bluuebunny/crossref_metadata_2025 huggingface dataset:
Anti-psychotics: To withdraw or not to withdraw?
Authors: Ferreira C. , Alves S. , Oliveira C. , Avelino M.J.
Published: June 2017

Introduction

Anti-psychotics constitute a class of psychotropic drugs used for the treatment and prophylaxis of several disorders, including schizophrenia, bipolar disorder and psychotic depression. Frequently, clinicians are asked by their patients to withdraw this medication. In some cases, that may be related to notable side effects. However, it may actually indicate an inadequate control of the psychiatric disorder with poor insight.

Aims

The goal of this work is to systematically review the scientific literature in order to understand if there are consistent data that support anti-psychotics withdraw in specific clinical situations.

Methods

The literature was reviewed by online searching using PubMed®. The authors selected scientific papers with the words “anti-psychotics” and “withdraw” in the title and/or abstract, published in English.

Results and discussion

Anti-psychotics improve prognosis and enhance patients’ quality of life. There are few data in the literature regarding recommendations that support anti-psychotic withdraw in psychiatric patients. Very specific conditions must exist for withdrawing anti-psychotics, like neuroleptic malignant syndrome, cardiac side effects, and change of diagnosis or prolonged remission after a first and single psychotic event. When that decision is made, it should be done slowly and carefully and both the patient and his family should be involved.

Conclusions

There is no evidence in the literature that supports withdraw of anti-psychotics for the majority of psychiatric situations. When specific conditions are present that possibility must then be considered, however, with careful consideration and after discussion with the patient and parties involved in patient's care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Selective serotonin reuptake inhibitors, anti-psychotics and metabolic risk factors in schizophrenia and bipolar disorder
Authors: Fjukstad K.K. , Engum A. , Lydersen S. , Dieset I. , Steen N.E. , Andreassen O. , Spigset O.
Published: June 2017

Objective

The aim of this study was to investigate the relationship between metabolic factors and use of selective serotonin reuptake inhibitors (SSRIs) combined with olanzapine, quetiapine or risperidone.

Method

Data from a cross-sectional study on 1301 patients with schizophrenia or bipolar disorder were analyzed. The main outcome variables were levels of total cholesterol, low – and high-density lipoprotein (LDL and HDL) cholesterol, triglycerides and glucose.

Results

One defined daily dose (DDD) per day of an SSRI in addition to olanzapine was associated with an increase in total cholesterol of 0.16 (CI: 0.01 to 0.32) mmol/L (P = 0.042) and an increase in LDL–cholesterol of 0.17 (CI: 0.02 to 0.31) mmol/L (P = 0.022). An SSRI serum concentration in the middle of the reference interval in addition to quetiapine was associated with an increase in total cholesterol of 0.39 (CI: 0.10 to 0.68) mmol/L (P = 0.011) and an increase in LDL-cholesterol of 0.29 (0.02 to 0.56) mmol/L (P = 0.037). When combined with risperidone, no such effects were revealed. No clear-cut effects were seen for HDL-cholesterol, triglycerides and glucose.

Conclusion

The findings indicate only minor deteriorations of metabolic variables associated with treatment with an SSRI in addition to olanzapine and quetiapine, but not risperidone. These results provide new insight in the cardiovascular risk profile associated with concomitant drug treatment in patients with severe mental illness, and suggest that SSRIs can be combined with anti-psychotics without a clinically significant increase of adverse metabolic effects.

Disclosure of interest

Co-author Dr. Ole Andreassen has received speakers’ honoraria from GSK, Lundbeck and Otsuka.
A retrospective study of drug – drug interactions in patients treated with pharmacotherapy in the biggest Slovenian correctional facility
Authors: Stuhec M. , Brunec S. , Svab V.
Published: June 2017

Background

Drug-drug interactions (DDIs) are known to lead to treatment failure.

Objectives

In most European countries there are no data on DDIs in patients within correctional facilities.

Aim

The main aim of this paper is to present the most frequent DDIs in the biggest Slovenian male, Slovenian correctional facility Dob to avoid serious DDIs in future.

Methods

A retrospective study was carried between September 2015 and June 2016 on 141 patients on substitution treatment (methadone, suboxone and buprenorphine) and 125 other prisoners with mental disorders in need for psychiatric treatment were included. All study data were extracted from the patients’ medical files of the psychiatric dispensary in the prison Dob. DDIs were determined by different interaction classes with Lexicomp Online™ 19.0 version and only X (major interactions and should be avoided) and D (minor interactions and avoid if it is possible) were included.

Results

Together 220 patients were included. Number of patients with at least 1 interaction, were 139 (63.2%). Number of patients with at least 1 X interaction, were 59 (26.8%). Number of patients with more than one (1) X interactions was 15 (6.8%). More than half of the patients (56.4%) were treated by hypnotics and 38.4% with benzodiazepines. The most frequent X DDIs were: buprenorphine, methadone and sulpride with antipsychotics (clozapine and quetiapine) and antidepressants (e.g. escitalopram, fluoxetine).

