bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of atomoxetine in eating disorders. A case report
Authors: Landera Rodríguez R. , Juncal Ruiz M. , Sánchez Blanco L. , Santayana Jenaro G. Pardo de , Porta Olivares O. , Gómez Revuelta M. , Río Hortega I. Madrazo del , Pérez Herrera M. , Abejas Díez D. , González Gomez J.
Published: June 2017

Introduction

Eating disorders (EDs) are an important public health problem and not all patients respond adequately to psychotherapy. In the last decade, researchers report a significant comorbidity of EDs and attention-deficit/hyperactivity disorder (ADHD), especially binge eating disorder and bulimia nervosa. Some studies postulate the hypothesis of a common neurobiological substrate, such as noradrenergic pathways among others.

Objectives

To revise the possible use of atomoxetine, a highly selective noradrenergic reuptake inhibitor, for the treatment of EDs.

Methods

We describe the effect of atomoxetine in a young woman with purging disorder and history of ADHD in childhood added to cognitive behavioural therapy (CBT).

Results

patient had selective/restrictive eating behaviours, daily purges and occasional binges for last five years. At age 14 she was diagnosed with ADHD by impulsivity/aggressiveness and poor school performance, but she did not take drugs and left medical consultations. She came to our specific unit of EDs in november-2015. Her BMI was 24.88 kg/m2. We initiated CBT and atomoxetine (80 mg/day). In this first year of treatment binges and purges have disappeared and exposure to new foods and body image have improved partially. We found clear improvement in mood, motivation and attention/concentration in relation with introduction of atomoxetine. These facts have positive impact on the clinical evolution. Her current BMI is 26.90 kg/m2.

Conclusions

Identify comorbid ADHD to assess the use of specific drugs for this disorder could be beneficial in the treatment and prognosis of EDs. However, more studies are needed to determine effectivenes, particularly of non-stimulant drugs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The disorder of lived corporeality: A possible link between attachment style and eating disorder psychopathology
Authors: Monteleone A.M. , Castellini G. , Volpe U. , Nigro M. , Zamponi F. , Ricca V. , Stanghellini G. , Monteleone P.
Published: June 2017

Introduction

According to the trans-diagnostic perspective, disturbances in eating patterns of eating disorders (EDs) are considered as epiphenomena secondary to the patient's overvaluation of his/her body shape and weight.

Objectives

The phenomenological theory states that the main feature of ED psychopathology is a disturbance in the way affected persons experience their own body (embodiment). Insecure attachment may promote the development of unstable self-identity leading to use body weight as a source of self-definition.

Aims

The aim of our study was to assess the role of embodiment impairments in the relationships between attachment stiles and ED psychopathology.

Methods

One hundred twelve ED patients and 108 healthy subjects filled in the Identity and Eating Disorders (IDEA) questionnaire, which assesses embodiment and personal identity abnormalities, the eating disorder inventory-2 (EDI-2) and the experiences in close relationships (ECR) scale, which defines attachment styles.

Results

ED patients showed IDEA, EDI-2 and ECR scores significantly higher than controls. Significant correlations between IDEA scores, insecure attachment and almost all EDI-2 sub-item scores emerged in ED patients but not in controls. IDEA total score mediated the relationship between avoidant attachment and EDI-2 interoceptive awareness.

Conclusions

These findings demonstrate that in ED patients insecure attachment is correlated to disorder of identity and lived corporeality that, in turn, mediates the association between attachment and a specific ED psychopathological trait. Therefore, we suppose that early relationships, through the development of disturbances in identity and embodiment, lead to altered perception of bodily signals and deranged discrimination of one's emotions, which could contribute to EDs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The impact of self-esteem on eating disorders
Authors: Mora F. , Fernandez Rojo S. , Banzo C. , Quintero J.
Published: June 2017

Introduction

Eating disorder (ED) are an important mental health problem because of theirs overall prevalence, especially in children and adolescents. Low self-esteem is considered, along with others, one of the risk factors for the development of these disorders, without having clarified the real impact of low self-esteem on the development of ED. The aim of this study is to analyze the relationship between self-esteem and the risk of developing an eating disorder.

Material and method We have selected a sample of 500 patients who were in the 2nd year of secondary school to which has been applied a battery of scales including the Rosenberg self-esteem scale, and the EAT-26 scale for ED. We used logistic regression using SPSS to analyze the relationship between both variables.

Results

In addition to analyzing clinical and sociodemographic characteristics of the sample, we have found that for every decrease of 1 point in Rosenberg scale, there is an increase of 9 % in the probability of being a case of ED for the EAT-26 scale (P < 0.05).

