bluuebunny/crossref_metadata_2025 huggingface dataset:
The Chinese version of the brief assessment of cognition in schizophrenia: Data of a large-scale Mandarin-speaking population
Authors: Wang L.J. , Hsu S.T.
Published: June 2017

Objective

The brief assessment of cognition in schizophrenia (BACS) is a cognitive assessment tool used to measure the broad aspects of cognition that are most frequently impaired in patients with schizophrenia. This study aims to develop the normative data of the Chinese version of the BACS among the Mandarin-speaking population.

Methods

This cross-sectional study included 382 healthy participants (age range: 19–79 years; mean age: 48.0 ± 16.7 years, 47.6% male) in Taiwan, who were evaluated with the BACS. Means and standard deviations of subtests and composite scores were arranged by age group and gender. The Z-scores calculated based on the U.S. norms were compared to our scores based on the norms established in the present study.

Results

The raw scores of all the BACS tests (verbal memory, digit sequencing, token motor test, verbal fluency, symbol coding, and Tower of London) were negatively correlated with participants’ age. Females were superior to males in verbal memory, but inferior to them in executive function. Furthermore, applying the U.S. norms of the BACS to determine the performance of the Chinese BACS results in bias with regard to verbal memory, token motor test, verbal fluency, symbol coding, Tower of London, and composite score.

Conclusions

These findings demonstrate that directly applying Western cognitive norms to a Mandarin-speaking population can cause biased interpretations. The results of the current study can be an important reference for clinical settings and research related to cognitive assessments in Mandarin-speaking Chinese populations.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Burnout as a form of mental health problem among nurses in the Philippines
Authors: Lu J.L.
Published: June 2017

Introduction

Nurses are among the health professionals that are confronted with burnout due to workload demands. The dominance of females in the profession reinforce the prevailing notion that the caring professions such as nursing are relegated to women. This gives the study its gender perspective.

Objectives

To determine the interaction between situational, factors, role stressors, hazard exposure and personal factors in the largest tertiary hospital in the Philippines.

Methods

This was a cross-sectional study, which aimed to determine the interaction between situational, factors, role stressors, hazard exposure and personal factors among 246 nurses consisting most of females (78.5%) from the different wards and units in the Philippines General Hospital (PGH).

Results

Almost half (49.6%) of the respondents reported being ill due to work in the past year, and 56.1% missed work because of an illness. Correlation statistics using the Spearman's rho showed organizational role stressors was most significant in burnout among nurses in the Philippine's largest tertiary hospital. Organizational role stressors consisted of ten dimensions, namely:

– inter-role distance (IRD);

– role stagnation (RS);

– role expectation conflict (REC);

– role erosion (RE);

– role overload (RO);

– role isolation (RI);

– personal inadequacy (PI);

– self-role distance (SRD);

– role ambiguity;

– resource inadequacy (RIn).

Conclusion

The contribution of the study is in advancing new concepts in the already existing framework of burnout, and thus, can assist nurses and hospital administration on how to control this problem.

Disclosure of interest

The author has not supplied his declaration of competing interest.
A case of neurosyphilis in a patient presenting with bipolar mixed episode suggestive symptoms
Authors: Martins M. , Fernandes R.
Published: June 2017

Introduction

Syphilis is a sexually transmitted disease caused by Treponema pallidum. Early invasion of the central nervous system might occur early in the course of the disease. Clinical manifestations may include acute meningeal syphilis, meningovascular syphilis, paretic neurosyphilis and tabetic neurosyphilis. Psychiatric symptoms are often the presenting symptoms of this illness and the correct diagnosis involves both a high degree of suspicion and adequate diagnostic tests.

Objectives

The authors report a case of a patient, with no previous history of mental illness, initially admitted in a psychiatric unit with a clinical picture suggestive of a mixed bipolar disorder episode who has been diagnosed with neurosyphilis a year after.

Methods

Review of clinical records and complementary exams.

Results

By the first admission, the patient presented with depressed and irritable mood, emotional lability, aggressiveness, grandiose and racing thoughts. Upon discharge, he was diagnosed with bipolar disorder and referred to ambulatory unit. The following year he starts presenting cognitive deficits and a progressive loss of autonomy in daily living activities, being referred to neurology evaluation. A year after the first admission, he is admitted in a neurology unit and diagnosed with neurosyphilis.

Conclusions

Current prevalence of symptomatic neurosyphilis in Western Europe is unknown. Atypical cases presenting with heterogeneous psychiatric and neurologic symptoms, with no previous history of mental illness, should raise a high index of clinical suspicion, since consequences for the patient's health might be severe if not properly diagnosed and treated.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Reduced left frontal GABA in ultra-high risk of psychosis patients. 1H MRS study
Authors: Menshchikov P. , Akhadov T. , Semenova N.
Published: June 2017

Introduction

Some previous findings indicate participation disturbance of balance between excitatory (GABA) and inhibitory (Glu) neurotransmitters in pathogenesis of schizophrenia. The aim of this study was to evaluate GABA and GLX levels in the brain of medicated UHR subjects.

