bluuebunny/crossref_metadata_2025 huggingface dataset:
The Introduction of Psychotherapy in Psychiatric Outpatients in the Last Four Years in a Greek Hospital
Authors: Lyrakos G. , Menti D. , Spyropoulos I. , Spinaris V.
Published: June 2017

Introduction

The use of psychotherapy is an important part of treating psychiatric disorders, in combination with medication taking. However, despite its importance, psychotherapy is still underused from individuals with psychiatric problems in Greece.

Objectives

To examine the use of psychotherapy, among psychiatric outpatients, in the last four years.

Aims

To investigate whether there are differences in the use of psychotherapy, in combination with medications, to treat psychiatric disorders, from 2012 to 2015.

Methods

In this study participated 5,551 patients, 2,760 males (49.7%) and 2,791 females (50.3%). The mean age was 45.54. Convenience sampling method was used and participants were recruited from the General Hospital of Nikaia, ‘Ag. Panteleimon’, in Athens, Greece, from 01/01/2012 to 31/12/2015. SPSS software was used to analyse the data.

Results

There were significant differences between the four years (2012–2015) with regard to the use of psychotherapy, in combination with medications, from psychiatric patients as χ2 (21): 753.057, P < 0.001. More specifically, only 0.1% of psychiatric patients undertook psychotherapy in addition to taking medications, in 2012, and this increased to 2.7%, in 2013, 13.8% in 2014 and 18.6% in 2015.

Conclusions

There was an increase in the use of psychotherapy, in combination with medication taking, during the four last years, from 2012–2015. However, the percentage of patients undertaking both psychotherapy and taking medications is still low. This has important clinical implications as the use of psychotherapy plays a significant role in achieving optimal health outcomes of psychiatric patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The use of “Pliable Media” in Promoting Symbolization in the Psychoanalytical Psychotherapy of Psychosis
Authors: Solano P. , Quagelli L.
Published: June 2017

Introduction

In psychosis, the capacity of symbolization is lost to different extents and patients live in a concrete world of objects. Moreover, the lack of boundaries between self/other, inside/outside severely impairs the capacity of these patients to understand and recognize reality from the delusional dimension.

Objectives

Working through psychotic concreteness and accessing a first subjectivation of this experience, that leads to the development of a first symbolization.

Aims

Achieving the possibility to access a first symbolization and begin a delicate process of appropriation of the emotional experience with the establishment of the boundaries between inside/outside.

Methods

The use of “pliable media”, such as drawing, as therapeutic mediation allows a partial defraction of the violent transferential dynamics from the therapist and let unsymbolized material to emerge less destructively in the treatment fostering a first figurability.

Results

The Squiggle game as “pliable medium” facilitates a first encounter in the therapeutic relationship and represents a primal transitional area that allows a gradual working through process to take place where the establishment of the boundaries between inside/outside could begin.

Conclusions

We suggest that the use of “pliable media” in the early stages of the psychotherapy of psychotics can significantly favor a first encounter between patient and therapist and, at the same time, provides the first experience of a transitional space where a working through process leading to first representations can take place.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Deinstitutionalization and Psychosocial Rehabilitation
Authors: Vidal C. , Melo Vidal L.
Published: June 2017

Introduction

Barbacena is a Brazilian city with 140,000 inhabitants, which was known as the “city of madmen” because of the excessive number of patients in psychiatric hospitals. In 2000 it began a deinstitutionalization process, and the patients were transferred to assisted residential services.

Objective

Describe the process of deinstitutionalization and social rehabilitation of psychiatric patients.

Methodology

The following characteristics were studied: sex, age, medication use, psychiatric diagnosis and the development of social skills.

Results

In each therapeutic residence (RT) lives eight patients, supervised by upper and mid-level professionals. Since the implementation of RTs about 400 patients leave the psychiatric hospitals. Most had mental retardation (51.0%), followed by schizophrenia (31.0%). More than half (58.5%) were men. The age ranged from 29 to 97 years, with a average of 64.8 ± 12.4. A decrease in the average dose of neuroleptics was seen after deinstitutionalization. Direct observation of patients in the RT, and the reporting of caregivers has shown that patients have developed wide range of social performance, such as dating, started at professional courses, attending exercise classes, travelling and learn how to use money.

