bluuebunny/crossref_metadata_2025 huggingface dataset:
Reconceptualilzing agitation in autism as primary affective dysregulation: Case report and literature review of use of quetiapine in a patient with Treacher–Collins syndrome and autism
Authors: Cosme R. , Dharmapuri S.
Published: June 2017

This case report describes the successful use of low dose quetiapine in the treatment of agitation in a patient with Treacher–Collins syndrome (TCS) and suspected autistic spectrum disorder (ASD). Results from this case report found better efficacy in controlling symptoms of agitation in ASD utilizing lower doses of quetiapine. TCS is a genetic disorder that is characterized by a mandibulofacial dysostosis but is not associated with developmental delay, nor is it associated with a high risk of co-morbid autism, and to our knowledge, there are no previous reports of a co-occurrence of TCS and ASD in the extant literature. There are reports of mandibulofacial dysostosis associated with co-morbid developmental delay that are similar but distinct from TCS, however these reports do not comment on the treatment of agitation in this patient population. The results described in this case report demonstrate a reduction of agitation with low dose quetiapine, and offers support for the reconceptualization of agitation in ASD as a primary affective dysregulation which is also in line with evidence from the extant literature regarding the neurobiologic basis of aggression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Low salivary secretory IgA levels correlate with hyperreactivity in children with autism
Authors: Sindelar M.T. , Furland N.E.
Published: June 2017

Introduction

Autism is a neurodevelopmental disorder characterized by deficits in communication and social skills as well as stereotypical behaviors. There are multiple lines of evidence, suggesting that the immune system is involved in autism. Since secretory IgA (SIgA) is the predominant antibody isotype in saliva and a marker of mucosal immunity, the aim of the study was to assess if the severity of clinical and behavioral parameters of autistic children was associated with low levels of sIgA in saliva.

Objectives

To assess possible associations between salivary levels of sIgA and the severity of behavioral outcomes related to autism. In addition, were studied sIgA in saliva of children with autism and the frequency of respiratory tract infections diagnosed in the first 3 years of life.

Methods

Saliva samples were obtained from 3–10 years old autistic children and age-matched typically developing Caucasian children from Patagonia, Argentina.

Results

Autistic children with reduced levels of salivary sIgA had a higher incidence of respiratory diseases compared to controls. The reduction in sIgA levels inversely correlated with the severity of the behavioral disorders. The patients with the most severe impairment in autism-related behaviors had the lowest levels of sIgA in the cohort studied.

Conclusions

These findings suggest that sIgA could be an early non-invasive indicator of the dysregulation of the immune system in some children with autism. Clearly, the characterization of immunological parameters has important implications for detection of subgroups of children with ASD, and should be considered when designing therapeutic strategies to treat behavioral impairments of ASD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) – intersections systematic review
Authors: Gomes Cano C. , Pires S. , Serrano A.C.
Published: June 2017

Given the well-known overlap of symptoms and diagnosis criteria between attention deficit and hyperactivity disorder (ADHD) and borderline personality disorder (BPD), recent studies have been made in this mental health research field. It is frequently observed that adults with a BPD diagnosis show a history of childhood ADHD symptoms, as well as a diagnosis for both diseases as adults. Even though many hypotheses have been presented, the nature of the relation between these two conditions is yet to be established. Thus, the authors consider the revision of the existing studies concerning how ADHD and BPD are related to be pertinent.

PUBMED was used as a research source, with the search terms attention deficit and hyperactivity disorder and borderline personality disorder. Thirteen studies showing different possibilities and association mechanisms between ADHD and BPD were eligible for revision. All the studies have shown a statistical association between both diseases.

The data mostly support the hypotheses that the two perturbations correspond to the same disease in different stages of evolution; that both are different diseases sharing a common etymological basis; that both perturbations are synergic, mutually powering each other while in comorbidity or that childhood ADHD may be a precursor to BPD during adolescence/adulthood.

The necessity for more studies becomes evident, namely about the influence of the precocious treatment for ADHD and the development of BPD in the future and other potential factors that may be involved in this association.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Determining the relation between the internet addiction in Turkish secondary school students and the perceived family support
Authors: Işık I. , Ergün G.
Published: June 2017

Objectives

The purpose of this study is to determine the relation between the internet addiction levels of secondary school students and the perceived family support.

Methods

The study was conducted in the cross-sectional and descriptive design, and the data were collected from 3391 students who were studying at 5th and 7th grades at 23 secondary schools in the city of Burdur and its central villages. The Personal Information Form, the Internet Addiction Scale, and the Social Support Received from the Family Scale were used to collect the data. The data were collected between the dates 15.11.2013 and 15.01.2014. After the necessary explanations were made to the students, the informed consent form were sent to their parents/legal guardians, and the students who returned these forms were included in the study. The numbers, percentages, average values, and standard deviation, which are among the descriptive statistical methods, were used in evaluating the data. The Pearson correlation and regression analysis were applied between the continuous variables of the study.

