bluuebunny/crossref_metadata_2025 huggingface dataset:
What Young Adults Know About The Factors That Affect Fertility?
Authors: Carolino N. , Galhardo A. , Moura-Ramos M. , Cunha M.
Published: May 2016

Introduction

The literature has shown that young adults reveal lack of knowledge about factors that influence fertility. Given this gap of knowledge regarding fertility, several authors indicate the need for awareness-raising and promotion of attitudes and behaviors that preserve fertility.

Objective

This study aimed to assess the knowledge about factors that affect fertility as well as the impact of information transmission on this topic.

Materials and methods

Five hundred and fifty-one subjects aged between 18 and 40 years old without children completed an online questionnaire specifically developed for this study. Two assessment moments were considered and participants were randomly assigned to three groups:

– video group;

– website group;

– control group.

The video and website groups accessed information on fertility-related factos such as age, weight, exercise, substance abuse, irregular menstrual cycles, pollution, etc. The control group had no access to this information.

Results

Male participants revealed more knowledge about the factors that affect fertility in both moments. Participants in the groups that had access to fertility information (video group and website group) improved their level of expertise. No significant differences were found in the control group.

Discussion/conclusion

Groups that watched the video or visited the website where information on fertility-related lifestyle and other factors was available increased their level of knowledge, suggesting that education on this subject should be provided to general population. The means used for the information dissemination had no impact on the improvement of knowledge.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Embedded Mixed Methods Evaluation of the Psycho-educational Intervention Impact on People Diagnosed with Schizophrenia and Their Primary Caregivers: Findings From a Randomized Controlled Trial
Authors: Hasan A.A.
Published: May 2016

Background

Psycho-educational interventions for people diagnosed with schizophrenia (PDwS) and their primary caregivers (PC) can improve knowledge about schizophrenia, reduce PCs’ burden of care, PDwSs’ symptoms, and enhance PCs’ quality of life. However, the majority of existing studies have significant methodological weaknesses. Also, little is known about the impact of psycho-educational interventions delivered by booklets and in developing countries like Jordan.

Objective

The aim of this study was to examine the effectiveness of psycho-education delivered via a printed booklet for PDwS and their PCs’ in Jordan.

Methods

A single blind parallel randomized controlled trial was conducted between September 2012 and September 2013 at four mental outpatient clinics in Amman, Jordan. One hundred and twenty-one PDwS with their PCs were allocated randomly to an experimental (psycho-educational intervention plus treatment as usual in outpatient clinic) group (n = 58) or control (treatment as usual alone) group (n = 63). Outcomes, measured prior randomization (pretest), immediately post-intervention (posttest 1) and at three months after intervention (posttest 2).

Results

Participants receiving psycho-education and treatment as usual had better knowledge of schizophrenia, reduced positive and negative symptoms and hospitalisation at both follow-up points. PCs had reduced burden of care and experienced a better quality of life.

Conclusion

Psycho-education delivered via printed booklets improves outcomes for PDwS and their PCs in Jordan better than treatment as usual. Our hypothesis is supported.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Use of antidepressants in maintenance phase of patients with bipolar disorder in an outpatient setting
Authors: Peh A. , Tay W.K.
Published: May 2016

Introduction

Guidelines for the maintenance treatment of bipolar disorder discourage the use of antidepressants chiefly on grounds of unproven efficacy and risk if mania for bipolar I. However, for patients stabilised on an antidepressant, naturalistic data support its continued use.

Aim

The aim is to describe use of antidepressants in patients with bipolar disorder in remission seen at an outpatient clinic in Singapore.

Methods

The case notes of patients with bipolar disorder in remission, seen by psychiatrist in an outpatient psychiatric clinic in a general hospital unit from December 2014 to March 2015 were studied. Data describing the age, sex, type of bipolar disorder and psychotropic medications prescribed, was obtained.

Results

Forty-two patients were included, of which 13 (31%) were male and 29 (69%) were female. The age ranged from 23 to 82, with mean age of 47 years. Of these 17 (40%) had bipolar I and 25 (60%) had bipolar II. Antidepressant use for maintenance treatment was present in 19 out of 42 (45%) of these patients; of these 7 out of 17 (41%) were bipolar 1 and 12 out of 25 (48%) were bipolar II. Eighteen out of the 19 (95%) patients who were prescribed antidepressants were on combination treatment with mood stabilizers. Antidepressant type included SSRI (37%), NDRI (37%), SNRI (10.5%), TCA (10.5%), NASSA (5%).

