bluuebunny/crossref_metadata_2025 huggingface dataset:
P02-241 - Comparing the Prevalence of Psychoticism and Paranoid Ideas Between two Wards of Internal Medicine and A&E (2005–2006)
Authors: Amanat N. , Behnam B. , Ghorbani R. , Imani A. , Khankeh H.R.
Published: June 2010

Objectives

Some psychological disorder-comorbid with a medical diagnosis-presents a challenge for treatment because of diagnostic and treatment dilemmas. This study investigated associations between Psychoticism and Paranoid ideas in internal medicine and A&E1patient in a university hospital.

Methods

In this cross-sectional study, we checked 150 patients of internal medicine department and 150 patients, who have admitted to the A&E department as a control group. They have chosen by a Purposive accessible sampling method. The psychopathological profile was assessed using the SCL-90 questionnaire by Iranian version. Data have been computed and analyzed by SPSS V.17 and we used t-student, Mann-Whitney tests and logistic regression methods. The results have been considered significant when the two tailed p-value was less than 0.05.

Results

In internal ward 70% and A&E department 43.3% of patient have had Paranoid ideas (OR= 4.2; 95% CI, 1.9 to 8.9). Psychoticism were observed in 38% of internal medicine patients and 20% of A&E's patients (OR= 7.64; 95% CI, 3.2 to 17.8).

Conclusion

The present results confirm the high prevalence rate of Psychoticism and Paranoid ideas in patients that hospitalized in internal to A & E ward. Recommendation are made to further investigate by greater sample size and different setting in this field is warranted.
P02-244 - Evaluation of Cognitive-Executive Functions in Subjects with Borderline Personality Disorder and Childhood ADHD
Authors: Di Rosa A.E. , Cambria R. , Crescenti M.C. , Pata M.
Published: June 2010

About 20-25% of children diagnosed as affected by ADHD show in adulthood residual symptoms such as hyperactivity, impulsive behaviours and disattention with a variable degree of cognitive impairment, and are diagnosed as affected by a cluster B personality disorder (mostly antisocial or borderline).

Objectives

The aim of our study is the evaluation of the presence of ADHD and cognitive-executive functions in patients with Borderline Personality Disorder (BPD).

Materials & methods

We enrolled 54 adult male patients with BPD diagnosis (mean age 40,6 years). The Wender Utah Rating Scale 25-items (WURS) was used to assess the presence of ADHD in childhood. The neurocognitive assessment included the following tests: Wisconsin Card Sorting Test (WCST), Stroop Color/Word Interference Test, Verbal Fluency Test (VFT), AB-AC Test.

Results

From scores obtained at WURS 25-items (cut-off score ≥ 46) the observed frequency of subjects with childhood ADHD was 27.8% (15/54). Therefore the subjects were divided into two groups: BPD without ADHD and borderline ADHD. Scores obtained were compared and statistical significance was observed in regard to WCST (p=0.006), VFT fonemic (p=0.04), VFT semantic (p= 0.05), AB-AC test (p=0.05).

Conclusions

Our study shows that borderline subjects with childhood ADHD have worse cognitive performances than borderline subjects without childhood ADHD.
P02-245 - Two Extreme and Parallel Cases of Borderline Personality Disorder
Authors: Di Lorenzo R. , Moretti V. , Muratore C. , Pighi M. , Rigatelli M.
Published: June 2010

Introduction

Borderline Personality Disorder (BPD) shares many symptoms with Bipolar Disorder (BD) and Attention-Deficit/Hyperactivity Disorder (ADHD), like aggressiveness, mood instability and impulsivity, which are often treated in off label modality with mood stabilizer drugs. We point out the diagnostic, therapeutic and rehabilitative difficulties of BPD treatment through the analysis of two extreme and parallel cases.

Materials and methods

Two females, born in extra-EU Countries in 1986 and in 1988, emigrated in Italy in childhood, presented overlapping traumatic early life events and ADHD during scholar age. Later, both the patients presented such growing relational problems and disruptive behaviours to be expelled from family and school. So they began a long psychiatric history, characterized by frequent hospitalizations, due to violent behaviour against themselves and other people, many unsuccessful rehabilitative programs, due to poor compliance, and various pharmacological switches, due to drug scarce effectiveness. Both the patients were followed by the same staff for 8 years, with an integrated psychotherapeutic, rehabilitative and pharmacological program, which consisted of a perseverant and meantime flexibly setting, a support of educational community operators and an off label prescription of two mood stabilizers combined to an atypical antipsychotic drug.

Results

At the moment, the patients showed reduced dangerous behaviours, but need a perseverant effort by many operators in order to promote their emancipation from institutional dependence.