Results

It was observed in the study that 4.6% of the students had internet addiction at pathological level. The factors that influenced the internet addiction were determined as the social support received from the family, being male, low school success, weekly allowance being high, studying at senior grades, and going online frequently.

Conclusions

When the study results are analyzed it is observed that the internet addiction in secondary school students in our country is at a rate that has to be taken seriously.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Telepsychiatry: The new reality of psychiatry in the future
Authors: Jain U.
Published: June 2017

Background

Do we need to work from offices in psychiatry? The clinical interface has been debated particularly in child and adolescent psychiatry with continued beliefs related to the differences in therapeutic alliance when compared to face-to-face practice. That literature clearly shows that telepsychiatry is equal in its therapeutic effects. But not much has been written about the other advantages of telepsychiatry, which may be intuitive but needs to be documented.

Methodology

The University of Toronto Telepsychiatry Program is the largest in the world with over 60 psychiatrists and 1400 sites. This is an anaectodal review of 25 years of practice using this medium outlining the advantages (ADV) and disadvantages (DADV) to this medium.

Results

ADV: convenience from home, complete access to hospital files, physician safety during sessions, able to see multiple sites and include multisystem professionals including schools, cost effective (when compared to outreach psychiatry), simplicity of connection with minimal interference. DADV: novelty to client, quality of video to pick up very subtle nonverbal information, technical support required, capital cost to set up, mental health biases to technology.

Conclusion

This technology is evolving. It is essential physicians understand the issues whether it be privacy, cost, utility and clinical application. The long-term impact will likely affect future practice and allow resource sensitive care to outlying areas with the ability to impact a country's mental health significantly. Health economic data is required for future research.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Yes we can – Positive CAMHS
Authors: Jansen P.
Published: June 2017

Yes We Can Youth Clinics has fundamentally innovated (mental) health care for children and adolescents just by taking a different approach: the force of Positive Health!

The WHO definition of Health, adopted in 1948 and since then never amended, has become obsolete: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

A new, more positive definition ought to replace the obsolete.

“The ability to adapt and self-manage physical, mental and social well-being challenges.”

Different approach

WHO.

Health care is to be claimed unlimitedly, making sure you get better, free from symptoms, against any price, something you undergo and releases you from the responsibility to self-manage and recover.

YES WE CAN.

Care appealing to personal strength and possibilities. Care that also demands commitment, not a lack thereof. Care that apart from physical/mental functioning also deals with a spiritual dimension within a personal context. Care that deals with purpose (life goals) for both the patient and the caretaker.

Conclusion

Yes We Can and Positive Health has been very successful:

– perfect climate for recovery: e.g. role models, positive group dynamics, expert experience, no coercion or compulsion, structured healthy program;

– focus on strength hand abilities, coping skills, learn what is important, moral, values;

– system oriented: family therapy is mandatory;

– after-care (helping back to school/work);

– be Aware: old fellows help with prevention by visiting various schools.

Illustration

Vision of Yes We Can and life story of a fellow.

Disclosure of interest

The author has not supplied his declaration of competing interest.
The identifying of depression’ risk in students with impaired hearing and vision
Authors: Kupriyanova I.
Published: June 2017

Introduction

The depressive states in adolescents have their specificity: they are often poorly understood by the children themselves as reduced mood and can be expressed in the growth of aggressive behaviour, stubbornness, oppositional behavior, care. Even the pre-clinical level of depression can have a significant negative impact on the lives of adolescents.

Materials

One hundred and seventy-three visually and 139 hearing impaired students of correctional boarding schools, 7–18 years old.

Methods

Children's Depression Inventory (CDI) M. Kovacs, statistical (nonparametric test Mann–Whitney).

Results

At 20.8% the increased and at 3.1% the high risk of depression was identified. For students with visual impairments often were characterized by significantly higher scores on a scale of “anhedonia” and “incompetence”. The girls revealed significantly higher scores for total scale depression, the scale “negative mood”, “interpersonal problems” and “negative self-esteem”.

A comparative analysis of data, obtained by different researchers was held. There were no literature sources, which would have provided data about the level of depression of children with sensory impairments.

Conclusions

Children with sensory impairments have a greater risk of developing depression in comparison with pupils of general education schools. Therefore, a screening of children in this category on the level of depression should be obligatory in addition to clinical examination. The detected data must be taken into account in psychotherapeutic and preventive measures.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Behavioral disorder of adolescents with Prader–Willi SY
Authors: Tripkovic M. , Knez Kovačić S. , Bogadi M. , Bakija I. , Ropar S.
Published: June 2017

Introduction

The paper discusses the problem of psychiatric treatment of rare diseases and “diagnostic screening” of certain psychic symptoms that affect people with intellectual disabilities. Prader–Willi (PWS) is a genetic syndrome that belongs to a group of rare diseases and is caused by deficiency or loss of function of genes on chromosome 15 inherited from the father. This disease affects both sexes and its main characteristics are: obesity, hyperphagia, mental retardation and hypogonadism. Chronical feeling of insatiable hunger and slow metabolism leads to excessive body weight which is, according to existing date sources and monitoring studies, the primary cause of premature death of patients with PWS. Anxiety, psychomotor agitation, behavioral problems, difficulties with short-term memory, frequent skin injury in the form of wounds and bruises are the symptoms of this disease that hinder diagnosis and treatment. Research suggests that patients with PWS have unusual reactions to the standard drug dosages, specifically anxiolytics.