Objectives

Twenty-one (18–25 years, mean = 19.4, SD = 3.5) right-handed medicated UHR men and 26 (18–25 years, mean = 19.8, SD = 2.2) mentally healthy volunteers participated in this study. The patients were included in the UHR group in accordance with criteria of prodromal states.

Methods

1H MRS (MEGA-PRESS pulse sequence [Mescher, NMR Biomed 1998;11:266]) was used for GABA and GLX detection. Volumes of interest in size of 30 × 30 × 30 mm were placed in the left and right frontal lobes in the areas of the anterior cingulate cortex (ACC) (Fig. 1).

Results

The main effects on the GABA/Cr (t[45] = 4.17, P < 0.01) (Fig. 2A) and GABA/GLX (t[45] = 2.84, P < 0.01) (Fig. 2B), were found in the left ACC (t[45] = 4.17, P < 0.01), with the patients having lower GABA/Cr and GABA/GLX ratios as compared to the control group. Also significant negative correlation (r = −0.49, P = 0.04) between GABA/Cr in the right ACC and the current daily dosage of antipsychotic medication in CPZ-Eq was found (Fig. 3).

Conclusion

This study reveals for the first time a significant reduction of (GABA) (25%) and GABA/GLX ratio (20%) in left AC of UHR subjects. According to (de la Fuente-Sandoval, Int J Neuropsychopharmacol 2015;19[3]) and association of (GABA) with daily dosage of medication found, this reduction may be caused by the antipsichotic treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cannabis use decreases prefrontal glutamate levels in early psychosis
Authors: Rigucci S. , Xin L. , Klauser P. , Baumann P.S. , Alameda L. , Cleusix M. , Raoul J. , Ferrari C. , Pompili M. , Gruetter R. , Cuenod K. Do , Conus P.
Published: June 2017

Recent evidences have consistently reported lower glutamate (Glu) levels in various brain regions, including the medial prefrontal cortex (mPFC), in chronic schizophrenia but findings in the early (EP) or in the prodromal phase of the disorder are equivocal. Although regular cannabis use has been associated with an increased risk of subsequent psychosis and with a perturbed Glu signalling, to date, the critical question of whether or not Glu abnormalities exist in EP and are related to cannabis use remains unanswered. Magnetic resonance spectroscopy was used to measure [GlumPFC] of 35 EP subjects (18 of whom were regular cannabis users) and 33 healthy controls (HC). For correlative analysis, neuropsychological performances were scored by a comprehensive cognitive battery. [GlumPFC] was lower in EP users comparing to both HC and EP non-users (P = 0.001 and P = 0.01, respectively), while no differences were observed between HC and EP non-users. In EP users Glu declined with age (r = −0.46; P = 0.04) but this relationship was not observed in non-users. Among neuropsychological profiles, working memory was the only domain that differentiates patients depending on their cannabis use, with users having poorer performances. In summary, our research revealed that cannabis use in EP is associated with Glu decreased levels, which are normally not seen in the early phase of the disorder. This finding is in line with previous 1H-MRS studies in cannabis users without a psychotic disorder and sheds light for the role of cannabis use in the progression of the disease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Serotonergic modulation of cognition; An acute challenge
Authors: Skandali N. , Rowe J. , Deakin J. , Robbins T. , Sahakian B.
Published: June 2017

Serotonin is well known to affect the multifaceted construct of impulsivity. Lowering brain serotonin levels is shown to increase impulsive choice in delay-discounting tasks (1) but improves response inhibition in stop-signal paradigms. (2) Administration of the antidepressant citalopram in healthy people increases tendency to perform go choices in a Go/No-Go task independent of outcome valence (3). It is rather unclear thought how serotonergic neurotransmission affects several aspects of cognition. We administered a single dose of 20 mg escitalopram, a selective serotonin reuptake inhibitor, to 66 healthy participants, aged 18–45 years old, in a double-blind, randomized, placebo-controlled, parallel-groups study. Acute escitalopram administration had a beneficial effect on inhibitory control with reduced stop-signal reaction time observed in the treatment group. Participants made significantly more errors in a probabilistic learning task and had lower accuracy during the discrimination stage in an instrumental learning task thus indicating a learning impairment. More errors in the CANTAB intra-extra dimensional set shift task were also observed in the escitalopram-treated group. Our findings following acute administration of a clinically relevant dose of escitalopram show a dissociate role for serotonin in modulating cognition mediated by a potentially differential modulation of fronto-striatal loops.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Microstructural and metabolic disorders in CC of juvenile schizophrenia patients
Authors: Ublinskiy M. , Semenova N. , Akhadov T. , Melnikov I. , Kupriyanov D. , Lebedeva I. , Kaleda V.
Published: June 2017

Introduction

The aim of the study was to analyze the microstructural and metabolic features of the corpus callosum in recently onset schizophrenia.