Conclusions

The complexity of these cases, characterized by the persistence of a childhood disease, developed into a stables unstable mood chronic pathology till the late adolescence, suggests us a likely pathogenic relationship among BPD, BD and ADHD.
P02-248 - Could Methadone Maintenance Improve Insensitivity to Long Term Consequences in Opioid Addicts?
Authors: Ganjgahi H. , Ekhtiari H.
Published: June 2010

Objectives

Delay discounting (DD) procedure has been used to probe the extent to which behaviour is insensitive to its long-term consequences. During the DD task, participants are offered a choice between a small reward, which is delivered immediately, and a larger reward, which can be obtained only after a delay. Several studies has been reported that drug addicts are insensitive to future outcomes in DD. Previous studies indicated that Methadone Maintenance Treatment (MMT) decreases risky behaviors such as illegal drug use, needle sharing and risky sexual behaviors. But, there is a serious question that could it change underlying cognitive processing of risky behavior or not?

Material and methods

In this study, we evaluated 266 opioid dependents (age: 31±9 years, education: 10±3 years) before MMT entry on DD. 78 patients (30%) has been completed at least three month MMT and re evaluated on DD. The Mazour model was fitted to data (V=A/(1+kD)) (K: delay discounting coefficient, D: delay) and least square parameter estimation was used to estimate delay discounting coefficient.

Results

K was significantly reduced after 3 month successful MMT (0.12±.6 vs. 3.9±12.6) (P values=0.016). Successful patients in MMT had lower K in baseline but not significantly.

Conclusion

MMT could improve future time horizons in underlying cognitive processing of decision making. Based on this study, We could accept more favorably MMT as a real effective addiction therapy not just a substitution between street drugs and state drugs.
P02-249 - Reduced Prefrontal and Orbitofrontal Gray Matter in Female Adolescents with Borderline Personality Disorder: is it Disorder Specific?
Authors: Henze R. , Brunner R. , Parzer P. , Kramer J. , Feigl N. , Lutz K. , Essig M. , Resch F. , Stieltjes B.
Published: June 2010

Introduction

Neuroimaging studies in adults with borderline personality disorder (BPD) have reported alterations in frontolimbic areas, but cannot differentiate between alterations originating from disease and those occurring as side-effects of medication or other consequences of the disorder.

Objectives

To provide a clearer picture of the organic origins of BPD, the present study reduced such confounds by examining adolescents in the early stages of the disorder. It also examined the extent to which alterations associated with BPD are specific, or shared more broadly among other psychiatric disorders.

Methods

Sixty right-handed, female adolescents (14-18 years) participated. 20 had a DSM-IV diagnosis of BPD, 20 had a different DSM-IV defined psychiatric disorder, and 20 were healthy controls. All groups were matched for age and IQ. Images were analysed using voxel-based morphometry.

Results

No differences were found in limbic or white matter structures. Compared to healthy controls, adolescents with BPD displayed reduced gray matter in dorsolateral prefrontal cortex bilaterally and in left orbitofrontal cortex, but there were no significant differences in gray matter between BPD and other psychiatric patients. Like BPD patients, non-BPD psychiatric patients displayed significantly less gray matter in right dorsolateral prefrontal cortex compared to healthy controls.

Conclusions

These findings indicate that the prefrontal cortex is the earliest affected in the progression of BPD, but this does not distinguish it clearly from other psychiatric disorders. Alterations in limbic areas and white matter structures were not observed, but may play a later role in the progression of the illness.
P02-250 - How to Transform Borderline Personality Through Lifetrack Couple Therapy
Authors: Ishizuka Y.
Published: June 2010

Borderline personality (disorder) can be understood as the consequence of ‘successful’ if desperate adaptation to overwhelming adversity in childhood, charcterized by unsuccessful or conflicted attachment to difficult parents.

Accordingly, Lifetrack therapy attempts to give the patient his/her first successful closeness (attachment) with his/her committed partner through therapy, transforming borderline personality itself.

Working with the patient and his/her partner Lifetrack therapist concentrates on bringing the couple closer than ever before guided by Lifetrack daily self-rating program on 41 parameters that allows accurate and comprehensive tracking of dynamic mental status and subtle daily changes in personality.

As the case example of Jane illustrates, advancing intimacy provokes spikes of symptoms (and setbacks) characteristic of borderline personality. However, daily self-rating graphs makes it possible for the therapist to demonstrate to the couple that advancing intimacy provokes setbacks (symptom spikes) but recovery from setbacks can allow intimacy to reach peaks higher than before the setbacks

-

caused by exhaustion of defense/symptoms. This insight greatly empowers the patient couples and the therapist to continue to advance in intimacy provoking and overcoming defense (symptom spikes) until it becomes exhausted and disappear.

Transformation of BPD typically go through 4 distinct stages, with stage 4 representing complete transformation. Of the 134 BPD patients treated with partners, 34% reached stage 4. Of 234 BPD patients treated with Lifetrack therapy, 66.4% (134) of patients treated with partners exceeded their previous maximum level of adjustment. When couples persisted beyond the first month of therapy, 70.7% (123) exceeded their previous maximum level.
P02-254 - A Meta-Analysis of the Effectiveness of Methylphenidate in the Treatment of Adult ADHD
Authors: Kösters M. , Weinmann S. , Becker T.
Published: June 2010

Objectives

We will present results of a systematic review of the effectiveness of methylphenidate in the treatment of adult ADHD. Furthermore, we will discuss the influence of methods on the results of meta analyses.

