bluuebunny/crossref_metadata_2025 huggingface dataset:
P03-350 Pharmacotherapy of Generalized Anxiety Disorders Under Conditions of Routine Treatment
Authors: Linden M. , Pyrkosch L.
Published: June 2010

Background

Generalized anxiety disorders (GAD) are characterized by persistent excessive worrying about minor hassles. GAD patients are high utilizers of medical services and medication.

According to an analysis of 21 double-blind placebo-controlled trials by of Hidalgo et al. (2007) highest effect sizes are reproted for pregabalin (0.50), hydroxyzine (0.45), venlafaxine XR (0.42), benzodiazepines (0.38), SSRIs (0.36), buspirone (0.17) and herbal medicines (-0.31). The question is how GAD is treated under conditions of routine treatment. This was studied in patients were admitted to inpatient treatment.

Method

Psychotropic premedication and changes in medication during the inpatient treatment were analyzed in 107 patients.

Results

Before admission, 27,1% of GAD patients got tricyclic antidepressants, 25,2% SSRI, 8,4% benzodiazepines, 7,4% atypical antidepressants, 1,9% anticonvulsants/pregabaline, 1,9% herbal drugs. Furthermore, 20,6% got betablocker, preferably because of hypertension.

During the inpatient stay changes in medication were made according to the clinical discretion of the therapist. At discharge 41,1% of GAD patients received SSRI, 23,4% tricyclic antidepressants, 22,4% pregabaline, 9,4% atypical antidepressants.

Conclusion

SSRI and tricyclic antidepressants play the major role in the drug treatment of GAD. Under clinical conditions there has been an optimization of treatment by increasing preferably the rate of SSRI treatments and of pregabaline treatment, while reducing benzodiazepine treatment and to some degree tricyclic antidepressants.

Literature

Hidalgo RB, Tupler LA, Davidson JRT (2007): An effect-size analysis of pharmacologic treatments for generalized anxiety disorder. J Psychopharmacol 21(8):864-872.
P03-351 Benzodiazepines in Primary Care
Authors: Ruiz Peña M. , Sanchez Guerrero J. , Iglesias Hernández M.I. , Dominguez Dominguez J.A. , Gomez Diaz I. , Gallego Castillo E.
Published: June 2010

Introduction

In Spain, consumption of psychotropic drugs is high and benzodiazepines represent 74% of the total. His prescription in primary care is very common and their use continues to grow. They are safe and effective drugs, but patients with prolonged use are elaborating the most adverse effects, particularly the dependency.

Desing

Descriptive ans cross-sectional.

Scope

Primary Health Care.

Subjects

We seleted 202 patients treated with benzodiazepines, consecutive sample, belonging to the health center Los Barrio who were seen in consultation during 2009.

Methods

We conducted through a questionnaire that cointained the treatment and demographic characteristics.

Results

We detect a frequency of use of benzodiazepines 9% (95% CI 4,7-12,1%). The profile of the consumer responds to middle-aged woman, with primary and housewives. Somatic diseases were associated in 72.6% (CI 67,2-77,5%) and had mental pathology at 59.7% (CI 53,9-65,3%). 35% (95% 29,6-40,6%) of prescribed benzodiazepines were clorazape dipotassium. Consumption was constant for over a year. The prescription from primary care represents 81% (95% 76,3-85,4%) and in 65% (CI 59,3-70,3%) is associated with other psychoactive drug.

Conclusions

In our area, highlights the prescription of benzodiazepines from primary care on demand and consumption during prolonged time. Interventions should be conducted on the prescription of benzodiazepines in medical and other interventions for patient support.
P03-353 Neuroprotective Effect of Haloperidol vs. Aripiprazole at Hippocampal and Frontal Cortex at Rats
Authors: Marinescu D. , Mogoanta L. , Udristoiu T.
Published: June 2010

Objectives

The hypofrontaliety syndrome and the hippocampal alterations are correlated with the dopamine deficit secondary to D2 receptors blockade by the antipsychotic substances. The dopamine deficit amplifies the cognitive deficit, which is an important predictor for poor outcome in schizophrenia. The psychopharmacological action of aripiprazole is a dopamine modulator compared to haloperidole which is a highly potent D2 receptors blocker.

Method

We have studied 3 groups, each consisted of 5 male adults Winstar rats each (200-250g), held through the study in temperature, humidity, food and ambient stressless conditions: N1 - control group; N2 - intraperitoneal administration of haloperidol (equivalent of 3mg); N3 - administration of aripiprazole (equivalent of 10mg). After 14 days, the rats were sacrificed and sections of their frontal cortex and hippocampus. The sample brain was histopathologically processed.

Results

Compared with control group N1, the rats of group N2 (haloperidol) have shown significant alterations in frontal cortex (neuronal loss, pinocytosis and neuronal depopulation in III, IV and VI layers) and hippocampal areas (neuronal loss). The rats of group N3 (aripiprazole) have shown minimal, non-significant changes in frontal cortex and minimal loss in hippocampal areas.

Conclusion

The decrease of neuroprotection realised by haloperidole in frontal cortex and hippocampal areas suggest the aggravation of the structural cerebral abnormalities comparative to the aripiprazole action which presented a high level of neuroprotection.
P03-361 - Determination of CYP2C19 and CYP2D6 Genotpes in a First-Episode Psychotic Sample
Authors: Nascimento M. , Berge D. , Mané A. , Hernández J. , Merino A. , Bulbena A.
Published: June 2010

Genetic factors Genetic factors contribute to psychotropic drug response. Some CYP2D6 and CYP2C19 genes polymorphisms have been described to have an important influence on the required therapeutic doses of antidepressants and antipsychotics. The knowledge on this can help to avoid and manage drug-drug interactions.

