bluuebunny/crossref_metadata_2025 huggingface dataset:
Utilization of psychotropic drugs in Europe: Why is Portugal such a particular case?
Authors: Alves-dos-Reis T. , Matias M.A.
Published: May 2016

Introduction

Psychotropic drugs are among the most utilized medications in Europe.

Objectives

To perform an international comparison of the utilization trends of antidepressants, anxiolytics, hypnotics and sedatives (AHS).

Methods

We used data from the Organization for Economic Cooperation and Development (OECD). We used the World Health Organization's Defined Daily Dosage (DDD) per 1000 inhabitants per day (DHD) methodology. We performed a general comparison between 14 European countries and a more detailed comparative analysis between Portugal, Italy, Spain and Germany. These countries were selected according to the following criteria: similar 12-month prevalence of mental health disorders, similar results for negative mental health (SF-36 questionnaire) and similar standardized death rates for suicide.

Results

Portugal had the highest overall utilization of antidepressants and AHS in 2011, amounting to 110.7 DHD, and the highest increase in utilization of AHS (1.8%) from 2003 and 2011. Concerning antidepressants, Portugal had the third highest utilization of these drugs in 2011 (78.3 DHD). Regarding the more detailed comparative analysis, utilization of AHS was still significantly higher in Portugal. Considering antidepressants, Portugal experienced an increasing utilization, which grew by approximately 11.4% from 2003 and 2008. From 2009 onward the utilization increased but at a slower pace.

Conclusion

The very high utilization of these drugs, especially of AHS, is a worrying fact since this might indicate an inadequate treatment choice for anxiety and depressive disorders. Further research is needed to better understand the relationship of these findings with regulations concerning utilization of psychotropic drugs and compliance with best medical practices between distinct European countries.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Efficacy and safety of generic escitalopram (Lexacure) in patients with major depressive disorder: A 6-week, multi-center, randomized, rater-blinded, escitalopram-comparative, non-inferiority study
Authors: Jeong J.H. , Bahk W.M. , Woo Y.S. , Lee K.U. , Kim M.D. , Kim W. , Yang J.C. , Lee K.H. , Lee S.Y.
Published: May 2016

Objectives

The primary aim of this non-inferiority study was to investigate the clinical effectiveness and safety of generic escitalopram (Lexacure) versus branded escitalopram (Lexapro) for patients with major depressive disorder (MDD).

Methods

The present study included 158 patients who were randomized (1:1) to receive a flexible dose of generic escitalopram (n = 78) or branded escitalopram (n = 80) over a 6-week single-blind treatment period. The clinical benefits in the two groups were evaluated using the Montgomery–Åsberg Depression Rating Scale (MADRS), the 17-item Hamilton Depression Rating Scale (HDRS), the Clinical Global Impressions-Severity Scale (CGI-S), and the Clinical Global Impressions-Improvement Scale (CGI-I) at baseline, week 1, week 2, week 4, and week 6. The frequency of adverse events (AEs) was also assessed to determine safety at each follow-up visit.

Results

At week 6, 28 patients (57.1%) in the generic escitalopram group and 35 patients (67.3%) in the branded escitalopram group had responded to treatment (P = 0.126), and the remission rates (MADRS score: ≤ 10) were 42.9% (n = 21) in generic escitalopram group and 53.8% (n = 28) in the branded escitalopram group (P = 0.135). The most frequently reported AEs were nausea (17.9%) in the generic escitalopram group and nausea (20.0%) in the branded escitalopram group.

Conclusions

The present non-inferiority study demonstrated that generic escitalopram is a safe and effective initial treatment for patients with MDD and may also be considered as an additional therapeutic option for this population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Knowledge and attitude toward repetitive transcranial magnetic stimulation (rTMS) among psychiatrists in Saudi Arabia
Authors: Alhadi A. , AlShiban A. , Alomar M. , Aljadoa O. , AlSayegh A. , Jameel M.
Published: May 2016

Introduction

Repetitive transcranial magnetic stimulation (rTMS) is a new treatment, used for different psychotic disorders mainly depression.

Objectives

Assessing knowledge and attitude toward rTMS among psychiatrists in Saudi Arabia, and determining factors affecting that.

Aims

To ensure that psychiatrists have sufficient knowledge regarding rTMS. A good knowledge will most likely have a positive impact on their attitude.

Methods

Cross-sectional study was conducted through an online survey. The study population is all psychiatrists in Saudi Arabia. A new valid and reliable questionnaire was developed.

Results

Sample of 96 psychiatrists enrolled in the study, 81% were males. Participant's mean age was 37 years. Half of participants were consultants. The sample mainly consists of general psychiatrists (65%). The study showed that 80% of psychiatrists have an efficient knowledge about rTMS. Consultants have higher knowledge than residents do. Abroad training has no association with the level of knowledge or attitude. Seventy-nine percent of psychiatrists have a positive attitude toward rTMS. Only 53% of psychiatrists agreed to receive (rTMS) in case they were in a psychotic depressive condition. Minority (7%) of psychiatrists would not refer their patients for rTMS.

