bluuebunny/crossref_metadata_2025 huggingface dataset:
Drug prescriptions associated with long acting. Pharmaco-economic aspects
Authors: Riolo A. , Babici F. , Tassi F.
Published: June 2017

Introduction

The polypharmacy is a very controversial subject; it brings together problems of interaction between drugs, side effects, and rationality of co-prescriptions, pharmaco-economic aspects. The long acting is useful to solve adherence to treatment but they are often prescribed in polytherapy.

Method

The aim of this studies is to compare long-acting haloperidol, fluphenazine, risperidone and paliperidone regard to prescribing associations and pharmaco-economy. Also we want to consider for each long-acting which and how many drugs are associated and the implications in terms of pharmaco-economics. We examined all prescriptions (126 patients) over a period of 12 months in a mental health center, identifying which long acting had the best pharmaco-economic profile.

Results

Despite being the less prescribed and not being associated with other psychiatric drugs, paliperidone palmitate shows the best pharmaco-economic profile.

Conclusions

The costs of a drug are in relationship not only with unit price but also with the question of safety in order to oppose the overmedication.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Trauma-related dissociation: Psychological features and psycho-physiological responses to script-driven imagery in borderline personality disorder
Authors: Bichescu-Burian D. , Jürgen S. , Tilman S. , Stefan T.
Published: June 2017

Background

Defense reactions to threatening situations are vital adaptations to stress that protect organisms from injury and ensure survival. We retrospectively investigated the role of peritraumatic dissociation (PD) in the occurrence of severe psychopathology and dissociative patterns of reactions in borderline personality disorder (BPD).

Methods

We recruited 28 patients with a clinical diagnosis of BPD and 15 healthy controls. The BPD group was divided according to the level of PD (low vs. high): BPD and PD (n = 15) and BPD only (n = 13). We conducted an extensive investigation of history of trauma, clinical status, and measurements of emotional and physiologic responses to recall of personalized aversive experiences.

Results

Participants with BPD and high PD displayed highest degrees of trauma exposure and clinical symptoms. Their significant heart rate decline during the imagery of personal traumatic events was opposed to the heart rate increases exhibited by the other two groups and may indicate a dissociative reaction pattern. Skin conductance responses did not differentiate between groups. Several emotional responses to imagery provided also support of the idea that PD may play a role in memory processing of traumatic events and thus in the aggravation and maintenance of symptoms in particularly severe forms of BPD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Trait Mindfulness at Baseline Predicts Increases in Telomerase Activity Over Time
Authors: Bersani F.S. , Gilbert A. , Coccia M. , Saron C. , Epel E.
Published: June 2017

Introduction.

Preliminary investigations of cross-sectional samples have linked trait mindfulness with measures related to the hypothalamic–pituitary–adrenal (HPA)-mediated stress response and to the inflammatory system, suggesting that this is one potential pathway linking mindfulness based interventions and health. However, no previous studies explored the association between the trait mindfulness construct and markers of cellular ageing.

Methods.

In the current study we examined in a sample of healthy mothers (n = 92) of a child with Autism Spectrum Disorder (i.e. women showing high levels of chronic psychological stress) the prospective associations between a multidimensional scale of trait mindfulness, the Five Facet Mindfulness Questionnaire (FFMQ), and telomerase activity (TA), a marker of cellular ageing and telomere homeostasis. Participants’ trait mindfulness and TA were assessed at baseline as well as 9 and 18 month follow-up.

Results.

Analysis showed that higher levels of baseline mindfulness on FFMQ observation and describe subscales were related to increase in TA from baseline to 9 month (r = 0.27, P = 0.03 and r = 0.24, P = .04, respectively). Additionally, the FFMQ Describe subscale was related to increase in TA from baseline to 18 month (r = .30, P = .02). Results are reported following covariate adjustment of age, BMI, ethnicity, and education.

Discussion.

Our results showed that higher levels of baseline mindfulness are associated with higher increases in TA after 9 months and 18 months, with increased TA reportedly being associated with decreased oxidative damage, increased telomere length and overall more functional cellular physiology. These findings support a role of mindfulness-related interventions to increase general and mental health.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Time Perspective in Multiple Sclerosis Patients: Looking for Clinical Targets for Psychological Interventions
Authors: Nikolaev E. , Vasil’eva N.
Published: June 2017

Introduction

Interaction with time is a fundamental human characteristic that varies significantly in situations of severe chronic disease. Multiple sclerosis (MS) refers to medical conditions with severe damage to the nervous system, which have poor prognosis for patients.

Objectives and aims

To explore the relation between clinical variants of multiple sclerosis and time perspective in MS patients for goals of psychological interventions.

Methods

A total of 104 MS inpatients (25 men and 79 women aged 19 to 64) filled out Russian version of Zimbardo time perspective inventory (ZTPI) developed by A. Sircova, E.T. Sokolova, and O.V. Mitina, 2008. Seventy-three patients were diagnosed for relapsing-remitting multiple sclerosis (RRMS) and 31 patients for secondary progressive multiple sclerosis (SPMS).