Conclusion

Almost half of patients with bipolar disorder managed in an individual practice were on antidepressants together with mood stabilisers. They remained in remission with combination treatment, which did not seem to jeopardise their condition.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Insight and aggressive Behavior in acute Schizophrenic Patients
Authors: Campi S. , Esposito C. , andreassi P. , Bandinelli P. , Girardi P. , Ducci G. , Cannizzaro C. , Cacciari C. , Spalletta G.
Published: May 2016

Introduction

aggressive behavior in wards is associated to poor treatment compliance and low clinical insight. Most studies focused on the clinical and cognitive dimensions of insight, while the relationship between metacognitive dimension and aggressive behaviors was not investigated. Our aim was to understand what relationship occurs between dimensions of insight (metacognitive, cognitive, clinical), and specific aggressive behaviors in acute patients.

Methods

we recruited 75 acute schizophrenic patients using: aQ; MO aS; IS; P aNSS; BCIS.

Results

a positive correlation between the IS score and the hostility, angry and physical aggression sub-scores of the aQ was highlighted, while no correlation between the score of IS and MO aS total score was found. No correlation between the score of the P aNSS G12 item and the aQ scores and MO aS was found, and no correlation between BCIS scores, MO aS and aQ scores was found.

Conclusions

in our patients, a higher level of metacognitive insight, but not clinical nor cognitive insight, was associated to higher levels of hostility. we suggest that a higher ability to monitor and appraise one's own altered processes of thought and related discomfort, feeling of destabilization and loss of control, could contribute to enhance resentment and suspiciousness. Findings help develop specific therapeutic strategies to enhance metacognitive and self-monitoring abilities, helping patient's understanding of the illness, improving compliance with treatment, and patient's quality of life. Our results support the multidimensional nature of insight in schizophrenia, confirming that clinical, cognitive and metacognitive dimensions are independent though related facets of the phenomenon of insight in schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Change of Mood in Relation with The Seasons
Authors: de la Mata Hidalgo R. , de la Mata Hidalgo M. , Valriberas Herrera I. , Ana O.E. , Al Chaal Marcos L. , González Soria C. , Sánchez Pernas L. , Exposito Montes C.
Published: May 2016

Introduction

Emergency situations related to mental disorders represent a significant proportion of all medical emergencies. Over the last years we have been witness to an upturn in the incidence of psychiatry emergency service because to change of mood.

Objective

To determine the profile of the patient who requires psychiatric attention with changing of mood in our area in different seasons.

Methodology

This is a prevalence and prospective study in which the dependent variable is taken as change of mood and we also use three more independent variables that are age sex and seasonality. The seasonality (spring period and summer period) will be at the same time the form of divided the population in two groups to compare.

Results

Out of all the consultations for changing of mood in the emergency service during the first period (113 patients), 34% were men and 66% were women. The age range of 36–50 years was more frequent for women and the age range of 51–65 years was more frequent for men. in the second period (with 162 patients), 137 women (86%) and 25 men (14%). in this case, the most common age range was 36–50 years, both for women and for men.

Conclusions

The epidemiological and clinical characteristics of patients with changing of mood assessed by the emergency service are described from a naturalistic approach.

Which Chi2 we will discover if the population who has been taken between woman and man is significant and with the median, we will also determine if the age ranges are enough significant to confirm our hypothesis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Physicians’ Burnout: Can We Make a Difference?
Authors: Moreira C.A. , Sobreira G. , Oliveira J.M. , Aleixo M.A.
Published: May 2016

Introduction

Burnout is a commonly observed syndrome in healthcare workers and it has been defined as a psychological condition involving a continuous exposure to stressful work events leading to adverse consequences both in physical and mental health. Persistent pressure can lead to exhaustion, psychological and/or physical distress and may increase the risk of medical errors and decrease job satisfaction, which incites early retirement.

Objective

The authors pretend to make a brief review regarding Physicians’ burnout, its prevention and management.

Aims

To understand and to be capable of dealing with physicians’ burnout.

Methods

The review was based in papers published on PubMed using the following terms: “burnout”, “risk factors”, “healthcare professionals” and “physicians coaching”.

Results

Twenty-five to 60% of physicians report burnout across all specialties. Changes in the healthcare environment have created marked and growing external pressures. Numerous studies suggest that the difficulty that physicians face with balancing their personal and professional lives is a major contributor to distress. To reduce stress at work, one should consider two levels of intervention: the individual and the environmental. Multidisciplinary actions that include changes in the work environmental factors along with stress management programs that teach people how to cope better with stressful events showed promising solutions to manage burnout.

Discussions/conclusions

Burnout among physicians is a common and serious issue with potentially devastating personal and professional consequences. More interventional research is needed in order to improve psychological well-being, professional career enjoyment as well as the quality of care provided to patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Loneliness And Mortality: a Community-based Prospective Study
Authors: Henriksen J. , Kyle P.R. , Bech P. , Mattisson C. , Andersson N.
Published: May 2016

Introduction

Loneliness affects up to one in every third individual in the western population, and the prevalence is increasing. The literature suggests an increased mortality risk of about 26% when feeling lonely, and an association to some disorders of physical health.