Conclusion

Most of psychiatrists have a good knowledge and a positive attitude toward rTMS. Those who have high level of training and experience show higher level of knowledge. Articles are found to be a better source for updating knowledge. Having an rTMS treated person in the family or relatives will positively affect the psychiatrist's attitude.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Student's strategies to cope with stressful situations
Authors: Theodoratou M. , Nτavarinou M. , Stratoudaki-chondrou E. , Xiga M.P. , Nikolopoulou I. , Kloni P. , Psychogiou A.
Published: May 2016

Introduction

It is well known that students have several stressful situations to cope with and their coping strategies are of a wide range (Brougham et al., 2009, Zi et al., 2011, Pierceall and Cane, 2009).

Objective

The purpose of the study was to investigate how students coped with various stressful situations they faced.

Aims

One hundred participants, 60 men and 40 women, studying at TEI of Patras, Greece, were randomly selected and asked to describe their stressful situations and the ways they dealt with them.

Method

The questionnaire used was based on “Échelle Toulousaine de Coping” (Tap et al., 1993) adjusted by Theodoratou et al. (2006).

Results

Forty-five percent of the students could not control their feelings, while facing a difficult situation and might feel panic, but the majority of the students (63%) did not use medication to cope with a difficult situation. When facing a problem, the 45% of the students did not amuse themselves and 35% of the participants avoided communication with other people when they faced a problem. Moreover, 29% of the students chose to pray to face a difficult situation. Finally, 58% of the participants estimated that a counseling center in TEI of Western Greece would be necessary.

Conclusions

In conclusion, many students were overwhelmed by a negative emotion and most of them chose social withdrawal. Thus, they might feel helpless and suggested that a counseling center in their College and university might help them to overcome difficulties during their studies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A neuropsychological group rehabilitation program with institutionalized elderly
Authors: Lemos L. , Espírito-Santo H. , Simões S. , Silva F. , Galhardo J. , Oliveira M. , Costa M. , Martins S. , Daniel F.
Published: May 2016

Introduction

Elderly institutionalization involves an emotional adaptation and the research shows that the risk of depression increases.

Objectives

Evaluate the impact of a neuropsychological group rehabilitation program (NGRP) on depressive symptomatology of institutionalized elderly.

Aims

NGRP influences the decrease of depressive symptoms.

Methods

Elderly were assessed pre- and post-intervention with the Geriatric Depression Scale (GDS) and divided into a Rehabilitated Group (RG), a Waiting List Group (WLG), and a Neutral Task Group (NTG).

Results

In this randomized study, before rehabilitation, 60 elderly people (RG; 80.31 ± 8.98 years of age; 74.2% women) had a mean GDS score of 13.33 (SD = 9.21). Five elderly included in the NTG (80.13 ± 10.84 years; 75.0% women) had a mean GDS score of 10.60 (SD = 4.72). Finally, 29 elderly in the WLG (81.32 ± 6.68 years; 69.0% women) had a mean GDS score of 14.93 (SD = 6.02). The groups were not different in GDS baseline scores (F = 0.74; P = 0.478). ANCOVA has shown significant differences (P < 0.05) in GDS scores between the three groups after 10 weeks. Sidak adjustment for multiple comparisons revealed that elderly in the WLG got worse scores in GDS, comparing with elderly in RG (P < 0.01), and with elderly in NTG (P < 0.05).

Conclusions

Elderly that are not involved in a task get worse in depressive symptomatology. Being involved in a structured group task means lower depressive symptoms and being in a NGRP means even greater results.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Agreement between clinical judgments and subjective perceptions of clinical change
Authors: Müller M. , Stefan V. , Godehard W. , Prinz S. , Egger S.
Published: May 2016

Introduction

Research into the relationship between the subjective perception of clinical change and the objective evidence of the same is very limited. Less is known about the relationship between clinical judgments by mental health experts and the patient's perception of symptom change, in particular across different diagnostic groups.

Aims and objectives

This study aims to determine the level of concordance between the HONOS as a tool for clinical outcome monitoring and the self-reported change in psychopathology in a total sample of psychiatric patients as well as stratified by their primary diagnosis at admission.

Methods

A consecutive sample of patients admitted to a Swiss psychiatric hospital for either alcohol use disorders, schizophrenic psychoses, mood disorders, anxiety and somatoform disorders, or personality disorders, was assessed using the Brief Symptom Inventory (BSI) at admission and at discharge. The HoNOS were rated by the responsible clinicians. Complete data of admission and discharge were available from approximately 600 cases. Reliable change index (RCI) will be calculated to determine a clinically meaningful change based on the HoNOS scores. Concordance of RCI and change in BSI scores will be explored and compared between different diagnostic groups.

Results and conclusions

According to our preliminary results from this ongoing evaluation program, we hope to provide a step towards a deeper understanding of the interrelationship between clinical judgments and the course of subjectively experienced mental health problems.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Validation of the self-compassion scale in a community sample of Portuguese pregnant women
Authors: Bento E. , Xavier S. , Azevedo J. , Marques M. , Freitas V. , Soares M.J. , Martins M.J. , Xavier A. , Castilho P. , Morais S. , Macedo A. , Pereira A.T.
Published: May 2016

Introduction

In recent years, researchers and clinicians have shown an increasing interest in self-compassion. Indeed, several studies have suggested that self-compassion is a positive factor for mental and physical health. The Self-Compassion Scale (SCS; Neff, 2003) has been widely used to assess six dimensions of self-compassion (self-kindness, self-judgment, common humanity, isolation, mindfulness and over-identification) among diverse populations. Recently, it has also been used in perinatal samples but its psychometric properties in pregnant women is still unexplored.