Conclusions

Regarding these results, we can conclude that, in our sample, having low self-esteem score, significantly increases the likelihood of having a high score on the scale of ED. This data can be useful in establishing a preventive strategy and an adequate treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Sleep disturbances in anorexia nervosa
Authors: Vieira M.F. , Afonso P.
Published: June 2017

Introduction

In clinical practice, insomnia is a common feature in anorexia nervosa (AN). Sleep self-reports in AN suggest that these patients report poor sleep quality and reduced total sleep time. Weight loss, starvation and malnutrition can all affect sleep. Patients with eating disorders who have sleep disturbances have more severe symptomatology.

Objectives

The authors intend to review sleep disturbances observed in AN, describe possible pathophysiological mechanisms and evaluate the clinical impact of sleep disturbances on the treatment and prognosis of the disease.

Methods

In this study, a non-systematic search of published literature from January 1970 and August 2015 was carried out, through PubMed, using the following keywords: ‘sleep’, ‘anorexia nervosa’ and ‘insomnia’.

Results

These patients subjectively report having poor sleep quality, with difficulty falling asleep, interrupted sleep, early morning waking or reduced total sleep time. Sleep disturbances found in AN using polysomnography are: reduction in total sleep time, decrease in slow wave sleep, slow wave activity and reduced sleep efficiency.

Conclusions

Privation of adequate and restful sleep has a negative impact on the quality of life of patients, may contribute to the appearance of comorbidities, such as depression and anxiety, and to a poor prognosis for AN.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The correlation between mood disorders and suicide attempts for the period 2013–2015 at “Mother Teresa” hospital center, Fatbardha Myslimaj, Psychiatrist, Mirela Gokaj, Deana Rama
Authors: Myslimaj F. , Gokaj M. , Rama D.
Published: June 2017

Background

People, who have tried to commit self-injurers or suicidal attempts, refer symptomatic presence of disorders of humor and numerous problems social as factors precipitant to suicidal thoughts and actions. It is important recognition of the signs of suicide and self-inflicting behavior to help prevent suicide.

Materials and methods

The study includes a period of 3 years of cases hospitalized in the psychiatric clinic UHC, since 2013–2015. The data are taken from the records of admissions at the Psychiatric Clinic at the University Hospital Center. Results are grouped and studied issued by mood disorders, sex, age, place of residence and social status.

Results

The influence of mood disorders is recently estimated very important in causing suicide attempts compared with other mental illnesses, similar values with contemporary literature.

Conclusions

The majority of suicide attempts do not result in death. Many of these efforts are made in a way that makes salvation possible. These efforts are often a cry for help. Suicide is a social phenomenon different cognitive aspect such as ethical, philosophical, legal, psychiatric, etc. Employees of psycho-social care should be informed about this phenomenon and finding the diagnosis, prevention and treatment of suicidal attempts by persons at risk of suicide.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Maladaptive and addictive Internet use in zagazig university students, Egypt
Authors: Abdelghani M. , El-Deen G. Salah
Published: June 2017

Background

Internet use has increased broadly worldwide. There are growing concerns about problematic Internet use (PIU) among youth. Among undergraduate students, excessive Internet use can adversely affect their interpersonal relations and academic achievements.

Aim

To estimate the prevalence of PIU among Zagazig university students, and to identify the possible associations between sociodemographic and Internet-related factors and PIU.

Methods

A cross-sectional study included a total of 732 undergraduate students, aged 17–34 years, from various colleges in Zagazig University. Participants were randomly selected and assessed for their internet use and abuse using the Internet Addiction Test (IAT), along with a semi-structured questionnaire for sociodemographic and Internet-related factors.

Results

Maladaptive Internet use was found in 37.4% of respondents, and addictive Internet use was found in 4.1% of respondents. Logistic regression showed the predictors of PIU were: using the Internet throughout the day (OR 3.34, 95% CI: 1.75, 6.38), the number of hours spent daily using the Internet (OR 1.17, 95% CI: 1.10, 1.25), the number of days/week using the Internet (OR 1.28, 95% CI: 1.04, 1.58), accessing the Internet using multiple devices (OR 1.55, 95% CI: 1.21, 1.98), and accessing the Internet both indoors and outdoors (OR 1.57, 95% CI: 1.13, 2.19).