Conclusion

In despite of difficulties in the psychiatric reform process, the community-based treatment and psychosocial rehabilitation approach are the principal models of psychiatric care presently, and the residential services play an important role in this process. The authors emphasize the importance of community support, professional staff and rehabilitation programs as a condition for good outcomes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Smoking: A Risk Factor for Suicide
Authors: Aubin H.J.
Published: June 2017

First demonstrated in 1976, the robust association between smoking and suicide mortality has been established and is dose-dependent, with an estimated increase in suicidal deaths risk of 24% for each increment of 10 cigarettes smoked per day. The statistical association has been shown to exist very soon after smoking initiation, during adolescence, and to withstand adjustments for confounding factors, such as demographics, socio-economic status, somatic and psychiatric comorbidity, and substance use. As the underlying mechanism of the greater suicide risk in smokers is not currently elucidated, we will briefly recapitulate the main hypotheses proposed to date: the toxic effects of nicotine, hypoxemia, monoamine oxidase activity inhibition, the high prevalence of psychiatric comorbidity and consequent suicide risk, and smoking-induced serious physical illness with pain and disability resulting in negative mood response. Smoking could also be an inadequate self-medication for psychological symptoms, themselves causing suicide, and finally the association could be due to a third underlying factor associated with both smoking and suicide.

Disclosure of interest

Henri-Jean Aubin was member of advisory boards for Pfizer, D&A Pharma, Ethypharm, and Lundbeck, and has received sponsorship to attend scientific meetings, speaker honoraria and consultancy fees from Bioprojet, D&A Pharma, Ethypharm, Lundbeck, Merck-Serono, Novartis, and Pfizer.
The geometrical analysis of handwriting as a new tool to evaluate motor symptoms in psychosis
Authors: Cobo Y. Crespo , Molina A. Ibañez , Parro S. Iglesias , Peña M.F. Soriano , Aznarte J.I.
Published: June 2017

Introduction

There is growing evidence about the importance of motor symptoms in psychosis. Motor abnormalities have been observed in naive-drugs, first-episode patients. Clinical assessment of motor abnormalities normally relies upon subjective observer-based ratings. Kinematic analysis of handwriting has proved to be an objective measure of motor symptoms, but it has not been used in clinical settings.

Objectives

In the present work, the geometrical analysis of handwriting patterns is proposed as a new tool to evaluate motor symptoms in psychosis.

Method

Overall, 35 healthy participants and 43 patients with psychosis from San Agustín Hospital (Linares, Spain) participed in the study. Participants were asked to write with a pen on a white paper (see patterns in the Figure 1). In order to analyze the heterogeneity of handwriting pattterns, we employed lacunarity, a nonlinear measure previously used in the analysis of biomedical images. Lacunarity measures the distribution of gap sizes in a geometrical space. A large value implies large gaps and clumping of points, whereas a small value suggests a uniform distribution with shorter gaps.

Results

Lacunarity was significantly higher in handwritten patterns from patients than in controls. In addition, we found a higher heterogeneity in patients with motor symptoms in comparison with patients without motor symptoms.

Conclusions

Our results suggest that analysis of handwritten patterns can be a valuable method in the evaluation of motor symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychosis and psoriasis, the skin talks the truth
Authors: Marin S. Garcia , García I.M. De Haro , Pedrosa N. Martínez , García M.D. Ortega , Garnica V. Marti
Published: June 2017

Introduction

It is well known about relation between skin and mind, not only due to their mutual origin, but also by their illness expression parallelism. We report a case to show that reciprocity.

Personal antecedents

Woman, 42-year-old, single. She only suffers from a skin disease; mild psoriasis guttata placed in both elbows and knees. She treated it with local treatment (cortisone cream) during seasonal prutius and the lesions did not grow or expand. She was hospitalized due to psychotic symptoms (paranoid delusions with her colleagues) and started antipsychotics treatment (risperidone 12 mg per day and olanzapine 10 mg per night). By the same time, she suffered a psoriasis crisis. Her psoriatic plaques increased their sizes and her chest and both thighs were affected too. She complained about grave pruritus. All her medical test results were normal. After that, the patient improved her psychotics’ symptoms, but she started with agoraphobic signs and seclusion at home. Psoriasis were even worse than before and she needed metrotexate to treat it. Being introduced to escitalopram 15 mg per day, anxiety and depression symptoms disappeared and her grave psoriasis became the mild one that she knew.

Conclusion

Schizophrenia was associated with a greater variety of autoimmune diseases than was anticipated. Studies found evidence for a shared genetic etiology between schizophrenia and psoriasis. Despite that, we think that the study of psychopathology can amplify our understanding about the etiopathogenesis of psoriasis and associated mental disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The side effects of risperidone depot in patients with psychotic disorders
Authors: Jupe T. , Elezi F. , Zenelaj B. , Myslimi E.
Published: June 2017

Background and aim

A long-acting form of risperidone is now broadly available for the treatment of schizophrenia and closely related psychiatric conditions. It combines the advantage of previously available depot formulations for first-generation drugs with the favorable characteristics of the modern “atypical” antipsychotics, namely higher efficacy in the treatment of the negative symptoms of schizophrenia and reduced motor disturbances [1].