Objective

This study aims was to investigate the reliability and the validity of the SCS using Confirmatory Factor Analysis in a sample of Portuguese pregnant women.

Methods

Participants were 417 pregnant women with a mean age of 33 years old (SD = 4.74) in their second trimester of pregnancy (M = 17.26, SD = 4.78, weeks of gestation). Participants completed the Portuguese version of the SCS while waiting for the routine prenatal consultation in Maternity Hospital, Portugal.

Results

A was tested and results showed that the six-factor model had a good fit to the data (TLI = 0.93, CFI = 0.94, RMSEA = 0.06). The total SCS presented a good internal reliability (α = 0.91) and their subscales showed Cronbach's alphas ranging between adequate (α = 0.77) and good (α = 0.87).

Conclusions

Overall, these findings suggest that the Portuguese version of the SCS is a valid and reliable measure to assess self-compassion among pregnant women. Thus, SCS could be useful in diverse settings in the perinatal period.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Regret Anticipation Failures Scale (RAFS): Validation of the Portuguese version
Authors: Borges J. , Pereira A.T. , Borges D. , Cabral A.S. , Martins M.J. , Bento E. , Macedo A.
Published: May 2016

Introduction

Failures in regret anticipation undermine regret avoidance, increasing regret frequency and ultimately the risk of regret-related problems. The Regret Anticipation Failures Scale (RAFS; Schmidt and Linden, 2011) was developed to evaluate interindividual differences in regret anticipation.

Objective

To investigate the psychometric properties of the RAFS Portuguese version.

Methods

A community sample composed of 108 university students and 79 employees (78.1% females; mean age = 33.16 ± 13.175; range: 17–62) answered the Portuguese preliminary version of the RAFS. To study the temporal stability, 31 participants (83.9% females; mean age = 26.54 ± 18.761) answered the RAFS again after approximately 6 weeks.

Results

The RAFS Cronbach alpha was “very good” (a = 0.81). All the items presented significant correlations with the total (excluding the item; > 0.20); only item 2 (Even when I’m stressed, I can foresee the regrets that certain behaviors could evoke in me) had the effect of lowering the internal consistency if deleted. The test-retest correlation coefficient was high, positive and significant (0.61; P < 0.001); there was not significant difference between test and re-test scores [14.26 ± 5.170 vs. 13.06 ± 4.761, t (30) = 1.532, P = 0.136]. Following Kaiser and Cattel Scree Plot criteria, only one factor was extracted, meaning that the scale is unidimensional.

Conclusions

The Portuguese version of RAFS has good reliability and construct validity. It could be very useful both in clinical and research contexts, namely in an ongoing project on the relationship between regret, personality and psychological distress.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Frequency of subtypes of irritable bowel syndrome in positive and negative subtypes of schizophrenia
Authors: Ahmed S. , Rasool G.
Published: May 2016

Objective

The aim of the study was to determine the frequency of subtypes of irritable bowel syndrome in positive and negative subtypes of schizophrenia.

Methods

Sixty-two drug naïve hospitalized patients between 18 and 65 years (mean age: 33.6) with first episode of schizophrenia based on DSM IV-TR and 69 control subjects matched for age and sex completed this study. A semi-structured clinical interview was used to assess both groups. Clinical data were obtained and basic lab investigations and ultrasonography of abdomen were done in all subjects to exclude any related abdominal pathology. Axis-I disorders of DSM IV-TR were excluded in control subjects. Positive and Negative Syndrome Scale (PANSS) and Rome III Urdu language version scale (cross-validation obtained) for irritable bowel syndrome (IBS) were administered to assess the severity of positive and negative symptoms of schizophrenia and subtypes of irritable bowel syndrome, IBS constipation (IBS-C), IBS Diarrhoea (IBS-D) and IBS Mix (IBS-M) in case and control groups respectively.

Results

Forty-seven patients (75.8%) and 15 patients (24.2%) had positive and negative schizophrenia respectively. Patients with positive and negative schizophrenia had higher rate of IBS-C 6.5% (n = 4), IBS-D 8.1% (n = 5), IBS-M 12.9% (n = 8), non-IBS 72.6% (n = 45) versus healthy subjects IBS-C 1.4% (n = 1), IBS-D 2.9% (n = 2), IBS-M 2.9% (n = 2), and non-IBS 92.8% (n = 64), OR = 4.8; 95% CI.