Objectives

13 young (17–28 years old) male patients with recently onset schizophrenia (F20, ICD-10) and 15 sex and age matched mentally healthy subjects were examined.

Methods

3 T Philips Achieva scanner with 8-channel SENSE coil was used. DTI was conducted with EPI SENSE (TR = 9431 ms; TE = 70 ms). The values of diffusion coefficient (ADC), fractional anisotropy (FA), radial (RD) and parallel (PD) diffusivity were calculated using workstation Philips EBWS 2.6.3.4. Spectroscopic voxel (2 × 1 × 1 cm) was placed consequently in the corpus callosum genu and splenium. PRESS (TR/TE = 1500/40) was used.

Results

In patients, increased ADC (P = 0.02) and RD (P = 0.008), decreased FA (P = 0.008) and NAA (P = 0.03) were found in the corpus callosum genu, No intergroup differences by PD, Cho, Cr, Glx were found in this area. Also, no statistically significant intergroup differences were observed for the DTI and MRS characteristics of the corpus callosum splenium.

Conclusions

It has been shown that RD increase is associated with demyelination process. So, an increase of RD in the present study could reflect demyelination in CC genu. Cells membranes abnormalities should lead to an increase of Cho which was not found. NAA reduction could be caused by reduction of axonal integrity. The latter process is considered to precede demyelination and not to be accompanied by PD rise. Thus, the present study revealed axonal integrity reduction and low demyelination in the genu of the corpus callosum in the early stages of schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
What make suicide depressions different from non-suicide ones: A diffusion tensor imaging study
Authors: Zhang H. , Jia Z.
Published: June 2017

Introduction

Depression is a common psychiatric disorder affecting many people globally, and the worst outcome is suicide. But its neurobiology is hardly understood.

Objectives

To use DTI to characterize abnormalities of white matter (WM) integrity in major depressive disorder patients with suicide attempts or suicidal ideation.

Aims

Present study aimed to give a more complete profile for the association of cerebral WM abnormalities with suicidal behavior in major depressive disorder patients by quantifying the suicidal ideation and behavior severity.

Methods

Thirteen depressive patients with suicide attempts (SA), 14 depressive patients with suicidal ideation but no suicide attempts (SI), 13 depressive patients without suicidal ideation or suicide attempts (NSD) and 40 healthy controls (HC) received MRI scans on a 3 T magnet. Whole brain voxel-based analysis of FA based on DTI was performed among the four groups using a threshold of P < 0.05 with FWE correction. FA values were extracted by Marsbar software to quantify the changes.

Results

The four groups had significant differences of FA in the in the left splenium of corpus callosum (peak Z = 5.36 at −14, −36, 22). Quantify comparison revealed that SA had significant decreased FA value than SI, NSD, and HC. There was no significant difference among the other three groups, although there was a trend that SI and NSD had lower FA values than HC in this region.

Conclusions

Depression and suicide are associated with microstructure abnormalities of the white matter and patients with suicide attempts may have severe cerebral alteration.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The effect of the mental health improvement programs in firefighters
Authors: Choi T.Y. , Kim J. , Lee J. , Chang S. , Jung S.
Published: June 2017

Objectives

The purpose of this study was to investigate the effectiveness of the mental health improvement programs in Korean firefighters through cooperation with the urban fire station. And we assessed the firefighter's degree of traumatic events and psychopathologies including depression, anxiety, suicidal ideation and insomnia.

Methods

A mental health improvement program was provided to 502 firefighters working at Daegu, Gumi and Ulsan during 8-week period. The program included not only an evaluation and treatment of psychiatric symptoms through counseling but also a psychoeducation for mental health awareness. The validated Questionnaires to measure psychiatric symptoms were used; symptoms included depression, anxiety, suicidal thoughts and insomnia. Subjects were divided to two groups; PTSD high-risk group and non-high risk group. Psychopathological levels were compared before and after the program.

Results

PTSD high-risk group included 57 subjects (11.35%) and non-high risk group included 445 subjects (88.65%). Before the program, PTSD high-risk group showed higher depression, anxiety, insomnia scores statistically significant. Multiple logistic regression analysis with PTSD high-risk group as a dependent variable showed depression as a factor for firefighters to become PTSD high-risk group compared to those not depressed. Insomnia turned out to be another variant. The program resulted in significant decrease total scores of BDI and ISI for PTSD high-risk group.