Conclusions

In patients treated with methadone and buprenorphine there are frequent DDIs resulting in contraindications for prescribed combination of drugs. If an antidepressant is to be used in patients prescribed methadone and buprenorphine, sertraline is recommended.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Identification of a Long Lasting Stress Signatures Associated with Enhanced Vulnerability for Depression by Using ‘Omics and Cross Species Approaches
Authors: Cattaneo A.
Published: June 2017

Depression results from the interplay of vulnerability genes with environmental factors, a phenomenon named as ‘gene-environment (GxE) interaction’. To date, GxE interaction studies have been limited to hypothesis-based candidate genes, since genome-wide (GWAS)-based GxE interaction studies would require enormous datasets with genetics, environmental and clinical variables. We used a novel, cross-species and cross-tissues “omics” approaches to identify genes predicting depression in response to stress in GxE interactions. We integrated the transcriptome and miRNome profiles from the hippocampus of adult rats exposed to prenatal stress (PNS) with transcriptome data obtained from blood mRNA of adult humans exposed to early life trauma, using a stringent statistical analyses pathway. Network analysis of the integrated gene lists identified the Forkhead box protein O1 (FOXO1), Alpha-2-Macroglobulin (A2 M) and Transforming Growth Factor Beta 1 (TGFB1) as candidates to be tested for GxE interactions, in two GWAS samples of adults either with a range of childhood traumatic experiences (Grady Study Project, Atlanta, USA) or with childhood emotional abuse only (Helsinki Birth Cohort Study, Finland). Six FOXO1 SNPs showed significant GxE interactions with emotional abuse in the Grady Study that survived stringent permutation analyses and were all replicated in the Helsinki study. In addition, other SNPs in all the three genes showed significant GxE interactions with emotional, physical and sexual abuse in the Grady Study. We therefore provide a successful ‘hypothesis-free’ approach for the identification and prioritization of candidate genes for GxE interaction studies that can be investigated in GWAS datasets.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Association of behavioral “Theory of Mind” Test performance with neurophysiological and vegetative parameters in schizophrenia patients and healthy subjects
Authors: Garakh Z. , Zaytseva Y. , Morozova A. , Strelets V.
Published: June 2017

Introduction

Theory of Mind (ToM) deficit is investigated by psychological and neurobiological methods using a range of social cognitive tests, including the verbal test Hinting Task. However, it remains unclear whether there is a connection between ToM results and the physiological characteristics in norm and in pathology.

Objectives

We performed the comparison of Hinting Task performance in patients with schizophrenia and healthy subjects; analysis of correlations between Hinting Task performance with physiological parameters; discriminant analysis in order to classify subject groups according to predictors, including psychological and physiological parameters.

Methods

We measured Hinting Task, spectral power of the EEG mu-rhythm (SP) and heart rate (HR) at rest and during a motion imagery task in 114 right-handed subjects, 1st episode patients with schizophrenia (SCH1) n = 29, chronically ill patients with schizophrenia, duration of illness more than 5 years, (SCH2) n = 23, and healthy subjects (НС) n = 62.

Results

Hinting Task rate: HC > SCH2 (P < 0.01), HC ≥ SCH1 (P = 0.07), SCH1 = SCH2 (P = 0.3). Only SCH1 Hinting Task score was associated with a complex of physiological parameters in the resting state [Multiple R = 0.78, F (3.25) = 13.31, P < 0.0001]. Discriminant function analysis of HC and the combined SCH group [F (7.106) = 7.078, P < 0.0000]. The samples were classified at 89% and 71%, respectively, including HR (P < 0.000001), SP in the resting state in C4 (P < 0.001), C3 (P < 0.01), SP changes in C3 (P < 0.05) and Hinting Task (P = 0.2).

Conclusions

Hinting Task Hinting Task is a part of classification model of norm and schizophrenia. Patients with first episode and chronically ill patients with schizophrenia do not differ in the studied parameters.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
From hypomania to mania after correcting severe hypoglicemia: A case report to recall insulin shock therapy
Authors: Felgueiras J. , Freitas C. , Carvalho A.T.
Published: June 2017

Introduction

In the early 20th century, shock therapies developed worldwide as the most effective means to treat severe mental illness. In 1927, Manfred Sakel introduced the newly discovered insulin as a means to treat opioid-addicted patients, by relieving withdrawal symptoms. After noticing that some psychotic patients notably recovered from their psychotic symptoms after accidental insulin comas, he extended this technique to schizophrenic patients, arguing that up to 70% of his patients improved with this therapy. Insulin shock therapy soon spread all-over the world and became one of the most important treatments for severe mental illness. Regardless of the high-rate complications, insulin shock therapy only declined after the introduction of anti-psychotic drugs.