Conclusion

Irritable bowel syndrome is more frequent in patients with schizophrenia than in general population. This functional gastrointestinal disorder associated with psychotic symptoms requires attention and management while managing patients with subtypes of schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cognitive dysfunctions in first episode pychosis
Authors: Alptekin K. , Aydınlı E. , Ayer A. , Yalınçetin B. , Ulaş H. , Binbay T. , Akdede B.
Published: May 2016

Cognitive dysfunctions are one of the main domains of symptom clusters in schizophrenia that are strongly related to poor prognosis and psychosocial impairment. We conducted a study to investigate the level of cognitive functions in patients with first episode psychosis (FEP) and effect of psychosocial factors related to psychosis and cognitive dysfunctions in this population. We included 60 FEP patients and 60 healthy control subjects. Cognitive functions of the study population were evaluated by using neuropsychological test battery including Stroop, Rey Verbal Learning and Memory, Digit Span, Trail Making, Digit Symbols, Controlled Word Association etc. Psychosocial risk factors were assessed using Childhood Trauma Questionnaire, Social Environment Measurement Tool, Life Events Scale, Tobacco Alcohol Use Scale and Substance/Marijuana Use Scale. Cognitive functions were significantly impaired in FEP patients compared to normal controls. Patients had poor performance in verbal memory, attention, processing speed, working memory and executive functions that is similar to the previous literature findings. Stressful life events in the last year and familial liability of schizophrenia and psychosis in 1st degree relatives were strong predictors to develop psychosis in patients with FEP. Both factors also seemed to be related to cognitive dysfunctions. In this study, patients with stressful life events in the last year were likely to have memory and executive dysfunctions. It has been shown that psychosocial risk factors had played an important role in developing psychosis. However, these factors also may negatively affect cognitive functions that may make the patient predispose to develop psychosis in FEP patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Avolition in schizophrenia: associations with trait and state anhedonia
Authors: De Simone S. , Mucci A. , Bucci P. , Merlotti E. , Chieffi M. , Piegari G. , Campana T. , Patriarca S. , Rocco M. , Palumbo D. , Galderisi S.
Published: May 2016

Introduction

Current research suggested that avolition in patients with schizophrenia (SCZ) is not due to a deficit of hedonic experience, but to a poor ability to translate pleasurable experiences into motivational states. In line with this hypothesis, several evidences showed a preserved hedonic experience, even in the presence of severe trait anhedonia and avolition in SCZ.

Objectives

To test the hypothesis that memory dysfunction, generally found in SCZ, could lead to inaccurate representations of emotional experiences and interfere with translation of pleasurable experience in motivation.

Aims

The present study was aimed to investigate the relationships between state and trait anhedonia, avolition and cognitive functioning in 35 SCZ.

Methods

In SCZ and matched healthy controls (HC) the Temporal experience of Pleasure (TEPS) and Chapman's scales were used to assess trait anhedonia. The MID task was used to assess in-the-moment hedonic experience. Avolition was measured by the Schedule for the Deficit Syndrome. MATRICS Consensus Cognitive Battery was used to assess cognition.

Results

SCZ did not differ from HC on TEPS or on MID task performance but reported higher scores for trait social anhedonia. Trait social anhedonia was associated with memory dysfunction and showed a correlation with avolition.

Conclusions

Our results confirm the disjunction between state and trait anhedonia and demonstrate a relationship of the latter with memory impairment and avolition, suggesting that inaccurate representations of emotional experiences might impede their translation in motivation to act.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Depressive symptoms in a sample of patients diagnosed with schizophrenia
Authors: Fernandez-Quintana A. , García-Mahía M.D.C.
Published: May 2016

Introduction

Previous studies highlight the difficulty of correctly diagnosing depressive symptoms in schizophrenic patients, as well as the impact on clinical progression among patients who present with both syndromes, worsening treatment adherence and overall prognosis.

Aims

To determine the prevalence of depressive symptoms in patients diagnosed with schizophrenia. To analyze the relationship of depressive symptoms with other demographic and clinical variables.

Material and methods

Eighty-four patients diagnosed with schizophrenia according to ICD-10 criteria and treated in an Outpatient Mental Health Clinic were recruited for this study. Symptom severity was assessed using The Positive and Negative Syndrome Scale (PANSS; Kay et al., 1987); classifying patients as positive, negative or mixed schizophrenia subtypes. Data from clinical and sociodemographic variables was obtained from clinical records.

Results

The mean age was 43.2 years (SD: 10.2). Depression is objectively detected in 10.3% of the sample, and presented as subjective depression in 29.5%. The prevalence of depressive symptoms is higher among women, unmarried patients, lower social classes and patients who met criteria for predominantly positive Schizophrenia subtype. Higher prevalence of depressive symptoms was found in patients with a shorter course of disease.

Conclusions

Depressive symptoms present with a high prevalence among patients diagnosed with schizophrenia, especially during the early years of the disease. Given the severe impact of depression on both the evolution and prognosis of patients with severe mental illness, screening and early treatment must be carried out.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Real-world paliperidone palmitate data from acute units: The SHADOW study
Authors: Parellada E. , Bioque M. , Herrera B. , García-Dorado M.
Published: May 2016

Introduction

There is an increasing interest in understanding how antipsychotic treatments work in a real-world-setting. This is especially important with long-acting-antipsychotics, where explanatory trials may not always represent the real-world-population. Observational studies and pragmatic-clinical trials could provide additional information about new therapies, which could inform decision-making processes.