Conclusions

The results on this study showed that higher levels of depression and insomnia especially influenced the manifestation of PTSD in firefighters. The evaluation and management of psychopathologies including depression, insomnia with traumatic events for firefighters can be helpful.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Perinatal dissociation during premature childbirth: A comparative study
Authors: Ellouze S. , Aloulou J. , Ben Thabet A. , Halouani N. , Gargouri A. , Amami O.
Published: June 2017

Premature childbirth is sometimes perceived as a painful and traumatic experience, in which mothers can manifest dissociative symptoms. Our study aims to evaluate dissociative symptoms during premature childbirth compared with full-term delivery and to identify predictors of perinatal dissociation. We conducted a cross-sectional, descriptive and analytical study, including 97 mothers of premature infants who presented to the outpatient unit of neonatology at the UH Hedi Chaker of Sfax in Tunisia. For each mother, we collected sociodemographic and obstetric data. We used the peritraumatic dissociative experiences questionnaire (PDEQ) for screening dissociative symptoms during labor. We assessed severity of prematurity by the perinatal risk inventory (PERI). Responses were compared with a control group of 80 mothers of full-term infants. Average age of mothers was 30.2 years. Average gestational age was 32.82 weeks. Pregnancies were single (83.5%) or twins. 77.3% of mothers gave birth by caesarean section. Prematurity was unexpected by 56.7% of them. According to the PERI, 47.4% of newborns were considered as high-risk preterm infants (PERI ≥ 4). The average score of PDEQ was 16. The prevalence of perinatal dissociation for this sample (20.6%) was significantly higher compared with the control group (P = 0.014). It was also correlated to unexpected prematurity (P < 0.001) and a PERI score ≥ 4 (P = 0,023). Our results show that perinatal dissociation is more frequently occurring in preterm childbirth, especially when prematurity is severe and unexpected. Early interventions providing adequate information and support during delivery for mothers at risk of developing perinatal dissociation can alleviate such distress and prevent the development of subsequent post-traumatic stress disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Is autonoetic recollection of threat in PTSD related to impaired inhibitory skills?
Authors: Tudorache A.C. , El-Hage W. , Tapia G. , Goutaudier N. , Kalenzaga S. , Jaafari N. , Clarys D.
Published: June 2017

Introduction

Intrusive traumatic reminiscences are among the most distressing and salient characteristics of post-traumatic stress disorder (PTSD). Associated with involuntary onsets, emotional disturbances and consciousness-related impairments, such symptoms suggest that memory functioning could be impaired in PTSD. While there is a growing body of research on experimental assessments of memory in patients with PTSD, inconsistent results remain.

Objective

Using an experimental methodology, this study aims to measure memory in PTSD in consideration of central features of intrusive symptoms, especially emotional, inhibitory and consciousness-related memory impairments.

Method

34 patients diagnosed with PTSD were compared with 37 non-PTSD controls on an item-cued directed forgetting paradigm for emotional words combined with a remember/know recognition procedure.

Results

Results confirmed prior findings of an increased and peculiarly conscious recognition of trauma-related words in PTSD. Interestingly, our results showed that, despite general memory inhibitory deficits, PTSD patients, if requested, presented a preserved ability to inhibit this improved recollection of trauma-related words.

Conclusion

While our findings highlight a biased memory functioning in favour of threatening stimuli in PTSD, inhibitory deficits for such information was not reported to play a role on this effect. Conversely, it seems that instead of inhibitory deficits, patients presented a preferential treatment of threat concordant with vigilant-avoidant models of information processing. Focusing on memory impairment in treatment for PTSD appears of prime importance. Our findings regarding preserved inhibitory skills for threat memories in the disorder could be an interesting clue for therapeutic interventions on intrusive symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Decrease in antipsychotic and other psychotropic medication during 30 months of lifestyle intervention among outpatients with schizophrenia
Authors: Højlund M. , Elliott A.F. , Madsen N.J. , Viuff A.G. , Hjort P. , Munk-Jørgensen P.
Published: June 2017

Introduction

Patients with schizophrenia have 3-fold higher mortality from lifestyle diseases, and a long-lasting exposure to antipsychotic medication may contribute to the development of somatic illnesses. Region of Central Jutland was inspired by European initiatives to establish a lifestyle intervention program in an attempt to reduce mortality among individuals with severe mental illness.

Objectives

To investigate whether this intervention could possibly lower the need for antipsychotic treatment, and to provide a unique view of actual medication practice.

Aims

To investigate the influence of a lifestyle intervention program on changes in antipsychotic medication and polypharmacy in an unselected cohort of patients with newly diagnosed schizophrenia.

Methods

Observational study of outpatients participating in a program with individual consultations, group sessions and exercise groups.

Results

One hundred and eleven patients were eligible for analysis. Fifty-four percent of the patients were subject to antipsychotic monotherapy. Median Defined Daily Dose (DDD) of antipsychotics was 1.3 at index (interquartile range [IQR] 0.67–2.00). Fifty-two percent of the patients experienced a decrease in DDD during the period with median change of −0.33 DDD (IQR −1.00 to 0.43). We found no significant difference in baseline variables or extend of participation between patients with decrease in doses and patients with increase (Fig. 1).

Conclusions

Most patients decreased or stabilized their doses of antipsychotic medication during the study period. Half of the patients were subject to antipsychotic polypharmacy. Extend and type of participation in the lifestyle intervention program did not correlate to changes in dosing of antipsychotic medication.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Fig. 1

Change in total DDD from index to follow-up (111 patients).
Web search query data and prescription volumes of antidepressants
Authors: Gahr M. , Uzelac Z. , Zeiss R. , Connemann B.J. , Lang D. , Schönfeldt-Lecuona C.
Published: June 2017

Introduction

Persons using the Internet generate large amounts of health-related data, which are increasingly used in modern health sciences.