Results

Analyzing the difference in ZTPI values in MS patients one could notice that RRMS patients showed a greater focus on positive past, while SPMS patients indicated a higher priority on the future. No gender specifics were identified in MS patients with different clinical variants of the disease (P > 0.05).

Conclusions

The data revealed could be related to the fact that SPMS patients having more severe clinical variant of MS were forced to the issues of living with the disease planning. They were ready to assess and to prepare for possible negative consequences of the disease. They also sought the most efficient use of available resources for their own future and future of their loved ones. The resulting evidence can be used to determine clinical targets for psychological interventions in MS patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychosomatic Inpatient Treatment Achieves in the Medium Term Sustainable Clinical Improvement as well as a Reduction in Utilization of Medical Services-Results of a one-year follow-up
Authors: Valdes-Stauber J. , Merath S. , Krämer S.
Published: June 2017

Background

The research on sustainability of effectiveness of inpatient psychosomatic treatment is necessary for epidemiological and economic reasons as well as towards their legitimacy.

Objectives and aims

To investigate whether the achieved clinical improvement by the inpatient treatment continues one year after discharge and whether the utilization of medical services display a significant reduction post-discharge compared to the year before admission.

Methods

Naturalistic 1 year follow-up study of a cohort (n = 122). Three measuring time points: T1 (discharge), T2 (6 months after discharge; drop-out rate about 33%), T3 (12 months after discharge; drop-out rate about 49%). Assessment by means of standardized tests of changes in clinical variables, self-efficacy, quality of life, and personality between discharge and one year after discharge. Utilization variables (hospital days, days of incapacity, medication and doctor visits) were compared with ranges in the year before admission.

Results

Improvements at discharge in general functionality, psychological and somatic stress, depressiveness, bitterness level, quality of life and self-efficacy remain one year after discharge sustainably. Furthermore, hospital days, days of incapacity, number of doctor visits and of prescribed drugs decreased significantly in comparison with the year prior to admission.

Conclusions

Inpatient psychotherapy is effective not only in short-term but also in medium-term. One year after discharge clinically improvement at discharge time-point remains stable and the utilization of medical services decreased significantly. Longer periods of observation, identification of risk groups and of resilient prognostic factors, as well as ensuring post-discharge care are necessary in order to prevent relapses and to made early interventions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Quality of Life at Disabled Child's Parents
Authors: Cavo F. , kurti A.
Published: June 2017

This study is focused on presenting the quality level of the life of parents with disabled children and the determination if there are any differences between parents that are in a treatment process and those that have just started this treatment for their children. Another aspect where this study is focused, are the indicators of life quality. A sample made by disabled children parents (n = 100), who are in “QKZHMT” center in Kombinat and PLM in Vlora, underwent the measuring instrument with a total of 40 self reporting allegations as well as, they became part of the focus groups how they present differences in applied conditions of the compound factors of life quality. In this study the research question was: “are there differences in the reported levels of parents with disabled children life quality who have just started the children treatment program with those who have started it six month ago?” Part of the quality focus was: “the differences and similarities exploration of the parenting experience of the parents with disabled children”. These conclusions where reached, affected by the comparative statistical analysis conducted in this study, that there are no statistical differences reported as well as in the overall life quality level as in its compound factors for both groups. The same result applies for the gender differences.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Coping Skills Training Intervention on the Quality of Life of Psychiatric Patient's Caregivers: A Randomized Controlled Study
Authors: Fattah Moghaddam L. , Mollasalehi F.
Published: June 2017

Introduction

The caregivers of the psychic patients experience decreased quality of life (QOL).

Aims

The aim of this study is the determination of the effect of coping skills training on improved quality of life of these caregivers compared to traditional treatments.

Methods

The samples consisted of 82 caregivers of psychiatric patients who were admitted in the educational hospital of Tehran for the first time from 2015 to 2016. The caregivers were randomly divided into two groups including Interventional group (n = 41) who received an educational booklet in addition to coping skills training, and control group (n = 41) who received usual care. A two-group randomized controlled trial was conducted, including WHOQOL-BREF questionnaire used to collect the data before and after 90 days.

Results

The results demonstrated that there were significant changes in the quality of life of family after training (P = 0.05). But this change was not seen in the control group. The comparison of the two groups after intervention indicated, that the scores of the intervention group were higher than the control group in all dimensions. But these scores were significantly different in the psychological health and the environmental health.

Conclusions

To educate the coping skills interventions can have a positive effect on the quality of life of caregivers than usual care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Integrating Mental Health care and Vocational Rehabilitation to Improve Return to work rates for People on Sick Leave Because of Common Mental Disorders
Authors: Hoff A.
Published: June 2017

Introduction

Sick leave due to common mental disorders (CMD) has major negative influence on society because of the lost productivity, social benefits, and treatment costs, and OECD estimates that the cost is equivalent to 3.4% of the Danish gross domestic product.