Methods

We searched Medline, PsycINFO and CCTR to identify randomised controlled clinical trials comparing methylphenidate with placebo in the treatment of adult ADHD. Studies were summarized with meta-analytic methods. Subgroup analyses were conducted with respect to parallel group vs. cross-over trials and self vs. observer ratings. The relationship between dosage and effect size was explored by weighted regression analysis. The results were tested for publication bias, and several sensitivity analyses were conducted.

Results

Nineteen studies met the inclusion criteria of which 17 were included in the meta-analysis. The overall effect size was significant at d=0.42 different from zero, but this was only half the size expected on the basis of a previous meta-analysis. No significant differences could be observed in the subgroup analyses. The regression analysis showed no significant influence of mean daily dose on effect size.

Conclusions

These results contradict findings of a previous meta-analysis and challenge guideline recommendations. Differences between populations of children and adults and methodological issues in meta-analyses are discussed.
P02-255 - Dissociation, Trauma, Affect Regulation and Personality in Patients with a Borderline Personality Organization
Authors: Loeffler-Stastka H. , Blueml V.
Published: June 2010

Introduction

Over the past few decades the concept of dissociation has become more and more popular in the psychiatric and psychotherapeutic research community. Psychoanalytic theories (Kernberg, Fonagy) see the cause for dissociative symptoms in a troubled developmental history.

Objectives

1.

In the present study we wanted to empirically study these relations between childhood traumatisation and dissociative phenomena in patients with a Borderline Personality Organisation (Kernberg).

2.

Further we were interested in examining personality and affect regulation factors of these patients. It was hypothesized, that certain personality traits (such as primitive defence mechanisms) would be associated with trauma and dissociation, while others (e.g. high-functioning personality structure) would be absent in the sample group.

Methods

52 psychiatric inpatients with a Borderline Personality Organisation completed the Dissociative Experiences Scale, the Childhood Trauma Questionnaire, and the personality and affect regulation measurement instruments SWAP and AREQ.

Results

Significant correlations between dissociative symptoms and childhood traumatisation were found, especially with emotional abuse in childhood. Childhood trauma also correlates with severely disturbed personality characteristics.

Conclusions

The results empirically support psychoanalytic theories that a failure by the primary attachment figure in containing affects and sensations of a child can lead to dissociative symptoms and a disturbed personality development. Results are critically discussed within a psychoanalytic framework which should also help clarify the rather vague concept of dissociation.
P02-256 - When Psychiatric Action is Limited: Cases of Personality Disorder
Authors: Martins A. , Ferreira P. , Silva A.
Published: June 2010

The distinction between normal and abnormal behaviors depends on many factors: economic, social, biological, …. As a society gets more developed and informed, the frontier between moral, religious or social problems and psychiatric disease tends to be a frequent object of reflection. In the past many medical conditions (such as epilepsy, mania and several psychosis) were inicially considered moral or social problems. On the other side, nowadays, Psychiatry is often asked to act in disruptive situation: difficulty in controlling impulses, aggressive behaviors and criminality.

The authors present some case studies of personality disorders, in which the principal symptom at admission was violent behavior. The psychiatric action was limited by therapeutic solutions and ethic issues.

According to literature there’s an association between personality disorders and criminal behavior. Antisocial personality is a strong predictor of violence and aggression. The clinical cases presented confirm these findings.
P02-257 - Comparison of Coping Mechanisms of Adolescents Inhabiting “Tehran Correction and Rehabilitation Center” and High School Students
Authors: Rahimnia M. , Rasulian M. , Ebrahimzadeh M.
Published: June 2010

Aim

Comparing coping mechanisms of 15-17 year-old inhabitants of “Tehran Correction and Rehabilitation Center” (named: delinquents) and the same age students of Tehran high schools (named: non-delinquents).

Method

In a cross-sectional descriptive study, all 105 inhabitants of the center (81 males and 24 females) and 372 high school students (181 males and 191 females) who were randomly selected from area 6 of Tehran high schools completed the “Adolescent Coping Scale” which consists of 18 strategies and 3 styles. Results were analyzed using ANOVA and T-test.

Results

Non-delinquent males and females used productive style more than reference to others, and reference to others more than non-productive style. Delinquent males used productive style and reference to others without significant difference, and also used these two styles significantly more than non-productive style. Delinquent females used all three styles without significant difference. Delinquent males used all three styles significantly more than non-delinquent males. Delinquent females used productive style less, non-productive style more and reference to others without significant difference from non-delinquent females.

Conclusion

In comparison with delinquent females, Delinquent males have a more comprehensive set of coping skills and can use external resources more effectively. Delinquent females use a very dysfunctional collection of coping mechanisms, which may have caused their vulnerability to social pathologies.
P02-264 - Temperament and Charactertraits in Patients with Epilepsy: Epileptic Personality?
Authors: Yazici E. , Yazici A.B. , Aydin N. , Orhan A. , Kirpinar I. , Acemoglu H.
Published: June 2010

Objectives

Personality and behavioral changes in epilepsy is known for a while. But neither quantitative characteristics nor etiology of these changes are not clear yet. There are many studies focusing on personality disorders in epilepsy using different methods. Cloninger has developed a psychobiological model of personality which provides to evaluate personality in a dimensional way.