Objectives

To assess if loneliness increases the risk of mortality, and if so, if health indicators (hypertension, heart disease, tobacco use, alcoholism, diabetes, obesity, and depression) mediate the association.

Methods

The design is a community-based prospective cohort study using data from the Swedish Lundby Study. Loneliness is measured in 1997 with a singleton question during interview of a psychiatrist. The outcome is death between 1997 and 2011. Survival analysis is used to estimate the relative risk of mortality. Stratification of potential explanatory covariates examines if any of the health indicators mediate the relationship.

Results

Significant more females, unmarried, unemployed, and childless people feel lonely. Moreover, feeling lonely correlates to being smoker or alcoholic when adjusting for age and gender. The statistical work on the survival analysis is still in progress. However, we expect to find a positive correlation between loneliness and mortality corresponding to previous studies, and perhaps to reveal some of the health indicators to cause the association.

Conclusions

With increasing prevalence, potential health consequences, and a neglected role in the society, loneliness is an important research area.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Analysis of Demand in The First Visit To The Mental Health Unit
Authors: Mata Saenz B. , Lopez Lavela E. , Rodríguez Cano T. , Beato Fernández L.
Published: May 2016

Introduction

The first visit is crucial, since it is where a treatment plan is selected and the decision to refer or not the patient to a specialized unit is made. Mental care could be improved through the centralization of demand and the identification of patients’ and psychiatrists’ expectations.

Objectives

Analyzing patients’ and psychiatrists’ demands and expectations in the first visit to use them as a starting point for the planning and coordination of treatment actions.

Aims

To design a record system of the Minimum Basic Data Set of the Centralized Department of our Unit.

Methods

This is an epidemiological, observational, prospective study of patients referred to our department. Following variables were collected:

– referral origin;

– reason;

– demographic data;

– diagnosis impression;

– destination of referral.

The Statistical Package for Social Science version 19.0 was used to analyze the data.

Results

Table 1.

Conclusions

The data obtained are consistent with those reported in the literature for this population. The high rate of wrong referrals reveals the necessity of improving coordination and establishing specific referral criteria. Some initiatives have been designed and will be prospectively evaluated in the future.

Table 1

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Community Mental Health: Description of the Patients Concerning the Uls Guarda Department of Psychiatry and Mental Health Area
Authors: Nunes J. , Feliz J. , Brigadeiro D. , Ventura Gil T. , Teixeita A.F. , da Costa P.
Published: May 2016

The World Health Organization (WHO, 2004) stresses the importance of home patient visiting as an answer to the epidemiologic, demographic, social and economic challenges that the world is facing.

The severe psychiatric patients are a risk group and often need domicile consultation and visiting. The domicile consultation approach favors the clinical, social and familiar support as well as promotes the integration and the recovering of the patients with mental problems, preventing the relapses and the hospital admissions of these patients.

This study, of descriptive nature, is based on the observation and consultation of 287 clinical processes of patients inserted in the domicile consultation program designed by the Department of Psychiatry and Mental Health of Sousa Martins Hospital, ULS Guarda, which covers the 7th biggest district in Portugal (in a universe of 18), between July and September 2015.

The main goal of this study is to characterize and analyze the profile of the population, which is followed by the community mental health team of our Department, namely, the socio-demographic and clinic features, in order to improve the assistance practice in the future.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Relationship Between Insight and Internalized Stigma in Persons With Sever Mental Illness
Authors: Szczesniak D. , Wojciechowska I. , Kłapciński M. , Zwyrtek E. , Rymaszewska J.
Published: May 2016

Introduction

Stigma is a multistage process that makes person marked by the stigma to be perceived as diminished or even as “not fully human”. The internalized stigmatization is seen as one of the levels of stigma to be present in persons with mental illness. A new perspective to mediation models between internalized stigma and illness-related factors is needed.

Aim

To assess the relationship between insight in mental illness and internalized stigma, as well to verify the knowledge of illness-related factors on the phenomenon of internalized stigma among patients with severe mental illnesses.

Methods

A cross-sectional study design conducted among participants of both sexes between 18 years old and 65 years old with diagnosis of psychotic disorders (F20–29) and mood disorders (F30–39), who after reading the information about the study, give their written consent to participate. Among used methods were: a questionnaire of Internalized Stigma of Mental Illness (ISMI) by Ritsher [Boyed] et al. translated into Polish version and self-prepared interviews. Insight into mental illness was assessed using the Positive and Negative Syndrome Scale.

Results

The preliminary results showed patients with the insight into the mental illness have significantly higher scores on the ISMI scale. Moreover, inpatient participants and those with the diagnosis of depression were characterized by higher level of stereotype endorsement compared with outpatients and psychotic patients.