Methods

During this study, we observed side effects that appear in patients that are treated with risperidone depot. Patients were observed for a period of 3 months (October–December 2015) and the side effects were evaluated with Glasgow Antipsychotic Side-effect Scale (GASS). The data obtained were analyzed with SPSS, trying to prove the impact of variables such as: gender, age, diagnosis, dose and duration of treatment on the occurrence of side effects.

Results

Through statistical processing, we reached the conclusion that there is a statistically significant correlation between duration of treatment and side effects (P value was 0.0001). Between two variables has a strong positive correlation (Kendall value was 0.766). Has a statistically significant correlation between the drug dose and side effects (P value was 0.026). Between two variables has a moderate positive correlation (Kendall value was 0.504). No statistically significant correlation between these variables: gender-side effects, diagnose-side effects and age-side effects.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychological resilience and quality of life amongst people with psychotic illnesses
Authors: McCarthy G. , Liston A. , Adamis D.
Published: June 2017

Introduction

Psychological resilience is defined as an individual's ability to adapt to stress and adversity. People with psychotic illness often experience high levels of distress and difficulties adapting.

Aims

To assess the relationship between the resilience of people with psychotic illnesses and their quality of life.

Methodology

Outpatients from multiple settings attending Sligo-Leitrim Mental Health Services, aged 18+ years old with a diagnosis of either schizophrenia, bipolar affective disorder or schizoaffective disorder were approached by their treating teams and invited to participate. Other inclusion criteria were having a family member. Drug induced psychoses or no family member were exclusion criteria. The scales used were the Resilience Appraisal Scale and the schizophrenia Quality of Life Scale. This study is part of a larger study looking at family factors and psychosis.

Results

The study sample was 58 enrolled but only 49 participants completed the 2 assessments, of these 33 were males (67.3%). Data was analysed using SPSS 21. Pearson's correlation coefficient for resilience and quality of life was 0.503, P < 0.001. This shows that higher resilience is associated with better quality of life amongst people with psychotic illnesses. These results could have useful clinical implications. If we can intervene to therapeutically increase resilience, we can eventually improve the quality of life of people with psychoses.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Erotomania: A psychodynamic overview
Authors: Pereira E. , Coutinho F. , Machado A.S. , Reis C.
Published: June 2017

Introduction

Erotomania is a delusional disorder in which one believes to be loved by someone else. Even though its etiology is not known, psychodynamic factors have been proposed as a possible explanation.

Objectives

To review the psychodynamic etiology of erotomania.

Methods

A search of the Medline/Pubmed database was conducted using the terms “erotomania” and “psychodynamic”.

Results

Several authors wrote about the psychodynamic etiology of erotomania. Kraepelin describes it as a “compensation for the disappointments of life”. De Clérambault highlights the idea of “sexual pride”: stimulated by the absence of affective and sexual approval, erotomania flourishes as a way of satisfying the individual's pride. Hollender and Callahan explain the disorder as a result of an ego deficit of not feeling attractive enough. According to Segal, the erotomanic delusion meets the patient's need for love and it is related to the idea of it as the ultimate way of approval. Taylor highlights the patients’ isolation, loneliness and extreme dependence on others.

Conclusions

About every author agrees with the idea that the erotomanic delusion acts as a gratification to the individual's narcissistic needs, when personal experience has failed to do so. Wanting to be loved is the core of human motivation and the delusion most commonly appears in people who feel rejected by society; facing that perceived rejection, it emerges as the fantasy that other human being is in love with them. This is a relevant overview of this disorder with implications in patients’ treatment, since psychotherapy could be important along with drug treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cardiac adipose tissue, intra-abdominal adipose tissue, and risk for cardio-metabolic diseases in patients with schizophrenia
Authors: Ruppert J. , Hartung D. , Gutberlet M. , Westhoff-Bleck M. , Kahl K.
Published: June 2017

Introduction

Schizophrenia is associated with increased physical morbidity and mortality. In particular, cardio-metabolic diseases are more frequent. Several underlying reasons have been discussed, including adverse lifestyle behaviors, or adverse effects of neuroleptic treatment. However, little is known about changes of cardiac and intra-abdominal adipose tissue, both are risk factors for the development of cardio-metabolic diseases.

Objectives/aims

To compare, cardiac and intra-abdominal adipose tissue between patients with schizophrenia and healthy controls.

Methods

Ten physically healthy patients with schizophrenia according to DSM-V were included, and compared to healthy control subjects. Cardiac and intra-abdominal adipose tissue was quantified using magnetic resonance tomography. Further factors assessed comprise the metabolic syndrome, physical activity, smoking behavior, and scores for the assessment of cardio-metabolic diseases (FINDRISK score and modified ESC score).

Results

Cardiac adipose tissue and intra-abdominal adipose tissue was increased in patients with schizophrenia. Further findings were higher diastolic blood pressure, more smoking, less physical activity, and an increase for diabetes and cardiovascular disease risk according to the modified ESC and FINDRISK score.