Conclusion

This is the first prevalence study of PIU at an Egyptian university. PIU was common among university students. Addressing this issue and its predictors could eventually help to enhance academic performance and achievement among those students.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mental health and human rights in Morocco: The urgent need for new policy
Authors: Aroui C. , Khoubila A. , Alami K. Mchichi , Agoub M. , Battas O. , Moussaoui D.
Published: June 2017

Introduction

All over the world, there is global emergency when it comes to respecting human rights in providing good mental health services. Morocco as an African and a developing country has always had a mental health policy defined by several glitches and failures, which had not helped him improve its mental health services quality. Nevertheless, huge improvements were achieved through time.

Objectives

This report, aims to draw attention on how compulsory it is to think and act all together to promote mental health and provide patients with better health services in Morocco.

Methods

The National Human Rights Council conducted an information and investigation mission in Morocco's main mental health hospitals and facilities between March 27 and July 6, 2012.

Results

Structures are insufficient and inadequate in terms of geographical distribution, architecture and equipment. There is a big shortage of medical and paramedical staff and little interest is given to vulnerable groups. Nevertheless, huge improvements have also been achieved through time with mental health issues becoming a cornerstone of the ministerial program, the involvement of the NGOs, the construction of newer facilities, the implementation of an information gathering system and the presence of a substance use policy.

Conclusion

Psychiatry in Morocco has come a long way since it was firstly implemented in the country as a medical specialty. Undoubtedly, a lot has been done but much more remains to be achieved. The current situation requires relevant actions and that clearly includes the implementation of a new mental health policy and the update of the legal framework.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Epidemiological study of disability from mental disorders in children and adolescents population in Saratov region in 2000–2014
Authors: Barylnik Y. , Popkov V. , Filippova N. , Abrosimova Y. , Kolesnichenko E. , Pakhomova S. , Samoilova D. , Antonova A. , Bachilo E. , Deeva M. , Sizov S.
Published: June 2017

Introduction

Children and Teenager's disability is an extremely important medical and social problem, being very characteristic of the state of public health in the country and the level of social well-being of society.

Objectives

An epidemiological study of the structure of disability due to mental disorders in children and adolescent population of the Saratov region for the period from 2000 to 2014.

Methods

The analysis of the statistical data reporting forms “Information on the health care system” and “Information on the groups of the mentally ill” in the Saratov region in 2000–2014 by epidemiological, demographic and mathematical-statistical methods.

Results

Number of children and adolescents (0–17 years), recognized as disabled by mental illness, increased both in absolute numbers (growth rate-12.86%), and the intensive indicators (49.88%). Increasing the number of disabled children and adolescents registered in schizophrenia, schizoaffective psychosis, schizotypal disorder, affective psychosis with delusions incongruent the affect. The most significant increase is observed in the group of chronic nonorganic and childhood psychoses. In epilepsy and mental retardation in the analyzed period was a slight decrease in total disability.

Conclusions

The most significant increase in disability in the group of chronic nonorganic and childhood psychosis, most likely due not only to a true increase in morbidity and disability, but also with a great attention of both the public and the country's health services to the problems of childhood autism and, as a consequence, greater detection of children with this category of disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The impact of stigma and discrimination on the quality of life and social disability in persons with a diagnosis of mental disorder. A pilot study
Authors: Gondek T.M. , Kotowicz K. , Kiejna A.
Published: June 2017

Stigma and discrimination of persons diagnosed with mental disorder is a common issue. In many European countries, research studies on the prevalence and implications of this problem are conducted in order to better understand how to overcome it. In Poland, there is a scarcity of such studies, what results in neglecting this issue by the policy makers. The objective of the study is to assess the prevalence of stigma and discrimination affecting the patients hospitalized in psychiatric day units and in-patient wards between 2016–2017 as well as to analyze the relationship between the stigma and the quality of life and social disability in persons with a mental disorder diagnosis of F20–F48 according to ICD-10, aged 18–65, in a day ward and an in-patient ward settings. The pilot study presents the data gathered from a preliminary sample of 20 patients of both genders diagnosed with the aforementioned mental disorders, equaling 10 per cent of the targeted total study sample. The quality of life is assessed with WHOQOL-Bref, WHO-5 questionnaire and Rosenberg self-esteem scale, while social disability is measured with the second version of the Groningen Social Disabilities Schedule. The assessment of the impact of stigma on the social disability of persons with mental disorders and their quality of life can be useful in the context of developing evidence-based interventions for these persons, while it could also provide the scientific data to support public information campaigns aiming at tackling the stigma against persons with mental disorders in Poland.

Disclosure of Interest

The authors have not supplied their declaration of competing interest.
Social stigma in severe mental illness in Tunisia: Clinical and socio-demographic correlates
Authors: Ouali U. , Jomli R. , Nefzi R. , Ouertani H. , Nacef F.
Published: June 2017

Introduction

Mental patients generally internalize some of the negative conceptions about how most people view them: they might be considered incompetent or untrustworthy or believe that people would not want to hire, or marry someone with mental illness. A lot of research on stigma has been conducted in western countries; however, little is still known on the situation in Arab-Muslim societies.