Conclusions

The obtained results may contribute in the clinical and therapeutic fields, assuming that insight and the type of treatment are strongly linked with the process of recovery and the internalized stigma.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Involuntary Hospitalization in a Mental Health Unit in 2014
Authors: Alvarez Montoya A.M. , Diago Labrador C. , Ruano Hernandez T.
Published: May 2016

Objectives

Deliver a detailed analysis of the mental distortions, which led to involuntary hospitalization in a mental health unit in 2014 and their gender distribution.

Method

We analyze the total number of hospitalizations in our mental health hospital unit. From the patient registry, we extract the type of hospitalizations (voluntary or involuntary), the diagnosis and the gender.

Results

In our analysis, we find a total of 315 hospitalizations. One hundred and fifty-nine (50.48%) of them are voluntary, 150 (47.62%) are involuntary and 6 (1.90%) are a result of a judicial order. From the total involuntary hospitalizations, 81 patients were diagnosed as psychotics disorders (60%), 34 (25.18%) affective disorders, 11 (8.14%) personality disorders, 3 (2.22%) adaptative disorders, 2 (1.48%) mental retardation and 2 (1.48%) autism spectrum disorders.

Conclusions

According to article 763 of Spanish Procedural Law (Ley 1/2000 de Enjuiciamiento Civil) from the 7th of January: “The hospitalization of a person due to mental disorders who is not in a condition to decide for himself/herself, even should he/she be a subject to parental authority or guardianship, shall require court authorization, which shall be obtained from the court of the place of residence of the person affected by such hospitalization.” For this reason the involuntary admission is considered as an exceptional and necessary measure, which is limited in time.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Ethical Aspects of Involuntary Outpatient Treatment
Authors: Galiano Rus S. , Soler Iborte A. , López Díaz Á.
Published: May 2016

Introduction

Involuntary outpatient treatment (IOT) is a type of non-voluntary treatment applied in the community, which tries to ensure the therapeutic compliance of patients that have a severe mental illness.

In Spain, a specific legal regulation about this matter does not exist; however, it is a fact in clinical practice. The application of IOT is not without controversy, with advocates, who consider it a way of achieving therapeutic compliance, and detractors, who think it is an infringement of the fundamental rights of a person.

Objectives/methodology

An evaluation of the knowledge on IOT in Spain. Analyze the four ethical principles found in this treatment.

Results

The protection of the patient is encompassed in the principle of beneficence. And how could we combine this with the principle of autonomy? The answer should be individualized and based on a determined disorder. Starting with non-maleficence, we ask if IOT would provoke a rejection so that the patient would distance himself further from the therapeutic environment. As for the principle of justice, the high cost by patients that do not comply with the treatment would be diminished if we are able to have them follow the treatment with higher effectiveness. This would allow a greater number of patients to access these resources.

Conclusions

The proposal of IOT should be preceded by a deliberative process. This process should include a psychiatric diagnosis that includes not only psychiatric aspects, but psychological, familial and social as well. This would compel us to create a personalized design of the therapeutic needs of each patient.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Freedom as Theme in Psychotherapy and Cognitive Behavioral Therapy
Authors: Vyskocilova J. , Prasko J. , Slepecky M. , Hruby R. , Grambal A. , Holubova M. , Marackova M. , Jelenova D. , Cinculova A.
Published: May 2016

Background

The problems that a client presents with to therapy may be associated with his possibility of free choice.

Method

Review of psychotherapeutic and cognitive behavioral literature.

Results

From a psychological perspective, freedom may be either inner or outer, depending on the nature of obstacles and barriers that limit freedom. Therapy may be understood as a process through which the client is guided to actively increase his freedom. This refers to freedom from destructive habits, self-limiting attitudes, compulsive actions, symptoms etc. When creating the relationship, neither the client nor the therapist is entirely free as they bring past conscious and unconscious experiences into it. From the point of view of CBT, freedom is always relative. The idea of absolute freedom results from cognitive distortions – black and white thinking. CBT does not consider overall freedom but relatively free decision-making in particular situations that the client is in. The therapist helps the client to identify his errors in thinking and to learn a more realistic way to formulate his experiences and to use the new attitude to decide more freely. The change in attitude is realized through rehearsing freer behavior and experiments with it in one's life.

Conclusion

Freedom may be either inner or outer, depending on the nature of obstacles and barriers that limit freedom. Therapy may be understood as a process through which the client is guided to actively increase his freedom.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Moral Obligation to Acknowledge and Prevent Suicide in Life Sentence Incarcerated Inmates
Authors: Tsopelas C.
Published: May 2016

Introduction

For an inmate incarcerated for life we could acknowledge factors contributing to the desire to commit suicide, as social isolation, insensitive discipline, lack of privacy, constant threat of violence, fear, guilt, hopelessness, and depression are prominent in the life imprisonment.

Aims

To discuss the ethical issues of prevention suicide in inmates incarcerated for life.

Methods

We performed thorough research of the main medical databases, and web search engines for relevant studies, articles and opinions and reviewed them independently.