Objectives

To describe the prevalence of the different phenotypes for genes CYP2C19 and CYP2D6 in a population of first episode psychotic patients and its relation to clinical outcome, dose and race during a 2 years follow-up period.

Methods

Patients with a first psychotic episode were recruited form January 2006 to January 2009. Clinical and treatment related variables were registered at baseline and during a 2 years follow up period. CYP2D6 and CYP2C19 genotype were determined.

Results

From the 48 initially recruited patients, 21 (44%) were genetically determined. Amongst them, 13 subjects (62%) presented an efficient phenotype for the CYP2D6, 3(14%) presented an increased phenotype (ultra rapid metabolizers), 3 (14%) were intermediate metabolizers and 2 (9%) were poor metabolizers. All the patients presented an efficient phenotype for CYP2C19. The patients were Caucasian (71%) and other ethnic groups (29%). Patients were treated with risperidone (42,85%), olanzapine (47,61%), clozapine (4,76%) and aripiprazol (4,76%).

Conclusions

Most of the patients presented an efficient phenotype. However a considerable proportion were ultrarapid or poor metabolizers. Due to the small sample size, differences between ethnic groups, relapse or drug intolerance could not be found, however first glance differences were not apparent. Further studies using larger samples and considering other confounding factors would be needed.
P03-364 Comparison of Intramuscular Ziprasidone and Haloperidol for Acute Psychotic Agitation in an Emergency Room
Authors: Martínez-Formoso S. , Ramos-Ríos R. , Tajes-Alonso M. , Arrojo-Romero M.
Published: June 2010

Objectives

To compare the efficacy and safety of the intramuscular formulations of ziprasidone and haloperidol in treating agitation in schizophrenic patients attended in an emergency room.

Method

Consecutive patients were alternatively assigned to receive 20 mg of IM ziprasidone or 10 mg of IM haloperidol. Efficacy measures were improvement in Behavioral Activity Rating Scale (BARS), in the sum of five items of the Positive and Negative Syndrome Scale that focused on agitation (PANSS-A) and scores on the Clinical Global Impression improvement scale (CGI-I), obtained 45 minutes and 2 hours after the IM medication. Tolerability assessments included changes in ECG, monitoring of vital signs and register of adverse events.

Results

Finally 18 patients (13 men, mean age 40.8 ±10.2) were included in the analysis of data. At arrival in the emergency room, there were no differences between ziprasidone (Z) and haloperidol (H) groups in age, mean QTc length, mean BARS and mean PANSS-A scores. Analyzing the global sample there was an improvement in agitation scores. No significant differences were found between the groups in change of BARS and PANSS-A scores, in CGI-I scores or in the variation of the length of QTc interval at two hours. No serious adverse events were reported.

Conclusions

In spite of the small sample size, both treatments ziprasidone IM and haloperidol IM seems to be similarly effective for the management of psychotic agitation in the emergency room. Both were well tolerated. Lengthening of QTc interval due to ziprasidone IM had not been found in our sample.
P03-365 - Venlafaxine and CYP2D6 in Clinical Practice: Work in Progress
Authors: Zeppegno P. , Rolla R. , Dalò V. , Ressico F. , Parafioriti A. , Prosperini P. , Vidali M. , Bellomo G. , Torre E.
Published: June 2010

Objective

Venlafaxine (V) is a SNRI metabolized primarily by the highly polymorphic cytochrome P4502D6 enzyme (CYP2D6) in O-desmethylvenlafaxine (ODV), the main active metabolite. Four CYP2D6 metabolizer phenotypes have been identified: poor (PM), intermediate (IM), extensive (EM) and ultrarapid (UM). Approximately 5-10% Caucasians are PMs; in these individuals metabolism of substrate is decreased and adverse clinical effects may be expected. The effectiveness of pharmacogenetic tests is controversial because the association between plasma levels of V/ODV and side effects is not attested.

We discuss the association between CYP2D6-genotype and Venlafaxine clinical effects.

Methods

We will recruit Caucasian patients aged 18 to 65, eligible for Venlafaxine treatment, satisfying DSM-IV criteria for major depressive episode, dysthymia or depressive adjustment disorder. Exclusion criteria will be: pregnancy, acute suicidality, alcohol/substance abuse, concomitant/prior antidepressive treatment in the previous 3 months. We will assess patients’ age, gender, DSM-IV diagnosis, Venlafaxine dose, concomitant pharmacological treatment, BMI, BP, tobacco use, liver and kidney functionality. Clinical response and side effects will be monitored using CGI, HAM-D and SIDE at T0 (onset), T1 (1 week later) and T2 (6 weeks later).

The patients will be analyzed for the presence of 16 CYP2D6-genotype variants by INFINITITTM CYP2D6 assay which utilizes AutoGenomics proprietary film-based microarray technology.

Results

We expect to find out a correlation between CYP2D6-genotype, Venlafaxine dose and clinical response to treatment.

