sporadic pattern.

Disclosure of Interest

None Declared
The World Network of Psychiatric Trainees’ Human Rights Curriculum Initiative
Authors: Pereira-Sanchez V. ,   NYU
Published: August 2023

Dr. Pereira-Sanchez, Founder and Executive Director of the World Network of Psychiatric Trainees (WNPT) and responsible for the WNPT Human Rights Curriculum Initiative, will present an overview of the same, which aims at understanding the current state of human rights education for psychiatric trainees across the world and at partnering with relevant organizations to develop international standards on the topic. The talk will highlight pilot results and achievments of the initiative and invite feedback, discussion, and further collaboration.

Disclosure of Interest

None Declared
Alcohol use in adult patients with autism spectrum disorder (ASD). Case report
Authors: Del Sol Calderon P. , Izquierdo de la Puente A. , Alvarez Astorga A. , García Moreno M. , Fernandez Fernandez R.
Published: August 2023

Introduction

Patients with autism spectrum disorder are characterized by high anxiety when facing social situations and dealing with interpersonal relationships on a daily basis. Although initially because of their rigid personality with the norm, and their tendency to social distancing, we do not have in mind this pathology as the most likely to develop a substance use disorder. However, it is observed in the literature a remarkable percentage of patients who resort to consumption, mainly alcohol, as an anxiolytic to be able to interact in society.

Objectives

To show the case of a 19-year-old adult with a diagnosis of ASD who resorts to alcohol consumption in her daily life as a strategy to manage anxiety in social situations.

Methods

Case report and literatura review

Results

This is a 19-year-old woman with a recent diagnosis of ASD. She is studying biotechnology and lives with her parents and 3 siblings. The patient reports difficulty in social relationships since early childhood, with experiences of school bullying. She expresses desire to relate with others, although she does it in an inadequate way, with difficulty in detecting nonverbal language, irony and anger when she does not understand a joke. The patient confesses that since she was 16 years old she has consumed alcohol to mitigate the anxiety caused by facing a group of people. She says that she feels that it relaxes her and facilitates interaction, making it more fluid and less tense. However, she recognizes that initially she used to drink 1 or 2 beers, but now she needs to drink up to 2 glasses of gin, recognizing this as something problematic.

Conclusions

The literature shows how patients with ASD can also present substance use disorder. It has been shown that about 10% of these patients have an abusive use of alcohol. Other samples show wider ranges (7-71%) of prevalence of alcohol consumption in patients with autism. In relation to cannabis, it is seen that around 3% of these patients consume it. These patients seek its anxiolytic effect and to reduce mental health symptoms. In addition, the purchase of alcohol does not involve high social interaction to obtain it, since it is a substance that can be purchased legally. It is important to explore alcohol consumption in consultation with patients with ASD to help them develop more functional anxiety management strategies.

Reference

Prevalence of psychiatric disorders in adults with autism spectrum disorder: A systematic review and meta-analysis. Lugo-Marín.J et al. 2019. Research in Autism Spectrum Disorders Volume 59, March 2019, Pages 22-33

Disclosure of Interest

None Declared
Diagnostic Overshadowing of Post-ictal Psychosis in the ED– A Case Series
Authors: Keenan K. , Moran A.
Published: August 2023

Introduction

Diagnostic overshadowing is established as a mechanism by which physical symptoms are misattributed to mental disorder, hence under-diagnosing and under-treating medical pathology. We report a case series of adult males with established neurological disorders who presented to the ED with visual hallucinations in the postictal period. The phenomena of postictal psychosis is long established in neuropsychiatric literature, with reported rates of postictal psychosis in epilepsy of 2%. Patients vsual hallucinations resolve with anticonvulsant stabilisation and rarely require antipsychotic augmentation.

Objectives

To illustrate diagnostic overshadowing in a case series of postictal psychosis

Methods

Retrospective case series

Results

Case 1:

A 36year old man self-presented to the ED 24hrs post tonic-clonic seizure of 15minutes duration. Medical history was significant for hydrocephalus as an infant with 29 surgical revisions of in-situ ventriculoperitoneal shunt since initial placement. Secondary epilepsy was reported to be poorly controlled with an estimated 50 ED attendances in the past year for management of seizure activity. On assessment new symptomatology of non-threatening visual hallucinations with associated low mood was elicited. A diagnosis of postictal psychosis was advised following psychiatric assessment and medical admission with anticonvulsant titration recommended. Despite this characteristic presentation there were repeated requests to admit this patient to the psychiatric unit and a perceived lack of understanding of his acute medical needs.

Case 2:

A 45year old man self-presented to the ED <24hours post discharge following medical admission for management of seizure. Medical history was significant for a right parieto-temporal infarct one year prior, with acceptable return to functioning following rehabilitation. The man had recently been diagnosed with secondary epilepsy and titration of sodium valproate commenced. The patient presented as distressed in the context of new onset visual hallucinations and palinopsia. Medical admission with urgent neurology input and anticonvulsant titration was advised following psychiatric assessment. ED physician repeatedly stated this patients presentation was stress related and requested psychiatric admission. Following medical admission the patient was managed by neurology. Sodium valproate was augmented with clobazam and the patients psychopathology resolved in full.