Aim

We shall present a multidisciplinary approach of pharmacological and psychotherapeutic treatment of a 16-year-old female patient with PWS.

Result

This patient responded well to a small dosage of quetiapine, at the same time monitoring other physical parametres. Pharmacotherapy, combined with psychotherapy, along with providing counseling and support for parents resulted in decreased psychomotor restlessness and, subsequently, better control of food intake and prevention of weight gain.

Conclusion

This paper has emphasis on the importance of a multidisciplinary approach, as well as experience from clinical practice in the treatment of complex and rare syndrome diseases.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Underestimation of autism spectrum disorders according to DSM-5 criteria: A pilot study
Authors: Ferrara R. , Esposito M.
Published: June 2017

Introduction

Recent studies on autism concern the number of individuals diagnosed with pervasive developmental disorder (PDD) according to DSM-IV-TR who may no longer qualify for diagnoses under the new DSM-5 autism spectrum disorder (ASD). ASD is diagnosed using the impairments in two dimensions:

– the social and communication dimension;

– the restricted and repetitive interests and behaviors (RRIB) dimension whereas PDD is diagnosed using impairments in three dimensions.

All the studies indicate between 50 and 75% of individuals will maintain diagnoses.

Objectives

The aim of the study is to quantify how many individuals with previous PDD diagnoses under DSM-IV-TR criteria would maintain a diagnosis of ASD under DSM-5 criteria.

Methods

Our sample consists of 23 cases (21 males, 2 female) related to the treatment Centre “Una breccia nel muro” of Rome and Salerno. All the cases previous received a PDD diagnose according to DSM-IV TR criteria. The mean age of cases was 7.7 years. All the cases were diagnosed by our team according to DSM-5 criteria, clinicians also used to make diagnoses: the Autism Diagnostic Observation Schedule-2, the Autism Diagnostic Interview-Revised.

Results

Eighty-seven percent of cases with PDD were classified as ASD using DSM-5 criteria. Thirteen percent of cases, that previous received an Asperger diagnose, did not meet the ASD criteria (Fig. 1).

Conclusions

DSM-5 criteria may easily exclude cases with high functioning from ASD because they tend to be atypical for ASD according to this study.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pattern of online technology and its impact on productivity at workplace
Authors: Gupta H.
Published: June 2017

Background

Internet use has affected the pattern of working style at the workplace. Recent years have seen an increased use of online activities (especially pornography/gaming) at the workplace. It has been shown to affect productivity at the workplace. There is a dearth of literature from the Indian context in this area.

Aim

This study was conducted to explore the pattern of pornography use and gaming at the workplace and its dysfunctions.

Setting and design

The present study was a cross-sectional prospective study.

Materials and methods

The objective of the study was to assess the pattern of pornography use at the workplace. Five hundred employees having experience of internet use for more than a year of various government/private sector organizations in Bengaluru were assessed using background data sheet, DSM-5 criteria, internet addiction test and pornography addiction screening instrument. Users who were unwilling to participate were excluded from the study.

Results

Seven to 9% reported preference for Internet to work, meals, personal hygiene, sleep, and interaction with family members and effects on productivity. Three to 4% have excessive use of pornography and game.

Conclusions

The present study has implications for evolving psychoeducational modules for the promotion of healthy use of technology.

Disclosure of interest

The author has not supplied his declaration of competing interest.
The connection between drugs of abuse and personality disorders
Authors: Barylnik Y. , Abrosimova J. , Pakhomova S. , Samoylova D. , Kolesnichenko E. , Antonova A. , Bachilo E. , Deeva M. , Filippova N. , Sizov S. , Paraschenko A.
Published: June 2017

Introduction

Patients who are suffering from different type of drugs have special individual and psychological problems. These changes are important for regulation and to control their behaviour.

Objectives

To study the psychological characteristics and personal resources of the patients who are suffering from abuse of drugs.

Methods

Fifty patients were studied, 63.3% men and 36.7% women and in the ages of 18–21 years. Following psychodiagnostic methods are used: Kettel's sixteen personality factor test, Leonhard-Shmishek's personality test, scale of reactive and personal anxiety Spielberger-Hanin.