Methods

In this present study, we examined the relationship between the Cloninger's dimensional psychobiologic model of personality and epilepsy. 73 outpatients of epilepsy and 70 healthy controls were examined using SCID I, Temperament and Character Inventory (TCI) and a questionnaire for epilepsy.

Results

Epilepsy patients had higher harm avoidance (HA) and lower persistence, self-directedness (SD), cooperativeness scores than healthy controls.

In epileptic subjects no correlation was determined between TCI traits and age and duration of epilepsy. HA scores were higher in women. Subjects with partial seizures had higher HA scores and lower SD scores than generalized ones. Self Transcendence (ST) scores were different in groups due to frequency of epileptic seizures in One Way ANOVA but not corrected with Tukey HSD. Existence of comorbid depression was represented with lower ST scores. In multiple linear regression models only MDD predicted lower scores of SD.

Conclusions

This study confirms existence of specific personality changes among the epileptics by dimensional personality model of Cloninger and indicates a relationship between the characteristics of epilepsy and psychiatric comorbidity. Further investigations are needed for a clear understanding of common etiology of epilepsy and personality changes.
P02-269 - The Logical Affirmation of Non Being as Clear Indication of Psychosis Balvet's Syndrome
Authors: Allen D.
Published: June 2010

When Dr Leuret published his “Psychological fragments on madness” in 1834 he went to great lengths to describe a woman who claimed to be Other than herself.

She uses the third person (s) and describes a sort of break between what she sees and experiences as two lives lived by two persons ; persons in no way connected.

The paper then moves to Dr Klein, a psychotic psychiatrist who in 1937 published his thesis on the logical impossibility of being a person.

The last case quoted is that of a great British poet who doubted the nature of the unified I.

The paper concludes by opposing Balvet's syndrome to the Ganser syndrome in which we find suspension of identity but not dissolution of identity.
P02-270 - Pathographical Aspects About N.V. Gogol
Authors: Anatolievich Skavysh V.
Published: June 2010

Whether the dead of the author, who burnt the second volume of his book “The Dead Souls”, was psychopathological? A part of N.V.Gogol's contemporaries supported that his death was a consequence of “mental disease”. The myth about Gogol's “craziness” became a firm stereotype in European psychiatry presented by C.Lombrozo. Later, many russian psychiatrists (N.Bazhenov, V.Chizh, G.segalin, I.Galant, A.Lichko, A.Molochov, D.E.Melechov) tried to prove this opinion using published materials. However, all these psychiatrists did not give any scientific answer, for they had rather superficial understanding of life, kind of mind and religious constitution of N.V.Gogol. These psychiatrists, sorry to say, didn't have the systematic humanitarian knowledge so that to overcome the stereotype of natural-scientific paradygm of contemporary Psychiatry. One can't understand and relevant explain the behaviour of a man in another cultural and historical age, for example Gogol, without any special philological and philosophical preparation. The process of true understanding of another person is rather subjective, depending on an intentia of the consciousness on terminology of F.Brentano or on the hermeneutic circle according to M.Heidegger. All psychiatrists were under his personal delusions and simulacres about Gogol's spiritual life as a orthodox Christian man, because they used not full, and, mainly, not authentic information about Gogol's life, distored by some false interpretations, yet taken indirectly.
P02-272 - Why Validating ICD and DSM is Illusory? The Case of Psychoses
Authors: Foucher J. , Bennouna-Greene V.
Published: June 2010

Introduction

The international classifications in psychiatry, i.e. ICD-10 and DSM4R, allowed a fast increase of factual information. The improvement of reliability account for most of it. But it did not came with an increase in validity. We will argue that these classification are not “validable” unless questioning some of the postulates that guided their elaboration.

Method

We will state the epistemological principle underlying scientific and medical classifications and compare the ones at work in psychiatric classifications. Examples from the field of psychoses will be given.

Results

Validity is a notion that can only apply to scientific classification, i.e. that aim at providing a model for an external reality. The validable part of a classification is the model on which it relies, not the definition that ensue the model. In medicine, the term “disease” apply to natural morbid entities defined by an hypothesis, i.e. a model, on their aetiology or pathophysiology. Only this hypothesis can be validated.

ICD and DSM utility is oriented toward a practical objective. This constrains choices in their elaboration not adapted to pursue a scientific goal. The most challenging is the atheoretical orientation which take away from the classification their only validable part, i.e. a model.

Conclusion

There is urgent need to clarify the utility of ICD and DSM in psychiatry, i.e. epidemiology and clinical practice. Requiring their use in scientific inquiry could only slow down any progress toward the discovery of real disease in psychiatry.
P02-273 - Religion in Psychiatry? The Pilot Study in Freiburg, Germany: the Meaning of Religion / Spirituality in Psychiatry from Staff's Perspective
Authors: Lee E. , Baumann K. , Voderholzer U. , Zahn A.
Published: June 2010

Objectives

In the context of a growing body of international research though not in German-speaking countries, this study examines

1)

the extent of spirituality of staff in a psychiatric hospital,

2)

their relationship to staff's attitudes towards religion / spirituality (ReS) of patients

3)

and the integration of religious and spiritual contents to the patient's therapy.

