bluuebunny/crossref_metadata_2025 huggingface dataset:
Boderline versus personality
Authors: Cotta C. , Jesus G. , Vila Nova V. , Moreira C.
Published: May 2016

Introduction

Latest classifications led to an inflamed debate urging for change or validation in the way personality disorders are classified. The placement in psychiatric classifications of several personality disorders, particularly Borderline Personality Disorder (BPD), is also a matter of discussion.

Objectives and aims

The present work aims to question BPDs place in classification alongside with other personality disorders, rather than focusing on the algorithms used to classify it. The authors review updated literature on core features of the disorder collected from online scientific databases.

Results

Studies reveal that the stability of the diagnosis of BPD over the longer term is less than what standard general definitions of personality disorders would appear to require. It is a chronic and debilitating syndrome with severe functional and psychosocial impairment that remain relevant when comparing to other personality disorders. Additionally, these measures show further declines over time in spite of improvement in psychopathology, in contrast to what happens with other personality disorders. Several misconceptions may have led to the placement of BPD on former axis II, namely being a direct consequence of trauma and merely explained by environmental factors. However, recent research on heritability shows the contrary and several neurobiological markers suggest it has got a nature of its own.

Conclusion

BPD is probably the most studied and validated personality disorder and has substantially greater empirical basis, clinical significance and public health implications, being both enduring and distinct from other personality disorders. We suggest the placement of BPD as major psychiatric disorder in classifications.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Comorbidity of adult ADHD and obsessive-compulsive disorder
Authors: Duque Domínguez A. , Echeverría Hernández N. , Lázaro Redondo M.D.M. , de la Torre Brasas F. , Otalora Navarro M. , Martín Díaz L. , García Montero C. , Mas Villaseñor A.
Published: May 2016

Introduction

In prospective and controlled studies followed up until adult age of patients diagnosed with ADHD in their childhood, the most frequent comorbid disorders were major depressive disorder, personality disorder (borderline and antisocial), substance use disorder and, less frequently, panic disorder and obsessive compulsive disorder.

Objectives

We report the case of a male patient aged 60, diagnosed with obsessive-compulsive disorder from his adolescence. His psychopathological progress has become aggravated over the years. Nowadays, he presents an important restlessness, which has led him to social isolation and family claudication.

Methodology

Our patient is admitted to the Psychiatric Day Hospital with an appropriated treatment for his OCD (sertraline and aripiprazole). After several days under observation, we used the scales ASRS-V1.1 y WURS finding results that suggested adult ADHD. Extended release methylphenidate was prescribed, with a fast improving of our patient's symptoms of restlessness, insecurity and impulsion phobia. He was discharged from the Centre for Psychosocial Rehabilitation showing a good evolution.

Results

– Anankastic personality disorder (F60.5);

– Dependent personality disorder (F60.7);

– Hyperkinetic disorders (F90).

Conclusions

Seventy-five percent of adults diagnosed with ADHD have comorbid disorders that should be used as severity rates, since they may cover up the ADHD symptoms or complicate the response to treatment. Adults with ADHD present high score on the scales “social maladjustment” and an often concomitant and polymorphic psychiatric pathology, object of varied diagnoses.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A comparative study between the attachment styles of adults who were raised by mothers with schizophrenic disorders, depression, and those raised by mentally healthy mothers
Authors: Hatam S. , Lea Baranovich D.
Published: May 2016

Introduction

Maternal psychopathology can have a server effect on the ability of mothers to attach to their children.

Aim

To ascertain the level of attachment of adults between the ages of 18–25 years of age who were raised by mothers who suffer from schizophrenic disorders and depressive spectrum disorders, then compared to adults who were raised by mothers with no formal clinical diagnosis.

Method

This study used the Adult Attachment Questioner (AAQ), by Simpson Rholes Philips (1996) to ascertain the level of attachment of adults between the ages of 18–25 years of age who were raised by mothers who suffer from schizophrenic disorders (n = 30) and depressive spectrum disorders (n = 30). The findings of these two groups were then compared to adults who were raised by mothers with no formal clinical diagnosis (n = 30).

Result

The findings indicated that there is a significant difference between adults who were raised by mothers with the aforementioned mental disorders (schizophrenic and depression), as compared to those who were raised by mentally healthy mothers.