Objectives

To evaluate social stigma as viewed by patients suffering from severe mental illness (SMI)

Methods

This is a cross-sectional study on clinically stabilized patients with schizophrenia and Bipolar Disorder (BD) according to DSM IV, who were interviewed in our out-patients clinic with the help of a semi-structured questionnaire, containing 8 opinions on the social inclusion and stigmatization of psychiatric patients, with special reference to the local cultural context (e.g.: “It is better to hide mental illness in order to preserve the reputation of my family”)

Results

We included 104 patients, 51% with schizophrenia and 49% with BD. Mean age was 38.4 years (18–74 years); 59.6% were males. Overall social stigma scores were high. Social stigma in patients was correlated with gender, age, place of residence and diagnosis. Patients with BD showed significantly less social stigma than patients with schizophrenia.

Conclusion

Our results show the need for a better understanding of this phenomenon in patients with SMI, but also within Tunisian society, in order to elaborate anti stigma strategies adapted to the local context.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Prevalence of tobacco smoking among school teachers in Greece
Authors: Liozidou A. , Fragkoulakis M. , Papazisis G. , Tzortzi A. , Behrakis P.
Published: June 2017

Introduction

Teachers serve as models for young people and significantly influence their health behavior.

Aim

We were interested in conducting the first epidemiological survey about tobacco smoking among Greek teachers.

Methods

A total of 1032 teachers of the two biggest cities of Greece participated in the study. A questionnaire was created to include questions regarding tobacco smoking, history of tobacco use, nicotine dependence as well as health attitudes. Frequencies and relative frequencies were determined for all the questions. Pearson's Chi2 and Chi2 adjusted tests were used to examine the potential association of current smoking status with gender, age and school level in a statistical significance level of 0.05.

Results

Prevalence of current smokers in the sample was 25.6%. Cigarette emerged as the tobacco product of choice reported by 88,3% of the respondents, followed by e-cigarette (5.2%), cigar (2.4%), hookah (2.4%) and pipe (1.7%). The highest prevalence of current smoking was found in the age group of 40–49 years old (46.1%). Current smoking proportion was higher among female (26.0%) than male teachers (24.9%). Intention to quit smoking was reported by 18.1% of the sample.

Conclusions

As compared to other countries, teachers in Greece have a moderate percentage regarding tobacco smoking. A concerted effort must be made towards smoking cessation in this population with gender specific interventions. It is of great importance for teachers to act as public health promoters, as performers of tobacco prevention curricula and as leaders in the implementation of school tobacco control policies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
False memories, false innocence belief syndrome (FIBS) and ‘mind control’
Authors: Kurz R.
Published: June 2017

Introduction

Child sexual abuse allegations are extremely tricky matters to deal with as situations can range from ritual violence at one extreme to complete fabrication by vested interests at the other. A level headed approach is required that does not fall into the trap of categorizing all early childhood memories as ‘false memories’ while also being alert to possible ‘mind control’ coaching of false allegations.

Objectives

The presentation covers the origins of the false memory syndrome group and the implantation of false memories that is seemingly practiced by vested interests.

Aims

Child custody and criminal cases are frequently decided based on testimony of mental health professionals who routinely appear to be poorly informed and blatantly biased.

Methods

A review of articles in the BPS publication ‘The Psychologist’ uncovered a large amount of materials written by advocates of the BFMS prompting further research.

Results

There appears to be a multitude of articles written by BFMS associates in The Psychologist. Furthermore, instances of BPS ‘censorship’ are disconcerting. On top of this, concerns have been raised in the US about the ethics of Elizabeth Loftus–the academic ‘darling’ of the false memory movement. Finally cases have come to light where false memories were seemingly implanted by vested interests to ‘snatch’ children into authority care.

Conclusions

The mine field of child sexual abuse needs to be tackled with an even-handed manner considering the full range of possibilities in assessment.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Violent incidents within psychiatric settings
Authors: Motamedi B. , Mahmoudi A. , Motamedi M.
Published: June 2017

Objective

To determine the frequency and types of aggressive and violent behaviors in acute psychiatric inpatient settings and potential interactions between staffing and patient mix and rates of the behaviours were explored.