Objectives

To assess the effectiveness of Paliperidone-Palmitate(PP) in an acute setting within real-world-conditions. Functionality, satisfaction with treatment and pattern of use were also evaluated.

Methods

An observational, prospective 6-week follow-up study was performed in acute units including adult patients with acute exacerbation of schizophrenia that started treatment with PP. Data were collected from initiation of PP until week-6 (or patient's discharge if earlier). Clinical-Global Inventory-Severity (CGI-S) was used to assess effectiveness as well as changes in illness severity. Other outcomes included total score on the Personal and Social Performance scale (PSP), patient-satisfaction with medication (MSQ) and tolerability. Student's-t tests were used to assess changes from baseline in CGI-S and PSP.

Results

Two hundred and eighty patients were included in the analysis (mean age: 40.5 ± 12.2 [SD] years). A significant decrease in mean (SD) CGI-S score between baseline (4.7 [0.9]) and endpoint (3.3 [0.9]) (P < 0.0001) was observed. (Note that 21% of patients were discharged on PP-monotherapy). Patient-functioning also significantly improved from baseline to endpoint (P < 0.0001). Seventy-four percent of patients were satisfied (measured by MSQ) at the end of follow-up. Anticholinergic-treatment was less frequent for PP discharged on monotherapy vs. not monotherapy (12.5% vs 21.2% respectively). Overall, PP was well-tolerated. Twenty-five AEs were reported in 20 patients (incidence 7.1%). No serious AEs occurred.

Conclusions

These results support the effectiveness and tolerability of PP in an acute setting under daily-clinical-practice with good acceptance by patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Quality of care for medical comorbidities among patients with and without schizophrenia
Authors: Jørgensen M. , Mainz J. , Paaske Johnsen S.
Published: May 2016

Introduction

The association between schizophrenia and quality of care for medical comorbidities in universal health care systems remains unclear.

Objectives

To elucidate whether equal access also implies equivalent and sufficient care.

Aims

To compare the quality of care for heart failure, diabetes and chronic obstructive pulmonary disease (COPD) among patients with and without schizophrenia in Denmark.

Methods

In a nationwide population-based cohort study, we used Danish national registries to estimate the risk of receiving guideline recommended disease-specific processes of care between 2004 and 2013.

Results

Compared to patients without schizophrenia, patients with schizophrenia had lower chance of receiving high overall quality of care (≥ 80% of recommended processes of care) for heart failure (Relative risk [RR] 0.67, 95% CI: 0.48-0.92), diabetes (RR 0.84, 95% CI: 0.79-0.89) and COPD (RR 0.82, 95% CI: 0.72-0.93) as well as lower chance of receiving individual disease-specific processes of care including treatment with beta-blockers (RR 0.87, 95% CI: 0.79-0.96) in heart failure care and measurement for albuminuria (RR 0.96, 95% CI: 0.93-0.99), eye examination at least every second year (RR 0.97, 95% CI: 0.94-0.99) and feet examination (RR 0.96, 95% CI: 0.93-0.99) in diabetes care. Diabetic patients with schizophrenia also had lower chance of receiving antihypertensive (RR 0.84, 95% CI: 0.73-0.96) and ACE/ATII inhibitors (RR 0.72, 95% CI: 0.55-0.94). In COPD care, patients with schizophrenia had lower chance of receiving LAMA/LABA medication (RR 0.92, 95% CI: 0.87-0.98), however, higher chance of treatment with non-invasive inhalation (RR 1.85, 95% CI: 1.61-2.12).

Conclusions

Quality of care for three medical comorbidities was suboptimal for patients with schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Perceived and anticipated stigma in patients with schizophrenia according with the length of illness
Authors: Reneses B. , Gallego L. , López-Micó C. , Fernández del Moral A. , Rodríguez R. , Argudo I. , Carrascosa C. , Ochoa S.
Published: May 2016

Introduction

Perceived and anticipated stigma are relevant issues in patients with schizophrenia. Stigma has negative consequences both in quality of life and in the course of illness.

Objectives

To analyze differences in perceived and anticipated discrimination in two groups of patients with schizophrenia: one with a recent diagnosis of illness and another with a long course of disease.

Methods

A cross-sectional study was carried out in a sample of 100 patients with diagnosis of schizophrenia, 18 or more years old, clinically stabilized, without axis I DSM-IV comorbidity. Patients received treatment in the outpatient services of a catchment area in Madrid. Perceived and anticipated discrimination was evaluated trough the DISC-12 (Discrimination and Stigma scale). Other study variables were: socio-demographic status, length of disease, symptoms of depression (Calgary Scale) and functionality degree measured by Global Assessment of Function (GAF). Two sub-groups of patients were compared: one with a length of illness below 5 years and a second one with a length of illness over 5 years.

Results

Patients with a length of illness longer than 5 years showed elevated degree of perceived and anticipated discrimination compared with patients with less than 5 years of illness course. In the same way, patients with a recent diagnosis of illness showed increased scores in the measure of face the stigma.