Methods

An anonymous survey distributed to the staff in the department of psychiatry and psychotherapy of the Freiburg university hospital in 2009. Main predictor variable was the extent of spirituality using DRI. Main criterion variables were the relevance of ReS of patients and staff's attitudes towards ReS during their therapies using the questionnaire of Curlin et al.(2007).

Results

The response rate was 44.16% (n=197). The extent of spirituality of staff is 6.89 on a scale of 12.0. Although there is no significant relationship between the extent of spirituality and staff's attitudes towards ReS as well as their integration of religious and spiritual contents to therapies, staff regard the influence of ReS generally positive to patients. 95.4% endorse ReS as coping strategy. However staff do not integrate religious and spiritual practices in their therapies. The most frequent reasons are insufficient time/occasion, insufficient knowledge and concern about offending patients.

Conclusions

Religious and spiritual contents have not been integrated yet in psychiatric therapy methods, although they are regarded as important for patients. Further studies and discussion about religious and spiritual matters are essential for their integration into psychiatric therapies to overcome these problems for patients and staff.
P02-277 - Link Between Physical Education and Language Acquisition in Childhood
Authors: Danoiu S. , Danoiu M. , Danciulescu R. , Dragomir M. , Zavaleanu M.
Published: June 2010

Objectives

The purpose of this study was to demonstrate the possible implication of physical education in the process of hemispheric lateralization in childhood, and behind this in the acquisition of the speech and hand writing language.

Method

The present study was taken on 116 pupils (av. = 6.4 yrs). Our goal was to emphasize if the ball games can play any role in the finalization of cerebral dominance. Using three tests of psychomotricity i.e. Tapping test, String test and Matorin test, we selected 18 ambidextrous pupils. Ten of them have a slightly greater performance of the right hand. These pupils were separated in two sample-groups:

Sample I: 5 pupils involved in a regularly ball-games-program

Sample II: 5 pupils who did not practice this program

Results

This research has shown that children from sample I presented a greater performance and skill in achieving the speech and the hand writing language.

Conclusions

In a previous reported study we observed a comparable influence regarding performance and skill in achieving the speech and the hand writing language at pupils with borderline IQ. In this study the pupils performed a score between 89 and 120 at WPPSI III (Wechsler Preschool and Primary Scale of Intelligence).

We conclude that it may be taking in account the influence of these kinds of practice to influence the acquisition of the speech and hand writing language.
P02-281 - Aripiprazole on Therapy of Major Depressive Episode with Psychotic Features
Authors: Istikoglou C. , Foutsitzis D. , Papouli F. , Kanellos P. , Polonifis N. , Theodorakopoulos G. , Kogeorgos J. , Vlissides D. , Michelidakis K.
Published: June 2010

Objectives

Aripiprazole is a non-typical 2nd generation anti-psychotic drug, which acts on the majority of D-receptors of dopamine, as well as 5HT2 serotonineergic receptors.

Methods

240 (n=240) patients, age 20 to 75 years, have been studied during the years 1999 to 2009. 80 of these patients were male and 160 were female, treated with Aripiprazole. The subjects were diagnosed with major depressive episode with psychotic features, combined with SSRIs, SNRIs, and NaSSas. The severity of depression at the patients was assessed with the MADRS, SCL-90R, and BPRS scales, administered during evaluation and after 1, 3, and 6 months following the initiation of therapy. After 6 months, the patients were also submitted to the GAF (Global Assessment Functionality).

Results

217 (n=217) patients (90,4% o the population) showed a decrease following evaluation with the scales MADRS, SCL-90R, and BPRS respectively. The MADRS and SCL-90R showed a considerable decrease of somatic symptoms, suicidal ideation, and luck of activity, while the BPRS scale showed a decrease of delirious ideas and hearing delusions that constitute common features of the disorder. Furthermore, the GAF had considerably increased after 6 months.

Conclusions

Based on the study above, Aripiprazole constitutes a basic choice for the treatment of Psychotic Depression. Given that the patient sample is relatively small, multi-focused studies are required in order to investigate in depth the original hypothesis.
P02-282 - Psychiatric Care for Patients of Somatic Primary Care Unit
Authors: Lebedeva V. , Semke V.
Published: June 2010

Purpose was complex epidemiological, clinical, psychopathological, clinical and dynamic study of mental disorders co-morbid with somatic pathology, development of differentiated rehabilitation programs and evaluating their effectiveness.

Materials and methods: The study involved 2.010 people. General characteristics of the patients of a specialized mental health office in the identification of somatic clinic were determined according to seeking help. Main groups of patients: patients with somatogenic in need of psychiatric counseling and treatment in specialized somatic facilities, requiring course of therapy followed by observation at a psychiatric clinic, requiring systemic therapy, and dynamic observation in psychiatric clinic. Number of group 1 was 14.8 per 1000 population, group 2 - 20, in group 3 - 30. Basic principles of combined therapy of mental disorders in patients in somatic network are: gradual character, complexity, availability, individually-differentiated approach, continuity.