Methods

Data on violent incidents were gathered prospectively in two acute psychiatric units in two general hospitals and two units in a psychiatric hospital in Isfahan, Iran. Staff recorded violent and aggressive incidents by using Morrison's hierarchy of aggressive and violent behavior. The classification ranged from level 1, inflicted serious harm to self or others requiring medical care, to level 8, exhibited low-grade hostility. They also completed weekly reports of staffing levels and patient mix. Regression analysis was used to calculate relative rates.

Results

A total of 400 violent incidents were recorded over a three-month period. Based on the scale, more than 50 percent of the incidents were serious. Seventy-eight percent were directed toward nursing staff. Complex relationships between staffing, patient mix, and violence were found. Relative risk increased with more nursing staff (of either sex), more non nursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and more use of seclusion. The relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness.

Conclusions

Violent incidents within psychiatric facilities were frequent and serious, with great significance for occupational health. Some clues were found in the prediction of violence.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Spitefulness and psychopathy: A contribution for an Italian adaptation
Authors: Garofalo C. , Rogier G. , Velotti P.
Published: June 2017

Introduction

Psychopathy has been individuated as an important predictor of criminal recidivism. As a consequence, a growing number of studies has examined factors associated with psychopathic traits in criminal population. While spitefulness has been associated with a range of destructive behaviors, there is a paucity of instruments that evaluate the spitefulness (Marcus & Zeigler-Hill, 2015).

Objective

Testing the validity and reliability of an Italian version of the Spitefulness Scale.

Aims

Correlate Spitefulness Scale scores and other indices of psychological functioning. We recruited an offenders sample (n = 400) and a community sample (n = 400). We administered the Spitefulness Scale (Marcus, 2014), along with the following measures: Dirty Dozen (Carmines & Zeller, 1979), Aggression Questionnaire (Buss & Perry, 1992), Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), and SRP (Hare, 1980).

Results

Offenders participants showed higher levels of spitefulness. Further, the construct validity of the scale was confirmed by associations with measures of psychopathy, emotion dysregulation, and interpersonal problems.

Conclusions

The use of the Italian version of the Spitefulness Scale seemed promising for the study of emotion recognition in both clinical and nonclinical samples.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Homicide, borderline personality disorder and paraphilic disorder: A case report
Authors: Zghal M. , Fekih Romdhane F. , El Ghali F. , Mezghani M. , Jouini L. , Ghazeli I. , Ridha R.
Published: June 2017

Introduction

Zoophilia consists of sexual intercourse by a human being with a lower animal. There is a paucity of literature on this paraphilia.

Method

In this paper, we report an uncommon case of homicide committed by a man with co-morbid borderline personality disorder and paraphilic disorder, and review the literature.

Case report

Mr SH was a single and unemployed 30-year-old male. He was hospitalized in our forensic psychiatric department following a dismissal for criminal responsibility for an act of attempted murder with premeditation. There was no history of any other psychiatric disorder, chronic physical illness or drug dependence. He complained that he had been suffering for the past ten years from sad mood, sleeplessness, loss of interest, and feelings of guilt worthlessness, and hopelessness. He had started sexual intercourse with animals eight years ago. He harbored feelings of guilt for his sexual experiences with animals. There was no formal thought disorder or perceptual abnormality. At the beginning of bestiality, he explained his unconventional behavior, by the fact that he had been bewitched, by his uncle's wife. Projective tests found borderline psychopathology. The crime occurred after a zoophilic sexual intercourse. Mr SH was obsessed with bewitchment thoughts, and got an uncontrollable urge to kill his uncle's wife. The crime was impulsive and violent. Psychiatric experts retained the diagnosis of co-morbid borderline personality disorder and other specified paraphilic disorder (DSM-5).

Conclusion

In this case, we discuss the clinical and therapeutic challenges of this complex case, and the legal liability of Mr SH.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Occupational activation centers as a solution to improve vocational rehabilitation of patients with intellectual disabilities in Poland
Authors: Krysta J. , Krysta K.
Published: June 2017

Introduction

Since the 1990's the main form of vocational rehabilitation centers in Poland were occupational therapy workshops (OTW), but the low ratio of the employment of the participants of OTW‘s led to the creation of newer, more effective institutions called Occupational Activation Centers (OAC). They were expected to be professional activity establishments, aimed at launching new career paths of people with intellectual disabilities, enabling the candidates to pass through various stages of rehabilitation and vocational activation.

Materials and methods

The analysis of available statistical data concerning the activity of OAC‘s in Poland was done.

Results

In the whole country the number of these facilities is 53, while the number of occupational therapy workshops is 665. The Law on OAC‘s restricts the employment of people with moderate disability in total employment to 35%, this indicator covering not only the persons with mental retardation, but also people with autism and mental illness. In addition the OAC‘s activity generates the cost of creating them inadequate for the quantity and quality of jobs being created.