Objective

Description of a clinical case.

Methods

Non-systematic review of literature and case report.

Results

A 70-year-old female with type-1 bipolar disorder and type-2 diabetes was referred to a psychiatry emergency department (ED) for 2-week behavioral disorder, featuring restlessness, agitation, insomnia, verbiage and persecutory delusions. In the ED, she presented calm, cooperating, with a subtle humor elation and slight disinhibition. The speech was somewhat confusing, but with normal debit. Delusional thought or hallucinations were not evident. Severe hypoglycemia was first detected by capillary glucose measurement and confirmed by a blood test. After the blood glucose was corrected she became gradually more restless, talkative, disinhibited, with clear humor elation, compatible with a manic state.

Conclusion

We discuss if this case might be explained by the severe hypoglycemia and its correction, linking it to insulin shock therapy, reviewing this procedure's history, controversies and current developments.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Role of Psychotherapy in Improving the Quality of Life and Social Rehabilitation of Patients with Psoriasis
Authors: Bialuhina V. , Belugina I. , Azarova L. , Siatkovskaia N. , Siatkovski V. , Jagovdik N.
Published: June 2017

Introduction.

Psychotherapy can ease physical symptoms of patients with skin pathology.

Objectives.

To study features of social and psychological maladaptation and quality of life in patients with psoriasis.

Aim.

To study psychotherapy role in quality of life improvement and social rehabilitation of patients with psoriasis and their family members for the period 2000–2015 in the Belarusian population.

Methods.

One hundred and twenty four patients with cutaneous psoriasis, 12 patients with psoriatic arthritis and 42 healthy persons were studied. Quality of life, types of attitude towards the disease, level of social frustration, depression, level of social maladaptation, psychological defense mechanisms and patients attitudes towards psychotherapy were assessed.

Results.

There were detected among patients with psoriasis (especially with arthropathy form): social maladaptation, higher level of social frustration and depression (P < 0.05), decrease in quality of life (P < 0.001), the wider range of psychological defense mechanisms (negation, regression, substitution, reactive formation, P < 0.05). Maladaptive types of attitude towards the disease were presented in 24% patients with psoriasis and almost in 41% patients with arthropathy.

Conclusions.

Psychotherapy can have a high potential for social rehabilitation and quality of life improvement for patients with psoriasis. Obtained data in social maladaptation indicate family therapy as an important therapeutic part for patients with psoriasis. Moreover, knowledge about patients psychological defense mechanisms can help to choose a direction and methods of individual psychotherapy of social maladaptation. This research shows also that psychotherapeutic approach and family psychotherapy remains underestimated in Belarus.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Should I Save my Marriage?: Addressing Couple Relationships by Means of Art Therapy Intervention
Authors: Citak Tunc G. , Eren N.
Published: June 2017

Objective.

This study investigates the case of a female patient, who was experiencing marital problems and had separated from her spouse, with whom an art (drawing) therapy process was carried out.

Aim.

It was aimed to address the relationship of the couple by supporting the ego and increasing self-awareness skills by means of art materials (drawings) in the process of the situational crisis.

Method.

Case study.

Result.

With this case study, it was aimed to make emphasis on the impact of drawing sessions as a means of using art in therapeutic relationships for self-awareness and opportunity for development in a situational crisis during marriage.

Conclusion.

During the process of individual art therapy, nine sessions and eight drawing tasks were conducted. The case patient, OS, had been separated from her spouse for 2 months. In the first session, a personal history was taken, the scores of the state-trait anxiety scale was evaluated and a therapy plan was jointly developed. Each action was carried out by providing specific instructions. Each session was evaluated within the same week in a supervision meeting with an expert experienced in art therapy and the next session was planned. OS, who developed self-awareness as a result of the sessions, evaluated his/her expectations and boundaries in his/her relationship and discovered the connections with her own nuclear family. In a session with OS one year later, she gave the information that she had started to share a house with her spouse.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Effect of Art Group Psychotherapy with Photograph in Chronic Psychiatric Disorders: A Pilot Study
Authors: Celik Aypak O. , Eren N. , Cıkrıkcılı U. , Buyukgok D. , Ucar Isaret S.
Published: June 2017