Main functions of a specialized psychiatric room of general medical primary care unit are as follows:

1.

Organization accessible and focused on needs of patients of psychiatric care in somatic network

2.

Educational programs

3.

Consultative-diagnostic function

4.

Therapeutic and diagnostic assistance.

5.

Organizing-regulatory function

6.

Expert function.

7.

Preventive and prophylactic function.

8.

Standardization of diagnosis and differential therapy of disorders identified

9.

Dynamic monitoring and counseling patients with mental disorders

Using developed by us prevention and rehabilitation programs on basis of somatic clinics in unity with mental health services has resulted in improved quality of life, high clinical and cost effectiveness in patients with combined mental and somatic pathology.
P02-286 - Metyrapone and Mifepristone Reverse Memory Loss Induced By Spontaneous Morphine Withdrawal in Mice
Authors: Mesripour A. , Hajhashemi V. , Rabbani M.
Published: June 2010

Objectives

Morphine withdrawal leads to cognitive deficits and an increase in corticosterone concentrations in plasma. Evidently glucocorticoid hormones influence memory. Therefore the current study evaluated the effects of metyrapone and mifepristone on memory deficit following spontaneous morphine withdrawal.

Methods

To evaluate memory novel object recognition task was used, which comprised of three sections; habituation, first trial and the test trial. In this method, the difference in the exploration time between a familial (F) object and a novel (N) object is taken as an index of memory performance (recognition index, RI ={N − F/N + F} × 100). Male NMRI mice weighing 25-30 g were made dependent by increasing doses of morphine (30-90 mg/kg) subcutaneously twice daily for three days; RI was assessed 4 hour after the last dose of morphine on the third day. Mifepristone and metyrapone were used subcutaneously (40 min and 90 min, respectively) before the first trial.

Results

Memory performance was impaired in morphine dependent animals (RI= −14.8% ± 10.7, P< 0.05). Serum corticosterone concentration in 4 hr morphine withdrawn animals was 26.6 ± 0.9 ng/ml, which was 20% more than normal animals. Metyrapone 25 mg/kg, and mifepristone 50 mg/kg notably improved RI to 34.8% ± 10.8 and 25.4% ± 11.7 respectively, compared to vehicle group.

Conclusions: Therefore mifepristone and metyrapone by manipulating the corticosteroid function improves memory performance after withdrawal. These results show that increased glucocorticoid concentration is involved in memory deficit caused by morphine withdrawal.
P02-287 - Primary Prevention in Depression. How to Inform Primary Care Attendees About Their Risk Level and Risk Profile of Major Depression?
Authors: Moreno-Peral P. , Bellon J. , Motrico E. , Moreno-Küstner B. , Oliván-Blazquez B. , Fernández A. , Fernández C. , Rüntel A. , Rodriguez A. , Ballesta M. , Payo J. , Amezcua M.
Published: June 2010

Introduction

The predictD study is a pioneering international study whose main objective was to develop a risk index for the onset of major depression in general practice attendees.

Objective

The aim of this exploratory study was to determine the opinion of primary care attendees and their general practitioners about how to implement primary prevention of major depression. The intervention consisted of informing primary care attendees about their risk level and risk profile for the onset of major depression.

Methods

The study participants were primary care attendees and general practitioners in urban health centres of 7 Spanish provinces. The methodology used was qualitative: there were 14 in-depth interviews (two from each province), 7 DAFO groups and 7 focus groups.

Results

The results showed that attendees generally welcomed this precautionary measure. Some even proposed potential changes in their lifestyles to prevent depression, such as improving social relationships, taking things more calmly or doing more leisure activities, while others asked their GP for advice. The GPs were more resistant about informing primary care attendees, raising doubts about the validity-reliability of the instrument, their lack of education about what they should or should not advise their attendees, the danger of creating excessive fear in their attendees, or the barrier of lack of time in the office to do these activities.

Conclusions

Primary care attendees welcome this preventive measure more than their general practitioners.
P02-290 - Oxidative Stress in Patients with Mild Cognitive Impairment and Depression Could be an Important Risk Factor for Dementia
Authors: Padurariu M. , Ciobica A. , Branzei R. , Hritcu L. , Stefanescu C.
Published: June 2010

Introduction

Mild Cognitive Impairment (MCI) seems to represent an early stage of Alzheimer's disease (AD) and there is a great interest in the relationship between MCI and the progression to AD.

It has been demonstrated that patients with depression and mild cognitive impairment present a doubled risk of developing dementia of Alzheimer type as those with MCI only. Considering the importance of oxidative stress in MCI and Alzheimer disease, our current objective was to determine the level of oxidative stress in MCI patients with depression, compared with non-depressed MCI patients.

Methods

The patients were selected using Petersen criteria for mild cognitive impairment. The cognitive performance was assessed using MMSE (Mini Mental State Examination) and ADAS-cog (Alzheimer's disease Assessment Scale- cognitive subscale) and Geriatric Depression Scale for depression.

We assessed the levels of some enzymatic antioxidant defences like superoxide dismutase (SOD) and glutathione peroxidase (GPX), as well as lipid oxidation makers like MDA (malondialdehyde), from the patients peripheral blood.