Objectives/aims

We analysed the relation between annual prescription volumes (APV) of several antidepressants with marketing approval in Germany and corresponding web search query data generated in Google to test, if web search query volume may be a proxy for medical prescription practice.

Methods

We obtained APVs of several antidepressants related to corresponding prescriptions at the expense of the statutory health insurance in Germany from 2004–2013. Web search query data generated in Germany and related to defined search-terms (active substance or brand name) were obtained with Google Trends. We calculated correlations (Pearson's r) between the APVs of each substance and the respective annual “search share” values; coefficients of determination (R2) were computed to determine the amount of variability shared by the two variables.

Results

Significant and strong correlations between substance-specific APVs and corresponding annual query volume were found for each substance during the observational interval: agomelatine (r = 0.968; R2 = 0.932; P = 0.01), bupropion (r = 0.962; R2 = 0.925; P = 0.01), citalopram (r = 0.970; R2 = 0.941; P = 0.01), escitalopram (r = 0.824; R2 = 0.682; P = 0.01), fluoxetine (r = 0.885; R2 = 0.783; P = 0.01), paroxetine (r = 0.801; R2 = 0.641; P = 0.01), and sertraline (r = 0.880; R2 = 0.689; P = 0.01).

Conclusions

Although the used data did not allow to perform an analysis with a higher temporal resolution our results suggest that web search query volume may be a proxy for corresponding prescription behaviour. However, further studies analysing other pharmacologic agents and prescription data that facilitates an increased temporal resolution are needed to confirm this hypothesis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Analysis of big data shows haloperidol with a decreased level of serum potassium
Authors: Noh J.S. , Park M.Y. , Lim K.Y.
Published: June 2017

Introduction

Haloperidol has been used for the treatment of schizophrenic disorders and other disorders with psychotic symptoms in psychiatric cares. It has been reported that haloperidol can cause QT-prolongation as well as Torsades de Pointes, especially in hypokalemic condition. Here, we tested the usefulness of the large clinical electronic medical record system data from a hospital located in South Korea and further investigated any change in potassium levels before and after an exposure to haloperidol.

Methods

The dataset used in this study is derived from open access database with information such as admission, discharge, diagnosis, prescribed drugs and selected laboratory data for the period 1 June 1994 to 31 July 2013. This database contains information of total 461,170 patients with 4,920,758 prescriptions and 3,811,812 data about serum potassium levels.

Results

Extracting a dataset from this database to compare the levels of serum potassium before and after haloperidol usage, we selected 3661 cases of data, 2476 of them (67.6%) were males and 1185 (32.4%) were females. More than 98.5% (3606) was Asians, and mean age of the patients was 68.63 ± 17.3 years old. The levels of serum potassium before and after haloperidol usage were 4.93 ± 2.53 and 3.86 ± 0.6 mEq/L, respectively, and t-tests revealed that those levels were significantly different (< 0.001).

Conclusions

Findings showed that an exposure to haloperidol could lead to a decrease in levels of serum potassium. We suggested that EMR data can be a valuable tool to investigate the effects of treatment on several clinical data.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Description of anesthetic drugs used in hospital del Mar and their impacts on convulsion duration and blood pressure in electroconvulsive therapy
Authors: Angelats M. , Leila A. , David C. , Laia P. , Laura M. , Itziar E. , Adinson B. , Purificación S. , Víctor P. , Dani B.
Published: June 2017

Introduction

The electroconvulsive therapy (ECT) is an effective treatment used for several psychiatric disorders. However, there are multiple enigmas about the mechanisms of action and factors that improve its results. Some frequent questions are if the anesthetic drug makes a difference in the time of convulsion and blood pressure.

Aims

Our principal aim is to describe the utilization of anesthetic drugs among the patients that are being treated with ECT in hospital del Mar. We also want to know the differences in the time of convulsion and systolic arterial pressure for every anesthetic drug (propofol, thiopental and etomidate).

Material and methods

We have used the database of ECT in hospital del Mar. It contains information like age, principal diagnosis, medical background and pharmacological treatment at the moment of starting ECTs; it also contains information of each individual ECT session as basal, 2 and 5 minutes arterial pressure; the anesthetic drug used, and convulsion duration.

We made an analysis of general conditions of the population, the differences of convulsion time and arterial pressure between the three anesthetic drugs.

Results

Propofol was used in 1140 sessions, thiopental in 61 sessions and etomidate in 54 sessions. The differences in the means of convulsion times between propofol and etomidate are statistically significant (“P” value < 0.05). Etomidate or thiopental increases the difference of arterial pressure more than propofol.