Conclusions

The new finding in our study is an increase of cardiac adipose tissue, a risk factor for the development of cardiovascular disorders, in physically healthy patients with schizophrenia. Furthermore, the risk for the development of type-2 diabetes mellitus is increased, indicated by higher amount of intra-abdominal adipose tissue, and the results of the FINDRISK score. We conclude that lifestyle alterations, particularly exercise training that has been shown to reduce cardiac and intra-abdominal adipose tissue, should be recommended in patients with schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Not the same old madness: Evaluating the clinical profile of the “schizophrenia spectrum” disorders
Authors: Russo A. , Verdolini N. , Menculini G. , Moretti P. , Quartesan R. , Tortorella A.
Published: June 2017

Introduction

The “schizophrenia spectrum” concept allowed better identifying the psychopathology underpinning disorders including schizophrenia, schizoaffective disorder (SZA) and cluster A personality disorders (PD).

Aims

To compare the clinical portrait of the schizophrenia spectrum disorders, focusing on the impact of the affective dimension.

Methods

Inpatients at the acute psychiatric ward of Perugia (Umbria-Italy) were evaluated with the structured clinical interview for DSM-IV Axis I and Axis II disorders and diagnosed with a “schizophrenia spectrum” disorder according to DSM-IV-TR. The clinical evaluation was conducted using the positive and negative syndrome scale (PANSS). Pearson correlations of the different subscales in the three groups and between the negative scales with the affective symptom “depression” were conducted.

Results

The sample consisted of 72 inpatients (schizophrenia 55.6%, SZA 20% and cluster A PD 19.4%). The negative and the general psychopathology scales directly correlated at different degrees in the three groups (schizophrenia: r = 0.750; P < 0.001; SZA: r = 0.625, P = 0.006; cluster A PD: r = 0.541, P = 0.046). The symptom “depression” directly correlated with 5 out of 7 negative symptoms: blunted affect (r = 0.616, P < 0.001), emotional withdrawal (r = 0.643, P < 0.001), poor rapport (r = 0.389, P = 0.001), passive/apathetic social withdrawal (r = 0.538, P < 0.001), lack of spontaneity & flow of conversation (r = 0.399, P = 0.001).

Conclusions

Our study confirmed the existence of the “schizophrenia spectrum” with combined different disorders lying on a continuum in which negative symptoms mainly correlated with the psychopathological functioning. Noteworthy, the symptoms of the negative scale strongly correlated with the “depression” symptom, underlying the impact of the affective symptoms on the severity of the “schizophrenia spectrum” disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Providing Care for Migrants and Refugees
Authors: Schouler-Ocak M.
Published: June 2017

With growing globalisation and an increasing number of people on the move across boundaries, it has become vital that service providers, policy makers and mental health professionals are aware of the different needs of the patients they are responsible. One of the most fundamental barriers for migrants, refugees and asylum seekers in accessing health services are inadequate legal entitlement and, mechanisms for ensuring that they are well known and respected in practice. Access to the healthcare system is impeded by language and cultural communication problems. Qualified language and cultural mediators are not widely available, and moreover, are not regularly asked to attend. This can lead to misunderstandings, misdiagnosis and incorrect treatment, with serious consequences for the afflicted. The language barrier represents one of the main barriers to access to the healthcare system for people who do not speak the local language; indeed, language is the main working tool of psychiatry and psychotherapy, without which successful communication is impossible. Additionally, the lack of health literacy among the staff of institutions, which provide care for refugees and asylum seekers means that there is a lack of knowledge about the main symptoms of common mental health problems among these groups. The healthcare services, which are currently available, are not well prepared for these increasing specific groups. In dealing with ethnic minorities, including asylum seekers and refugees, mental healthcare professionals need to be culturally competent.

In this talk, main models for providing mental health care for migrants and refugees will be presented and discussed.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Schizoaffective disorder and life quality
Authors: Bouali W. , Marrag I. , Ellouze F. , Dekhil A. , Nasr M.
Published: June 2017

Introduction

schizoaffective disorder is a nosographic entity characterized by a combination of symptoms of schizophrenia with mood episodes. The fact that its diagnosis is difficult, and often oscillates between schizophrenia and bipolar disorder raises the problem of its care and the outcome of patients who suffers from it.

Objective

To evaluate the quality of life of treated patients with schizoaffective disorder.

Materials and methods

This is a cross-sectional study realized at the psychiatric consultation of Mahdia hospital during a 6month period. Data were collected from patients and from their medical records using a predefined questionnaire.