Conclusions

Preventive strategies to avoid the stigma in schizophrenia should consider some differences in patients in relationship with the length of evolution of illness in order to be more accurate. Early intervention programs about stigma are necessary.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effects of nicotine abstinence on clinical symptoms. Study at 3 and 6-months follow-up of outpatients with schizophrenia
Authors: Sáiz Martinez P.A. , Al-Halabí S. , Fernández-Artamendi S. , García-Álvarez L. , Díaz-Mesa E. , Martínez-Santamaría E. , Florez G. , Arrojo M. , García-Portilla M.P. , Bobes J.
Published: May 2016

Introduction

Tobacco use has been associated with more excitement and agitation symptoms, greater severity of global psychopathology as measured by the Clinical General Impression (CGI) Scale, and psychotic symptoms in patients with schizophrenia.

Aim

To assess the effects of nicotine abstinence versus nicotine maintenance on the clinical symptoms of a sample of outpatients smokers diagnosed with schizophrenia.

Methods

Sample: 81 outpatients with schizophrenia [72.8% males; mean age (SD) = 43.35 (8.82)] currently smoking tobacco [no. of cigarettes (SD) = 27.96 (12.29)]. Desing: non-randomized, open-label, 6-month follow-up and multi-center study conducted at 3 sites in Spain (Oviedo, Santiago de Compostela and Orense). Instruments: Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression for Schizophrenia (CGI-SCH), Hamilton Depression Rating Scale (HDRS). Antropometric measures: Body mass index (BMI) and waist circumference. Vital sings: heart rate. Procedure: Patients were assigned to 2 conditions:

– control group = patients continuing their tobacco use;

– experimental group = patients participated in vareniclina or nicotine patches treatment for smoking cessation.

Patients were evaluated at baseline (all patients smoking) and after 3 and 6 months.

Results

No significant differences (P>.05) were found between groups at baseline evaluation. Likewise, there were no significant differences between smokers and non-smokers after treatment (3 and 6 months follow-up) in their clinical symptomatology (according to PANSS, HDRS and CGI-SCH), anthropometric measures and heart rate.

Conclusions

No significant differences were found in the clinical symptoms after a period of nicotine abstinence. Therefore, clinicians should motivate and help their patients to quit smoking (CIBERSAM - FIS PI11/01891).

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Functional outcome in psychosis is better determined by negative symptoms than cognitive impairment
Authors: Sánchez-Torres A.M. , Elosúa M.R. , Lorente-Omeñaca R. , Moreno-Izco L. , Peralta V. , Cuesta M.J.
Published: May 2016

Introduction

Cognitive impairment is considered the best predictor of functional outcome in psychosis. However, the nature of this relationship still remains to be determined.

Objective

To ascertain the relationship of negative symptoms and cognitive impairment with functional outcome in psychosis.

Methods

Ninety patients with a DSM-IV psychotic disorder diagnosis and 65 healthy controls were included in the study. We assessed the predominant negative symptoms over the course of illness with the Comprehensive Assessment of Symptoms and History (CASH). Functional outcome was assessed with the Specific Levels of Functioning (SLOF). Cognition was assessed with a set of neuropsychological tests, which were normalised to z-scores (regarding controls’ performance). Then, a Global Cognition Index (GCI) was obtained as a mean of the cognitive domains assessed: processing speed, attention, verbal and visual memory, executive functions, working memory and social cognition. We divided the sample in four groups, considering the presence/absence of negative symptoms (cut-off point of 2 in the CASH), and the presence/absence of cognitive impairment (considering a GCI z-score of–1 as cut-off point). We performed a MANOVA to compare the 4 groups’ functional outcome scores.

Results

Fig. 1 shows the significant differences between groups regarding functional outcome.

Conclusions

The combination of negative symptoms and cognitive impairment has deleterious effects over functionality, but negative symptoms alone are related to functional outcome, independently of cognitive impairment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Internalized homophobia, social pain, severity of depressive symptoms and quality of sexual life among homosexual young adults
Authors: Wiszniewicz A. , Wojtyna E.
Published: May 2016

Background

Being a homosexual may be burdened by several psychological problems. This is due to the minority stress that results from feeling excluded and it is characteristic of social minorities. Negative beliefs about their psychosexual orientation and sense of exclusion may be the cause of both depressive disorders and internalized homophobia. These factors can affect the quality of sexual life.

Aim

The aim of the study is to analyze the relationship between internalized homophobia, social pain and the severity of depressive symptoms and quality of sexual life.

Methods

The study included 103 young adults remaining in permanent homosexual relationships. The study was cross-sectional. The study used Beck Depression Inventory, Social Pain Thermometer, Internalized Homophobia Scale and Quality of Sexual Life Questionnaire.

Results

It observed the significant correlations between the level of internalized homophobia and a sense of social pain and the severity of depressive symptoms. Both internalized homophobia, and severe social pain and depressive symptoms proved to be significant predictors of reduced quality of sexual life of homosexuals.