Results

Prevalence of mental illness is high among inmates and several common stressors typically herald an inmate's suicide. Suicide is often the single most common cause of death in correctional settings. Even though some suicide victims have consulted a mental health service-provider before their suicide, the majority of suicide victims were not mentally ill. The paradox, particularly for life sentence inmates is that we are trying to persuade an inmate to live within a disciplinary environment, which has as side effect the increase of suicidality of the inmates.

Conclusions

Prisons’ inability to protect the health and safety of inmates could raise ethical issues. We have obligation to adequate suicide prevention for all inmates, and we should be more broad minded as the will to die in mentally healthy individuals is beside an free will expression, a sign of serious lack of support and humane living conditions. We should be vigilant not to use the prevention of suicide programs as another way to increase punishment of life long imprisonment.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Patterns of Long Acting Injectable Antipsychotic Prescription During Criminal Acts in a Portuguese Psychiatric Hospital
Authors: Duarte M.A. , Vieira F. , Ponte A.
Published: May 2016

Introduction

Under the Portuguese law, criminal offenders that are designated as non-criminal responsible – “inimputáveis”, similar those in the United States of America found “not guilty by reason of insanity”, are forced to be committed to inpatient forensic units either in psychiatric hospitals or prison hospitals for mandatory security measures.

Objectives/aims

To evaluate if patients committed in a regional forensic inpatient unit (RFIU) who had a psychiatric history preceding the crime, were under long acting injectable antipsychotic (LAIA) in during the period of the crime.

Methods

During September/October 2015, patients committed to the RFIU in Centro Hospitalar Psiquiátrico de Lisboa were characterized using medical and court records regarding clinical and demographic variables. The type of crime and previous number of criminal acts were also accounted for.

Results

We included 33 patients in the study. During time of the crime, 25 patients (75.8%) had history of previous psychiatric appointments, with an average of 3 commitments to the psychiatric inpatient units. The majority (n = 17; 68%) had a diagnose of “schizophrenia, schizotypal and delusional disorders” (F20–29; ICD 10) and committed “crimes against life” (n = 13; 52%). They had an average of 0.8 previous criminal acts. During the crime, 7 patients (28%) were taking LAIA. Those, 16% (n = 4) were doing an unknown antipsychotic and 12% (n = 3) were doing Haloperidol.

Conclusions

Despite several studies showing the clinical and rehabilitative benefit of using LAIA early in the disease course, most of the patients in our study, who were already being followed in outpatient psychiatric units, did not benefit from them.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Profile of the Mentally Incompetent Patient of the Local Health Unit of Guarda, Portugal
Authors: Batista P. , Nunes J. , Da Costa P.
Published: May 2016

Forensic psychiatry, as a specific branch of psychiatry, is the medical science that approaches mental illness and its relation with law enforcement. In this regard, medicine and justice converge in the contact with individuals that, due to the alleged assumption of acting under the effects of a psychiatric disease, have a disturbing behaviour and infringe the laws of Society. The objective of this research project, which has a retrospective nature, is to delineate the profile of the mentally incompetent patients of the Local Health Unit of Guarda, Portugal, resorting to the reports of mental faculty's examinations of, at least, 30 individuals. With this methodology, we will be able to study the characteristics of selected individuals who have committed some sort of criminal offences but are not subject to prosecution, namely with regard to the specific personal and family data, psychiatric background, diagnostic formulations, applied legal concepts, among others. Statistical analysis was carried out using the Microsoft Excel tool. The main goal of the study is to provide to the Psychiatry Department of the Local Health Unit of Guarda an analytical instrument that characterizes the respective mentally incompetent population and may, essentially, contribute positively to the contextualization and accomplishment of the future assessments on mental faculties of the individuals who are involved in judicial proceedings.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Treatment of Charles Bonnet Syndrome with Continuous Positive Airway Pressure in an Older Adult
Authors: Arts M. , Michielsen P. , Petrykiv S. , de Jonge L. , Voshaar R. Oude
Published: May 2016

Introduction

Charles Bonnet syndrome (CBS) is a disorder in older adults, and is characterized by a triad of recurrent vivid visual hallucinations, ocular pathology causing visual impairment due to lesions in central or peripheral visual pathways, and normal cognitive status. It is often misdiagnosed as a psychosis, early dementia or a drug related condition. Hypoxemia was anecdotally reported as a cause of CBS.

Objectives

We present an older adult with CBS caused by severe obstructive sleep apnea syndrome.

Aims

To report a case study, describing treatment of obstructive sleep apnea syndrome as a cause of CBS.

Methods

A case study is presented and discussed.

Results

An older male adult was admitted to hospital for persistent vivid visual hallucinations. There was no personal or family history of mental illness. Neurological examination was normal, except for visual impairment due to age related macular degeneration. The remainder of his physical examination was normal. Previous treatment with antipsychotics proved not to be effective. Severe hypoxemia (SaO2 79%) was diagnosed with overnight pulse oximetry and subsequent polysomnography revealed an obstructive sleep apnea syndrome. After three nights of nasal continuous positive airway pressure, the vivid hallucinations ceased.