Results

A total of 52 patients were included, the average age was 38 years. The majority of patients (63.5%) were unemployed. The use of psychoactive substances was noted in 63.5% of patients. Multiple linear regression analysis allowed us to find that 12 factors were more significantly associated with impaired quality of life which were, in descending order of importance: the EAS score > 39, the EGF score ≤ 70, the null or partial adherence, the presence of side effects seriously affecting daily activity, the depressive subtype, the lack of employment, the socio-economic level, the lack of stable budgetary resources, an age > 60years, the widowed and divorced marital status, the PANSS score (≥ 45) and negative symptomatology (PANSS).

Conclusion

The diagnosis of schizoaffective disorder has a triple relevance: clinical, prognostic and therapeutic. Identifying a schizoaffective disorder and the risk factors that may affect the quality of life provides a significant practical impact for the patient's benefit.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Schizoaffective disorder and life events
Authors: walid B. , Marrag I. , Ellouze F. , Dekhil A. , Nasr M.
Published: June 2017

Introduction

The schizoaffective disorder is multifactorial. Several factors almost unquestioned, even indisputable, participate in the episodes’ decompensation and affect various fields: biological, pharmacological or neurobiochemical.

Objectives

Draw up the sociodemographic and clinical profile of patients treated for schizoaffective disorder and determine the role of life events in the onset of the disorder.

Methods

This is a retrospective study of 52 patients hospitalized in the psychiatric department of Mahdia diagnosed with schizoaffective disorder according to DSM-IV-TR during the period from January 2014 until June 2014. The information was collected using a preset sheet with 35 items.

Results

A total of 52 records was gathered. The average age was 38 years. The sample was predominantly male, of rural origin in 61.5% of cases. The level of education was low in 59.6% of cases. More than half were without profession and single in 46.2% of cases. The mean age at onset of the disorder was 25.2 years. The presence of life events preceding the onset of the disorder was noted in 22 patients, that to say, 42.3% of the sample. Family and emotional events were most frequently encountered with respective rates of 48.2 and 24.7%, followed by the professional events (20%) and social ones (6%).

Conclusion

Life events are due to chance but also to the environment. The complexity of the “event” concept was again underlined in a new perspective, breaking social rhythms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Digital communities of people with paraphilia: A study of zoophiles
Authors: Sendler D. , Lew-Starowicz M.
Published: June 2017

Introduction

Accessibility of the Internet allows people to connect anonymously and without boundaries – features particularly important for people with relatively rare sexual preference such as paraphilia.

Objectives

To (1) allow for conceptualization and improved management of zoophilic patients in clinical practice or forensic examinations, (2) analyze how zoophiles network using online discussion forums, and (3) describe main goals of digital networking.

Methods

A qualitative observational study of user activity (n = 958) on discussion forums, combined with brief demographic survey. Data were analyzed according to principles of grounded theory. Next, surveys of own design (demographic, discreet + open ended questions) were answered by 350 participants. Presented data show aggregate conclusions from mixed methods qualitative and quantitative analysis.

Results

Zoophiles (or, zoos) use Internet to connect with other zoophiles (26.6% to have casual sex, 17.7% for dating, and 17% to exchange pornography). Connections are easiest to be established in countryside, where zoophilia clusters. In fact, there are village communities of zoos where explicit sharing of animal sexual partner(s) (28%) and/or voyeurism (30%) serve as bonding ritual. Over 40% of zoophiles are reluctant to meet other zoos in person, since they view them as “weird”, pointing to phenomenon of internalized stigmatization due to having non-normative sexuality. Online forums are also used by zoophiles to exchange information about which districts are at risk of becoming a target of social ostracism.

Conclusions

People with zoophilia use digital communities to network, meet for sex, find dating partners and for own safety reasons.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Is cloninger type 1 and type 2 alcoholism differ in terms of emotion regulation?
Authors: Gulec Oyekcin D. , Gurgen A.
Published: June 2017

Introduction

Emotional disturbances are a central characteristic of many mental disorders, including alcohol addiction.

Objectives

In this study we aimed to investigate the emotion disregulation among alcohol use disorders and to compare the emotion regulation difficulties with type 1 and type 2 alcoholism.

Methods

Thirty-three treatment-seeking AUD individuals were recruited from addiction division of psychiatry department of Çanakkale Onsekiz Mart University. Patients who agreed to participate in the study and completed detoxification treatment were enrolled to the study. After describing the study and obtaining informed consent, participants were assessed with demographic questionnaires (including questions such as age, gender, income status, duration of alcohol use, amount of alcohol use, duration of abstinence were given to participants) followed by the semi-structured interview. Emotion regulation was assessed with the difficulties in emotion regulation scale.

Result

Of the patients, 93.9% were male. The average age of participants was 41.21 ± 12.8 years. Of the participants, 60.6% were type 1 and 39.4% of type 2. There was statistically significant difference between type 1 and type 2 alcoholism in terms of emotion regulation. Type 2 alcoholism has more emotional regulation difficulties than type 1 alcoholism. This finding may be consistent with earlier onset of having more impulsive drinking pattern in type 2.