Conclusions

Further research about the factors that improve convulsion duration and minimize adverse effects on blood pressure is needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Predictive response factors of repetitive transcranial magnetic stimulation in treatment-resistant depression
Authors: Calvet B. , Gardère O. , Girard M. , Clément J.P.
Published: June 2017

Introduction

Repetitive transcranial magnetic stimulation (rTMS) is a neurostimulation technique used in many indications, especially in psychiatry in the treatment of mood disorders. Although its efficacy in this treatment has been demonstrated, the study of predictive response factors currently remains a major challenge.

Method

We conducted a retrospective study from the cohort of treatment-resistant depressed patients that received rTMS treatment in Esquirol Hospital in Limoges in order to identify response predictors at three months. Of the 416 patients treated between January 2007 and November 2015, 107 subjects have been included. The clinical characteristics of responders and nonresponders at three months after treatment, but also at the end of treatment and after one month were compared. Predictors of clinical improvement objectified by the Hamilton Depression Rating Scale (HDRS) were identified using a logistic regression model.

Results

In our cohort, the response rates were 52% at the end of treatment, 61% at 1 month and 57% at 3 months. Psychiatric family history and the recurrence of thymic episodes were found to be negative predictors of response to rTMS treatment. Similarly, high subscore of depression core symptoms in HDRS could also predict a poorer response.

Conclusion

Our data from a naturalistic cohort tended to prove that a number of clinical features should be taken into account in determining the profile of the treatment-resistant depressed patients that could respond to rTMS treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A systematic review and meta-analysis of the mortality rate of electroconvulsive therapy (ECT)
Authors: Torring N. , Sanghani S.N. , Petrides G. , Kellner C.H. , Ostergaard S.D.
Published: June 2017

Introduction

Electroconvulsive therapy (ECT) is an efficacious treatment for many mental disorders, but is underutilized because of fears of adverse effects, including the risk of death.

Objectives and aims

To provide a full picture of the magnitude of ECT-related mortality worldwide.

Methods

We performed a systematic review and meta-analysis (PubMed and Embase) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Only publications reporting on a specific number of ECT treatments as well as specific number of ECT-related deaths were included in our analysis. The ECT-related mortality rate was calculated by dividing the total number of ECT-related deaths by the total number of ECT treatments. The 95% confidence interval (95% CI) of this estimate was calculated using Bernoullis principle of distribution.

Results

Fourteen studies with data from 32 countries reporting on a total of 757,662 ECT treatments met the predefined inclusion criteria. Fifteen cases of ECT-related death were reported – yielding an ECT-related mortality rate of 2.0 per 100,000 treatments (95% CI: 1.0–3.0). In the eight studies published after 2001 (covering 406,229 treatments), no ECT-related deaths were reported.

Conclusions

The ECT-related mortality rate was estimated at 2 per 100,000 treatments. For comparison, a recent meta-analysis on the mortality of general anaesthesia in relation to surgical procedures reported a mortality rate of 3.4 per 100,000. Thus, our systematic review and meta-analysis documents that death caused by ECT is extremely rare. This information can be used to reassure patients in need of ECT.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Predictive biomarkers in clozapine-treated patients: Assessment of the evidences and suggestion for research methodology
Authors: Cerrato F. , Guizzaro L. , Scudellari P. , Atti A.R. , De Ronchi D.
Published: June 2017

Introduction

Predictive biomarkers are tools that identify a subpopulation of patients who are most likely to respond to a given therapy. In order to identify them a strict methodology is necessary (RCT's studies). In consideration of its cost in economic and medical terms, predictive biomarkers would be useful to distinguish clozapine-resistant patients before its administration.

Aims

The evidence concerning genetic biomarkers was reviewed with the aim of assessing whether there is enough evidence to claim for predictive biomarkers useful in practice. Secondary aims were the assessment of the evidence concerning genetic prognostic biomarkers and predictors of side effects in clozapine-treated schizophrenic patients.

Methods

One hundred and twenty-eight studies, searched on the Pubmed database or referenced in other studies, were included in this review. Sixty-five papers were related to clozapine efficacy and explored 167 genetic variants.

Results

Fifty-four variants were supported as prognostic biomarkers, three were successfully replicated: rs6280, rs6314 and rs4680; 49 papers were related to clozapine weight gain and explored 216 different genetic variants. Forty-five of which were positively related to weight gain during clozapine treatment. Among these 45 variants, only two, Rs3813929 and Rs779039, were successfully replicated.

Fourteen studies explored 111 genetic variants potentially correlated to Clozapine-induced agranulocytosis. Thirty-four variants were found to be associated with agranulocytosis. Five variants had positive results, successfully replicated. In particular, HLA B38.

Conclusions

To date there is no evidence to support a modification of clinical practice towards predictive medicine. The research could ideally progress with RCTs involving the prognostic factors found in association studies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Loss of motivation and frustration for visitor surgeons in provincial health centers or psychiatric hospitals in Greece
Authors: Christodoulou I. , Pogonidou E. , Pogonidis C. , Charalambous C.
Published: June 2017

Introduction

The core workplace for a surgeon is the operating theatre. Secondary duties may include visits to small health centers for outpatient examinations and visitor work to psychiatric hospitals.