Conclusions

During the treatment of depressive symptoms and discomfort associated with the sexual life of homosexuals, it is important to take into account the phenomenon of internalized homophobia.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Sleep quality in epileptic children
Authors: Abouzed M. , Kinawy S.
Published: May 2016

Sleep problems frequently coexist in epileptic patient. The effect of them on each the other has been extensively evaluated. Little review exists on the reciprocal interaction of sleep problems and epilepsy in the children.

Aim of study

To evaluate prevalence, pattern and risk factors of sleep problems in epileptic children.

Method

Eighty-two epileptic children and 40 healthy controlled children were evaluated using children's sleep habits questionnaire – Arabic form and night polysomnography (2 consecutive nights).

Result

Prevalence of sleep problem in epileptic children was 45% and 17% of normal control children with significant difference in sleep latency, total sleep time and number of awaking per night with significant prevalence with partial epilepsy, poly therapy and poor controlled epilepsy.

Conclusion

Sleep problems are common in epileptic children with close relation to partial epilepsy, number of anti epileptic and poor controlled epilepsy. This is important to deal with it in order to better control of sleep problems in such patient.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Sleep disorders, depression and anxiety among medicine university students in Sfax
Authors: Moalla M. , Maalej M. , Nada C. , Sellami R. , Ben Thabet J. , Zouari L. , Maalej M.
Published: May 2016

Introduction

Sleep symptoms, depression and anxiety often coexist and tertiary students are a population group that are increasingly recognised to be at risk. However the rates of these conditions in the tunisian population are poorly understood.

Aim

The aim of this study was to evaluate sleep quality among medicine students during exam periods and identify correlations with anxiety and depression.

Methods

This is a descriptive and analytical cross-sectional study. It involved students of medicine University of Sfax during the period of exams. Each student filled out demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI) to assess the quality of sleep and Hospital Anxiety and Depression scale (HAD) to screen for anxiety and depressive disorders.

Results

The average age was 22.27 years. The sex ratio M/F was 0.66. The students were single in 96.7% of cases. The average score of PSQI was 6.67 ± 3.23. According to the PSQI, 53.3% of students had poor sleep quality. The anxiety score ranged from 0 to 7 with an average of 8.37. The depression score ranged from 0 to 16 with an average of 7.47. Anxiety and depressive symptoms were present in 26.7% of students. The PSQI score was significantly correlated with anxiety (p <0.01) and depression scores (P = 0.019).

Conclusion

Anxiety and depressive symptoms are common among students during exam periods. They are associated with poor quality sleep. The establishment of a helpline for students during exam time, with psychologists and psychiatrists, would help them better manage this difficult period.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicide and body mass index
Authors: Barranco E.M. , de la Vega D. , Arcenegui Á. , Rico A. , Blanco M. , Martín R. , Guija J.A. , Giner L.
Published: May 2016

Introduction

It has been suggested that there is a relationship between BMI and suicide. Thus, BMI of subjects who commit suicide would be lower than the BMI of other unnatural deaths (Flaig 2013).

Objectives

Explore the possible relationship between BMI and suicide.

Material and methods

A total of 1197 suicides and 473 unnatural deaths (not by suicide) were collected systematically for 60 months at the Institute of Legal Medicine of Seville. Age, sex, weight, height and cause of death were recorded. Statistical analysis was performed using SPSS v19.0.

Results

(Figure 1)

Discussion

In our study we found that suicide (of all age groups and both sexes) have a lower BMI than controls. However, the relationship between these two variables is complex and not all studies support it. Moreover, the relationships between depression, suicide and overweight point in different directions. More and more studies indicate the existence of a relationship between depression and overweight, suggesting that perhaps the “epidemic” of depression and overweight that we see in Western societies has some connection. In addition, depression is a risk factor for suicide well established. Our results indicate that suicide group tends to have lower BMI (less weight in relation to its size) than the controls.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Prevalence of mental disorders in 1519 suicides: A meta-analysis
Authors: de la Vega Sánchez D. , Guillén E. , Gordillo M.J. , Giner L.
Published: May 2016

Introduction

Psychological autopsy studies have constantly indicated a clear relation between mental disorders and suicide. This relation has been found in studies across the world, although the percentage of cases with at least one mental disorder diagnosed may vary between studies and specially, between countries and geographical regions.

Methods

Review of psychological autopsy studies of suicide completers which contained information on diagnostic distribution. Only studies carried out in Europe and North America were included.

Results

A total of 14 studies, including 1519 suicides, were analyzed (Table 1).

Conclusions

Suicide risk is a multifactor phenomenon, however, it is strongly related to mental disorders. Mental health strategies should be directed to target clinical groups at high risk of suicide.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The effect of the financial crisis in Greece on the health habits of young adults
Authors: Menti D. , Fanioudaki V. , Lyrakos G.
Published: May 2016

Background

Periods of financial crisis have been strongly associated with changes in the health habits of affected individuals. Previous research suggests that these periods usually affect drinking, smoking, physical activity and eating habits, thus affecting our psychophysical health as well.

Aim

To investigate the effect of the financial crisis in Greece on the health habits of young adults.

Method

Two hundred and seven Greek young adults participated in the study, 75 (36.2%) males and 132 (63.8%) females, with a mean age of 29. Analysis of data was conducted with Anova, Ancova, regression and correlation analyses, using the SPSS software.