Photograph was used as a therapeutic tool for the first time in 1856 by Dr. Hugh Diamond. Photos are considered to be representations of a person's reality. The possibility of producing visual images when a client has verbal expression difficulties, photography provides a more structured way of expressing ideas and emotions and to be a means of projective-symbolic communication. Photo therapy with chronic psychotic patients may contribute to development of perception of reality, part-whole relationship, integration, distinction of external-internal world, symbolization capacity and improve ego functions The aim of this study was to determine the effect of phototherapy on symptomatology, functionality, emotional regulation, cognitive skills and coping skills in patients with chronic psychiatric disorders. In accordance with this aim, the study was carried out with 14 outpatients diagnosed as chronic schizophrenic or psychotic disorder. Seven patients received routine medical care plus 28-week psychotherapy with photograph and 7 patients received only routine medical care. Patients were assessed in pre and post-treatment with Beck Depression Inventory, Beck Anxiety Inventory, Difficulties in Emotion Regulation Scale, Global Assessment of Functioning, Ways of Coping Inventory and Neuropsychological Test Battery. Wilcoxon Signed Ranks Test used for statistical analysis. The therapy method resulted in statistically significant reductions in the level of depression and general symptom levels and statistically significant improvement in cognitive abilities and functionality (P < .05). There was also statistically significant improvement in positive reappraisal subscale of coping ways. These findings may indicate that photo-oriented art group therapy might show positive effects on the course of chronic psychotic disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clinical Usefulness of Confrontations in the Initial Interview
Authors: Barac-Otasevic Z.
Published: June 2017

Principal objective of this work is to illustrate the clinical usefulness of confrontations in the initial interview. Balint, Kernberg, Sullivan, Fromm-Reichmann are the authors, among many of them, who pointed out importance of the initial interview and the consequences of the interview for the future psychotherapeutic work. Initial interview represents two persons; therapist and person who needs help who meet for the first time and do not know anything about each other. Interaction between therapist and the patient through communication is a major source of information about potential patient in the initial interview. The nature of disorder, capacity of motivation for psychotherapy can be evaluated in the current interaction with the person who needs help. Confrontation is a routine technique in psychoanalysis and psychotherapy, unilateral and potentially dangerous, especially when working alliance is not established and that is the case in the initial interview. Purpose of confrontation in the initial interview is to collect information about patient, his psychopathology, his structural personality features, presence of defensive operations, capacity and motivations to work and what kind of psychotherapy is best suited for him. Confrontation can be very harmful so it requires tact, patience and timing. Incorrect use of confrontations which are poorly conceptualized, premature could stop the flow of the material, make sense of chaos in the interview, increasing anxiety and risk the possibility of leaving interview.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Countertransference in Psychotherapy of Paranoid Patients
Authors: Manojlovic S. , Nikolic-Popovic J.
Published: June 2017

The complexity of psychotherapy is based on the very nature of the paranoid process. The therapist must not only have a good understanding of the paranoid process, but also needs to be especially careful regarding the transference-countertransference emotions. Long-standing experience in psychotherapeutic work with paranoid patients, in the individual and group setting, has enabled us to systematize countertransference reactions. Dominant projective mechanisms require a high ability to contain emotions from the therapists. The most prominent is aggression, in regard to which the countertransference feelings appear, ranging from aggression to exposedness, impotence, and victimization. The therapist must constantly separate feelings which represent his “blind spot” from those which he perceives as a patient's part in therapist himself. The latter countertransference enables the therapist to experience the internal object of the patient by the mechanism of projective identification. Beside the aggression, the feelings from the narcissistic spectrum related to topics of value, competence, rivalling, idealization, and devaluation represent a significant countertransference problem. The countertransference feelings in group psychotherapy are of lower intensity, and rarely focused on the therapist himself. In the group, there is also the possibility of significant intensification of the projection of aggression, when the whole group is focusing the projections onto the therapist. In the group milieu, commonly emphasized countertransference feelings are related to the position in the group, competence, autonomy, and dependence. The understandings and way of coping with countertransference emotions determine the potential for creating the safe emotional ground in psychotherapy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
System of Integrative Psychotherapy of Somatoform and Psyhosomatic Disorders Patients
Authors: Mykhaylov B. , Kudinova O.
Published: June 2017

The main goal of the investigation was the integrative psychotherapy system established. On the basis of the examined 350 patients with somatoform disorders and 250 patients with chronic psychosomatic diseases, we have elaborated a test that allows to evaluate quantitatively the influence of the disease on patients’ social functions. We created the integrative psychotherapy system with cognitive-oriented, suggestive and autosuggestive implementations. Elucidation of peculiarity of personal perception of the disease served as basis of elaboration of purposeful system of psychotherapy, consulting, and psychological support for psychosomatic patients with high-effectiveness 1.5–3 years catamnesis in 85% patients. Psychotherapy should be used first of all as a target-oriented. Our experience showed the necessity of the use the integrative models of psychotherapy, parted on stages. On the first stage, the receptions of cognitive and suggestive psychotherapy are used. There is group therapy on second stage. On the third stage elements of the autogenic training mastered. The system examination high efficacy was shown.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cognitive Behavioral Therapy and Acceptance and Commitment Therapy as Augmentation Treatment for Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): A Case Report
Authors: Pozza A.
Published: June 2017

Introduction

Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are a subgroup of conditions including obsessive-compulsive disorder (OCD), tic disorders, pre-pubertal and sudden onset, temporal association between streptococcal infections and associated neurological abnormalities. Some strategies were developed, including the use of antibiotic prophylaxis to prevent streptococcal-triggered exacerbations, and immunomodulatory interventions for the management of acute symptoms. Cognitive-behavioral therapy (CBT), which has been demonstrated to be the first-line treatment for OCD, can be a valid adjuvant during the difficult course of PANDAS to target acute symptoms and prevent exacerbations.