Conclusions

We will investigate whether a pharmacogenetic test prior to treatment can be useful in clinical practice to detect a proper Venlafaxine dosage or to switch to a different drug.
P03-367 - Sertindole in the Treatment of Tardive Dyskinesia in a Patient with Genetically Abnormal Dopamine D3 Receptors
Authors: Rizos E. , Douzenis A. , Michopoulos I. , Siafakas N. , Katsantoni E. , Gournellis R. , Lykouras L.
Published: June 2010

Objective

Tardive dyskinesia (TD) is a difficult-to-treat condition. The presence of genetically abnormal D2 and D3 dopamine receptors is associated with increased like hood of TD in patients with schizophrenia. We present a case of a patient with TD and genetically abnormal dopamine D3 receptors with chronic schizophrenia, treated successfully by sertindole.

Methods

A 47-year old male with history of chronic chizophrenia was assessed clinically by means of SCID IV, PANSS and AIMS, and was genotyped for DRD3ser-gly and 5-HT2C receptor gene polymorphisms.

Results

The patient suffered from an exacerbation of positive and negative psychotic symptoms and TD. He was also found to be DRD3ser-gly heterozygous. He had been suffering from TD for two years, developed by chronic administration of haloperidole and resperidone. A trial with quetiapine failed to ameliorate his TD and psychotic symptoms, whereas a successive trial with clozapine induced life-treating hematological side effects. After the administration of sertindole (16mh/day) his psychotic and TD symptoms remitted (PANSS:29, AIMS : 0). One year later his level of improvement was wholly preserved.

Conclusion

Sertindole might be beneficial for the treatment of TD in patients who have genetically abnormal D3 receptors.
P03-370 - Effect of Transcranial Magnetic Stimulation in Pharmacoresistant Depression
Authors: Sakkas P. , Tzavellas E. , Zaloni R. , Paparrigopoulos T. , Papadimitriou G.
Published: June 2010

Background

Transcranial magnetic stimulation (TMS) is a novel treatment for patients with depressive disorder. TMS is a noninvasive method to excite neurons in the brain: weak electric currents are induced in the tissue by rapidly changing magnetic fields. We report two cases suffering from pharmacoresistant depression and the efficacy of TMS in their treatment.

Cases

The first case was a 45-year-old male Caucasian patient suffering from unipolar depression and the second case was a 53-year-old female Caucasian patient suffering from bipolar depression.

The patients were under treatment with SSRI, SNRI, NASSA (one medicine or combination of them) without any or minor improvement.

So TMS sessions were performed daily in both patients for a period of one month.

Discussion

A marked reduction of depressive symptoms was demonstrated in both patients. Thus, TMS sessions may help the pharmacoresistant depression by minimizing physical and subjective discomfort. Furthermore TMS appears to be safer and better tolerated than many others medicines or electroconvulsive therapy. Further studies are needed in order to investigate the effect of TMS in resistant depression
P03-375 - Audit on use of Hypnotics for Insomnia in Comparison with National Institute of Clincal Excellence Guidelines
Authors: Singh G. , Bhardwaj R.
Published: June 2010

Objective

To compare prescribing practices of hypnotics against NICE guidelines (National Institute of Clinical Excellence) and to develop recommendations with action plan. The NICE recommends:

•

Due consideration should be given to non-pharmacological measures prior to hypnotic prescription.

•

Hypnotics should be prescribed for short periods of time only (maximum 4 weeks)

•

The drug with the lowest purchase cost should be prescribed.

•

Switching from one hypnotic to another should only occur if a patient experiences adverse effects.

Methodology

The audit tool was developed. The data was compiled using medical records of the patients who were seen during a specified three month time period in an out-patient setting. A total sample size of 308 was generated out of which 41(12.5%) were being prescribed hypnotics. The medical records of these 41 patients were scrutinised to gather evidence whether NICE guidelines were adhered to. The data was analysed using the tool recommended by NICE.

Results

The significant results are:

•

Only 25% of the patients were advised Non-pharmacological measures.

•

Duration of prescription ranged from one week to more than 10 years, with 33% approximately being prescribed for less than one year, and 10% being prescribed for more than 10 years.

•

There is no evidence that consideration was given to cost while prescribing.

•

Only in one patient hypnotic was switched. However, there was no evidence of adverse reaction which could be directly related to the hypnotic prescribed.

Conclusions

The overall compliance with guidelines was found to be 42%.
P03-378 - Dramatic Response of Resistant Obsessive Compulsive Disorder to Repeated Transcranial Magnetic Stimulation, a Case Report
Authors: Talaei A.
Published: June 2010

Introduction

The response rate of obsessive compulsive disorder is 21.6% to 61.3%; which shows the relative resistance to current treatments and a need for novel methods. Here, we have reported a case of resistant obsessive compulsive disorder (OCD) with fast and dramatic response to a relatively new method named repeated transcranial magnetic stimulation (rTMS). In rTMS a pulse magnetic field is emitted from a coil over the surface of the scalp which induces a localized electrical current in the cortex below. Cortical activity can then be either inhibited or stimulated.

Case report

The patient is a 40 years old female admitted for severe OCD in Mashhad Ibn-e-Sina Psychiatric Hospital. The patient was treated with 10 sessions of rTMS on right supplementary motor area (SMA) with 110% intensity, 1 Hz frequency and duration of 30 minutes per day (a total of 1200 pulses per day). Improvement of patient was evaluated serially with Yale Brown scale. By the end of the 2nd day she reported a major improvement of her symptoms. Her improvement was so dramatic in obsessive and compulsive behaviors and her avoidance recovered completely. She also reported significant improvement in her ability to control her obsessive thoughts and impulses and her anxiety symptoms.