Objectives

The Objective is to examine, whether integrating mental health care with vocational rehabilitation, conveys shorter return to work (RTW) time, compared to treatment as usual, after sick leave due to a CMD such as depression, anxiety, and stress-related disorders.

Aims

The aims of the intervention of are to provide the shortest possible RTW time. Primary outcome is RTW time, and secondary outcomes are (a) time from RTW until recurrent sick leave and (b) symptom level a six months.

Methods

Patients are included in one of two randomized controlled studies (anxiety or depression in one RCT, and stress-related disorders in another RCT), after referral from the municipality vocational rehabilitation (VR) center, after sick leave for at least four weeks. Patients, in both trials, are randomized into one of three groups, in a ratio of 1:1:1: (a) control group, where they receive treatment as usual in primary care and municipally located VR, (b) intervention group: mental health care (MHC) in the research project, and municipally located VR (not integrated), and (c) intervention group: MHC in the research project, integrated with a special project VR.

Results

We are currently including, and as of December 2016, more than 300 are included. The total sample will be 1536 patients.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Quality in Community-Based day Center Services for People with Psychiatric Disabilities from the Attendees’ Perspective
Authors: Lundqvist L.O. , Rask M. , David B. , Agneta S.
Published: June 2017

Community-based day centers in Sweden are well-established arenas for psychiatric rehabilitation. Little is, however, known of the attendees’ perception of the quality of the service provided. Therefore, the aim of the study was to describe and investigate the quality of community-based day center services for people with psychiatric disabilities. A sample of 218 attendees (44% females) between 18 and 71 years old in 14 community-based day center services in Sweden completed the quality in psychiatric care–daily activities (QPC-DA) instrument. The results showed that people with psychiatric disabilities perceived the quality of community-based day center services as high and 87% perceived the overall quality as satisfactory. The highest ratings were found in encounter followed by support, daily activity-specific, secure environment, participation, and the lowest quality was found in secluded environment dimensions of the QPC-DA. Most notably, quality of service was rated higher by those with lower educational level, had waited shorter time to attend the center, and had better mental and physical health. However, particularly aspects of a secluded environment and participation (information) may be areas with potential for improvement. In conclusion, the results adhere to the importance of occupational balance, with periods of rest/privacy during the time at the center.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychometric Properties of the Arabic Version of Adult Hope Scale
Authors: Alali T.
Published: June 2017

Introduction

The adult hope scale (AHS) was developed as measure of hope with a 12-item using an 8-point Likert-type scale (Snyder et al., 1991). Although there is an Arabic version of AHS, it is not identical to the original version in terms of the number of items response.

Objectives

To evaluate the psychometric properties of the Arabic version of the AHS in undergraduate sample.

Methods

The participants were undergraduate Kuwaitis (1000) males and (1000) females. The mean age of the males was (20.25 ± 0.05) years, and for females was (19.96 ± 1.44) with a significant age difference (t = 4.22. P < .000). The Arabic version of the AHS was administered to participants. The internal consistency reliability, factor structure, and convergent validity of the AHS with Life Orientation Test (LOT-R), oxford happiness inventory (OHI), and Satisfaction With Life Scale (SWLS),while the divergent validity of AHS were assessed with Beck Depression Inventory-II (BDI-II) and the beck anxiety inventory (BAI).

Results

Internal consistency was satisfactory for the AHS (Cronbach's alpha = 0.83) for males and (Cronbach's alpha = 0.81) for females. The results revealed no significant gender differences on happiness (F = 1.68, P > .05). Principal component analyses (PCA) showed that a three -component solution explains %54.56 of the total variance for males and 51.99% for females. The AHS positively correlates with the following variables: SWLS (r = .43), LOT-R (r = 0.40) OHI (r = .49) while the AHS correlates negatively with BDI-II (r = −.49) and with BAI (r = −.39).

Conclusions

This study provides evidence for the reliability and validity of the Arabic AHS for Kuwaitis.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Towards a New Structure of the Interpersonal Reactivity Index. reliability and Validation of the Portuguese Version: A Comparative Analysis
Authors: Manarte L.
Published: June 2017

Objective

Empathy has received a lot of attention with the creation of an Interpersonal Reactivity Index (IRI). IRI is assessed using a 28-item questionnaire with four 7-item scales:

– perspective-taking (PT) scale;

– fantasy (FS) scale;

– empathic concern (EC) scale and iv) personal distress (PD) scale.

Such questionnaires have been translated in many languages (see Table 1). This work aims to compare the original model with existing modified, hierarchical, shortened models in the literature and to also translate and validate the IRI for Portuguese.

Methods

A convenience sampling was used (n = 130) to conduct confirmatory factor analysis (CFA) using AMOS software. The original four-factor model is contrasted with modified, hierarchical and shortened models proposed in the literature, reporting internal consistency statistics and their fit indices.