Results

Amount those patients were suffering from different type of drugs: synthetic cannabinoids-66.7%, 20% were dependent on synthetic cathinone and 13.3% were dependent on opiates (heroin). According to Leonhard-Shmishek's scales, the most often of personality disorders were dysthymic type, hyperthymic type and explosive type. According to Kettel's scale were indicated the leading individually-psychological properties in more than half of the subjects is the development of abstract thinking, free thinking, impulsiveness, lack of confidence to the authorities, the high emotional tension, emotional instability and irresponsibility. An analysis of global factors indicative of the severity indices of extraversion. According to Spielberger-Hanin's scale, 80% of patients with substance abuse had mild level of situational and personal anxiety, which can be identified as an important psychotherapeutic resource.

Conclusions

According to scales, the most often of personality disorders were dysthymic type, hyperthymic type and explosive type. Eighty percent of patients with drug abuse had mild level of situational and personal anxiety. This feature is main of predictor as an important psychotherapeutic resource.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Bipolar disorder and co-occurring cannabis use disorders
Authors: Mustapha S. Ben , Homri W. , Jouini L. , Labbane R.
Published: June 2017

Aims

Assess the prevalence of cannabis use disorders (CUD) in patients with bipolar disorder, describe the demographic and clinical profile socio bipolar patients with comorbid addictive and assess the implications of this comorbidity on prognosis and evolution of bipolar disorder.

Methods

A case-control study, 100 euthymic patients treated for bipolar disorder, recruited in the department of psychiatry C of Razi hospital. Two groups were individualized by the presence or not of cannabis use disorders comorbidity. The two groups were compared for sociodemographic, clinical, therapeutic and historical characteristics.

Results

The prevalence of CUD was 27.53% (n = 19) in our sample. Comparing bipolar patients according to the presence or absence of CUD, we found the following results with patients with CUD comorbidity: younger, mostly male, a disturbed family dynamic, low educational level, poor socio-economic conditions, more time abroad history, more suicide attempts in history, more criminal record, more psychiatric family history, an earlier onset of the disease, a longer duration of undiagnosed bipolar disorder, more personality disorder, more frequent presence of a triggering factor for bipolar disorder, more psychotic features during mood episodes, more need of antipsychotic long-term treatment.

Conclusions

The frequency of CUD in BD is higher than the prevalence in the general population and CUD is a factor in the evolution and prognosis of bipolar disorder and promotes the development of mood disorders in predisposed patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
One-year changes in psychiatric disorders following bariatric surgery
Authors: Bianciardi E. , Giorgio D.L. , Cinzia N. , Flavia G. , Paolo G. , Alberto S.
Published: June 2017

Introduction

Psychiatric disorders in obese patients range from 20% to 60%, with a lifetime prevalence as high as 70%. Bariatric surgery (BS) is an effective therapy for long-term weight control and ameliorates comorbidities. After BS, psychiatric outcomes are still a matter of controversy. Moreover, while psychosocial pre-surgical evaluation is mandatory, post-operatively psychiatric follow-up programs are lacking. Aim of this prospective study was to examine changes in psychiatric symptoms and weight over 1 year of follow-up among a population of individuals submitted to BS.

Methods

One hundred forty eight participants were enrolled, 98 women and 50 men; mean age was 46 (SD = 10.7), and mean BMI was 46 (SD = 7.7). Clinical interview and self-report instruments were administered before and one year after BS. Depressive symptoms were measured using Beck Depression Inventory (BDI), Binge Eating Disorder was measured using Binge Eating Scale (BES).

Results

One year after surgery 86% of patients achieved a percentage excess weight loss (%EWL) ≥40%. Rate of psychiatric comorbidities declined from 41% at pre-surgery to 12% at 1 year post-surgery, P = 0.01. BDI mean score declined from 12 to 8, P > 0.000. After BS, binge eating, depressive symptoms, and age were independent and significant predictors of %EWL (F6,523 = 79.599, P < 0.0001, adjR2 = 0.471).

Conclusions

We reported an improvement of psychiatric symptoms through 1 year after BS. Post surgical binge eating disorder and depression were associated with less weight loss after surgery, adding to the literature suggesting that psychiatric disorder after surgery, unlike pre-surgery, are related to suboptimal weight loss.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Therapeutic patient education: A solution to the treatment of obesity and metabolic syndrome in psychiatry
Authors: Bailly A. , Fau L. , Lourioux C. , Gramaje N. , Mechain A. , Arnaud A. , Pillot-meunier F.
Published: June 2017

Introduction/objectives

Obesity and overweight are major public health issues. Obesity is a risk factor associated with many non-communicable diseases such as diabetes, certain types of cancers, musculoskeletal disorders and cardiovascular, dermatological or gastroenterological diseases. Patients with severe psychiatric disorders have a higher risk of developing overweight or obesity than the general population. The risk of obesity in schizophrenics patients can be multiplied by a factor ranging from 2.8 to 3.5. Patients suffering from mood disorder have sightly lower risk of obesity, however we still consider a factor ranging from 1.2 to 1.5. This significant weight gain can be partly explained by medication.