Conclusions

In conclusion alcohol use disorders are thought to be associated with emotion dysregulation. Emotion regulation difficulties, was higher in type 2 than type 1. Emotional regulation strategies should be considered in the interventions and may be evaluated as a new prognostic criteria.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Nalmefene against alcohol use disorder: A report of one case
Authors: Juncal Ruiz M. , Porta Olivares O. , Sánchez Blanco L. , Landera Rodríguez R. , Gómez Revuelta M. , Santayana Jenaro G. Pardo de , Martín Gutiérrez R. , López García E. , Medina Blanco R. , García Ayala L.
Published: June 2017

Introduction

Alcohol consumption represents a significant factor for mortality in the world: 6.3% in men and 1.1% in women. Alcohol use disorder is also very common: 5.4% in men and 1.5% in women. Despite its high frequency and the seriousness of this disorder, only 8% of all alcohol-dependents are ever treated. One potentially interesting treatment option is oriented toward reducing alcohol intake.

Aims

To describe one case who has improved his alcohol consumption after starting treatment with nalmefene, an opioid receptor antagonist related to naltrexone.

Methods

A 35-year-old male with alcohol use disorder since 2001 came to our consult in November 2015. He was in trouble with his family and he had a liver failure. We offer a new treatment option with nalmefene 18 mg to reduce alcohol consumption.

Results

Before to start nalmefene he drank 21 drinks/week. Six-month later, he decreased alcohol intake until 5 drinks/week with better family relationship and liver function. After starting nalmefene he complained of nausea, so we recommend to take the middle of the pill for next 7 days. After this time he returned to take one pill with good tolerance and no more side effects or withdrawal syndrome.

Conclusions

Nalmefene appears to be effective and safe in reducing heavy drinking and in preventing alcohol withdrawal syndrome due to its opioid receptor antagonism. This case suggests nalmefene is a potential option to help patients, who do not want or cannot get the abstinence, in reducing their alcohol consumption.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Interventions to improve lifestyle and quality of life in patients with concurrent mental illness and substance use
Authors: Juel A. , Kristiansen C.B. , Munk-Jørgensen P. , Hjorth P.
Published: June 2017

Background

Patients with co-existence of psychiatric disorders and substance use have an increased risk of premature death. This is attributable to a higher prevalence of physical comorbidities and the lifestyle related to substance use. Furthermore, they experience low quality of life (QoL). Studies addressing lifestyle interventions for these patients are warranted.

Aims

To investigate the physical health and QoL in patients with co-existence of psychiatric disorders and substance use, and to analyse for changes in their (a) health, (b) substance use and (c) QoL after a 24-month health-promotion programme. Further aims were to investigate associations between (a) QoL and number of interventions, (b) QoL and patient characteristics and (c) QoL and length of participation in the intervention.

Methods

In this naturalistic cohort study, 64 non-selected patients were engaged in health-promoting interventions added to contemporary treatments. QoL and clinical variables were measured at the beginning of and continuously during the programme by means of the WHOQoL-Bref questionnaire.

Results

At enrolment, the patients’ intake of cannabis and alcohol was high. During follow-up, patients consumed significantly fewer caffeinated beverages (P = 0.038) and fast-food meals (P = 0.018), and slept significantly less (P = 0.032). The average dose of antipsychotic medication increased significantly (P = 0.015). QoL was low at enrolment but improved significantly overall (P = 0.009) and in the psychological (P = 0.020) and environmental domains (P = 0.012) at follow-up. The difference in total QoL was positively associated with the number of interventions attended.

Conclusion

This programme shows promise in addressing health promotion for these patients and can easily be integrated into contemporary treatments.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cannabinoid hyperemesis syndrome: A Parisian case series
Authors: Marillier M. , Batisse A. , Chevallier C. , Laviale L. , Djezzar S.
Published: June 2017

Introduction

Currently, cannabis remains the most widely used illicit psychoactive substance in the world. Its main pharmacological properties are known and its use for therapeutic purpose is still expanding. Also, its acute and chronic toxicity become more described, even if some mechanisms of pharmacotoxicology still remain to clarify as the cannabinoid hyperemesis syndrome (CHS).

Objectives

To describe cases of CHS, to highlight the clinical presentation and all the complexity of the medical exploration for making an accurate diagnosis.

Method

We present a case series of CHS related to cannabis use and notified to the Parisian addictovigilance center.