Objectives

The study presented a case of a patient with PANDAS treated with antibiotic medication and CBT as augmentation.

Methods

The 11-year-old patient (Y-BOCS pre-test score = 32), had been hospitalized for three weeks for acute onset of PANDAS. The clinical picture consisted of asthenia, contamination fears and washing compulsions, separation anxiety, severe depression and anxiety. Pharmacotherapy involved risperidone 2 mg/die and sertraline 250 mg/die for five months combined with antibiotic prophylaxis for two years. The CBT intervention started at discharge from hospital and included psycho-education on anxiety, intensive exposure and response prevention (2 hour sessions three times a week) for twelve months, cognitive restructuring, diffusion and mindfulness for the subsequent twelve months.

Results

Anxiety and OCD symptoms substantially improved. The patient gradually started school again. Post-test score was 11 on the Y-BOCS.

Conclusions

Along with psychiatric and antibiotic medications, CBT may be a valid augmentation strategy for PANDAS to reduce risk of exacerbations and enhance symptom improvement. Limitations are discussed.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
First Episode Psychosis Service (EPS): Evaluation of Implementation in a Rural Australian Setting
Authors: Roy D.
Published: June 2017

Introduction

Recent decades, has seen an increasing focus on developing specific early or first episode psychosis services, in various parts of the world. There has been a growing awareness of the emotional impact of psychosis like trauma at onset, suicide and loss of social network. There is also a co relational link between the duration of untreated psychosis (DUP) and outcomes. The first 2–3 years following first episode onset have been argued to be a critical period for treatment.

Method

Our study was an evaluation of an early psychosis service (EPS) in a rural Australian MHS ‘experiencing’ or ‘at risk’ of experiencing first episode psychosis. The guidelines were based on the Australian clinical guidelines for early psychosis (1998). The audit tool used was a checklist based on 10 treatment guidelines developed by the EPS special interest group evaluation sub-committee.

Results

The overall results show that 7 out of the 10 treatment guidelines were well adhered throughout the implementation process. Guidelines strongly adhered to were numbers 2, 3, 5, 6, 7, 8, and 10, whereas guidelines 1, 4, and 9 were poorly adhered to.

Discussion

The implementation process was found to be generally effective. The factors that influenced the effectiveness will be discussed in the poster.

Conclusion

There were a number of trends when we looked at the overall results which included aspects of the guidelines that were done well and aspects that needed improvement which will be further discussed in the poster.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Applicability and Feasibility of the Italian Version of the Cognitive Remediation Program Circuits: A Pilot Study
Authors: Chieffi M. , Palumbo D. , De Simone S. , Rocco M. , Molle O.D. , Nicita A. , Mucci A. , Galderisi S.
Published: June 2017

Introduction

Cognitive deficits are considered central and persistent features of schizophrenia and have a significant impact on outcome and quality of life. The computerized interactive remediation of cognition (CIRCuiTS) is a new computerized cognitive remediation program aimed at improving different cognitive domains in patients with schizophrenia. In particular, the program was designed to mainly rehabilitate executive functions, attention and memory by training each cognitive function through several exercises and by improving metacognition.

Objectives

In the present study, CIRCuiTS was translated and adapted into Italian. The applicability and feasibility of the Italian version was evaluated. Moreover, preliminary data on the effectiveness of the program were investigated.

Methods

Four patients with a diagnosis of schizophrenia were recruited for the study. We investigated the changes in neurocognition, psychopathology, self-esteem and functional outcome at the end of the remediation program. The level of satisfaction of operators and participants was evaluated by means of the client satisfaction questionnaire (CSQ).

For each patient, the entire program took place through 2 weekly sessions of 50 minutes for a total duration of 40 sessions.

Results

CIRCuiTS produced an improvement in all domains of neurocognition, disorganization, self-esteem and real-life functioning in the areas “self-care” and “interpersonal relationships”. Moreover, high levels of satisfaction were shown by CSQ for both, operators and participants.

Conclusion

The Italian version of CIRCuiTS demonstrates high levels of acceptability and feasibility for both, patients and clinicians. Additionally, preliminary data suggest that the use of CIRCuiTS provides an improvement on several aspects of the disease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Specifics of Psychological Consulting of Patients After TBI According to the Structure of Neuropsychological Deficit
Authors: Kovyazina M. , Dobrushina O. , Aziatskaya G. , Zarudnaya E. , Spiridonov D. , Varako N.
Published: June 2017

Introduction

Present article introduces the case of a patient who had traumatic brain injury (TBI) in 2010. During examination V. demonstrated mild sensory aphasia, frontal lobes deficit, memory disorder, limiting beliefs, lack of adequate coping strategies, emotional reactions and disability to describe his feelings and body awareness.