Methods

The hospital centre Le Vinatier, in France, has developed a therapeutic patient education program in helping patients to self-manage their preventable disease. In order to tackle the multifaceted nature of obesity, the program used the expertise of many different professionals: general practitioners, dieticians, dentists, physical adapted education teachers, pharmacists, nurses and so on. This programme is provided for patients suffering from obesity or an overweight complicated by diabetes, or/and metabolic syndrome, and/or history of cardiovascular diseases or/and a failure of a dietary monitoring. The program includes individual care and collective workshops in nutrition, oral heath, body image, adapted physical education, and roundtable.

Results/conclusions

A retrospective study has already shown that this therapeutic patient education program, like others before, presented better results than dietary consultations. A prospective study is currently being carried out to validate these results in the long term and to demonstrate the benefit associated to this program.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
GERD is associated with the outcome of MDD treatment
Authors: Matić K. , Šimunović Filipčić I. , Bajić Ž. , Filipčić I.
Published: June 2017

Introduction

Gastroesophageal reflux disease (GERD) is more prevalent among patients with major depressive disorder (MDD) than in general population, and vice versa. Bidirectional association of GERD and MDD is well documented. Although protective effect for gastric symptoms has been indicated for several antidepressants like trazodone, citalopram, fluoxetine, mirtazapine or fluvoxamine, these findings are sometimes contradictory. Similar may be claimed for antidepressive effect of some proton pump inhibitors. We decided to examine the association of GERD with the long-term efficacy of MDD treatment.

Objective

To examine the association of GERD and efficacy of MDD treatment.

Methods

This nested cross-sectional study was done during 2016 at Psychiatric hospital Sveti Ivan, Zagreb, Croatia on the sample of 1008 psychiatric patients. Key outcome was the number of psychiatric rehospitalizations since the first diagnosis of MDD. Predictor was patient-self-declared diagnosis of GERD. Covariates controlled by multivariate analysis of covariance were sex, age, duration of MDD in years, education, marital status, number of household members, work status, clinical global impression scale–severity of MDD at diagnosis, treatment with tricyclic antidepressants (TCA), selective serotonin reuptake inhbitors (SSRI), serotonin-norephinephrine reuptake inhibitors (SNRI), noradrenergic and specific serotonergic (NaSSA) and antipsychotics.

Results

MDD patients with GERD had significantly larger number of psychiatric rehospitalizations (mean = 5.4 (SD 6.82)) than MDD patients with no GERD (mean = 3.1 (SD 4.45)). After adjustment for all covariates, GERD significantly moderated the efficacy of treatment of MDD (P = 0.048; η2 = 0.05) (Figure 1).

Conclusion

To treat MDD effectively we should treat GERD as well.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
From psychiatric to critical care: Patient profile and predictive transfer elements
Authors: Trabelsi R. , Bram N. , Benromdhan I. , Homri W. , Staali N. , Labbene R.
Published: June 2017

Introduction

Patients with mental illness have an increased risk of morbidity and mortality from somatic complications, with a reduction in life expectancy of 15 to 30 years. During hospitalization in a psychiatric setting multiple risk factors can combine and contribute to a severe deterioration in the general condition of patients who may require reanimation.

Aim

Describe the profile of patients admitted to Razi who required transfer to an intensive care setting during hospitalization to more precisely determine the predictors of severe somatic decompensation.

Methodology

A descriptive retrospective study of patients transferred from the Razi hospital to the emergency medical assistance center (CAMU) during the period between 1 January 2014 and 31 December 2015.

Results

The average age of patients was 39.5 years; 64.2% of the patients were men, 60% had a low socio-economic level, 34.7% had a comorbid disease. Forty-one percent (41%) of the patients transferred had been diagnosed with schizophrenia, and 27% had bipolar disorder. Antipsychotics were the most prescribed psychotropic drugs. High doses were used with therapeutic combinations in 85% of the cases. A toxic cause was identified in 58% of cases, including neuroleptic malignant syndrome in 18%. Dehydration and ionic disorders are among the most frequent causes in 27% of cases. Conclusion; Identifying risk factors for deaths in psychiatric hospitals highlights needed changes in psychiatric management strategies taking into account the patient's characteristics as well as the drugs’ safety profile.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
When seizures are non-epileptic
Authors: Nogueira J. , Taylor R.
Published: June 2017

Introduction

Non-epileptic seizures (NES) are a diverse group of disorders, whose paroxysmal events can be mistaken for epilepsy, although they are caused by a mental or psychogenic process rather than a neurological cause.