Results

The same structure of factors was found in the sample with reasonably good fit indices χ2/df = 1.57, CFI = 0.77, AGFI = 0.72 and RMSEA = 0.067. Internal reliability for each scale of the IRI was not excellent (< 0.90), but it is in line with the literature: PT with a Cronbach's alpha of 0.74, FS with 0.79, EC with 0.74 and PD with 0.65. The comparison with other modified versions of the IRI latent factor structure revealed that two models with better fit than the original version, and the potential for a shortened Portuguese version of the IRI.

Conclusion

IRI is a valid instrument to measure empathy in the Portuguese Population and is in line with previous findings. Some modifications to the original latent structure provide a better data fit than the original one.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Non-Pharmacological Treatment of ADHD Across the Lifespan
Authors: Philipsen A.
Published: June 2017

Attention Deficit Hyperactivity Disorder (ADHD) is a serious risk factor for co-occurring psychiatric disorders and negative psychosocial consequences over the lifespan. Given this background, there is a need for an effective treatment of ADHD patients.

In the lecture, evidence-based psychosocial interventions for ADHD will be presented.

Disclosure of interest

Books and articles on ADHD.

Ad Boards, Phase-III Studies on ADHD in the last five years.
CB1-5-HT2A heteromers in schizophrenia patients: Human studies in pro-neurons of the olfactory epithelium
Authors: Galindo L. , Robledo P. , Guinart D. , Pérez E.J. , Cuenca-Royo A. , Menoyo E. , Fernandez C. , García J. , Moreno E. , Casadó V. , de la Torre R. , Perez-Solá V. , Salgado P. , Oller S. , Campillo M. , Orejas O.
Published: June 2017

Introduction

Despite multiple clinical and preclinical studies investigating schizophrenia, the neurobiological basis of this disease is still unknown. The dysregulation of the serotonergic system, in particular the 5-HT2A receptor and the endocannabinoid system have been postulated as possible causes of schizophrenia.

Objectives

The aim of this study is to evaluate the expression of CB1-5-HT2A receptor heteromers in primary cultures of pro-neurons from the olfactory epithelium in schizophrenia patients and control subjects.

Methods

We recruited a group of 10 healthy volunteers and 10 patients diagnosed with schizophrenia, who were treated with atypical antipsychotics, were clinically stable and had an illness duration range from 1 up to 15 years. The patients were diagnosed with schizophrenia from the medical record and confirmed by the structured clinical interview for DSM disorders. The expression of CB1-5-HT2A receptor heteromers in primary cultures of pro-neurons from the olfactory epithelium was quantified using proximity ligation assays and confocal microscopy.

Results

Olfactory epithelium pro-neurons were viable and expressed the neuronal marker, III-β tubulin. We also established the presence and the functionality of CB1-5-HT2A receptor heteromers in these cells using the proximity ligation and cAMP activity assays, respectively. Heteromer expression was significantly increased in schizophrenia patients with respect to controls.

Conclusions

This highly innovative methodology will allow the noninvasive, low-cost study of new biomarkers for schizophrenia in a model closely related to the central nervous system.

Disclosure of interest

The authors have not supplied their declaration of competing interest.Acknowledgments

This work was supported by grants from DIUE-Generalitat-de Catalunya (2014SGR 680), Instituto de Salud Carlos III (PI14/00210) and (PI10/01708) FIS-FEDER-Funds. LG is supported by the Instituto-de Salud Carlos III through a “Río Hortega” (CM14/00111).
First acute psychotic episode: Factors associated with evolution to schizophrenia
Authors: Halouani N. , Guermazi F. , Yaich K. , Ennaoui R. , Chouayakh S. , Aloulou J. , Amami O.
Published: June 2017

Introduction

The acute psychotic episode have often a dramatic expression. Although it is easily diagnosed, it is not easy to predict the evolution and much less the prognosis that are of concern both for the therapist and the patients’ families.

Aims

To describe the profile of a population of patients with a first psychotic episode. To identify factors correlated with evolution to schizophrenia.

Methods

This is a retrospective study conducted among 55 patients hospitalized for a first acute psychotic episode, in the psychiatry B department during the period extending between January 2010 and December 2015.

Results

The average age of patients was 26.5. The majority was single male. The prodromal phase was present with predominantly psychotic symptoms (80%). Schizophrenia was the most frequently encountered scalable diagnosis (38%). Some factors are associated with the evolution to schizophrenia. We can mention male gender (P = 0.004) and premorbid schizoid personality (P = 0.047). About correlated clinical factors, we have found an initial symptomatology dominated by loss of interest (P = 0.05), withdrawal and isolation (P = 0.017), impulsivity (P = 0.011), breaking with the usual functioning (P = 0.04), mental automatism (P = 0.033), the delusions of persecution (P = 0.025) and intuitive mechanism (P = 0.023).

Conclusion

When a first acute delusional experience occurs in a young adult, it is always a test of uncertain outcome. However, schizophrenia remains the most feared evolutionary. A better understanding of poor prognosis and early and appropriate management seem paramount to reduce the prevalence of this dreaded evolution.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Reducing diabetes type 2 risk in non-selected outpatients with schizophrenia, a thirty-month program
Authors: Hjorth P.
Published: June 2017

Introduction

Diabetes type 2 is 2–3 fold more common in patients with schizophrenia compared to the general population. A lifestyle with focus on diet, exercise and medication is required to prevent complications from diabetes type 2.