The results were compared to an aged-matched non-depressed MCI group.

Results

A significant decrease in the specific activity of both superoxide dismutase and glutathione peroxidase was found in MCI patients with depression compared with non-depressed MCI patients. Also, the concentration of serum malondialdehyde was increase in MCI patients with depression.

Conclusions

We conclude that patients with MCI and depression have an increased level of oxidative stress, compared with non depressed MCI patients. This could explain the increased risk of patients with depression and mild cognitive impairment in developing dementia of Alzheimer type.
P02-292 - A Randomized Controlled Trial on the Efficacy of Group Psychoeducation Family Intervention for Carers of Persons with Schizophrenia in Shanghai
Authors: Weidong J. , Guoquan Z. , Wenli F. , Yunqing G. , Meizheng G. , Jun W. , Jianhong S.
Published: June 2010

Objective

This study explores the effects of a group psychoeducations family intervention for individuals with schizophrenia and their family.

Methods

A cluster randomized controlled trial design was employed.A total of 97 patients with schizophrenia and their relatives were recruited from two street and divided into two groups.The groups consisted of a group psychoeducational family intervention group and a control group.A 12-month follow-up study was conducted.

Results

The psychoeducational family intervention group attained a better knowledge gain related to mental illness and an increase in treatment compliance compared to the control group.Family attitudes toward the patient were positively related to the patient's clinical outcome.Family attitudes improved after 12 months of intervention.The clinical outcomes of family intervention group were enhanced and the relapse rate was significantly decreased as well.There was an increased readmission rate in the group family intervention may be due to better access to health care.Although there were no differences in overall social function,there were improvements in the specific components of marital role and care of self for the family intervention group.The patient's negative influence on society in the family intervention group decreased after 12 months of intervention.

Conclusion

The group psychoeducational family intervention played a important role in improving the relatives’ knowledge of mental health and attitudes towards the patients.The intervention promoted the patient's treatment compliance, decreased the relapse rate,improved clinical outcomes and social function.we think the group psychoeducational family intervention can provide the basis for future research and mental health practice in China.
P03-319 - The Truth About Polypharmacy in Elderly Inpatient Population
Authors: Kumar A. , Kapila A.
Published: June 2010

Introduction

There is increasing concern about the use of multiple medications in psychiatric patients.Older adults make up 15% of the population yet they account for 30% of the prescribed medications. There is increased risk of falls, confusion and consequent functional decline as a result of potential interactions and adverse drug events.

Aims/Objectives

To document the extent of polypharmacy and potential drug interactions in elderly inpatient population at the point of discharge.

Methods

25 consecutive discharge summaries from an elderly mixed (organic and functional) inpatient unit were evaluated.

Results

out of 25 (15 female and 10 male) patients with age range of 59-97 years, an average of 6.5 drugs (Range:2-17; Median:6) were prescribed. An average of 3.1 pair of interactions (Range:0-15; Median:3) were noted. Potentially hazardous interactions (Average 0.68; Range:0-4) was a worrying trend in this patient group.

Conclusions

Polypharmacy is commonplace in elderly patients and is worrisome. Different strategies like in-house pharmacist may offer some safeguards though further research is needed.
P03-321 Antipsychotic Polipharmacy in Schizophrenic Inpatients
Authors: Batalla A. , Undurraga J. , Grande I. , Pons A.
Published: June 2010

Objectives

Concomitant antipsychotic prescription is common in clinical psychiatry, although it is not an evidence-based practice. The aim of the study was to describe the prescription of antipsychotics in inpatients with schizophrenia and identify which are the factors associated with this tendency.

Methods

We reviewed retrospectively the psychotropic drugs prescribed at the time of discharge of 177 inpatients who met criteria for schizophrenia [DSM-IV-TR] on an acute psychiatry unit from 2007 to 2008.

Results

One hundred and two patients (57.6%) were male. Mean age (SD) was 38.1 (14.6) years. The percentage of patients discharged on treatment with two or more antipsychotics was 43.5%. Although in the strict sense we should not consider it as polipharmacy, the most frequent combination was long acting injectable risperidone with oral risperidone (21.5%), followed by long acting injectable typical antipsychotic with oral risperidone (3.4%). There was a significant association between the number of prescribed antipsychotics and the total number of previous hospitalizations and the number of hospitalizations during the previous year (ANOVA p=0.001 and p< 0.001 respectively). No correlation was found between polypharmacy and age. There was a significant association between the number of antipsychotics prescribed and the use of anticholinergic treatment (t-test p=0.005).

Conclusions

Our polypharmacy rates are comparable with prior European data (30-76%). Despite of the clinical guidelines, antipsychotic polipharmacy is an extended therapeutic strategy not necessarily related with resistant schizophrenia. Most of the antipsychotic associations identified are not evidenced-based practice. More clinical trials are needed to determine the efficacy of different combinations.
P03-329 - Impact of Transition to Atypical Antipsychotics in the Course and Outcome of First-time Admittances in a Psychiatric Clinic
Authors: Floros G. , Grammatikopoulos I. , Girouki M. , Amanatiadis V. , Ntouros E. , Pahumis G. , Nikolaidis N. , Garyfallos G. , Giouzepas I.
Published: June 2010

Objectives

We examined the course of patients admitted for the first time in the Acute mental health ward of a Psychiatric Clinic in a Psychiatric Hospital within a ten-year hiatus. During this time the sociodemographic characteristics of the population were altered due to migration from former Eastern Europe countries, the transition from typical to atypical antipsychotic medication was completed and attempts were made to promote community psychiatry.