Conclusions

Diagnostic overshadowing is prevalent in the ED. Despite established medical diagnoses there may be a reluctance for medical teams to acknowledge or treat organic psychopathology. Psychiatrists must keep abreast of medical comorbidities and physical treatment guidelines of neuropsychiatric disorders in order to advocate appropriately for due medical input. Postictal psychosis is effectively managed by neurological input for effective seizure control with collaborative neuropsychiatry input.

Disclosure of Interest

None Declared
A Case of Severe Somatized Depression in a Young Adult: Diagnostic Challenges
Authors: Pityk O. M. , Kuzhda I. M. , Pityk M. I.
Published: August 2023

Introduction

Depressive disorders in adolescence and young adulthood have always been and remain an urgent problem due to their fairly high prevalence among the population, serious difficulties in diagnosis and untimely treatment. Timely diagnosis and adequate treatment can have a powerful impact on the future life of a person in a positive context. This process requires both standardized mechanisms, and an individual detailed study of each case, as the future of the individual depends on it.

Objectives

A young adult M., 20 years old, a university student, from a socially prosperous family, approached us.

Main complaints: headaches that have been going on for almost 4 years. Pains did not depend on loads, both physical and mental, were of various characteristic and different localization. Non-steroidal anti-inflammatory drugs, as well as anti-migraine drugs, have little effect on the pathological experiences.

Methods

Our main method of examination was clinical interview. In the complex assessment detailed neurological and ophtalmological examination included.

Results

The parents referred patient for a medical examination about a year ago, because they noticed persistent mydriasis in him. During the year, the patient underwent a detailed examination (consultations of a therapist, endocrinologist, neurologist, ophthalmologist, MRI, EEG, dopplerography). Doctors expressed various assumptions about the diagnosis, because all the studies did not reveal any pathology that could explain the indicated complaints and mydriasis.

During the initial interview, a high level of intelligence and knowledge was revealed, as well as a sufficient ability to learn. Examining the emotional-volitional sphere, a slight level of emotional instability, mild irritability, anhedonia and a slight degree of hypobulia (which can be explained by long-lasting and persistent pathological somatic experiences in the form of headaches) were found. Incomplete Protopopov’s triad was revealed.

The patient was referred for repeated neurological and ophthalmological examination. Specialists with a high qualification level discovered the A. Athanassio symptom in him.

He was diagnosed with recurrent depressive disorder, a current episode of severe depression with somatic symptoms, and appropriate treatment was prescribed.

Conclusions

1. Depressive disorders in adolescence and young adulthood require special attention from specialists of all medical specialties.

2. The need for a detailed medical examination and modern neuroimaging methods is beyond doubt.

3. Psychiatric examination cannot be limited to assessment of mental status only, and assessment of Protopopov’s triad should be part of psychiatric examination.

4. Neurological and ophthalmological examination must necessarily include an assessment of neuro-ophthalmological symptoms.

5. Individual selection of treatment should be carried out by a psychiatrist.

Sorry to say, Professor Mykola Pityk died 27.12.2020

Disclosure of Interest

None Declared
Psychoemotional distress on patients with cutaneous manifestations and SARS-CoV-2 infection
Authors: Sapaniuc C. , Rascanu M. , Bran D. , Lacatusu G. A. , Rosu F. M. , Pulbere M. , Gheuca-Solovastru L. , Manciuc D. C.
Published: August 2023

Introduction

The new coronavirus had a huge impact on individuals from a social, economical and psychological point of view. In march 2020 The World Health Organization declared the coronavirus diseases 2019 (COVID-19) a pandemic and highlighted its psychoemotional implications.

Objectives

The aim of this study was to investigate the psychological distress during the COVID-19 pandemic in patients with cutaneous manifestations and SARS-CoV-2 infection.

Methods

Data was collected from one first-line infectious diseases hospital from northeastern Romania. All patients with cutaneous manifestations and SARS-CoV-2 infection who accepted to answer the quality of life questionnaire (QLQ) were included in the study. The descriptive data analysis was conducted with the SPSS.

Results

A total of 191 patients with cutaneous manifestations and COVID-19 completed a questionnaire concerning their psychological distress and financial burden during the pandemic. Patients with chronic dermatological diseases (psoriasis) – 31% reported the highest level of psychological distress and financial burden compared to patients with acute cutaneous manifestations (chickenpox, dermatitis, infectious mononucleosis, steven-johnson syndrome, etc.). Furthermore, this patients showed generalized anxiety disorder, depressive symptoms, post-traumatic stress disorder (PTSD), sleep disturbances and they attributed their individual psychological distress to the COVID-19 pandemic. This patients received psychological/psychotherapeutic treatment due to the COVID-19 crisis, during hospitalization and after discharge.

Conclusions

During the pandemic, patients with dermatological diseases needs not only medical support but also psychological and psychosocial support. This study results emphasize the importance of monitoring the psychological impact of the COVID-19 pandemic on patients with cutaneous manifestations.

Disclosure of Interest

None Declared