Objectives and aim

Neuropsychological, correction and psychological counseling performance, considering neuropsychological deficit profile.

Methods

counseling was carried out over six weeks in the form of 2 hour sessions once a week. Speech perception impairment was taken into consideration. The process was started with frontal lobe deficit correction. Goal management training was used in conjunction with external control of distractions. Training in structured organization of information has highly improved memorization. Techniques of CBT were used to work with cognitive distortions, dysfunctional beliefs, and self-restricting behavior. Body-oriented therapy was offered to cope with stress factors and vegetative reactions.

Results

V. compensated memory disorder using external sources and motivation. Some adaptive strategies of interaction with people and the outer world were formed. He improved time management skills and learned to follow the priority of current task without distractions. Moreover, he actively started to use body-oriented techniques to regulate his emotional condition. A considerable progress was achieved in understanding his limits and difficulties in everyday life.

Conclusion

Implementation of psychological consulting according to neuropsychological deficit profile may be effective in interdisciplinary holistic rehabilitation of patients after TBI.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Building A Psychosocial Rehabilitation Unit: The Experience of Centro Hospitalar Entre Douro e Vouga
Authors: Pais V. , Pinto O. , Figueiredo J. , Larez E. , Lopes F. , Pereira M. , Fernandez M. , Mariano S.
Published: June 2017

Introduction

In Portugal, the National Mental Health Plan sought to reform the mental health care system, decentralizing mental health care by promoting community based services. Guidelines point to treatment of Psychotic Disorders with collaborative, person directed and individualized approaches.

Objective

The authors propose to describe the development of a new psychosocial rehabilitation unit in a recently created psychiatric department.

Methods

The CHEDV's psychiatry department (2009) serves a population of around 340,000. The Psychosocial Rehabilitation Unit (2015) aims to ensure a multidisciplinary and integrated response to users with major psychiatric disorders. The Psychosocial Rehabilitation Unit structures 4 axes of response: detection and initial approach of the disease, intervention in crisis, psychosocial rehabilitation and management of difficult patients.

Results

CHEDV's psychosocial rehabilitation unit is responsible for the care of about 25 patients daily. Treatment activities range from specialized consultations, home visits, medication management and crisis telephone to social skills training, psycho-education, neurocognitive rehabilitation, occupational workshops and social intervention/orientation. The unit bases its work on constant communication within the team but also with all other carers of the patient (in or out of hospital).

Conclusions

Bringing to the population a set of previously unavailable responses is the most blatant success of this unit that is helping people getting a better and closer care. To improve our work we aim at integrating the quantitative and qualitative psychometric evaluation of the patients. The lack of resources, necessity of further training, insufficient funding, and low political priority remain as the main barriers to community based mental health care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Outcomes Assessment: Reliable Change Index (RCI) in Assessing Health Outcomes in Clinical Practice
Authors: Iraurgi I. , Penas P. , Gorbeña S. , Montero M. , Trujols J.
Published: June 2017

Introduction

The assessment of therapeutic outcomes and the evaluation of treatment efficiency and effectiveness is an area of interest for clinicians and researchers. Scientific evidence demands randomized controlled trials and inter-groups comparisons with a minimum number of participants in each treatment modality, a requirement rarely feasible in clinical practice where the assessment of treatment outcomes, with regards to therapeutic goals, is crucial both in terms of statistical significance and clinical relevance.

Objective

The aim of this poster is to present an alternative methodology which permits to evaluate the individual's change.

Method

The reliable change index methodology allows for the estimation of statistical significance (statistically reliable change) and clinical relevance (calculation of cutoff points and its interpretation criteria). Two examples are presented: a group of patients with asthma in treatment and a female with major depression who underwent electroconvulsive therapy (ECT).

Results/discussion

Both cases were analyzed using standardized statistical analyses and the RCI method in order to estimate clinical change. The results illustrated the adequacy of both procedures for decision making in terms of effectiveness. However the RCI offered greater specificity with regards to individual changes. More specifically, RCI provided a more concrete estimation of the proportion of cases of asthma that showed change after the intervention, and also, indicated if such change were not only statistically significant, but also clinically relevant. Besides, when a single case was assessed (ex: ECT case) this methodology proved useful to estimate the efficacy of a continuation and maintenance program.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Different Subjective Criteria for Quality of life Appraisal in youth with Non-Psychotic Depression, Recovering After First Psychotic Episode and Healthy Controls
Authors: Rasskazova E. , Enikolopov S. , Guldan V.
Published: June 2017

Introduction

Although a plenty of instruments for quality of life in mental illnesses was developed, both general and specific instruments could be biased if the process of well-being appraisal is different in different illnesses.

Objectives

We consider personal appraisal of quality of life as a result of the decision making process, which could have different subjective criteria in mental illnesses.