Conclusion

Considering that rTMS is a low risk method and has almost no interaction with the common medications and the faster response with this method, it seems that it can be used as supplementary treatment in resistant cases and even in the initial stages of OCD.
P02-295 - Mental and Psychosomatic Disorders at Children and the Teenagers who Have Suffered Owing to Chernobyl Accident
Authors: Berezovsky V. , Panchenko L. , Garazha M. , Basarab I.
Published: June 2010

Objective

78 children and the teenagers. The first group - 6-11 years - 35 people (44,9%), the second group - 12-15 years - 43 people (55,1%).

Methods

kliniko-psychiatric, psychodiagnostic: «family Drawing», «the Nonexistent animal», a questionnaire «diagnostics presence of fears» by the Rostov medical university, ЕРI, a children's questionnaire of neurosises, uneasiness school.

Results

The raised weariness and uneasiness are revealed at the 51 (65,4±5,4%) schoolchildren. Intensity and the emotional stress connected with school, were marked almost at the every second child with problems in study and at the every third in time pupil. These persons more often had psychosomatic diseases, school phobias, attention frustration, hyperactivity. 42 people (53,8±5,6%) have been established the diagnosis of vegeto-vascular dystonia. It is children and the teenagers more often suffering allergic diseases, a squint, an enuresis, stutter. 12 (15,4±4,1%) children and teenagers feel fear before to parents. The greatest quantity is necessary on “medical” fears - 22 people (28,2±5,1%) among the fixed fears. Then the fears were distributed connected with causing of a physical damage - 16 people (20,5±4,6%) and socially mediated fears - 11 people (14,1±3,9%). Aggression has been fixed at 27 people (34,6±5,4%) surveyed.

Conclusions

Psychological characteristics of children and the teenagers who have suffered owing to Chernobyl accident specify in high level neurotizen and family desadaptation, uneasiness, depressive, high degree neurotizen. The psychotherapy is the basic means of treatment and preventive maintenance in system of complex social-psychological rehabilitation: dezactual neurotic semiology; symptomatic psychocorrection; socially-psychological correction; individual and family correctional work.
P02-296 - Correlation Between Personality Structure and Symptoms of Anxiety or Depression and Quality of Achieved Metabolic Control of Diabetes
Authors: Brankovic A. , Pudar G.
Published: June 2010

Many studies bring out the influence of personality structure on the way patients with chronic disease/diabetes accept their illness. The aim of this study was to determine connection between patients personality characteristics, their depressive/anxious reaction and quality of glycoregulation.

We examined 90 patients with both types of diabetes, age 20 to 75 years. All patients were followed during six months. At the beginning we determined their personality types (Persona test) and personality traits (Eysenck Personality Questionnaire). During the study plasma glucose concentrations, HbA1c, body weight and height and BMI were followed. Also we followed the presence of depression and anxiety by using Hamilton anxiety and depression scales.

Almost all patients (96,67%) had expressed trait of neuroticism (p< 0,01). Most patients (51%) had facilitator personality type (p< 0,01). The presence of depression and anxiety didn’t depend significantly on patient's personality type. The duration of diabetes had high influence on manifestation of depression and anxiety, especially in patients with diabetes type 1 (p< 0,01). During this study the number of highly anxious patients decreased in group type 2 (p< 0,05) but remained the same in group type 1 diabetes (p< 0,05). The positive correlation between expression of depression and anxiety was found (p< 0,01). At the end of this study glycoregulation was improved in all patients (p< 0,01), especially in group of facilitators and promoters.

The achieved improvement in therapy acceptance and diabetes control points out the importance of patient psychological evaluation and appropriately adjusted support, motivation and education in their treatment.
P02-297 - Neurocognitive Functioning in Untreated Patients with Bulimia Nervosa: Neuroendocrine, Personality and Clinical Correlates
Authors: Bucci P. , Galderisi S. , Mucci A. , Bellodi L. , Cassano G.B. , Santonastaso P. , Erzegovesi S. , Favaro A. , Mauri M. , Tenconi E. , Monteleone P. , Maj M.
Published: June 2010

Objectives

Cognitive impairment in patients with eating disorders was reported by the majority of studies addressing this issue. However, heterogeneous patterns of cognitive dysfunctions were observed and, in a minority of studies, no impairment was found. The present study was aimed to define the pattern of neurocognitive impairment in a large sample of bulimia nervosa (BN) patients and to demonstrate that neuroendocrine, personality and clinical characteristics influence neurocognitive performance in BN.

Methods

Attention, executive control, conditional and incidental learning were evaluated in 83 untreated female patients with BN and 77 healthy controls. Cortisol and 17β-estradiol plasma levels were assessed. Cloninger's Temperament and Character Inventory-Revised (TCI-R), the Eating Disorder Inventory-2 and the Montgomery-Asberg Depression Rating Scale were administered.

Results

No impairment of cognitive performance was found in subjects with BN vs. healthy controls. The higher the cortisol level and “Self-directedness” scores the better the performance on conditional learning, while 17β-estradiol levels showed an opposite pattern of association; “Reward dependence” scores were associated to a worse performance on incidental learning; depressive symptomatology negatively influenced the performance on the WCST.