Objective

The objective of our study is to highlight the mistakes of management that lead to half-empty provincial health centers and psychiatric hospitals.

Methods

Presentation of the 2-year-experience of a surgeon visitor in provincial health centers and in a large psychiatric hospital in Greece.

Results

The provincial health center of Lagada needs at least 4 surgeons to serve; too many patients to be examined or/and operated in 2–3 hours only. Subsequently problems arise, as simultaneously in the emergencies department a surgical eye for an abdominal pain or a bad looking leg is needed every 15 minutes. The health center of Koufalia needs 3 hours of driving per day for 3–8 surgical patients only. The psychiatric hospital offered work for 3 surgeons 5 days a week for a long period of time. During 2012–2014, only one surgeon visited the hospital once a week. The work needed to be done may kill the surgeon or force him to receive antidepressants in order to keep his functions alive.

Conclusions

Not a hint of scientific motivation for two years is a strong reason for a surgeon to avoid the duty to provincial health centers and psychiatric hospitals which is obligatory according to our national health system Laws until two years are completed for newly appointed surgeons. Managers might encourage surgeons if some balancing convenience was offered.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clozapine augmented with risperidone in treatment-resistant schizophrenia
Authors: Sulejmanpasic G. , Bise S.
Published: June 2017

Introduction

The evolution of various pharmacological therapies for schizophrenia has given rise to several pharmacological models for the neuroreceptor targets of antipsychotics and the influence of various neuroreceptors on specific symptoms and side effects.

Objectives

Experience in clinical practice affirms clozapine's position as the treatment of choice for patients with treatment-refractory schizophrenia. Unlike clozapine, risperidone has a more targeted profile of neurotransmitter binding, with particular predilection for dopamine and serotonin receptors. Risperidone is, to date, the most extensively documented clozapine augmentation agent.

Aim

The aim was to evaluate clinical efficacy, safety and tolerability of augmenting clozapine with risperidone in patients with treatment-resistant schizophrenia.

Methods

In a randomized, double-blind, placebo-controlled 8-week trial, 10 patients unresponsive or partially responsive to 300 mg/day of clozapine monotherapy (n = 5) received a steady dose of 450 mg/day clozapine combined with or up to 4 mg/day of risperidone (n = 5). Patient psychopathology was assessed at 2-week intervals with the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS) and Clinical Global Impression (CGI) improvement scale.

Results

From baseline to week 4 and week 8, mean BPRS total and positive symptom subscale scores were reduced significantly in both groups, but the reductions were significantly greater with clozapine/risperidone treatment. Reductions in SANS scores were also significantly greater with clozapine/risperidone treatment than with clozapine monotherapy group. Clozapine/risperidone treatment did not induce additional weight gain or agranulocytosis compared with clozapine monotherapy treatment.

Conclusions

Clozapine augmentation with risperidone appears to be well tolerated, safe and may provide additional clinical benefit for patients who are nonresponsive or only partially responsive to clozapine alone.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Differentiated psychopharmacological treatment in three genetic subtypes of 22q11.2 deletion syndrome
Authors: Verhoeven W.M.A. , Egger J.I.M. , de Leeuw N.
Published: June 2017

Introduction

The 22q11.2 deletion syndrome (22q11DS), mostly caused by the common deletion including the TBX- and COMT-genes (LCR22A-D), is highly associated with somatic anomalies. The distal deletion (distal of LCR22D) comprises the MAPK1-gene and is associated with specific heart defects. The rare central deletion (LCR22B-D) encompasses the CRKL-gene and shows predominantly urogenital anomalies. 22q11DS also differs in its neuropsychiatric profile: common deletion accompanied by schizophrenia-like psychoses and autism spectrum disorders, distal deletion by anxiety disorders, and central deletion by autistic-like behaviours.

Objectives

Investigating genetic subtypes of 22q11DS.

Aims

Achieving a targeted pharmacological treatment based on genetic sub-typing.

Methods

Thirty-two patients with genetically proven 22q11DS, referred for detailed neuropsychiatric analysis.

Results

Apart from two patients with distal deletion and one with central deletion, common 22q11.2 deletion was detected in 29 patients. Those with the common deletion were typified by a history of relapsing schizophrenia-like psychoses and partial non-response to conventional antipsychotics. In most patients, anxieties and mood instability were also manifest. The two patients with a distal deletion predominantly showed anxiety symptoms, while the behaviour of the patient with a central deletion was characterized by symptoms from the autism spectrum. Most patients with a common deletion could successfully be treated with clozapine or quetiapine, often combined with valproic acid. One patient with a distal deletion showed full remission upon treatment with citalopram (the second refused such a pharmacological intervention). The behaviour of the patient with central deletion improved upon contextual measures only.