Conclusion

It turned out that the creation of OAC‘s occurred too slowly in relation to the already operating OTW‘s and the weaknesses in the Polish system of rehabilitation and employment of people with intellectual disabilities necessitates the need to find innovative ways to solve this problem.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Innovative home based assertive outreach service for treatment of schizophrenia in Larkano, Pakistan (SOUL): Programme implementation and outcomes at the end of five years
Authors: Afghan S.
Published: June 2017

Introduction

There is a significant service gap in provision of essential treatment to patients with severe mental disorders in low-income countries, which leads to increased mental health disability and bigger disease burden on the families and society. The SOUL programme is a first of its kind in the country, which utilizes assertively engaging patients at their homes.

Objectives

The key objectives are early recognition, treatment and psychosocial support to patients with the diagnosis of schizophrenia. Additional objectives include social recovery of the patients, psycho education to family members and generating clinical and functional outcomes.

Methods

Programme design developed by host psychiatry department through stakeholder consultation. Training was undertaken for programme team and included training on use of outcome measures namely Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF). Hosting carers and families meetings on regular intervals serve the purpose of family psycho-education and receiving informal feedback about the service.

Results

Preliminary findings on clinical and functional outcomes of cohort of 125 patients recruited over continual basis over 5 years are presented. Complex community intervention shows significant change in all outcome scales (with good effect size) with before and after analysis at one year. The programme demonstrated excellent engagement with patients and very low dropout rate.

Conclusions

Low cost community intervention involving trained doctor and psychiatric nurses working under close supervision of a senior psychiatrist is feasible and achievable and can lead to robust improvements in symptoms and functional outcomes for patients with schizophrenia.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Improving oral health care in mental health service – A retrospective study of oral health care monitoring for service users accessing community mental health team
Authors: Ahmed U. , Siddiqui S.K. , Tabani K.
Published: June 2017

Introduction

Poor oral health can have a serious impact on quality of life, social inclusion and self-esteem. There is evidence to suggest that people with serious mental illness have a greater risk of experiencing oral disease and have greater oral treatment needs than the general population. Oral health problems are not well recognized by mental health professionals. We therefore conducted a retrospective study to review oral health care monitoring within the community mental health team.

Aims and objectives

To review the oral health care monitoring for patients accessing the community mental health team.

Methodology

Audit tool was developed based on oral health care guidelines outlined by the department of health, and literature review. We then retrospectively review medical records of 25 patients against following standards:.

– every client should have the most basic of oral hygiene equipment–toothbrush;

– clients should have basic oral hygiene knowledge, (i.e. brush twice or at least once a day);

– every client should be registered to a dental practitioner;

– every client should have at least one dental check-up per year;

– clients with dentures should have their dentures checked up at least once in five years;

– have a tooth brush less than three months old.

Results

Out of the 25 patients none had met the standards. It could be a reflection of lack of documentation rather than not providing appropriate information.

Conclusion

Oral health care advice should be part of care plan for people accessing mental health service.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Time Management Education Influence on Decreasing Exam Anexiety and Conditioned University Students’ Negligence of Tehran Universities
Authors: Ebrahim F. , Kolahi P. , Nabipour E.
Published: June 2017

Introduction

Test anxiety is a multidimensional phenomenon, including concerns about conflicts lead to negative emotional and behavioral responses in academic scores.

Aim

Current study examines the influence of educating time management on decreasing exam Anxiety and educational negligence of conditioned university students on Tehran.

Methods

The method of doing study is of testing in which statistical society includes conditioned university students of Tehran. Of general statistical society, we have selected 20 persons by in access sampling method. Gathering information instrument in this study is Solomon and Roth bloom's educational negligence questionnaire and sarason test anxiety in which has been in access of studied sample after testing its stability and narration.

Result

After education, the result of t-test dependent and co-variance analysis has shown time management education does have meaningful influence on decreasing test stress and conditioned university students negligence on Tehran universities.