Conclusions

No cognitive impairment was found in untreated patients with BN in the explored cognitive domains. An influence of neuroendocrine, personality and clinical variables on neurocognitive functioning was found, which might explain discrepancies in literature findings.
P02-303 - Anxio-Depressifs Troubles and Diabetes Type 2
Authors: Halwani N. , Mnif L. , Masmoudi J. , Baati I. , Feki A. , Haj Kacem H. , Ayadi N. , Jaoua A.
Published: June 2010

The objective of our study is to estimate the prevalence of depression, anxiety and alexithymia, of patients presenting a diabetes type 2 and their echo on the disease.

Method

Our study, descriptive and forward-looking, was led with diabetics type 2, consulting in the service of endocrinology of HEDI CHAKER Hospital of Sfax.

The collection of the information was realized with the help of:

-

A data sheet containing socio-demographic data and clinical data concerning the diabetes.

-

Hospital-Anxiety and Depression Scale (HADS).

-

Toronto Alexithymia Scale of 20 items.

Results

Our sample consisted of 96 diabetics: 67 women and 29 men.

The average age was of 56.23 years (ET=10, 85)

The prevalence of depression was 32.3%, that of anxiety was 56. 3%.

The alexithymia was estimated at 46.9%.

The depression was correlated to the presence of cardiac co-morbidity (p=0,012).

High prevalence of depression was found in diabetic's suffering from neurological (0.002) and renal (p=0.007) complications.

The depression was the source of a less regular follow-up.

The association depression-alexithymia was correlated at a less good balance of the diabetes (p=0.038).

The anxiety does not seem to interfere with the clinical characteristics of the type 2 diabetes.

Discussion and conclusion

Diabetics suffering from depression have more co-morbidity and complications. This risk was increased by the association of alexithymia. So, a screening of the psychiatric symptoms is necessary to improve the quality of life and the evolution of the disease.
P02-329 - Mutidisciplinary Treatment Program for Fibromyalgia
Authors: Pirone S. , Alinovi G.
Published: June 2010

Fibromyalgia(fm) is a syndrome characterized by a chronic widespread musculoskeletal pain, fatigue, poor sleep, paresthesias, headache, irritable bowel syndrome, and other comorbid problems multitude of associated symptoms. The condition is described as primarily affecting middle-aged women. Fm has no known cause or cure, and it seems that a multidisciplinary approach to treatment is necessary to meet the complex needs of this patients. We have created, a multidisciplinary program that involves a cooperative effort among the departments of Neurology, Psichiatry, Immunology and Reumatology, and Physical Rehabilitation (University of Naples “Federico II”)to support the patients. After three primary visits the diagnosis is effected and we proposed to the patient the possible treatment pharmacological, psychotherapy or both, to follow. After treatment psychic symptoms significantly improved.
P02-331 - Trauma, Attachment and Personality Development
Authors: Ammon M.
Published: June 2010

The paper gives an overview about classic psychoanalytic formulations of psychic trauma and compares them with recent contributions from trauma therapy, attachment research, and neurobiology. It focuses especially on Günter Ammon's understanding of early relationship trauma and its consequences for personality development. After reviewing relevant trauma-therapeutic approaches in contemporary psychoanalysis, Ammon's therapeutic concept for patients with early traumatizations is outlined. Finally the realization of this concept in Dynamic Psychiatry, e. g. the therapeutic setting of the clinic Menterschwaige, is described.

Objectives

The paper gives an overview about classic psychoanalytic formulations of psychic trauma and compares them with recent contributions from trauma therapy, attachment research, and neurobiology.

Methods

Brain research and psychotherapeutic methodes.

Results

Results of the brain research show that early traumatization affects brain areas in emotional states which verbalization cannot reach.

Conclusions

For early traumatized patients a treatment concept of non-verbal methods as well as verbal are necessary,
P02-333 - Efficacy of Cognitive-Behavioral Therapy for the Treatment of Recurrent Depression in Adults
Authors: Carvalho M. , Estevens D. , Guete-Tur O.
Published: June 2010

Objectives

Several studies, carried out to assess the efficacy of psychological and pharmacological treatments for depression, have shown thar combined treatments are, in general, more efficacious than an unique approach. We will present the preliminary results of an on-going research, being carried out with the main purpose of analysing the efficacy of two psychological empirically supported treatments, Cogntiive-Behvioral therapy (CBT) and Interpersonal Therapy (IPT), combined with a pharmacological antidepressive (AD) intervention, for recurrent depression.

Methods

A sample of 20 adult females has been randomly assigned to one of three conditions: a) CBT plus AD, b) IPT plus AD, and c) AD only.

A multimodal assessment matrix was developed and is being used to evaluate depression features (including suicidal ideation, intention and attempts), and the main individual, social, and environmental factors commonly related to the onset and mantainance of the disorder, namely hopelessness and pessimism, cognitive processing, interpersonal relations, and life events.

Repeated measurements are being collected at 0, 2, 4, and 6 months, and follow-up.