Objectives

Patients may have trouble complying with a well-structured and healthy lifestyle because of factors related to their illness e.g. cognitive disturbances, negative/positive symptoms and treatment with psychotropic medication.

Aims

To measure and reduce diabetes type 2 risk factors in patients and examine characteristics associated with a positive outcome.

Methods

A naturalistic intervention study through 30 months of clinical work with individual guidance, group sessions and treatment as usual.

Results

At index, the newly diagnosed patients had a high consumption of soft drinks and low physical activity. Over time, the newly diagnosed patients worsened their physical profile with increased weight, waist circumference, visceral adiposity index (P = 0.030) and HbA1c (P = 0.010). HbA1c increased for newly diagnosed male patients with 0.24 m.mol/L (P = 0.007). The long-term patient's physical activity level was low. After the intervention, they improved in consumption of soft drinks (P = 0.001) and fast food meals (P = 0.009). Furthermore, the long-term patients lowered their weight and waist circumference while becoming more physically active. There were no changes in HbA1c in the intervention period.

Conclusion

Our study showed being long-term ill and female gender was associated with positive outcome of lifestyle intervention into improving physical health and reducing diabetes type 2 risk, meanwhile being newly diagnosed and being male showed a negative outcome despite intervention.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Serum 25-OH vitamin D level in patients with schizophrenia spectrum disorders
Authors: Kopecek M. , Protopopova D. , Knytl P. , Kohutova B. , Hanka J. , Mohr P.
Published: June 2017

Introduction

25-OH vitamin D level is an immediate precursor metabolite of the active form of vitamin D that leads to expression of more than 200 genes.

Aims

The aim of our study was to examine 25-OH vitamin D deficiency (<50nmol/L) and its relationship to demographic factors in recently hospitalised patients with schizophrenia spectrum disorders (SSD).

Methods

We assessed 25-OH vitamin D serum level in 41 SSD patients (54% of males, 46% with first episode, 63% during sunny season [May to October]), mean age 30 ± 10.4 years, within first days of hospitalization. The serum 25-OH vitamin D level was analysed with electrochemiluminiscence, using imunoanalysators Elecsys Roche.

Results

The serum level was significantly higher in sunny season (41.3 ± 27.2 nmol/L) than in November to April (28.4 ± 11.2 nmol/L): t-test, P < .05. Sixty-nine percent of patients suffered from 25-OH vitamin D deficiency (< 50nmol/L) in May to October and 100% during November to April. The 25-OH vitamin D serum levels were not different between males and females, or between first-episode and multiple-episode patients. No significant correlation between age and 25-OH vitamin D level was found.

Conclusions

The high prevalence of 25-OH vitamin D deficiency (< 50nmol/L) suggests that some patients with SSD may benefit from vitamin D supplementation.

Funding

This study is a result of the research funded by the project Nr. LO1611 with a financial support from the MEYS under the NPU I program.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
First-episode psychosis intervention – description of our early intervention model
Authors: Melo B. , Pereira C. Alves , Cajão R. , Silva J. Ribeiro , Pereira S. , Monteiro E.
Published: June 2017

Introduction

The research about the benefits of early diagnosis and treatment of first-episode psychosis had significantly increased in last decades. There have been several early intervention programs in psychotic disease, implemented worldwide, in order to improve the prognosis of these psychotic patients.

Objectives

To present a brief description of the first-episode psychosis intervention team of Tondela-Viseu Hospital Centre–Portugal and its model. We aim to further characterize our population and describe its evolution since 2008.

Aims

We aim to clarify the benefits of an early intervention in psychosis.

Methods

We conducted a retrospective cohort study of patients being followed by our team from November 2008 to September 2016. Demographic and medical data were collected (such as diagnosis, duration of untreated psychosis, treatments and its clinical effectiveness, relapse rate and hospital admissions) in patient's clinical records. The intervention model protocol of this team was also described and analyzed.

Results

This multidisciplinary team consists of three psychiatrists, one child Psychiatrist, one psychologist and five reference therapists (areas of nursing, social service and occupational therapy). It includes patients diagnosed with first-episode psychosis, aged 16 to 42 years old, followed for five years. The team followed, since its foundation, 123 patients, mostly male. The most prevalent diagnosis are schizophrenia and schizophreniform psychosis. The team is currently following 51 patients.