Results

Eight cases were collected between 2011 and 2016. The users are almost exclusively men (7/8), with a median age of 31 years and some of them present a history of psychiatric disorder. All of them report important daily cannabis consumption (up to 15 joints by day) with duration of consumption averaged at 10 years. All patients present recurrences of clinical signs of the syndrome including vomiting (8/8) and abdominal pains (8/8) leading to repeated hospitalizations. Despite the presence of compulsive taking hot showers notion (7/8), specific sign of the CHS, its diagnosis were made by a physician in 5 cases. Carried out medical examinations are often complete, invasive, even going to an explorative laparotomy for one patient.

Conclusion

The CHS remains not well known. A better understanding of this syndrome will enable better patient care while avoiding costly spending unnecessary investigations.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Alcoholism and alcoholic psychoses in Russia: An analysis of the trends
Authors: Razvodovsky Y.
Published: June 2017

Introduction

Russia has one of the highest alcoholism (alcohol dependence) and alcoholic psychoses incidence/prevalence rates in Europe, which may be explained by high overall population drinking and prevalence of irregular heavy drinking of vodka. The role of binge drinking in modifying the effect of alcohol on the risk of alcoholic psychoses in Russia has been emphasized in clinical and aggregate-level studies.

Aims

The present study aims to examine the phenomenon of dramatic fluctuations in alcoholism and alcoholic psychoses rates in Russia during the late Soviet (1970–1991) to post-Soviet period (1992–2015).

Method

To examine the relation between changes in the sales of alcohol and alcoholism/alcoholic psychoses incidence/prevalence rates across the study period a time-series analysis was performed.

Results

According to the results, alcohol sales is a statistically significant associated with alcoholic psychoses incidence/prevalence rates, implying that a 1 litre increase in per capita alcohol sales is associated with an increase in the alcoholic psychoses incidence/prevalence rates of 17.6% and 14.0% correspondingly. The association between alcohol sales per capita and alcoholism incidence/prevalence rates was also positive, but statistically not significant.

Conclusion

These findings suggest that the alcoholic psychoses incidence/prevalence rates are the reliable indicators of alcohol-related problems at the population level. The outcomes of this study also provide indirect support for the hypothesis that the dramatic fluctuations in the alcoholic psychoses incidence/prevalence rates in Russia during the last decades were related to the availability/affordability of alcohol.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Alexithymia in patients with substance use disorders
Authors: Sellami R. , Moalla M. , Feki I. , Hentati S. , Masmoudi J. , Zahaf A.
Published: June 2017

Introduction

Alexithymia is considered as a deficit in emotion processing. It includes difficulty to identify and describe feelings as well as discriminate between feelings and physical sensations. Alexithymia may be a risk factor for substance use (SUD).

Objectives

The objective of this work is to identify the prevalence and correlates of alexithymia among patients with SUD.

Methods

This study concerns 40 subjects who were hospitalized in a rehabilitation center in Sfax. The subjects completed a form investigating sociodemographic and drug use characteristics. Alexithymia was assessed using the Toronto Alexithymia Scale TAS-20 a. The TAS-20 have three factors: difficulty in identifying feelings (F1), difficulty in describing feelings (F2), and externally oriented thinking (F3).

Results

The mean age of 30.86 ± 8.07 years. The mean score of alexithymia was 65.39 ± 9.65 (42→83). The scores of its dimensions were 25.3 ± 6.10 for F1, 17.16 ± 3.3 for F2 and 23.16 ± 3.18 for F3. The prevalence of alexithymia was 62.8% among addicts. High alexithymic patients did not differ from low or moderate alexithymic patients in terms of, employment, education or the type of substance. TAS-20 was correlated to socio-economic status (P = 0.002). No correlation was observed between age and alexithymia (total TAS-20) when measured as a continuous variable (P = 0.802). High alexithymic patients exhibited a higher preference for poly-substance use compared with no alexithymic patients (P = 0.05).

Conclusion

Findings suggest that alexithymia is frequent in SUD patients. It should be noted in clinical practice that many patients with SUD may have a reduced capacity to identify and describe feelings during detoxification.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Anti-craving biofeedback program in clinical course of pathological addictions
Authors: Sosin I. , Chuev Y. , Volkov A. , Goncharova O.
Published: June 2017

Introduction

Modern clinical narcology searches for anti-craving programs to overcome psychoactive substances (PAS) pathological addiction with bio-adaptive regulation of systems (BARS).

Aims and objectives

To develop computer modified biofeedback program integrated with Luscher test.

Method

Twenty-two PAS addicts who were undergoing biofeedback modified psycho-training were examined. Computer rheoencephalogram (REG) was used as an external monitoring module.