Results

We expect that both combined approches will be more efficacious for the reduction of depressive symptoms, including suicidal behaviors, compared to the pharmacological approach. we also expect to understand the sensitivity to change of the assessed psychological processes underlying each form of psychotherapy.
P02-352 - Outpatient Group Psychotherapy: Impact on Number and Mean Duration of Re-Entries in Acute Inpatient Unit
Authors: Marin Diaz-Guardamino E. , Bravo Barba E. , Larrañaga Rementeria L. , Hervella Garces I. , Garcia Ormaza J. , Segarra Echevarria R. , Eguiluz Uruchurtu I.
Published: June 2010

Introduction

Outpatient group psychotherapy began in our department in 2002 as a complement to the acute inpatient unit. Patients with heterogeneous diagnoses were included before or after a short-duration stay in the unit. Clinicians’ impression was that re-entries to the acute unit were less frequent and shorter after group therapy.

Objectives

The objective is to determine the real impact of group psychotherapy on the number and mean duration of these re-entries.

Methods

Data was collected for 156 patients during period of two years. The number and mean duration of hospitalization in the psychiatric acute unit were registered for each patient during the year before and in the year after therapy to be analyzed and compared.

Results

Before attending group psychotherapy 60.3% of the patients were hospitalized in the acute unit (39.1% once, 12.8% twice, 6.4% three times, 1.9% four times). 65.4% had no re-entries in the following year; 71% of those who did had one re-entry. The mean number of entries per year in the acute unit before therapy was 0.92, while the mean after therapy was 0.52. The mean stay was 7.86 days before therapy, and 4.62 days after. The mean differences between before and after entries were significant in statistical analyses.

Conclusions

Group psychotherapy seems to have effects on number and duration of re-entries to the acute unit for most patients in the different diagnostic categories. These findings have important implications, as this form of therapy is cost-effective and available for a wide range of psychiatric patients.
P02-356 - Social Implications of Group Psychotherapy on Chronic Psychoses
Authors: Mitric B. , Macic A. , Radoman N.
Published: June 2010

Introduction

Center for mental health is established in May of year 2005. Center for mental health promotes the mental health care in the community.

Objective

To evaluate the effect of group psychotherapy on chronic psychoses, ambulatory treated in Mental Health Center in Kotor, Montenegro.

Aims

The influence of the effect of group psychotherapy on chronic psychoses in the development of optimal socialization.

Method

The group consists of patients who were coming for regular check-ups in our health center during previous 3 years. The group is semi-opened and it is heterogeneous in respect to gender and age. The effect is estimated by observing the behavior of group dynamics. There were 8 regular members in this group and additional ones who participated occasionally, on suggestion of their psychiatrist.

Results

During the initial group meetings it was noticed that the patients are not familiar with each other, even though they were previously treated in our local psychiatric hospital and are inhabitants of a same, small town. They didn’t communicate with each other and didn’t even know each others names. They were distrustful toward new group members and couldn’t think of the questions to ask when the new members were presented to them. After six months, group members formed friendship relationships.

Discussion

Evaluation of the effect of group psychotherapy on chronic psychoses treated ambulatory is facilitating the development of optimal socialization as well as optimal interpersonal relationships within group, in respect to the nature and progression of mental disorder.
P02-357 - Is Psychotherapy A Creative Process? Applying the Models of Creativity on the Process of Psychotherapy
Authors: Mahfouz R. , Taha M.
Published: June 2010

Introduction

Psychotherapy is usually viewed as a process of help, reparation and personal growth. Although creativity is the real essence of psychotherapy, few works have approached psychotherapy from its creative aspect. This work investigates some creative potentials of psychotherapy.

Objectives

We tried to investigate the research question: “Can Psychotherapy follow the same stages/phases of a well known creativity model?” in two different therapy groups; an analytic group held in UK and an interactive dynamic group held in Egypt.

Aims

We aimed to follow the evolutionary phases of the therapeutic process in the two groups and find if they could be categorized into certain stages/phases that can match the stages/phases of well-known creativity models; namely Wallas’ (1926) and Barron's (1988).

Methods

-

Clinical data were derived from two therapy groups that were held in the same time in two different cultural contexts; an analytic therapy group held in UK and an interactive dynamic therapy group held in Egypt.

-

Analysis of the therapeutic work was done using Interpretative Phenomenological Analysis.

Results

The therapeutic processes in the two different groups could follow the same stages and micro-processes of well known creativity models. However, the two therapeutic groups followed two different models of creativty (the British group followed Wallas’ model and the Egyptian one followed Barron's model). This could be explained by many sociocultural factors.

Conclusions

Psychotherapy can be regarded as a creative process in the sense that it can follow the same stages and micro-processes of well known creativity modes.
P02-361 - What Can Psychiatrists do When They Find Resistance? The View of Motivational Interviewing
Authors: Pedrosa R. , Almeida S.S. , Viana M.
Published: June 2010

Motivation is a state of readiness and willingness to change, which fluctuates over time and / or situation; it is therefore a dynamic process. This state can be influenced by external (pressure, enforcement actions) or internal factors.

Motivational interviewing (MI) is a brief psychotherapeutic intervention, a scientifically tested method developed by Miller and Rollnick and viewed as a useful approach in the treatment of lifestyle problems and disease.

MI assumes that everyone has the ability and the resources they need to perform a change. However this is unlikely if the patient is trapped in a situation of ambivalence. To resolve this conflict of attraction-rejection the patient's arguments should be explored.

The resistance arises from the interaction between psychiatrist and patient. The way the psychiatrist responds to resistance can markedly reduce or intensify it. Therefore, the psychiatrist should recognize the motivational state of the patient and guide his therapeutic interventions by it. It's useful when the patient expresses resistance to stop and to acknowledge that change can be difficult. In addition, the clinician can lead the patient to consider new information or perspectives, without imposing his own views. This may trigger arguments against change and the possible breakdown of the therapeutic relationship.