Conclusion

Physicians need to understand the underlying causes and mechanisms of CBS. One should be aware of the importance of a full clinical examination and sleep apnea research in elderly persons with visual impairment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Partial Nephrectomy After Oncocytoma Causing Repeated Lithium Poisoning with Normal Renal Function
Authors: Gómez Sánchez-Lafuente C. , Reina Gonzalez R. , Gonzalez Moreno A. , Moreno de Lara F. , Mateos Carrasco E. , De Severac Cano A.
Published: May 2016

Introduction

Lithium has been widely used as mood stabilizer in bipolar disease, despite its narrow therapeutic range and its side effects. Sodium levels and water consumption could affect lithium renal elimination.

Aims

Describe a lithium intoxication without risk factors and normal kidney function.

Methods

A 71-year-old female, diagnosed with bipolar disorder, current episode euthymic. On treatment with lithium 800 mg/day, 6 months ago she started with hematuria and urologist found a multifocal oncocytoma in left kidney. She was operated with double lumpectomy and partial nephrectomy without complications. Normal preoperative and postoperative renal function. Two months ago, she started with dysarthria, dystonia and coarse tremor, and T wave inversion on the electrocardiogram. In the blood test, lythemia was 1.67 mEQ/L. Creatinine was 0.65 mg/dL. She was admitted to Internal Medicine Unit. She was treated with rehydration by serum. All psychoactive drugs were removed. Twenty days later, lithemia was undetectable in the blood analysis.

Results

Two weeks ago, the patient was transferred to the mental health unit due to worsening her mood. Lithium was reintroduced 3 days ago, at doses of 200 mg per day. Today, the patient starts again with symptoms of poisoning by lithium. Lithemia was 1.78.

Conclusions

On this occasion, partial nephrectomy due to oncocytoma is the most likely cause two consecutive lithium poisonings. Although creatinine and glomerular filtration are in normal range, patients after partial nephrectomy may have a reduced sodium reabsorption in proximal convoluted tubule, which may cause lithium compensatory resorption. This could cause rising in blood lithium levels.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Collaborative Care Between Clinical Pharmacists and General Practitioners in Patients with Alzheimer's Disease in Slovenia
Authors: Stuhec M. , Marusic A. Premus
Published: May 2016

Background

Alzheimer's disease (AD) patients are often treated with inadequate doses of AD's medications, which can lead to harms and additional costs.

Objective

In most European countries, there is no data on inappropriate prescribing (IP) in patients with AD in terms of inadequate doses. In Slovenia, the interest for a collaborative care between clinical pharmacists and physicians is increasing, mainly because of payer's interest to reduce several additional costs.

Aim

The main aim of this paper was to present the benefits of clinical pharmacist interventions in AD patients in community health centres in Eastern Slovenia.

Methods

All included outpatients with AD in 2013 were included, where clinical pharmacists’ interventions were ordered by the general practitioners (GPs). All study data from the patients’ records were obtained from the clinical pharmacists’ reports and patients’ charts. Main outcome measures were obtained from the summary of the patients’ treatments and the questionnaires.

Results

Six hundred and twenty-nine patients were included. Before the clinical pharmacist medications review, 39 patients were treated with AD medications (10 without established AD). In 51.0% of these cases, the suggestions to GPs were provided (mainly dose adjustment). In 70.0% of all cases, the recommendations were accepted by GPs, which led to a total reduction in the number of patients with IP (before 20 and after 6).

Conclusions

A clinical pharmacist could help GPs in recognizing IP in patients with AD. These data will guide health system directors and clinical coordinators in allocating resources to establish this cooperation in more European countries.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Assessing Medication Beliefs of Mental Health Professionals: The Portuguese Version of the Medication Alliance Beliefs Questionnaire
Authors: Cardoso A. , Aguiar P. , Byrne M. , Xavier M.
Published: May 2016

Introduction

Clinician's attitudes are an important consideration in implementing adherence strategies and that these attitudes can be successfully improved as a result of training. The 22-item Medication Alliance Beliefs Questionnaire (MABQ; Byrne et al.2008) was used to assess clinician attitudes towards non-adherence. The MABQ contains five subscales reflecting the clinician's self-efficacy (adequacy), the satisfaction (work satisfaction); their appraisal of their self-worth (self-esteem), their outcome expectancies (pessimism) in relation to non-adherent patients, and the extent to which they understand the difficulties patients might experience in trying to adhere to treatment (empathy).

Aims/objectives

To develop the Portuguese version of the MABQ.

Methods

The MABQ was translated and adapted for Portuguese language. The translation was done by the first author (AC). The accuracy of this translation was discussed in a two focus group of experts, providing opinion on face and content validity. After pre-testing, the final version of the Portuguese translation was produced.