Methods

We compared two groups of 77 and 87 patients admitted for the first time during 1997 and 2007 respectively. Prescribed medication when given an exit diagnosis was calculated to haloperidol equivalency, following guidelines described in Kane et al.

Results

Results indicate that the groups were comparable as to size, sex, age, entry diagnosis and length of stay. The groups differed significantly as to origin, with the 2007 group having significantly more migrants but also patients originating from more distant provinces within Greece. There was a significant increase in involuntary admissions. While there was an increase in the use of atypical antipsychotics there was no significant difference in treatment potency.

Conclusions

Introduction of atypical antipsychotics enabled the clinician to provide treatment of similar antipsychotic potency with better tolerance profile, but failed to reduce length of stay. The increase in involuntary admissions and number of admissions from more remote regions raises doubts on the efficiency of the psychiatric reforms attempted during that time in order to promote community psychiatry.
P03-332 - Effect of Treatment with Lisdexamfetamine Dimesylate on Self-Reported Quality of Life in Adults with Attention-Deficit/Hyperactivity Disorder
Authors: Giblin J. , Brams M. , Gao J. , Gasior M. , Squires L. , Wigal T.
Published: June 2010

Objective

To assess the impact of lisdexamfetamine dimesylate (LDX; Vyvanse®, Shire US Inc.), which is the first long-acting prodrug stimulant indicated for treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adults in the United States, on performance and quality of life (QOL) in adults with ADHD.

Methods

Subjects (n=142; aged 18 to 55 years) with ADHD entered a 4-week open-label dose-optimisation phase, then a 2-week, double-blind crossover phase. The primary efficacy measure was the average postdose total score on the Permanent Product Measure of Performance (PERMP) math test given predose and 2, 4, 8, 10, 12, and 14 hours postdose. The Adult ADHD Impact Module (AIM-A) was self-administered during the dose-optimisation phase. Safety was assessed by monitoring adverse events (AEs).

Results

In the intention-to-treat population (n=105), postdose average PERMP least squares mean (SE) scores were higher (P< .0001) for LDX (312.9 [8.59]) vs placebo (289.5 [8.59]) and at every postdose time point ≥14 hours (P≤.0017 for each). Mean change from baseline scores on AIM-A subscales (n=127) showed improvement (P< .001) with LDX in 6 measured QOL domains (living with ADHD; general wellbeing; work, home, and school performance and daily functioning; relationships and communication; interference with life; and concern caused by symptoms). Treatment-emergent AEs (≥10%) in the dose-optimisation phase were decreased appetite (36.6%), dry mouth (30.3%), headache (19.7%), and insomnia (18.3%).

Conclusions

LDX improved QOL and performance (up to 14 hours) and demonstrated a safety profile consistent with long-acting stimulant use.

Supported by funding from Shire Development Inc., Wayne, PA, US.
P03-333 - Electrocardiographic Alterations in Patients in Treatment with Clozapine
Authors: Grande I. , Pons A. , Torras Á. , Baeza I. , Bernardo M.
Published: June 2010

Objectives

Cardiovascular side effects of antipsychotics are been studied both in typical and atypical antipsychotics but, in particular, with clozapine few systematic studies of these effects have been performed. In this study, we reviewed electrocardiographic (ECG) data from patients treated with clozapine.

Methods

Observational, retrospective study in our Clozapine Day Clinic from 2000 to 2008. We recluted 197 patients (70% men) with mean age 31,75 ± 9,0 years who began treatment with clozapine. All of them had an electrocardiogram taken before starting treatment and after 18 weeks of follow-up. None suffered from heart diseases. QTc was evaluated by Bazett formula (QT/ (R-R’)1/2). Treatment prescribed was taken down and drug serum levels were detected. Statistical analysis was executed by SPSS 17.0.

Results

There was significant correlation between doses prescribed and levels of clozapine and norclozapine (r=.304, p=.023; r=.354 p=.007), between levels of clozapine, norclozapine and QTc enlargement (r=.348, p=.008; r=.268 p=.046) and between levels of clozapine, norclozapine and heart rate (r=.390, p=.003; r=.326 p=.014). There were no differences between QTc and treatment with clozapine or other antipsychotic (p=0.902), between sex or if polypharmacy existed. ECG alterations were a case of supraventricular extrasystoles, another of Wolf-Parkinson -White Syndrome and other inespecific alterations like repolarizations or left hypertrophy.

Conclusion

We did not find either major incidence on cardiological effects or significative QTc enlargement during treatment with clozapine in contrast to other antipsychotic previously prescribed. Therefore clozapine may be in the same cardiologic safety rank than other antipsychotics.