Conclusion

The style of attachment in adults who were raised by mothers with the aforementioned clinical diagnosis (schizophrenic and depression) have insecure attachments, while the children who were raised by mentally healthy mothers have almost secure attachment style.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
First psychotic episode on the fifth decade? Differential diagnosis of psychotic symptoms, about a case
Authors: Manzur Rojas P. , Botias Cegarra P. , Gonzalez Galdamez A.L. , Ibernon Caballero M.I. , Raposo Hernandez M.R. , Sanchez Bahillo A. , Belmar Simo A. , Carrillo Cordoba M.A.
Published: May 2016

The postictal psychosis is a psychotic disorder that begins shortly after a crisis. Most often it affects patients with partial epilepsy and especially those with temporal lobe epilepsy. The postictal psychosis according to several publications can occur in up to 25% of patients with epilepsy. The psychotic disorder usually occurs within 24–48 hours after, be transient, with good response to treatment with antipsychotics and complete remission of psychotic symptoms. This case is for a woman of 58 years diagnosed with structural epilepsy after brain abscess left temporal intervened in childhood. The patient is being followed by neurology for complex partial seizures with secondary generalization in anti-epileptic treatment. The patient has previous studies of EEG, video EEG and brain MRI, evidence involvement of temporal lobe and hippocampus. The patient is brought to the emergency room after episode of sensory aphasia, unconsciousness and tonic-clonic limb movements, decreasing with diazepam. The patient, during the stay under observation, has auditory hallucinations, that generate anxiety must initiate being him quetiapina and clonazepam orally, yielding partially psychotic disorder, acute intracranial lesions are discarded and the patient is admitted by neurology. The evolution of psychotic disorder with antipsychotic down in a few weeks remaining asymptomatic. Epileptic psychosis is more common in refractory epilepsy. In all cases, you should make a joint approach between psychiatry and neurology, usually they have good response to antipsychotics.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Burnout and associated factors among Tunisian teachers
Authors: Masmoudi R. , Trigui D. , Ellouze S. , Sellami R. , Baati I. , Feki I. , Masmoudi J.
Published: May 2016

Introduction

Teachers are confronted with increasing difficulties and demands that make them vulnerable to burnout.

Aims

To evaluate burnout among a population of Tunisian teachers and to identify factors that may be involved.

Methods

It was a cross-sectional, descriptive and analytic study, involving 165 teachers working in 10 primary schools and 7 high schools in Sfax, Tunisia. The participants completed a self-questionnaire containing their socio-demographic and professional characteristics. They were explored by the scale of the burnout: Le Maslach Burnout Inventory General Survey (MBI-GS).

Results

The mean age of teachers was 39.96 years. The sex ratio (M:F) was 1.32. The majority (75.2%) was married. The burnout syndrome was found in 49.7% of teachers. Moderate burnout was found in 43% of cases and severe burnout in 6.7%. The causes of burnout reported by our population were bad working conditions (71.50%), quality of working relationships (65.5%) and overload work (30.3%). Bad working conditions were associated with a high level of emotional exhaustion (P < 0.005) and a low level of professional efficacy (P < 0.001), while poor quality of work relationships and overload work were associated to a high score on cynicism (P < 0.001) and a low score on professional efficacy (P < 0.001).

Conclusion

According to our study, poor working conditions, overload work and bad quality of relationships seem to be risk factors of burnout in teachers. Preventive measures should be instituted against those factors to reduce the constraints of work and improve the professional quality of life of these individuals, essential thing to optimize the educational level in our country.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The treatment of “shell shock” in World War 1: Early attitudes and treatments for post-traumatic stress disorder and combat stress reaction
Authors: Matson H.
Published: May 2016

Combat stress reaction is a mental health disorder first documented in the latter half of the 19th century. But it was not until World War 1 when men were put through the horrific ordeals of trench warfare that the term, “shell shocked” was coined. Many soldiers with shell shock then developed what is now called post-traumatic stress disorder (though the term was not defined until 1983) or acute stress disorder. The prevailing opinion was that these men who had often not suffered from any physical trauma were sufferers of cowardice. The British army created the PIE (proximity, immediacy, and expectancy) principles to get such men back to the trenches promptly where manpower was always needed. It was rarely regarded as a real psychiatric condition, which had two consequences. Firstly, that many soldiers progressed from shell shock to post-traumatic stress disorder and secondly, over 150 soldiers were executed by the British army for, “displaying cowardice” whilst in the grip of the illness. The diagnosis of “shell shock” was to be made increasingly frequently as wars became larger and more mechanized throughout the 20th century. Psychiatrists’ management of such patients initially was primitive and influenced by the zeitgeist that such servicemen were not ill, having never come across such a widespread prevalence of mental health problems until the Great War. These ranged from prescriptions of milk to lobotomies. Understanding how “shell shock” was understood, treated and learning from the mistakes made then, continues to inform management of our patients today.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Post-thalamic stroke apathy, a review and case report
Authors: Nuñez Sande C. , Torres Rincon T.M. , Fernández Hierro J.L.
Published: May 2016