Results

A convenience sample of 65 mental health professionals working in a variety of settings is being collected. The average score in MABQ was 80.06 (SD 9.5). The value of internal reliability coefficient α was 0.80. The intraclass correlation coefficient of total MABQ score was 0.35. The t-test showed that there were no statistically significant differences between the mean values of the measurement scale at two different times (80.4 vs.76.2; P = 0.02).

Conclusion

The attitudes of mental health professionals may have a predictive relationship with treatment outcomes of patients with mental health disorders. The validation of the Portuguese version of MABQ will provide professionals with a new tool to evaluate crucial issues related to medication beliefs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Decisional Trust and Regret Mediate the HRQL in Work-Related Hand Injury Patients
Authors: Liao H.H. , Cheng S.L. , Chang C.C. , Lin C.H. , Liu F.C. , Cheng C.S.
Published: May 2016

Background

Despite mounting evidence that non-injury-related factors have an important role in recovery from injury; specific variables associated with surgery outcomes are poorly understood. This lack of knowledge complicates efforts to improve the care of work-related hand injury (WRHI) patients. However, substantial research and investigation have still not clarified these underlying relationships, which merit further attention.

Objective

The purpose of this study was to evaluate the Health-Related Quality of Life (HRQL) outcome for WRHI patients after the impact of event and to investigate the moderated mediation analysis associated with their decision trust and regret.

Methods

A cross sectional study design was used to investigate the impact of event and the associated HRQL in 53 WRHI patients following severe and major hand injury. All consenting patients completed the Impact of Event Scale Revised, the Symptom Checklist-90-Revised, Decisional Trust scale, Decisional Regret scale and Short Form-36.

Anticipated achievement

In the result of mediation analysis, patients affected HRQL via decisional trust and decisional regret, respectively. In addition, our data suggest that certain decisional trust and decisional regret (partial) characteristics significantly moderate this association. These findings may aid in the development of clinical interventions to enhance HRQL for WRHI patients. Overall, it is important for clinicians to consider the notion that more decisional trust or less decisional regret may sometimes, but not always, be better.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Perceptions of Treatment and Adherence During Hospitalization in Psychiatric Patients
Authors: Lyrakos G. , Tetorou G. , Sittas D. , Dimitriou A. , Ypofanti M. , Spinaris V. , Spyropoulos I.
Published: May 2016

Background

Treatment adherence has a vital role in the patient's health outcome as poor adherence rates can reduce, even diminish, the effectiveness of the treatment as well as lead to a waste of the health care system's valuable resources. Previous research has shown that perceptions of treatment strongly affect adherence in psychiatric patients.

Aim

To investigate how the perceptions of treatment affect adherence during hospitalization in psychiatric patients.

Method

Fifty psychiatric patients participated in this research, 21 (42%) males and 29 (58%) females. Out of them, 25 (50%) had been diagnosed with depression, 15 (30%) with psychosis, 6 (12%) with psychosis and depressive symptomatology and 4 (8%) with bipolar disorder.

Results

The findings showed a significant effect of psychotherapy on treatment adherence (χ2 = 4.915, P = 0.027), with 7 out of 11 patients who undertook psychotherapy reporting good adherence rates compared to 12 out of 39 patients who did not. Gender had a significant effect on adherence (χ2 = 5.96, P = 0.05), with females reporting better adherence compared to males. Perception of treatment did not correlate significantly with adherence (χ2 = 0.439, P > 0.05) and neither did education (χ2 = 2.22, P > 0.05). Also, neither age (F(2,47) = 1.535, P > 0.05) nor hospitalization time (F(2,47) = 1.131, P > 0.05) correlated significantly with adherence to treatment.

Conclusion

Even though there was no significant correlation between perceptions of treatment and adherence, psychotherapy seems to improve adherence to therapy during hospitalization and is also correlated with positive perceptions of treatment, something which will be valuable for the patient even after the hospitalization.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Correlation of vitamin D to attention deficit hyperactivty disorder
Authors: Abouzed M. , Moshref A. , Elsherbiny A. , Elsheikh M.
Published: May 2016

ADHD is one of the most common neurodevlopmental psychiatric disorders. Many factors have been identified as the cause of ADHD. ADHD is thought to be the result of interactions between biopsychosocial factors leading to neurobiliogcal change. The aim of this study is to investigate the association between serum level of vitamin D and symptoms of attention deficit hyperactivity disorder (ADHD).

Design

This is a case-control study which was conducted in children below 12 years of age from June 2013 to May 2014 at outpatient child psychiatry clinic at Elhussin Hospital Al-Azhar University, Cairo, Egypt.