In summary, an important skill in MI is to identify resistance since it can be enhanced by the way the psychiatrist responds to it. The current review provides the MI approach to resistance behaviour offering practical advice on the ways the psychiatrist can address it.
P02-365 - The Effectiveness of Cognitive Behavioral Therapy on Reduction of Chronic Tension Headache
Authors: Akasheh G. , Sadoghi M.
Published: June 2010

Objectives

The International Headache Society (IHS) defined chronic tension type headache (CTTH) in adult patients as attacks of headache that occur on at least 15 days per month over a period of at least 6 months. CTTH is costly to individual sufferers, through pain and reduced functioning, and to society, through decreased work productivity and increased health care use. Drugs do not adequately benefit many disabled headache sufferers. Behavioral headache treatments are rooted in the conceptualization of headache as a psychophysiological disorder. Such treatments target the patient's headache-related physiological responses (relaxation training, biofeedback) or behaviors, emotions, and cognitions (cognitive-behavioral therapy, stress-management). The aim of present research was examine the efficacy of cognitive-behavioral therapy for reduction of headaches in patient with chronic tension headache.

Methods

The method of this study was field/experimental. The target population of the study consisted of patient with CTTH that referred to psychiatric or neurology clinics in kashan. The sample consisted of 38 women with CTTH were assigned randomly to drug plus cognitive behavioral therapy (experimental, n=18) and drug alone (control, n=20) groups. Subjects were completed the headache diary for one week before and after intervention.

Results

An analysis of covariance showed significant differences between experimental and control groups in variable of frequency, intensity and duration of headache attacks. Drug plus CBT was found to be more effective in reducing of headache than the drug therapy alone.

Conclusions

Drug plus CBT is better than drug alone in treatment of tension headache.
P03-106 - Theroregulation in Schizophrenia: A Hot Topic
Authors: Ariyanayagam T.A. , Xiu P.Y. , Agius M. , Zaman R.
Published: June 2010

Introduction

Schizophrenia associated with thermal dysregulation

has been demonstrated in several studies, as well as being noted in the

observations of clinicians for many years. However, while there is an

abundance of research, many of the results have proven to be contradictory,

in particular regarding the confounding effect of antipsychotic medication.

To this end we will review the evidence concerning abnormal

thermoregulation. Understanding the thermal dysregulation may give us an

insight into the pathogenesis of schizophrenia, and a potential role for

orexins in the disease.

Objectives

To analyse current experimental literature on thermoregulation

in schizophrenia in medicated and unmedicated patients.

Methods

PubMed - searched with MeSH term “schizophrenia”, with additional terms;

“thermoregulation”, “orexin” or “hypocretin”.

Results

While there may be disagreements in various studies, the weight of

the early evidence points to untreated schizophrenic patients having lower

baseline core temperatures, while later studies with neuroleptics showed an

increase. Several studies also showed an impaired heat loss in

schizophrenic patients, both in medicated and unmedicated patients.

Meanwhile, orexins have been linked to heat production and heat loss during

sleep. There are also studies showing that orexins are activated by

antipsychotics, and also project to thalamic nuclei that show reduced

volume and connectivity in schizophrenia.

Conclusion

The thermal dysregulation seen in schizophrenia is a complex

process, and the underlying pathogenesis remains to be uncovered. This

mechanism may involve orexins, which may also play a part in both the

pathogenesis of schizophrenia and the relief of symptoms by antipsychotics.
P03-110 - The Evaluation of Bone Mineral Density and Osteoporosis in Schizophrenic Patients
Authors: Ranjbar F. , Farjamfar M. , Aliasgarzadeh A. , Alizadeh M.
Published: June 2010

Introduction and objectives

Schizophrenic patients are prone to osteopenia and osteoporosis due to various reasons. No research has ever been conducted on this field in Iran.

Aims

The aim of this study was to determine the bone mineral density in schizophrenic patients.

Methods

In a cross- sectional and descriptive study with random sampling, we used (DEXA) to determine Bone Mineral Density (BMD) in the lumbar and neck femur region of 85 in- schizophrenics and they were compared with general population. Statistical analysis was done finally.

Results

Sixty eight of patients were males. The average age of males and females was 39.61± 6.77 and 36.29± 7.58 years respectively. The mean femur neck BMD of male and female patients were 0.88± 0.16 and 0.87± 0.15 respectively (Pv = 0.76). Mean lumbar BMD of male and female patients was 0.94± 0.18 and 0.96± 0.14 respectively (Pv = 0.761). Liner significant correlation was not found between age and femur neck BMD (P= 0.782). Liner significant correlation was found between femur neck BMD and lumbar BMD (P< 0.001). Frequency of osteopenia in patient with the age of 30-50 years was significantly higher than other patients (P= 0.011). Frequency of femur neck osteopenia and osteoporosis were 50.6% and 4.7% respectively and frequency of lumbar osteopenia and osteoporosis were 40% and 14.1% respectively.

Conclusions

Schizophrenic patients had lower bone mineral density than general population.
P03-117 - Ziprasidone Treatment Effects on Lipids in Patients with Metabolic Risk: Preliminary Results
Authors: Said M.A. , Sulaiman A.H. , Habil M.H.
Published: June 2010

Objective

Atypical antipsychotics have been reported to induce severe metabolic side effects such as metabolic syndrome. However, ziprasidone has a safer metabolic profile and metabolic neutral for schizophrenic patient. In this prospective 24-week study, we investigate the improvements in lipids observed in patients switched from other antipsychotics.