Objectives/methods

We present a case of a 45-year-old female patient with history of generalized seizures prior to Meningioma resection in August 2015, referred to the Liaison Psychiatry outpatient follow up clinic at the Royal London Hospital after has gone several times to emergency department complaining about flush and hot sensation that proceeded to corners of mouth turning down, teeth chattering, shaking of left arm and torso at first and then legs. During the episodes, she was awake with no consciousness loss. Her mood was low, with clinical evidence of depression and she had very high levels of health anxiety.

Discussion

A diagnosis of non-epileptic attacks was made in the sequence of those episodes. A holistic and multidisciplinary approach was made, including pharmacotherapy, cognitive-behavioral therapy and domiciliary support. The clinical response was good regarding both mood, anxiety levels and NES.

Conclusions

Approximately 25% of patients who have a previous diagnosis of epilepsy and are not responding to drug therapy are found to be misdiagnosed and it is common that epileptic patients have both epileptic and non-epileptic seizures. Although distinguishing epileptic and non-epileptic seizures is not easy, there are some clinical clues that the physicians should look for, like age of onset, time of the day that episodes occur and presence or absence of postictal confusion.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Report of clinical case: Catatonic symptoms as a result of cerebral venous sinus thrombosis
Authors: Orihuela P. Ortega , Morenilla A.L. Pérez , González C. Hernández
Published: June 2017

Clinical case

We present the case of an 18-year-old woman attending the emergency room due to behavioral disorders that appeared 24 hours ago. The clinic was of restlessness, uninhibited behavior, stereotyped movements, global insomnia, semimutism and negativism. Initially she was diagnosed with catatonia, and was admitted to the Mental Health Hospitalization Unit. There were no previous psychopathological antecedents, although relatives reported that she had several stressors. During admission, she had a partial response to benzodiazepine treatment, and a loss of strength in the left upper limb was evidenced, and venous sinus thrombosis was diagnosed. With the anticoagulant treatment, the psychiatric symptomatology presented was markedly improved.

Medical examination

Normal vital signs, afebrile. Absence of focal neurological signs. Stereotyped movements, oral-buccal dyskinesia. Negativism, disinhibition and oppositional behaviour. Supplementary tests with results within the normal range. Cranial MRI: Upper, transverse and sigmoid right sagittal sinus thrombosis.

Conclusions

Numerous cases of thrombosis have been documented as a result of a catatonic state, mainly due to the immobilization and the risk involved. However, in this case, sudden onset of psychiatric symptoms, absence of psychiatric antecedents, and excellent response to anticoagulant therapy, leads us to conclude that catatonic symptoms could be considered as a consequence of cerebral edema caused by thrombosis. The presentation of catatonia as the sole cause of a somatic disorder is not common, but would be stimulated by certain factors, such as excessive stress and personality disorders, documented as vulnerability factors for such symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
How are personality traits and physical activity involved in colorectal carcinogenesis? A cross-sectional study on patients undergoing colonoscopy
Authors: Marchi M. , Alboni S. , Artoni C. , Galletti M. , Giambalvo N. , Mancini S. , Mariani F. , Mattei G. , Merighi A. , Montardi G. , Pollutri G. , Rioli G. , Saraceni S. , Spiga G. , Visentini C. , Ferrari S.
Published: June 2017

Introduction

Inflammatory state of the large bowel is a key factor for the development of colorectal cancer (CRC). It has multifactorial aetiology, including psychological determinants. Physical activity may have a protective function against CRC via anti-inflammatory properties; on the contrary, personality traits correlate with an unhealthy and dangerous lifestyle.

Objective

To measure the association between personality traits, lifestyle and colonoscopy outcome.

Methods

Cross sectional study. Patients undergoing colonoscopy aged 40 or more, with a negative history for cancer or inflammatory bowel disease, were enrolled. Data collected: colonoscopy outcome, smoke, alcohol, physical activity, presence/absence of Metabolic Syndrome, personality traits assessed by the Temperament & Character Inventory (TCI).

Results

In a sample of 53 subjects (females = 24, 45.3%), the mean age was 60.66 ± 9.08. At least one adenoma was found to 23 patients (43.3%). Twenty patients were smokers (37.74%), 36 (67.92%) drank alcohol at least weekly; approximately 60% reported regular physical activity. At the multivariate regression, the outcome was associated to: TCI Self Transcendence domain (ST) (OR = 1.36, P = 0.04) and physical activity (OR = 0.14, P = 0.03).

Conclusion

People with ST's characteristic personality traits and sedentary life style are more likely to have precancerous colorectal lesions. This confirms the protective role of physical activity, and suggests to further explore the role of personality in cancerogenesis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Referrals of patients with schizophrenia to a consultation-liaison psychiatry service
Authors: González R. Sánchez , Lázaro E. Baillès , Villanueva S. Herranz , Pérez L. Pintor
Published: June 2017

Background

There are few studies specifically investigating the acute treatment procedures of patients with schizophrenia in the context of Consultation-liaison psychiatry (CLP).

Purpose

Describe the main clinical features of the referrals of patients with schizophrenia, attended by a general hospital CLP service.