Results

Technologically novel biofeedback computer modification was developed with preceding Luscher computer testing for determination of the individual preference colour and the colour producing individual unpleasant associations in respondents. Consequently, biofeedback program was corrected differentially by changing standard colour templates for those personified on monitor. Cerebral hemodynamics condition transferred to individually designed for a particular respondent colour registers is used as a homeostatic parameter reflecting alcohol craving presence/absence: in case of the disordered REG parameters the signal reflects the respondent's unpleasant (negative) colour, and with no craving the screen is filled with positive, pleasant, favourite colour. During BARS auto-training the respondents’ skills to mediate present subjective clinical PAS craving manifestations with unpleasant colour and the experimental auto-training method have been mastered, and those psycho emotional states which displace PAS craving symbolic colour from the screen are selected, and it is substituted with favourite colour (symbol of healthy mode of life motivations).

Conclusions

Usage of combined BARS biofeedback improved effectiveness of the training and allowed to objectivize and control the condition of the patient getting reliable visual and digital information about either regress or activation of PAS craving and potential relapse of addictive behaviour.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychological autopsies, suicide and psychopathological significance (Results of a survey of mental health from 2000 to 2008 in east of Algeria)
Authors: Benabbas M. , benelmouloud O.
Published: June 2017

This is an epidemiological study of suicide in East of Algeria (15 wilayas) through psychological autopsies (from 2000 to 2008) or more variables were studied to establish a standard profile of suicide in Algeria. The variables studied were: age, sex, occupation, place of residence, the existence of life events, psychiatric history and possibly a history of TS, a source of information (from whom we collected Information: father, mother, brother, sister…) and the proceeds used for suicide. In total, we identified 1263 cases of suicide with age 15 and older occurred in populations of East of Algeria during the period 2000 to 2008. The conclusion focuses on the emergence of certain variables can be risk factors namely age between 30 and 45 years, male gender, social and financial difficulties especially difficult life, the presence of a psychiatric diagnosis on axis 1 of DSM-IV and finally the lack of access to primary care in urban areas.

Finally, the authors highlight the prevalence per 100,000 population per wilaya and the average prevalence for the whole of east of Algeria.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicide sleep monitoring (SSleeM): A feasibility and acceptability study of a wearable sleep tracking monitoring device in suicide attempters
Authors: Guillodo E. , Berrouiguet S. , Simonnet M. , Conejero I. , Courtet P. , Baca Garcia E. , Billot R. , Lenca P. , Walter M.
Published: June 2017

Introduction

Sleep disturbances are associated with an increased risk of suicidal behavior. The evidence primarily stems from studies based on questionnaires about sleep quality. In recent years, the availability of wearable health technology has increased and offers an inexpensive, appealing, and accessible way to measure sleep.

Our aim is to assess the feasibility and acceptability of wearable sleep tracking monitoring devices in a sample of suicide attempters.

Methods

A prospective, open-label, 12-months study will be conducted in the emergency department (ED) and psychiatric unit (PU) of the university hospital of Brest, France. Inclusion criteria are male or female aged 18 or over, surviving a suicide attempt, discharged from ED or PU, and giving consent. The sleep tracker and a smartphone will be given to the patient after discharge. He or she will receive brief training on how to use the sleep tracker. Patient will be asked to monitor their sleep during the five days following the discharge. The feasibility will be explored by analyzing the data proceeding from the sleep tracker. The acceptability will be assessed during the five-days follow up visit, using a standardized questionnaire.

Results

Preliminary results of this ongoing study show that feasibility and acceptance may be related to technical features of wearable devices.

Discussion

A better understanding of the bidirectional mechanism between sleep disturbances and suicide behavior will allow the design of tailored interventions to prevent suicide attempts.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Breaking down the barriers to mental health crisis care: Evaluation of a training package for emergency department clinicians
Authors: Fernando M. , Bhat M.
Published: June 2017

Introduction

About one in 20 attendances at emergency departments (EDs) in the UK relate to mental health, yet recent work has shown that a majority of people presenting with mental health crises do not report positive experiences (Care Quality Commission, 2015). Although there are many reasons for this, one may be a lack of mental health training for staff working in EDs. In response to this, a new training module for multi-professional ED staff was developed.

Objectives and methods

We aimed to assess the impact of this new module on clinicians’ confidence in managing mental health presentations. Thirty-eight ED doctors and nurses across two centers were asked to complete surveys before and after receiving training.

Results

Following training, we found improvements in confidence in each of five domains explored: assessing self-harm; managing someone with personality difficulties; assessing psychotic symptoms; distinguishing between physical and psychotic symptoms; and, managing psychotic symptoms. These improvements were seen for clinicians across both centers.

Conclusions

The results show that training can help to improve confidence around mental health. This is particularly important given that before the training was developed a survey of local ED doctors had shown that 31% felt under-confident in managing mental health conditions. Since developing the training, it has been further enhanced at the request of local EDs to include video-based scenarios. We continue to assess its impact in improving the confidence of ED clinicians (as well as their knowledge, skills and attitudes towards mental health), and ultimately the benefit to patients experiencing mental health crises.

Disclosure of interest

The authors have not supplied their declaration of competing interest.