Aims

The aim was to compare the contribution of the quality of life domains to the appraisals of general life satisfaction in mental illnesses.

Methods

Three groups of males 17–28 years old (74 with non-psychotic depression, 90 developing recovery after the first psychotic episode and 185 healthy controls) filled quality of life and enjoyment questionnaire (version for mental illnesses) and Happiness Scale.

Results

Moderation analysis reveals that in non-psychotic depression health, emotional sphere and functioning during the day are more important predictors of general well-being than in the two other groups. Patients developing recovery after psychotic episode are less oriented to the emotional and social domains and financial well-being when appraising their life satisfaction than other participants.

Conclusions

Results demonstrate the importance of identifying and working with subjective criteria and process of appraisal of general well-being in patients with mental illnesses. Direct comparisons of quality of life in different clinical groups are biased by different subjective criteria that are important for patients.

Disclosure of interest

Research supported by the grant of president of the Russian federation for the state support for young Russian scientists, project MK2193.2017.6.
Age at the Time of Exposure to Trauma Modulates the Psychopathological Profile and the Level of Functioning in Early Psychosis Patients: A Prospective Study
Authors: Alameda L. , Philippe G. , Philipp B. , Kim Q D. , Philippe C.
Published: June 2017

Introduction

Evidence suggests a relationship between exposure to trauma and higher levels of symptoms and poorer functional outcomes in early psychotic patients (EPP). However, the impact of the age at the time of exposure to trauma in this association is as yet unknown.

Objectives

To examine the potential differential impact of trauma, according to age at the time of exposure, on the level of functioning and on the psychopathological profile of EPP followed-up prospectively.

Methods

Two hundred and fifty-five EPP aged 18–35 were followed-up prospectively over 36 months. Patients who had faced at least one experience of abuse or neglect were classified according to age at the time of first exposure (early-trauma: before age 12; late-trauma: between age 12 and 16), and then compared with unexposed patients (non-trauma). The level of symptoms was assessed using the Positive and Negative Syndrome Scale. The Young Mania Rating Scale, and the Montgomery-Asberg Depression Rating Scale. The level of functioning was assessed with the global assessment of functioning.

Results

Comparisons over the 3 years of treatment with non-trauma patients revealed that:

– early-trauma patients showed consistently higher levels of positive (P = 0.006) depressive (P = 0.001), manic (P = 0.006) and negative (P = 0.029) symptoms and showed poorer functional level (P = 0.025);

– late-trauma patients only showed more negative symptoms (P = 0.029) as compared to non-trauma patients.

Conclusions

The age at the time of exposure to trauma has a modulating effect on its impact on symptoms and functional outcome in EPP and it should be systematically examined in clinical and experimental settings.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
N-acetyl-cysteine in a double-blind randomized placebo-controlled trial: Towards biomarker guided treatment in early psychosis
Authors: Conus P. , Fournier M. , Xin L. , Baumann P. , Ferrari C. , Cousins A. , Alameda L. , Golay P. , Jenni R. , Kashavan M.S. , Eap C.B. , Cuenod M. , Buclin T. , Gruetter R. , Seidman L. , Do K.Q.
Published: June 2017

Purpose

Recent evidence points to a critical role of redox dysregulation induced oxidative stress in the pathophysiology of early phases of schizophrenia. An add-on trial with n-acetyl-cysteine (NAC) led to a reduction in negative symptoms in chronic schizophrenia patients. Aim of this study was to explore impact of addition of NAC to standard treatment in early psychosis (EP) patients.

Methods

Double-blind, randomized, placebo-controlled trial of addition of NAC, 2700 mg daily, to antipsychotic treatment over 6 months. Monthly assessment of PANSS, GAF, SOFAS and antipsychotics treatment; quantification of brain glutathione levels (GSHmPFC) by 1H-magnetic-resonance-spectroscopy and of blood cells glutathione (GSHBC) and glutathione peroxidase activity (GPxBC) as marker of oxidation status at the beginning and end of treatment.

Results

Overall, 63 patients were included. Spectroscopy data showed that GSHmPFC increased by +23% in the NAC group, while it tended to decrease by −5% in the placebo group (P = 0.005). No significant difference between NAC and placebo was observed on global changes in negative symptoms, positive symptoms or functional outcome. However, in patients with high-baseline oxidation status (GPxBC>22.3U/gHb), subgroup explorations revealed an improvement of positive symptoms over time compared to patients with low-baseline GPx (P = 0.02).

Conclusions

While addition of NAC induced an increase of brain GSH, it had no impact on symptomatic and functional outcome in EP patients. However, in patients with high oxidation status, addition of NAC leads to significantly greater improvement in positive symptoms. Future studies on antioxidant interventions in EP should consider biomarker-guided treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Victimization and perpetration of crime in patients with schizophrenia and related disorders involuntarily admitted
Authors: Fortugno F.
Published: June 2017

Introduction

Incidence of crime victimization and perpetration is higher in severely mentally ill people than in general population. In the literature, fewer papers investigate the risk of being a victim than the risk of perpetrating violence in psychiatric patients.