Methods

Longitudinal observational and descriptive study, assessing adult inpatients with schizophrenia (DSM-IV-TR criteria) admitted to non-psychiatric units of Hospital Clínic of Barcelona (Spain), who were consecutively referred to our CLP service over a 10-year period (from January 1, 2005, through December 31, 2014).

Results

During that period, 9.808 psychiatric consultations were requested. 163 of them (1.8%) concerned patients with schizophrenia. These groups of patients were aged 50.9 ± 15.3 years and 65% were male. A 25.9% of patients had history of suicide attempts and 45.6% presented current psychosocial stressors.

Characteristics of referrals Referral sources according to medical specialties are shown in Table 1.

The major medical conditions for referral according to ICD-10 categories were: external causes of morbidity (21.5%), infectious diseases (13.5%) and diseases of the digestive system (10.4%).

The two most frequent reasons for referral were the assessment of psychopharmacological treatment and/or psychopathological state examination (62%) and suicidal risk/attempt assessment (8.6%).

Conclusions

In our sample, only a 1.8% of all patients for whom psychiatric consultation was requested had a diagnosis of schizophrenia. The most common profile of them was: male, 50 years old, coming from general medicine department due external causes of morbidity and referred to the CLP service because of psychiatric state and/or medication review.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Describing the assistance, the basis for improvement
Authors: Sánchez E.J. Pérez , Miranda J.M. Ginés , Romero V. Chavarría , Moreno J. , Palma A. , Pale L. Alba , Leon J. , Bulbena A. , Perez V.
Published: June 2017

Introduction

Consultation-liaison (CL) psychiatry is a branch of psychiatry that study and treat mental health of patients with other medical or surgical conditions. The assistance between hospitals and health services is heterogeneous.

Aims and objectives

For this reason, the objective of our research is to define the clinical characteristics from our CL service and check out the quality relationship with the applicant service, for improving future assistance.

Methods

We made a descriptive analysis of clinical variables from the patients who received assistance during 2 months by the CL service from the hospital del Mar, Barcelona. We got the frequencies and we used the Chi2 test for the comparison between variables: Diagnosis, appearance in the report and treatment in the report.

Results

Total of the sample: 42 patients, 61.9% women. Mean age: 55.1 years. Psychiatric diagnosis was present before the assistance on 57.1% of the patients. The most frequent diagnosis was Adjustment Disorder (47.6%) and more than one diagnosis was made in the 14.3%. Near the half of the patients required only primary care assistance after the discharge from the hospital. In the 68.3% of the reports appeared information about CL assistance and the indicated treatment didn’t appear in all the reports. Statistically significant differences weren’t found in the comparisons.

Conclusions

Adjustment Disorder is supposed to be the most common psychiatric diagnosis in our CL psychiatry service, as we found in the reviewed literature. The results reveal that relationships between services can be improved. More studies must be done for completing information in this issue.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Exploring sources and types of information about Huntington disease received by affected families
Authors: Vamos M. , Conaghan J. , Lewin T.
Published: June 2017

Introduction

While revealing the presence of Huntington Disease (HD) within the family setting has received considerable research interest, the sources of information and the detail of which aspects of the illness are discussed remains unexplored. This study's primary aim was to identify HD information sources, both professional and family, and to describe the types of information received by members of affected families, with the hypothesis that some aspects of the disorder would be more fully addressed than others.

Method

Clients drawn from a specialist genetic unit looking after families with HD (n = 46) were engaged in structured interviews and completed standardized questionnaires, including: the psychological adjustment to genetic information scale (PAGIS); and a current psychological distress measure (K10). Participants obtained HD related information from a mean of 4.76 sources (49.3% professional).

Results

As expected, genetic and neurological symptoms were more frequently described (97.7% and 86.4% respectively) than cognitive and psychological/psychiatric (63.6%; 52.3%). Regression analyses were used to identify potential predictors of current distress, adjustment, and information satisfaction. Rated satisfaction with information received was higher among participants with a gene positive family member. Across the PAGIS sub-scales, there were differential associations with the predictors examined.

Conclusions

Given that HD is a multi-faceted condition affecting the entire family, needs would be better addressed if information provided went beyond discussion of genetic and movement disorders, and extended to the cognitive, psychological and behavioral aspects which are strongly associated with quality of life.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Global arginine bioavailability ratio is decreased in patients with major depressive disorder
Authors: Ali-Sisto T. , Tolmunen T. , Viinamäki H. , Mäntyselkä P. , Velagapudi V. , Soili L.
Published: June 2017

Introduction

The global arginine bioavailability ratio (GABR) is used to estimate arginine supply. Arginine is precursor to nitric oxide (NO) that has been suggested to play a role in major depressive disorder (MDD). NO also participates in neuronal, inflammatory and cardioprotective functions.