Conclusion

Dropped students compared to other students, provided a significant contingent of students had less time management and procrastination.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Surreptitious Drug Administration: Collective Decision Making Over Riding Personal Autonomy
Authors: Nagpal R. , Jhanwar V.G.
Published: June 2017

A quaint problem indeed. This is an issue where ethical and practical management issues lock horns. An individual with no insight on a rampage, a threat to self and others cannot be given medicines without consent except in an indoor facility and admitted under a specific provision of the current statute. Contrary to the law, the mental health policy envisages community care of the individual. For a time defined interval, surreptitious medication can be administered providing much needed relief to the caregivers and calms the recipient. Surreptitious medication can of course be an instrument of control and hence would necessitate a system of checks and balances. Surreptitious medication tests legal and ethical boundaries. It offers relief to caregivers but can be an instrument of abuse. The act of administering a drug without the individual's consent is prima facie wrong but if the context is woven in, a whole new dimension arises.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Informed Consent: Pitfalls in a Patriarchal & Poorly Literate Society
Authors: Nagpal R. , Warrier E.M.D.
Published: June 2017

The judiciary enquiring suomotu into deaths following an oncology trial in central India opened a can of worms. Searching investigation suggested that informed consent was only a cosmetic exercise and the victim was usually illiterate, poor and for a monetary reward and without being informed of the consequences of the intervention, subjected to a drug trial. Further, the process of informed consent was dispensed with and “patient” was asked to sign at the bottom of the document, no questions asked. The ‘patient’ in these trials usually is from the urban poor or deeply patriarchal, poorly literate rural hinterland. This led to a media outcry, a witch-hunt, indictments, penal action and the regulatory body now insisting on a video filmed informed consent. The wheel has truly turned full circle. The regulators while seeking idealistic regulation seem to live in a utopian world. The patriarchal and illiterate populace of rural India is far removed from the rarefied world of videotaped informed consent and presents an ethically quixotic situation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Documenting the decision-making process for initiation of pharmacological VTE prophylaxis in patients admitted to an adult psychiatry ward background
Authors: Sikka G. , Mistry N.
Published: June 2017

Background

Venous thromboembolism (VTE) is a condition that causes a blood clot to form within the venous blood system. If this blood clot forms in the peripheral venous system, it can cause symptoms such as calf pain and swelling. If this clot becomes dislodged, it may travel through the vessels into the pulmonary artery which can have much more severe consequences.

Objectives

There has been a great deal of effort in recent years to increase the percentage of in-patients receiving a VTE assessment; and for those patients to receive appropriate VTE prophylaxis. VTE is a significant cause of inpatient deaths. This audit aims to compare current working practice to local standards and identify learning points.

Method

VTE assessment data were collected from two acute psychiatric in-patient wards within a specified, random date range in 2016. Data was collected by checking paper admission documentation. NICE guidelines also state that all patients should be assessed for VTE on admission, with a standard of 100%.

Results

Overall, 6.25% of general adult psychiatry patients had a VTE assessment done within 24 hours of admission.

Conclusion

This audit shows that the necessary standards are not met. Importance of these assessments will be communicated during induction programmes for all staff and the results of this audit communicated to current staff on all in-patient psychiatry wards.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Admission to In-patient Psychiatric Care in the Veneto Region (Italy), Specialisation vs. Personal Continuity of Care Approach. Preliminary Findings from the COFI Study-Italian Sites
Authors: Miglietta E. , Lasalvia A. , Sara P. , Zanatta G. , Zoppei S. , Dimitri G. , Comacchio C. , Cristofalo D. , Bonetto C. , Giacco D. , Priebe S. , Ruggeri M.
Published: June 2017

Introduction

In Italy, considerable variations exist in the organisation of out- and in-patient mental health care. One main issue is whether to prioritise specialisation (distinct clinicians for inpatient and outpatient care) or personal continuity of care (same primary clinician for a given patient within the two settings).

Aims

To study the use of psychiatric in-patient units in the Veneto region (Italy) and to evaluate differences between personal continuity of care and specialization systems.

Methods

Study conducted in the context of the COFI, multisite naturalistic EU-funded research aiming to compare the two care approaches in 5 European countries. In Italy, baseline data collection was carried out in 14 in-patient units. Data on hospitalisation, diagnosis, severity of the illness (Clinical Global Impression Scale- CGI) and patients’ appraisal of inpatient care (Client Assessment of Treatment Scale- CAT) were collected.

Results

Overall, 1118 patients were assessed. Most frequent diagnostic categories were mood (41.6%) and psychotic (38.3%) disorders, while anxiety disorders were less represented (11.9%). The majority of patients were at least at their second admission (69.4%) and had been voluntary admitted (91.5%). Length of stay and CGI scores were significantly higher for patients with mood and psychotic disorders. No difference in CGI score between the two systems was found. Patients in the continuity of care systems reported higher level of satisfaction with initial treatment and longer hospital stay (P < .001).