Objectives

To study incidence of self-reported crime victimisation or perpetration in 2 multicentric database of patients suffering from schizophrenia or related psychoses who are admitted involuntarily to hospital.

Methods

Included involuntarily admitted patients with ICD-10 diagnosis of F20-F29, age 18–65, giving informed consent. Univariable and multivariable logistic regression to estimate odds ratios. Structured interview and BPRS by trained operators.

Results

Three hundred and eighty-three and 543 cases for each database. Victims: 37.8% and 28.0%. Accused: 25.6% and 11.6%. Victims had higher BPRS subscale of Mania, were unemployed and had fewer social contacts. Accused had higher mania in one of the 2 sample. Sociodemographic predictors included unemployment and homelessness, younger age and male gender.

Discussion

Sociodemographic factors are important predictors of being accused of a crime. Higher symptoms of mania are associated with higher odds of being victim of violence in 2 multicentric samples, after correction for other variables. Rates of both victimisation and perpetration rates are higher than in samples of people from general population or from outpatients settings. Accused and victims have a strong association with consideration on the context of life.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Help-seeking behavior among patients and their relatives presenting to psychiatric unit in southern Sri Lanka
Authors: Goonawardena K.D.D.R. , Kotalawala S.W. , Ruban R.
Published: June 2017

Background

Early recognition of the signs and symptoms of psychiatric illnesses is important as the delay would predict worse prognosis.

Aims

To study the help-seeking behavior and sociodemographic factors of psychiatric patients presenting to Psychiatric Unit Teaching Hospital, Karapitiya.

Methods

A descriptive cross sectional study. Sample drawn from patients presenting for the first time to Psychiatric Unit Teaching Hospital, Karapitiya. An interviewer administered questionnaire was used to collect data.

Results

Age ranged from 13 to 76 years (n = 50). Males 34 (68%). Duration from onset of symptoms to first presentation ranged from 2 days to nine years, mean 2 years. Twenty-five (50%) had symptoms for more than one year. Sixteen (32%) stated to have attributed illness to supernatural courses as the reason to delay seeking medical help. None gave difficulty in accessing a psychiatric unit as reason for the delay. Twenty-six (52%) referred by nonpsychiatric medical professionals. Regarding alternative treatment engaged in prior to presentation to a psychiatric unit, eighteen (36%) tried to dispose of evil spirits with the help of yakaduru or kattadi, seven (14%) sought help from indigenous medical practitioners and twenty (40%) engaged in religious rituals. Thirteen (26%) sought nonpsychiatric medical treatment.

Conclusions

A substantial number of patients suffering from psychiatric disorders present to psychiatric units delayed. As the majority were referred by nonpsychiatric medical professionals, alerting them regarding importance of early identification of psychiatric illnesses could help in reducing the delay.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Combined pharmacotherapy involving aripiprazole and clozapine for controlling the positive symptoms refractory to other antipsychotic treatments in a patient with schizophrenia
Authors: Santillan G. Hernandez , Lazo-Chávez K. , Blanco-Prieto M.
Published: June 2017

Introduction

Treatment resistance is considered a challenging problem of antipsychotic pharmacotherapy in schizophrenia, especially, when it is associated with other factors, such as cultural aspects, diverse clinical presentation, furthermore functional impact. Then, combination approaches are commonly used, for instance, the add-on of aripiprazole to clozapine; which allows increasing of efficacy and safety.

Objective

Assess the response to clozapine–aripiprazole combination treatment in the management of resistant schizophrenia.

Aim

Treatment of resistant schizophrenia.

Method

Analysis of a clinical case.

Result

A 27-year-old male resident in an Iberian country two years ago, is from a Latin American country, lives with his mother, his sister and his nephew. Their parents were separated. Eight years ago, his father died and shortly thereafter, he started impaired behavior, auditory and visual hallucinations, delusions about referentiality, persecution and prejudice, which required a brief hospitalization in their country. Upon arrival, he is included in the network of Mental Health, with positive symptoms, significant behavioral and cognitive disorganization and he needed hospitalization again. Then, treatment is instituted in different lines with risperidone, quetiapine, olanzapine, haloperidol, amisulpride, without results. Then, combined clozapine therapy is initiated up to 400 mg/day, more aripiprazole 20 mg/day, which switch after to pattern injectable depot, with informed consent. Six months after, he presents encapsulated delirium and improvement of disorganization, allowing the patient to retake studies.

Conclusion

Clozapine–aripiprazole combination was associated with 22% reduction of clozapine dose. There was improvement in positive and negative symptoms, social functions and amelioration in their metabolic profile.

Disclosure of interest

The authors have not supplied their declaration of competing interest.