Introduction

Apathy is commonly defined as lack of, or diminished, emotion, interest, concern, interest and motivation manifesting as poor engagement with others and loss of pleasure in usual interests. Occurs in various medical condition (stroke, HIV, dementia and Parkinson disease) and other psychiatric disorders. It has been related with thalamus stroke, and seen on clinical practice as a blunted emotional response and indifference.

Objective

We have tried to link cases of apathy associated with thalamic stroke and systematically review the literature for similar case reports.

Methods

We have searched MEDLINE, EMBASE, IBIDS, and the Cochrane Collaboration Database until October 2015. Published case reports of apathy in persons who had suffered a brain stroke were selected.

Results

Support the evidence in the literature of the multidimensional nature of apathy and correlate the psychiatric manifestation with the neurological findings. We find similar case reports that could support the anatomical subtract of the apathy and it's also correlated with the previous data reports.

Conclusions

These findings are discussed and interpreted in the seeking of regarding the neurobiological substrate of apathy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A case of neurosarcoidosis presenting with isolated psychotic symptoms
Authors: Onur O. , Carpar E. , Altunkaynak Y.
Published: May 2016

Neurosarcoidosis (NS) is a neurologic manifestation of sarcoidosis, a rare multisystemic granulomatous disease. Although psychiatric symptoms have been reported to occur in 20% of patients with NS, isolated NS without any signs of systemic disease is a rarity.

Case

A 56-year-old female admitted to psychiatry clinic due to complaints of forgetfulness, visual and auditory hallucinations, inability to go outside alone, washing hands in closet cabin, difficulty finding words for the last one year, progressing in last four months. Personal and family background was unremarkable. Vital signs and physical examination revealed no abnormalities. In neuropsychiatric examination, Glasgow Coma Scale score was 15 without any meningeal irritation signs or gait abnormalities. Cranial nerves, extrapyramidal, motor, cerebellar, and sensory systems were intact. All aspects of orientation (time, place and person) were impaired. She scored 12 points out of 30 in Mini Mental Test. Speech was non-fluent with looseness of associations. Impaired recall, abstract thinking, judgment, behaviour planning and attention were noted. Visiospatial disorientation and contructional dressing apraxia were revealed. MR Imaging reported a T2-weighted signal intensity change in nodular fashion suggesting a granulamatous lesion. Differential diagnoses included granulomatous diseases, neoplasms, infections and Behcet's disease. After necessary excluding evaluations were undergone, a diagnosis of NS was made due to increased angiotensin converting enzyme levels in cerebrospinal fluid. The clinical picture responded well to prednisone treatment and symptoms resolved within one month.

Conclusion

Increased awareness is essential to identify rare granulamotous diseases as a differential diagnosis in encountering psychotic symptoms accompanying demantial clinic presentation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Influence of clinical and organizational changes in the use of mechanical restraint. Eight-year retrospective analysis in Mental Health Hospital Unit of Jerez de Frontera
Authors: Pérez Revuelta J. , Montero Beltran Y. , Fernandez Cepillo L. , Molina Molina T. , Guerrero Vida R. , Villagran Moreno J.M.
Published: May 2016

Introduction

Aggressiveness is a multidimensional phenomenon, characterized by many cognitive and emotional processes, which is often present in psychiatric disorders. Until the present time, mechanical restraint has been a tool used in order to avoid risks for patients or other people around them. It should be used as a last option, so new strategies to reduce the use of these measures favoring others are being developed.

Aim

We try to analyze the influence of clinical and organizational changes in the frequency and duration of mechanical restraints, in order to provide new data and built hypothesis for future intervention plans.

Methodology

This oral communication presents a retrospective analysis of mechanical restraints carried out in the Mental Health Hospital Unit of Jerez de la Frontera between 2007 and 2014, both inclusive, a sample of 950 episodes. Several variables will be analyzed and related to the different organizational events conducted in the Clinical Management Unit of Jerez de la Frontera.

Results

There has been a gradual reduction in the duration of mechanical restraints carried out in the Mental Health Unit Hospital of Jerez de la Frontera over the eight years studied, specially after the implementation of the agitation protocol developed in 2011.