Conclusions

These preliminary findings suggest higher service satisfaction for personal continuity system, possibly reflecting a more individualised and comprehensive focus on the patient's needs, rather than on symptoms reduction only.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Dissociative Amnesia with Fugue vs. Shenjing Shuairuo: A Clinical Case Report. Are DSM-5 Distress Cultural Considerations Truly Transcultural Relevant?
Authors: Alberdi-Paramo I. , Tenorio M. , Montero G. , Baena R. , Niell L. , Ibañez J. , Peman J. , Villanueva M. , Gomez J. , Rodriguez J.
Published: June 2017

Introduction

We present the case report of a 21-year-old Chinese female, who was brought to the emergency department. We open the debate between the operative criteria stablished by DSM-5 of the clinical entity dissociative amnesia and Shenjing Shuairuo - the Chinese “culture-bound syndrome”.

Objectives

To expose the relevance of the cultural formulation in the clinical evaluation of patients with a different non-Western culture in Psychiatry.

Aims

The Shenjing Shuairuo syndrome (“nervous system weakness”) was originally descripted in China, it has a gradual onset, usually after a stressful event. It involves a minimum 3 of 5 symptoms group: weakness, emotions, excitement, neurological pain and sleep. This complex group of symptoms overlap with dissociative syndrome such as dissociative amnesia.

Methods/results

The cultural formulation interview (CFI) was used for the diagnostic and subsequent treatment of dissociative amnesia with fugue in a different culture patient who met the clinical criteria of this two divergent clinic entities.

Conclusions

In our clinical practice, we will deal with different culture patients, who could present common clinical entities or with the so-called “culture-bound syndromes”. The cultural formulation of the clinical cases will help the clinicians to diagnose and have better treatment's options in clinical manifestations do not correspond to the conventional entities included in mostly Western-based nomenclatures.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Homelessness and Immigrants: In Front of the Border Between Spain and France
Authors: Calvo F. , Giralt C. , Xavier C.
Published: June 2017

Introduction

In 2006, prior to the worldwide economic crisis which especially affected Western countries, Southern Spain was one of the illegal immigrant gateways from Africa into Europe. The aim of this study is to establish the rate of homeless immigrants in a cohort of 2006 and carry out a follow up until 2015 in order to explore the chronicity associated to the territory.

Methods

Sample: 949 persons experiencing homelessness in Girona, according to official records. Procedure: prospective longitudinal study of the total population of homeless people in Girona. In 2006, a list was made of all the homeless people detected by both specialised and nonspecialised teams, which have been followed until the present day. Instruments: data bases of different official teams. Statistical analysis: measures of central tendency and dispersion and contingency tables were used for the comparison of qualitative variables.

Results

Overall, 64.8% of the population of Girona are immigrants (n = 614), principally from the Maghreb, (χ2 = 36.9, df = 4, P < .001) and 333 (36.3%) are autochthonous. The percentage of homeless immigrants in relation to the total immigrant population was 4.4%. Comparing the homeless autochthonous population with the total of the autochthonous population, homelessness among autochthonous population was 0.4%.

Conclusions

The results suggest that homelessness was more incidental in the immigrant group than in the autochthonous group. The percentage of immigrants who still live in homeless conditions suggests that immigration is a risk factor in the chronicity of the problem.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Differences In Perceived Reasons for and Barriers to, Seeking Help for Depression Between People with and Without Heightened Depressive Symptomatology
Authors: Lienemann B. , Jason S.T.
Published: June 2017

Introduction

Depression is treatable, but many people with depression do not seek help. When studies are conducted assessing barriers to and reasons for help seeking, it is common to combine responses from people with and without depressive symptomatology.

Objectives/aims

The goal of the current study was to assess if people with and without heightened levels of depressive symptomatology perceive reasons/barriers similarly.

Methods

Prior to the main study, two pilot studies were conducted which resulted in sets of 10 reasons and barriers rated as those participants were most aware of as influencing their decision to seek help for depression. Participants (n = 520) rated the importance of these reasons/barriers to their decision regarding help seeking. Two groups were created based on their Beck depression inventory-II score: no to minimal and mild to severe depressive symptomatology.

Results

Although, the order across the reasons/barriers varied between the groups, the most important reason for both groups was seeking help to enjoy life again, while the most important barrier for both groups was negative side effects of depression medication. The no to minimal group rated reasons to seek help as significantly more important to their help seeking decision process than the mild to severe group, while the mild to severe group rated barriers to seeking help significantly more important to their help seeking decision process than the no to minimal group.

Conclusions

Greater importance of barriers to seeking help could partially explain why help seeking decreases as depressive symptomatology increases. Interventions should increase the importance of reasons to seek help.

Disclosure of interest

The authors have not supplied their declaration of competing interest.