Conclusions

This team's intervention have progressively assumed a more relevant importance in the prognosis of patients with first-episode psychosis, by reducing the duration of untreated psychosis, the relapse rate and by promoting social reintegration.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Combination of clozapine and aripiprazole once-monthly in resistant schizophrenia. A review of a clinical case
Authors: Palomo Monge M. , Tascon Guerra M.F. , Calvo Mauri J.F. , Padilla Romero P. , Duque Domínguez A. , Díaz Conde S. , Alcocer Lanza M.F. , Lara de Lucas B. , Ochoa Blanco R.
Published: June 2017

Introduction

We report the successful management of a 49-year-old woman with an initial diagnosis of schizoaffective disorder transitioned to resistant schizophrenia. First contact with our psychiatrist service in 2000; referring problems with treatment adherence and occasional toxic abuse, she underwent 15 admissions in acute adult psychiatric hospitalisation units since then (last discharge March, 2015), and a one-year stay (2012–2013) in an adult mid-term mental health unit. She is currently followed-up throughout the major mental-health outpatient visits program.

Aims

The patient was prescribed paliperidone 6 mg 2-0-0, oxcarbazepine 600 mg 1-0-1 and clonazepam 0.5 mg 1-0-1 during the last 2 months.

Methods

Due to lack of treatment adherence and toxic abuse she suffered a psychotic decompensation in May 2015. She was then prescribed clozapine 200 mg 1-0-2, boosted with aripiprazole 400 mg once monthly. The adjunction of aripiprazole once monthly (AOM) was intended to improve treatment adherence, and to supplement the psychotic control of clozapine without entailing a worsening of therapy tolerability. The patient was monitored during 5 months in our unit.

Results

We observed a positive psychopathological evolution of the patient, which allowed us to re-evaluate the initial diagnostic, ascribing the previous mood fluctuations to toxic consumption.

Conclusion

Previous works have been published about the combination of clozapine and oral aripiprazole for the treatment of resistant schizophrenia, but, as far as we know, this is the first repost of the combined use of clozapine and AOM. Based on our results, this antipsychotic combination resulted in a psychopathological improvement of the patient, with good tolerability.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A case of pharmacologic extrapyramidal syndrome
Authors: Porta Olivares O. , Juncal Ruiz M. , Fernández Abascal Puente B. , Gómez Revuelta M. , Santayana Jenaro G. Pardo de , Sánchez Blanco L. , Landera Rodriguez R. , Pérez Santos A.B. , Revillas Almajano F. Arnaiz de las
Published: June 2017

Introduction

More than 60% of patients receiving intensive treatment with first generation antipsychotic manifest some type of clinically significant extrapyramidal side effects. Parkinsonian syndrome is the most common and is characterized by rigidity, tremors, akinesia and bradykinesia and usually improves with discontinuation of antipsychotic drug or anticholinergic association.

Methods

It is a 60-year-old man, married with two children. Initiates contact with mental health in 2013 with a diagnosis of adjustment disorder. In February 2014 he requires hospitalisation, establishing the diagnosis of delusional disorder and starting treatment with long-acting injectable paliperidone palmitate (100 mg/month) with remission of psychotic symptoms in a few days. When we receive the patient in our clinic, he presents parkinsonian extrapyramidal symptoms (UKU subscale: 18), with significant functional limitation. We decrease the dose to 75 mg/month and an anticholinergic was added without improvement of Parkinsonian clinic, so we decided to switch to long-acting injectable aripiprazole 400 mg/month, objectifying complete remission of extrapyramidal syndrome (UKU subscale: 0).

Conclusions

The mechanism of action of aripiprazole m LAI (partial agonist of D2 receptors in the brain) without decreases in the nigrostriatal dopamine pathway, of improving extrapyramidal effects associated one other antipsychotics.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Ekbom syndrome in a visually impaired patient with alcohol abuse and OCD: A case report
Authors: Portilla Fernandez A. , Montes Reula L. , Saiz García H. , Ortigosa Aguilar R. , Rosero Enriquez A.S. , Ballesteros Prados A.
Published: June 2017

This is a case report of a 63-year-old patient with no previous attentions in mental health. He is referred by his general practitioner because he presents wounds all over his body. He reports that there is a plague of bugs at his place that bite him everywhere. Therefore, he scratches continuously, trying to remove the stingers, and injuring himself all over. The family ensures there are no bugs at all, but the patient threatens to set fire to the house in order to extinguish the plague or even kill himself. An OCD with cleaning compulsive behavior was also present since many years, as well as an alcohol abuse. The patient required hospitalization in the psychiatry service. Organic cause for the disorder was discarded. Long-acting injectable aripiprazol was introduced and the patient stopped drinking. Progressively, the delusional symptoms began to subside. Now he maintains no awareness of illness but he says the bugs are disappearing and, at least, they do not bite him anymore.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Dopamine, glutamate and biotypes in the future of schizophrenia
Authors: Prata-Ribeiro H. , Ponte A. , Luísa G.
Published: June 2017

Introduction

Approximately a third of patients with schizophrenia show limited response to antipsychotic medication. As several studies have been suggesting new classifications to schizophrenia, our aim is to review different hypothesis and seek a new way of approaching patient's treatment in day-to-day practice.

Methods

The methods we used consisted on reviewing several papers that have recently been published on the area of classification and treatment of schizophrenia, considering an approach to the findings that enables a practical and clinical advantage in the area.