Conclusions

The genetic subtype of 22q11DS enables targeting of treatment strategy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Smoking and tardive dyskinesia in patients with schizophrenia
Authors: Zouari L. , Smaoui N. , Abida I. , Charfi N. , Maâlej M. , Zouari N. , Ben Thabet J. , Maâlej M.
Published: June 2017

Introduction

Tardive dyskinesia (TD) is a drug-induced movement disorder that arises with antipsychotics. These drugs are the mainstay of treatment for schizophrenia. Epidemiological studies have shown mixed results on smoking's association with TD.

Objective

To study the association between smoking and TD induced by antipsychotics in outpatients with schizophrenia.

Methods

This was a cross-sectional study. It involved 89 patients suffering from schizophrenia, followed-up in outpatient psychiatry unit at Hédi Chaker university hospital in Sfax in Tunisia, between April and May 2016. We looked for TD in according to DSM-IV-R criteria. The intensity of TD was assessed with the Abnormal Involuntary Movement Scale (AIMS) and the level of nicotine dependence with the Fagerström Test for Nicotine Dependence (FTND).

Results

The prevalence of smoking in patients with schizophrenia was 69.6%. Of these, 54.8% had a high or very high degree of nicotine dependence. The prevalence of TD was 33.7%. The AIMS average score was 12.13 ± 5.6 with extremes ranging from 3 to 26. TD was correlated with tobacco consumption (P = 0.003), the average number of smoked cigarettes (43.7 vs. 33.8; P = 0.004) and the Fagerström average score (7.2 vs. 6.1; P = 0.012).

Conclusion

The results of this study showed a correlation between the amount of smoking and severity of TD in patients with schizophrenia. The nature of the relationship between smoking and TD needs to be clarified through an experimental study.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Attachment styles and severity of pathological gambling: Preliminary evaluations
Authors: Testa R. , Grandinetti P. , Pascucci M. , Bruschi A. , Parente P. , Pozzi G. , Janiri L.
Published: June 2017

Introduction

The addictive behaviors can be seen as attachment disorders. To our knowledge, the literature on the relationship between pathological gambling (PG) and attachment styles is still poorly represented. However, in addicted patients, the identification of secure or insecure attachment styles seems to have serious implications for the therapeutic alliance and the treatment.

Objectives

To examine the clinical role of attachment styles in the PG patients.

Aims

To study the relationships between the different attachment styles and PG and the severity of PG.

Materials

We recruited 33 patients with GP according to DSM-IV-TR criteria; all patients were abstinent from addictive behaviors at least since one month, the experiences in close relationships (ECR) was administered to investigate attachment styles, the South Oaks Gambling Screen (SOGS) to investigate the severity of gambling.

Results

The subjects showed the following attachment styles (Table 1). Ambivalent attachment style correlates with high scores to the SOGS (P < 0.001), and with a shorter period of abstinence from PG (P = 0.022). Patients with ambivalent attachment style have increased severity of PG at SOGS, correlating with higher raw score on the anxiety factor of ECR and lower raw score on avoidance factor (for both P = 0.036).

Conclusions

Patients showed ambivalent attachment, and anxiety factor correlates with a greater severity of PG. Attachment style could be a severity index of PG. Our findings need to be replicated in larger groups, also widening the target of other addictions both chemical and behavioral.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Incidence of Internet addiction in adult attention deficit hyperactivity disorder
Authors: Tuzun Mutluer B. , Yener Orum T.G. , Sertcelik S.
Published: June 2017

Objective

In this study, it was aimed to determine the internet use properties of Adult Attention Deficit Hyperactivity Disorder (ADHD) patients who were followed-up at Haydarpasa Numune Research and Training Hospital, Psychiatry Department; ADHD Outpatient Clinic.

Method

Thirty participants who were diagnosed with adult ADHD aged between 18–31 years rated their ADHD symptoms in childhood retrospectively, using Wender Utah Rating Scale. Patients rated current adult ADHD symptoms with the Adult ADHD DSM-IV-Based Diagnostic Screening and Rating Scale (DSRS) and severity of symptoms measured by Adult ADHD Self-Report Scale (ASRS). Internet addiction (IA) was assessed with Young's Internet Addiction Scale (IAS). It was determined that, none of 30 Adult ADHD patients have been diagnosed with IA.29 of patient have moderate internet use although 1 of patients have risky internet use. The results revealed that total ASRS score (P = 0.020), total Adult ADHD DSM-IV-Based DSRS score (P = 0.036) and the Attention Deficit related properties subscale total score (P = 0.042) were significantly correlated with the IAS total score. Subscale of the self-report scales including; failing to finish schoolworks, chores, or duties at workplace, difficulty of following through on instructions (P = 0.017), restiveness; impaired inhibitory performance (P = 0.017), feeling not confident (P = 0.017), difficulty of managing time (P = 0.047), failing to give close attention to details or making careless mistakes (P = 0.037) are closely relevant to IAS total score.

Result

In conclusion, clinical features, which are characteristic of Adult ADHD could have same shared etiology with IA. Furthermore, ADHD patients are more likely to have an IA diagnosis. However, it was thought that this result had to be supported with studies including larger samples.

Disclosure of interest

The authors have not supplied their declaration of competing interest.