Methods

150 patients with schizophrenia treated with antipsychotic who were having metabolic risk were switched to ziprasidone. They were analyzed to quantify clinically significant changes in metabolic parameters. At baseline assessment, fasting lipid profile was taken for total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. The same assessment was repeated at 4-weeks, 12-week and 24-week. Paired t-test and last observation carried forward (LOCF) were used for the statistical analysis. Preliminary results for those who completed 12 weeks follow up were presented.

Results

13 schizophrenic patients with 7 (53.8%) male and 6 (46.2%) female have completed the 12 weeks follow up. 6 (46.25%) patients were previously treated with olanzapine, 3 (23.1%) were on risperidal, 2(15.4%) were on paliperidone, 1(7.7%) was on haloperidol and 1(7.7%) was on trifluoperazine. There was statistically significant reduction in mean total cholesterol (5.40 ± 0.73 mmol) to (4.99 ± 0.71 mmol) p=0.007, mean LDL cholesterol (3.51 ± 0.65 mmol) to (3.21 ± 0.65 mmol) p=0.047. There was no statistically significant in mean difference for HDL cholesterol and triglycerides.

Conclusion

In short-term, switching to ziprasidone treatment resulted in clinically significant improvements in cholesterol and LDL cholesterol in at-risk patients.
P03-121 - Verbal Fluency Improves Significantly After Cognitive Remediation in First Episode Psychosis
Authors: Ojeda N. , Peña J. , Bengoetxea E. , Segarra R. , García J. , Eguiluz J.I. , Gutiérrez M. , Sánchez P.M.
Published: June 2010

Background

Verbal fluency deficits have been pointed out as a possible endophenotype in schizophrenia (Szöke et al., 2008). However, whether these deficits are specific or linked to semantic-verbal inability remains unclear. Additionally, this cognitive domain is already affected in early psychosis and do not improve despite early clinical interventions.

Objective

Authors tested the efficiency of a cognitive intervention specifically developed for improving fluency in psychosis.

Material and methods

Ninety patients with first-episode psychosis were randomly assigned to one of two groups: Cognitive rehabilitation group (REHACOP) or occupational therapy. Patients at the REHACOP group received one month structured group rehabilitation sessions (3 per week) to improve fluency. Repeated assessments of semantic fluency and phonological fluency were conducted before and after the treatment.

Results

Compared to occupational therapy, the experimental group produced significant additional improvements in phonological fluency (F = 6.87, p < 0.01), but not in semantic fluency (F = 0.61, n.s). The composite verbal fluency score was also significant (F = 4.65, p < 0.05). The improvement remained 3 months after the treatment end.

Conclusions

The cognitive treatment using REHACOP has proven to be effective in treating phonological fluency deficits in first-episode psychosis, whereas socialization or communication in group therapy by itself do not. The differential pattern showed by semantic fluency is consistent with the proposal of Szöke et al 2008, who suggest that semantic fluency is a putative endophenotype for schizophrenia with links to genetic basis compared to phonological fluency.
P03-128 - A Flexible-Dose Study of Paliperidone ER in Non-Acute Patients with Schizophrenia Previously Unsuccessfully Treated with Oral Risperidone
Authors: Schreiner A. , Hoeben D. , Lahaye M. , Tzotzoras T. , Louvrier J. , Helldin L. , Dilbaz N. , Naber D. , Dembinskiene L. , Tessier C.
Published: June 2010

Objective

To explore tolerability, safety and treatment response of flexible doses of paliperidone ER in adult non-acute patients with schizophrenia previously unsuccessfully treated with oral risperidone.

Methods

International prospective 6-month open-label study. Endpoints were the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity Scale (CGI-S), adverse events (AEs), extrapyramidal symptoms (Extrapyramidal Symptom Rating Scale; ESRS) and weight change.

Results

694 patients were included (59.2% male, mean age 40.0±12.8 years, 74.8% paranoid schizophrenia); most were enrolled because of lack of efficacy (n=366) or lack of tolerability (n=178) with prior oral risperidone treatment. 74.1% of patients (n=514) completed the 6-month study. Most frequent reasons for early discontinuation were patient choice (7.3%) and lack of efficacy (5.2%). The median mode dose of paliperidone ER was 6 mg/day, independent of the reason for switching. For all patients, mean total PANSS decreased significantly from 78.6±20.5 at baseline to 65.6±22.5 at endpoint (mean change -13.0±19.4; 95% confidence interval -14.5;-11.5, p< 0.0001). The percentage of patients rated mildly ill or less in CGI-S increased from 28.3% to 52.5% at endpoint, and the rate of patients with mild functional impairment increased from 16.5% to 36.6%. AEs reported in greater-than-or-equal-to 5% of patients were insomnia (8.8%) and anxiety (7.3%). Extrapyramidal symptoms in ESRS decreased significantly from 3.8±6.1 to 2.3±5.1 (p< 0.0001). Mean weight gain from baseline to endpoint was 0.4±4.3kg.

Conclusion

These data support results from recent randomized controlled studies that paliperidone ER is safe, well tolerated and effective in patients previously unsuccessfully treated with oral risperidone.