Discussion

New studies suggest that neuroimaging measures of dopamine and glutamate function might provide a means of stratifying patients with psychosis according to their response to treatment. Some of those studies associate treatment response with the anterior cingulate level of glutamate and striatal dopamine synthesis capacity. Other study identified three biotypes with different outcomes to psychosis, reaching a stronger association between biotypes as predictors of illness severity than the DSM-V classification. If a correlation between these studies was found, we would be able, in theory, to predict the response to treatment using simple and affordable neurobiological measures.

Conclusion

Associating the anterior cingulate glutamate levels, the striatal dopamine synthesis capacity and biotypes hypothesis in schizophrenia, one can expect to be possible to predict the degree of response to treatment, based on more affordable methods to day-to-day clinicians than the measure of neurotransmitter levels, enabling the regular clinicians to narrow their pharmacological options for patients, achieving better results in the approach to schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Antipsychotics in first-episode psychosis: Patterns of prescription in an inpatient unit
Authors: Monteiro F. , Azevedo P. , Monteiro L. , Machado C. , França G. , Norton A. , Reis A.
Published: June 2017

Introduction

The treatment of first-episode psychosis patients is different from those with multiple-episode schizophrenia: the response to antipsychotics is better, the required doses are lower and the sensitivity to side-effects is higher. As such, current guidelines recommend a “start slow, go slow” strategy and an active avoidance of side-effects.

Objectives/aims

To know the patterns of antipsychotic prescription in first-episode psychosis patients of our inpatient unit.

Methods

We retrospectively reviewed the clinical data of all non-affective first-episode psychosis patients admitted to the Inpatient Unit C of Hospital de Magalhães Lemos during 2015. The antipsychotics prescribed at admission and discharge were recorded, as well as the doses.

Results

A total of 29 patients were identified. The mean age was 36.6 and 65.5% were man. At admission, all patients were medicated with second-generation antipsychotics: 62.1% with risperidone, 27.6% with olanzapine, 6.9% with paliperidone and 3.4% with aripiprazol. The mean dose of risperidone was 3.5 mg/day. By the time of discharge, 34.5% of patients were prescribed a depot antipsychotic, half of them risperidone. Among those with oral medication only, 55.5% were prescribed risperidone, 22.2% paliperidone and the remainder 22.3% other antipsychotics (aripiprazol, olanzapine or quetiapine). The mean dose of risperidone was 3.7 mg/day.

Conclusions

Second-generation antipsychotics are clearly preferred. The mean dose by the time of discharge is similar to that used in clinical trials. However, antipsychotics are initiated at doses above the minimum effective dose. On discharge, an important proportion of patients are prescribed depot antipsychotics, which are known to improve medication adherence.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Diogene syndrome: About two clinical cases
Authors: Snene H.
Published: June 2017

Introduction

Diogenes syndrome was first described in 1975 by Clark to characterize the behavioral disorder in the elderly involving neglect of personal and domestic hygiene and a hoarding disorder or hoarding. He is regarded as a psychiatric disorder in its own right in the DSM V and declines criteria compulsive hoarding disorder (“Hoarding Disorder”). The condition is under diagnosed or its prevalence is important from 3.3 to 4, 6%.

Objective

Study through two clinical, etiologic and psychopathological diogenes syndrome (DS) and the main diagnostic and therapeutic difficulties.

Case no. 1

Mrs. L. is 57 years old, without children and with a degree in political science. She was taken back by his partner for behavioral disorder type of pathological accumulation of objects. His home has become inaccessible due to the accumulation of multiple stacks of magazines and other items. The meeting allowed to objectify an incurique presentation, delusional and hallucinatory syndrome.

Case no. 2

Mrs. BH aged 67, retired, widowed for 17 years. She lives alone after the suicide of his daughter. This would be followed by breast cancer. The patient was admitted following a report of neighbors who discovered that Mrs. BH, isolated for months, sleeping in the garden of her home saw the unhealthy state of the place and the accumulation of waste.

Conclusion

Diogenes syndrome is heterogeneous, covering multiple medical, psychiatric and social situations. Its pathogenesis remains poorly understood and its management refers to any clinician can examine ethical questions the legitimacy of its actions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Use of buspirone in selective serotonin reuptake inhibitor-induced sleep bruxism
Authors: Prisco V. , Iannaccone T. , Di Grezia G.
Published: June 2017