Objectives

To compare GABR between:

– D patients and non-depressed controls;

– remitted and non-remitted MDD patients;

– baseline and follow-up within remitted and non-remitted MDD groups.

Aims

To investigate the role of NO production in MDD.

Methods

The sample comprised 99 MDD patients and 253 non-depressed controls (Beck Depression Inventory scores < 10) aged 20–71 years. Altogether, 78 patients returned for the follow-up; 33 were remitted and 45 non-remitted. GABR was calculated from serum levels of arginine, citrulline and ornithine, which were analysed using ultra-performance liquid chromatography. Differences between the study groups were examined using logistic regression adjusted for age, gender, smoking, alcohol use, physical exercise and glycated haemoglobin. The follow-up regression analyses were adjusted for age, gender and physical exercise.

Results

Lowered GABR was associated with belonging to the MDD group (OR 0.13, 95% CI 0.03–0.50). Exclusion of participants using anti-depressants that were associated with measured metabolites did not change the results. Over the follow-up period, the remitted and non-remitted groups both showed an increase in GABR (Z = –.53, P < 0.001 and Z = –3.00, P = 0.003, respectively).

Conclusions

Decreased GABR may characterise MDD. This could affect neuronal, immunological and cardioprotective functions of NO.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clinical predictors of antidepressant response to ketamine in unipolar treatment-resistant depression
Authors: Del Sant L.C. , Magalhães E. , Lucchese A.C. , Alves H.N. Palhares , Sarin L.M. , Del Porto J.A. , Lacerda A.L. Tavares de
Published: June 2017

Introduction

The non-competitive N-methyl-d-aspartate glutamate receptor antagonist ketamine has been shown to have rapid antidepressant effects in treatment-resistant depression (TRD). However, only a few studies have investigated which clinical characteristics predict a response to ketamine.

Objectives

To assess sociodemographic variables and clinical markers that predict response to ketamine in unipolar TRD patients.

Methods

Searches of Pubmed, NCBI and Google Scholar were conducted for clinical trials and systematic reviews, through October 2016, using the keywords:

ketamine, N-methyl-d-aspartate receptor antagonist, rapid-acting antidepressant, depression, treatment-resistant depression, clinical predictors.

Results

Findings support the following clinical predictors:

– sociodemographic variables: positive family history of alcohol abuse disorder in first-degree relative (increased antidepressant response and fewer depressive symptoms for up to 4 weeks post-infusions), higher BMI (improvement in depression severity at 230 minutes and one day post-infusion), negative history of suicide attempt (greater improvement at day 7);

– infusion-associated events: greater dissociation during infusion (better antidepressant response at 230 minutes and one week post-infusion); rapid response to first infusion (sustained response to subsequent infusions in one-third responders for up to 83 days);

– symptomatology: anxious depression (fewer depression symptoms at day one up to 25 associated with longer time to relapse); neurocognitive performance (lower attention) predicts change in severity of depressive symptoms over six infusions.

Conclusions

Findings suggest that specific clinical characteristics are predictors of ketamine response in TRD. Future studies confirming reliable predictors will assist clinicians to implement efficacious and individualized treatment for TRD patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Correlations between doctors’ and patients’ assessment of depression’ severity and efficacy of treatment
Authors: Medvedev V. , Retyunsky K. , Ovchinnikov A. , Barilynik Y. , Shmilovich A. , Antohin E. , Usov G. , Frolova V.
Published: June 2017

Introduction

Data on accordance and clinical significancy of objective (doctor, psychometric scales) and subjective (patient with depression) assessment of severity of depression are almost lacking. Aim of the multicenter study “EMOTION” was to compare prognostic value of doctor's and patient's assessment of depressive symptoms severity as for its grading and treatment outcome.

Method

Study sample consist of 107 depressive patients. The study used clinical and psychometric (HDRS, SHAPS, CGI-S, CGI-I, PGI-S, PGI-I, Visual Analog Scale) methods.

Results

Our data suggest that there's statistically significant (Р ˂ 0.001) discrepancy between doctors’ (CGI-S) and patients’ (PGI-S) assessment of depressive symptoms’ severity at first visit. Concordant opinions were found only in “marked depression” (37.49% of doctors and 36.59% of patients) and in “borderline depression” (4.79% of doctors and 3.79% of patients). Otherwise, doctors’ and patients’ opinions were discordant. Doctors’ scores were more extreme (severe and extremely severe depression); patients’ scores were more “moderate”. We have found inconsistence between HDRS and CGI-S scores. In the course of reduction of depression severity during antidepressive treatment (agomelatine) doctors’ and patients’ scores were more and more in line with each other.

Conclusion

We have found leveling of prognostic value of psychometric assessment of depression severity by doctors and patients (in terms of reduction of depressive symptoms severity and treatment outcome) during antidepressive therapy. It is possible that in some HDRS items scores were overestimated.

Disclosure of interest

The authors have not supplied their declaration of competing interest.