Results

The findings showed a significant effect of the financial crisis on drinking patterns (F(1.173) = 4.488, P = 0.036). Individuals whose income was reduced consumed less alcohol (M = 11.646, SD = 1.434) compared to individuals who had not experienced such a reduction (M = 17.957, SD = 2.611). There was a significant effect of annual income on BMI (F(4.10) = 3.74, P = 00.01, ηp2 = 0.96), after controlling for the effect of exercise intensity (F(1.10) = 4.58, P = 0.034, ηp2 = 0.31). However, the financial crisis did not significantly affect exercise, smoking behaviour or eating habits (P > 0.05). Significant correlations between tobacco use and drinking were found (r(206) = 0.22, P < 0.001). A significant correlation was also found between exercise and the consumption of fruits and vegetables (r(174) = 0.26, P < 0.001).

Conclusion

The financial crisis reduced alcohol consumption whilst it did not affect physical activity, smoking or eating habits. These findings allow us to propose that, despite the bleak reality of a period of financial crisis, such periods could actually lead to the reduction of unhealthy behaviours.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The orientation to life questionnaire: Assessing older adults’ sense of coherence
Authors: von Humboldt S. , Leal I.
Published: May 2016

Introduction

Growing literature suggests that the sense of coherence (SOC) positively influences well-being in later life.

Objectives

This study reports the assessment the following psychometric properties: distributional properties, construct, criterion and external-related validities, and reliability, of the Orientation to Life Questionnaire (OtLQ) in an cross-national population of older adults.

Methods

We recruited 1291 community-dwelling older adults aged between 75–102 years (M = 83.9; SD = 6.68). Convenience sampling was used to gather questionnaire data. The construct validity was asserted by confirmatory factor analysis, convergent and discriminant validity. Moreover, criterion and external-related validities, as well as distributional properties and reliability were also tested.

Results

Data gathered with the 29-items OtLQ scale showed overall good psychometric properties, in terms of distributional properties, construct, criterion and external-related validities, as well as reliability. Three factors were validated for the OtLQ scale: (a) comprehensibility; (b) manageability; and (c) meaningfulness.

Conclusion

We validated the 3-factor OtLQ scale, which produced valid and reliable data for a cross-national sample with older adults. Hence, it is an adequate instrument for assessing sense of coherence among older people in health care practice and program development contexts.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Evidence-based psychosocial measures in rehabilitation
Authors: Becker T. , Guehne U. , Riedel-Heller S.
Published: May 2016

Background

Psychosocial interventions are essential tools in mental health care and rehabilitation. A range of interventions relevant to rehabilitation that are covered in a German DGPPN S3 guideline on psychosocial interventions are discussed.

Methods

Literature search and (mostly) systematic reviews were performed for a range of psychosocial interventions.

Findings

Milieu therapy (MT) includes measures that impinge on therapeutic milieu/atmosphere in joint professional/user groups in the course of treatment. MT provides a context in which psychosocial interventions can be implemented. There is evidence of its effectiveness in improving mental health outcomes. Peer involvement (PI) and peer support are supported by promising evidence as innovative interventions in mental health care. Findings on case management (CM) are inconsistent. There are difficulties in defining CM. CM strengths include treatment satisfaction and continuity of care. With respect to integration in the labour market for people with severe mental illness supported employment (SE) has been shown to be more effective in achieving job placement. A proportion of SE users fail to find jobs on the general labour market. Other types of work rehabilitation are required, and there is room for pre-vocational training interventions.

Discussion

Psychosocial interventions are strong interventions. The strength of the evidence is varied. The use of psychosocial interventions rests on experience, evidence and ethics.

Conclusions

Psychosocial interventions are indispensable in building mental health care systems. Vocational interventions and residential services are mandatory. Peer involvement could help in moving mental health services forward.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Asian perspective
Authors: Kanba S.
Published: May 2016

The 1990s saw an inexorable wave of globalization. This came as a massive jolt to the culture of Japan, which until then had been in a state of balance and stability. However, unlike the West, in Japan this economic globalization is not a manifestation born of individualistic value systems and socioeconomic systems that had previously been in place. The spirit that was imported together with economic globalization was not mature individualism. At the risk of overstating the case, Japan went too far in ripping apart the complex, intricate interpersonal relations that had been in place and moving toward the individualism.

I will explain that the relationship between culture and the mind takes the form of a cooperative organization. The relationship between culture and the brain therefore also takes the form of a cooperative organization. Culture has a top-down influence even on simple visual perception.

I will state that the phenomenon of the depressive state generally known as “modern depression” occurring in epidemic proportions can be explained in terms of a loss of etiquette due to cultural intermingling as well as cultural affordance. Public opinion tends toward the argument of whether or not those who have sunk into this depressive state simply want to slack off. However, from the point of view of psychiatry, it is more important to consider the fact that while manifestations and popular names may differ, mental disorders will continue to develop in the future, regardless of the era, and we need to cultivate a better understanding of their structure. The essential challenge in this respect is the merging of cultural psychology and cultural neuroscience.

Disclosure of interest

The author has not supplied his declaration of competing interest.