Sleep bruxism is characterized by the involuntary clenching or grinding of the teeth during sleep and can cause severe health problems, including the destruction of tooth structure, temporo-mandibular joint dysfunction, myofascial pain, and severe sleep disturbances. Iatrogenic sleep bruxism may be common during treatment with psychotropic medications, such as anti-psychotics and antidepressants, especially selective serotonin reuptake inhibitors (SSRIs). Bruxism is a common movement disorder that affects 8–21% of the population. The majority of bruxism symptoms are mild or moderate, although rare but severe cases may lead to serious periodontal damage, temporo-mandibular dysfunction, sleep disturbances, jaw pain, and stiffness. As a result, such cases must be treated with medication. It has been hypothesized that the mechanism of SSRI-induced bruxism may involve excessive serotonergic action on the meso-cortical neurons arising from the ventral tegmental area. It has been argued that,the addition of buspirone, was necessitated by the high level of residual anxiety. As a result, these symptoms may have been prevented through the use of buspirone alone. Buspirone, is an agonist of the 5-HT1A receptor that increases dopaminergic neuron, firing in the ventral tegmental area and increases the synaptic release of dopamine in the prefrontal cortex. These effects ameliorate drug-induced bruxism. Buspirone can also ameliorate extrapyramidal side effects, such as akathisia and tardive dyskinesia, and this property may be an additional explanation for the bruxism-related effects of the drug. Furthermore, buspirone may be an effective treatment for the bruxism associated with the use of these medications.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Which psychological and socio-demographic dimensions predict amphetamine abuse?
Authors: Farnia V. , Tatari F. , Alikhani M. , Shakeri J. , Ngo V.T. , Sadeghi Bahmani D. , Holsboer-Trachsler E. , Brand S.
Published: June 2017

Introduction

Amphetamine abuse has become a serious health concern worldwide, and this holds also true for Iran.

Aims

Investigating psychological and socio-demographic dimensions to predict amphetamine-abuse.

Methods

Hundred amphetamine abusers and 100 healthy controls took part in this cross-sectional study. Participants completed questionnaires covering socio-demographic and psychological dimensions.

Results

Compared to healthy controls, amphetamine abusers reported more insecure and ambivalent attachment styles, higher novelty-seeking and risky behaviour, less current social support and stable relationships, and lower emotional competencies. No differences were found for socio-demographic dimensions.

Conclusions

Results from this cross-sectional study underscore that amphetamine abuse was related to poor social relationships, poor emotional competencies and higher risky behaviour. The cross-sectional nature of the study, however, does preclude any conclusions about the causal direction of amphetamine abuse and poor interactional behavior.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Audit of near-fatal overdoses (NFOs) in patients on treatment via substance misuse services (SMS)
Authors: Javed U. , Moore R. , McIntosh C.
Published: June 2017

Introduction

In the NHS Forth Valley (Central Scotland) substance misuse service (SMS), there is an arrangement whereby the details of individuals administered naloxone for overdose via the ambulance service are passed to the SMS. Each patient has an allocated keyworker (nurse). It is accepted that near fatal overdoses (NFOs) are possible precursors to fatal overdose and drug-related deaths.

Objectives

To assess:

– if the information is being disseminated appropriately;

– service response and follow-up for individuals;

– patterns which might influence prescribing practice.

Methods

A list of NFOs of known patients for the previous two years was acquired from the ambulance service. There was a retrospective review of the SMS prescribing database and clinical casenotes.

Results

Patterns:

– 81% male;

– 53% aged < 40;

– 14% of NFO's involved those in titration phase;

– 86% were prescribed methadone. Methadone average dose 57 mg (20–80 mg) and 54% were prescribed > 60 mg/day.

Receipts of information:

– sixty-one percent of keyworkers were notified.

Service response:

– in most cases when the keyworkers was informed, there was prompt action to contact and review patients (0–21 days). However, only 21% had a timely review (within 1 month) by a doctor following NFO.

Conclusion

There needs to be an improvement in the dissemination of information between the ambulance service, administrative staff and keyworkers. Most NFO patients were prescribed > 60 mg of methadone. There needs to better identification of “harm-reduction” prescribing whereby methadone doses should be reduced at times of ongoing drug use. Fourteen percent of NFO's involved those in titration phase (twice weekly reviews) which provides an opportunity to screen and intervene for potential NFOs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The royal road to the obesity: A case report of food addiction
Authors: Kandeger A. , Bozkurt H.
Published: June 2017

Increasing prevalence of obesity in the world and increasing role of processed foods in daily life has led to become the focal point of food addiction. In recent years, the animal studies and human brain imaging studies demonstrated the neurobiological and behavioral similarities between drug addiction and food addiction. Here, we aim to present a 13-year-old, female, adolescent who applied with complaints of anger and irritability and shows serious addictive behaviors of chocolate. Our patient with increasing chocolate consumption in the last two years was using atomoxetine 60 mg/day with attention deficit hyperactivity disorder (ADHD). She gradually needs more chocolate to be satisfied. She has complained of nervousness, irritability and serious chocolate-seeking behavior during chocolate deprivation. She gained weight in proportion to the increase in chocolate consumption. Her daily diet was increasingly deteriorated. We used behavioral approach and sertraline in her treatment and were observed that partially benefit from treatment. Combined data from retrospective accounts of adults and prospective observations of youth indicates that juveniles with ADHD are at increased risk for cigarette smoking and substance abuse and behavioral addiction such as Internet addiction, gambling and sex addiction during adolescence. Recognition of the food addiction is important to fight against obesity, strengthening the treatment of choice in the food addiction and take political measures against food addiction are becoming inevitable.

Disclosure of interest

The authors have not supplied their declaration of competing interest.