Methods and subjects

The study was based on 62 cases and 30 controls. The data collection instrument included socio-demographic & Children Attention and Adjustment Survey (House form){CAAS}. And interview by (Diagnostic Interview Kiddie-Sads-Present and Lifetime Version (K-SADS-PL) to exclude other psychiatric morbidity. clinical data, serum 25(OH) Vitamin D. Descriptive statistical analysis were performed, Pearson Chi2 test (χ2) and Student (t) test.

Result

1-Vitamin D level was much lower in ADHD children compared to healthy children, and was a significant difference in the mean values of vitamin D between ADHD(23 ± 13) and control group means (44 ± 12) and P value was > 0.001 and was significant difference between subgroup of ADHD, means of inattentive subtype was(20 ± 13) hyper active subtype (30.1 ± 5)and combined subtype(24.04 ± 4). P value 0.011*.

Conclusion

Children with ADHD had significantly lower levels of VITAMIN D than healthy, and inattention subtype than other types of ADHD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mental Illness and Sexual Disease Transmission. A Case Report
Authors: Calvo I. Peñuelas , Llewellyn-Jones J. Sevilla , Sareen A. , Cervesi C. , Moreno A. Gonzalez
Published: May 2016

Introduction

Published rates of HIV infection among psychiatric patients are 3.1% to 23.9%, at least eight times higher than general population. (Nebhinan et al., 2013)

Aims

Defects in judgment and insight in patients with psychosis is often associated with lot of anger and impulsiveness, risky behavior and lower treatment adherence. This often led to worsening of clinical status and prognosis. (Uruchurtu, 2013)

Methods

A 31-year-old man diagnosed with schizophrenia and HIV four years ago. At the beginning of last year, the patient was hospitalized in the Acute Psychiatry Hospital Unit because of decompensation. Two years after diagnosis of HIV, he stopped taking his medications and was arrested several times because misdemeanours. Furthermore, patient was highly sexually active in the form of unprotected sex with multiple partners, as he had no concept of his disease. In addition to this, he made a delusional interpretation about HIV (known as VIH in Spanish) as Immortal human life (Vida Immortal Humana). He was admitted in the hospital for a month and was treated with medications and psychotherapy, which led to good stabilization, and he gained insight of both of his illnesses. At the moment, one year after this episode, the patient is stable, taking both medications regularly and followed up by his psychiatrist in the Mental Health team.

Conclusion

It is of extreme importance that psychotic patients with HIV receive a good follow-up during life, as decompensation can affect the patients’ health and health of others, with the implicit consequences that it carries. (Uruchurtu, 2013)

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Factors Related to Disability Pensions – A Cross-Sectional Analysis From A University Hospital In Istanbul
Authors: Sönmez E. , Tunca D. , Akvardar Y.
Published: May 2016

Introduction

Mental disorders are one of the leading reasons for disability-related retirement and payment of associated long-term benefits in many countries.

Objectives

To explore the characteristics of psychiatric outpatients who apply for disability pensions and to investigate the factors associated with making an application.

Methods

A four-month cross-sectional evaluation of disability pension and retirement applications to the psychiatry outpatient clinic in a university hospital in Istanbul.

Results

The majority of 144 patients were male (n = 102, 70.8%), based in Istanbul, married, living with their families and had no occupation at the time of inquiry. Excluding applications for individuals with a diagnosis of intellectual disability (n = 44), most applicants were primary school graduates (n = 31, 32.3%). For the whole group, the median age of application was 34. 60%, (n = 87) had an established psychiatric diagnosis before the application, with average duration since diagnosis of approximately 8 years. The most frequent diagnoses were intellectual disability, followed by schizophrenia and depression. More than half of the patients were treated only outpatiently, with no hospitalization (n = 55, 58%). Thirty-two of them (22.4%) had a comorbid psychiatric diagnosis and 58 (40.3%) had at least one comorbid medical diagnosis.

Conclusions

There are some similarities between our findings and findings from other countries, such as low educational level and frequent comorbid somatic diseases among patients applying for disability pension. In contrast with the literature and as an indicator of social inequality, most patients applied for disability pension were male. The results are reflecting the specificities of different health systems and cultural perceptions of disability.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mental Health Systems Development in UAE
Authors: Haque A.
Published: May 2016

Background

This paper examines the historical development of mental health services in the UAE including formation of federal laws associated with mental health and ministerial decrees. It also discusses cultural considerations in mental health practice in a society that is highly pluralistic and populated mainly by foreigners. The sharia aspects of mental health are also addressed.

Aims

The aims of the paper are to familiarize readers in above areas and encourage further work in the area of mental health in UAE.

Methods

The research is based on literature review.

Results

All federal laws and ministerial decrees are listed and local cultural considerations and sharia laws discussed, as they are unique to his country and region.

Conclusion

Although mental health is traditionally neglected in this country it is developing very fast and it is essential to keep track of and encourage such growth for the benefit of consumers and mental health professionals.

Disclosure of interest

The authors have not supplied their declaration of competing interest.