Conclusion

In our experience, the implementation of a comprehensive clinical record, deep observation of the patient by the professionals and the development of protocols to regularize interventions performed during an episode of psychomotor agitation are useful strategies to reduce the duration of each mechanical restraint episode.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Trichotillomania in delusional infestation
Authors: Sales P. , Lopes A. , Hanemann S.
Published: May 2016

Introduction

Trichotillomania is described as a recurrent failure to resist impulses to pull out hairs. It is usually associated with obsessive-compulsive disorder and body dismorphic disorder. It is usually confined to one or two sites in the body.

Objective

The aim of our work is to describe a case of delusional infestation with secondary trichotillomania and briefly review the theoretical aspects of this clinical presentation.

Methods

We searched online databases and reviewed current case reports published, using the keywords “delusional infestation”, “Ekbom syndrome” and “trichotillomania” and compared similarities in the presentation, development and outcome. We present a clinical vignette of a 38-year-old female, with no relevant psychiatric history. The patient developed severe itching that she believed was caused by bugs that lived inside her hair follicles, so she pulled out completely all of her eyebrows, eyelashes, pubic and underarms hairs. She maintained some hair on her head, that she repeatedly pulled out and proceeded to break in order to kill the bugs. She claimed to have absolutely no itchiness in the hairless areas of her body.

Results

The patient was referred to psychiatric consultation and was started on oral antipsychotics but, as the review from literature suggested, the clinical evolution only became satisfactory when an antidepressant (SSRI) was added.

Conclusion

Although, trichotillomania is more commonly seen in clinical practice in association with other psychiatric disorders, it may also present itself as a symptom of delusional activity.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Why Portugal is pushing towards migration?
Authors: Saraiva S. , Moreira C. , Andrade M. , Carneiro S. , Pinto da Costa M.
Published: May 2016

Background

International professional mobility is a reality, people have skills they can put in the global marketplace. The increasing migration of health professionals to wealthy countries is a phenomenon known as “brain drain”.

Objectives/Aims

This work aims to present the push factors that pressure people to migrate from Portugal.

Methods

A cross-sectional survey was carried out with the psychiatric trainees in Portugal. A self-administered structured questionnaire was distributed to collect psychiatry trainees’ demographic and educational characteristics.

Results

In Portugal, the majority of trainees have a Portuguese citizenship. Almost 2/3 did not have a short-mobility experience, and the majority never migrated to another country. Less than half consider staying in Portugal in the next years, and nearly 4/5 have considered leaving the country. Working conditions ranked first as the priority condition to be improved in psychiatry in Portugal, followed by financial conditions. In fact, an attractive job for psychiatry trainees in Portugal must have as the most important feature a pleasant work environment.

Conclusions

An alarming percentage of psychiatry trainees from Portugal intend to migrate. Impact on future career, financial conditions of doctors, job opportunities and better working conditions were some of the motivating factors behind the migration.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychiatric symptoms in Huntington's disease the importance of reliable information – A case report
Authors: Sobreira G. , Ferreira C. , Alves S.
Published: May 2016

Introduction

Huntington's Disease is an autosomal dominant neurodegenerative disease characterized by motor, psychiatric and cognitive symptoms. Irritability, affective disorders, apathy and psychosis are among the most frequent psychiatric symptoms and can predate the pre-clinical period.

Objective

The authors’ goal is to understand the complexity of Huntington's disease clinical presentation. Additionally, we present an illustrative clinical case.

Aims

To convey the importance of collecting reliable information in order to make a proper diagnosis.

Methods

A PubMed database review was performed using “Psychiatry”, “Psychiatric”, “Symptoms” and “Huntington's Disease” as keywords; retrieved papers were selected according to their relevance. The patient clinical record was reviewed.

Results

The authors report a case of a 39-year-old woman, who was referred in 2014, to a psychiatrist because of depressive mood and suicidal ideation with two suicidal attempts in the past 5 years. However, she did not disclose her family history of Huntington's disease neither to her GP nor her psychiatrist. She never complied with the treatment plan and was admitted, in November, into a psychiatric unit because of subtle motor changes and apathy, which had resulted in personal neglect. The diagnosis could only be made after a family interview was held and the family medical history was revealed.

Conclusions

Corroborative history from caregivers is of extreme importance in psychiatry. Early detection of symptoms can help mitigate the disease social impact. In our patient's case, by the time of proper diagnosis, she was estranged from her family and had endured distressing psychiatric symptoms without adequate treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Classical homocystinuria and psychiatric disturbances – A case report
Authors: Abreu T. , Freitas C. , Figueiredo A.R.
Published: May 2016

Introduction

Classical homocystinuria (cystathionine beta synthase deficiency) is a rare autosomal recessive disease of methionine metabolism that causes accumulation of homocysteine in the blood and cysteine deficiency. It is characterized by intellectual disability, ectopia lentis, skeleton abnormalities resembling Marfan syndrome and thromboembolic episodes. The majority of patients have psychiatric disturbances as depression, behavioral disorders, personality disorders, obsessive-compulsive disorder and, less commonly, bipolar disorder and psychosis.

Objectives and aims

To briefly review psychiatric disturbances in patients with homocystinuria and present a case report.

Methods

Literature research and analysis of patient's clinical data.

Results

A 22-year-old male was diagnosed with classical homocystinuria at age 4 due to intellectual disability and renal alterations. With aging, other problems emerged: epilepsy; postural tremor; dysesthesia; ectopia lentis; orofacial myofunctional disorder; asthma; and patellar instability. He went to a special education program. At age sixteen, he initiated Child Psychiatry consultations due to anxiety and behavioral changes, as difficulty in controlling impulses, establishing relationships and in the perception of the self. Nowadays, the patient is followed in psychiatric consultations, where he has demonstrated high difficulty to empathize. He is being treated with vitamin supplements; betaine; levetiracetam; clobazam; and propranolol, combined with a special diet.

Conclusions

It is not practical to screen every psychiatric patient for Homocystinuria, but this disease should be considered when there is a family history, early and/or acute onset, intellectual disability, atypical symptoms, unusual response to treatment, progressive cognitive change and other organic disturbances present in this disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The prevalence of depression and its correlates in ankylosing spondylitis: A systematic review and meta-analysis
Authors: Hopkins C. , Moulton C.
Published: May 2016

Introduction

Ankylosing spondylitis (AS) is a chronic inflammatory disease, associated with significant pain, functional impairment, and diminished quality of life. However, there is significant uncertainty regarding the prevalence of depression in AS and its associations.

Objectives

We performed a meta-analysis to examine the prevalence of depression in AS and its associated correlates.

Methods

The study protocol was prospectively registered with PROSPERO (CRD42015019676). EMBASE, Medline, PsycINFO and Web of Science were systematically searched for cross-sectional studies with ≥ 50 adult AS patients, which reported depression prevalence using diagnostic criteria or a validated screening tool. Depression prevalence, tool and threshold used, age, gender, disease duration, as well as measures of disease activity, functional impairment, pain and innate inflammation, were abstracted. OpenMeta was used to calculate pooled prevalence estimates and to conduct meta-regression.

Results

Eight hundred and seventy-seven texts were identified and 17 studies satisfied inclusion criteria, totalling 3187 participants (75.2% male). Six diagnostic tools and 10 different thresholds were reported, with depression prevalence estimates ranging from 4.9–55.5%. In studies using the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), 37.1% of participants satisfied criteria for mild (≥ 8) and 8.2% met criteria for moderate depression (≥ 11). Multivariate meta-regression demonstrated significant positive correlations between depression and, respectively, disease activity (P < 0.001) and C-reactive protein (P < 0.001).

Conclusions

The prevalence of depression in AS is comparable with that of other rheumatic and degenerative diseases. Moreover, depression demonstrates significant associations with age, inflammation and disease activity, which require further investigation in prospective studies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Use of antipsychotics and antidepressants in patients with HIV
Authors: Muñoz-Calero P. , García Sánchez F. , Rodriguez Criado N. , Martín Aragón R. , Cruz Fourcade J.F. , Bravo Herrero S. , Sánchez Sánchez B.
Published: May 2016

Introduction

Psychological distress appears in the majority of people infected with HIV. Depression is the most important affection, the prevalence in comparison with general population arises to 37%. Psychotic symptoms in patients with HIV are a very frequent entity, in some cases, these symptoms are pre-existent in others the evolution of the infection or a medical cause related with the infection can cause its apparition. Psychosis and depression in patients with HIV have some clinical and therapeutical considerations. Antidepressants and antipsychotics have many pharmacological interactions with antiretroviral therapy.

Objectives

Review the efficacy and safety of antidepressants and antipsychotics in patients with HIV infection.

Methods

PubMed was searched for articles published between 1966 and January 1, 2015, using the search terms HIV, AIDS, depression, phycosis, antipsychotics, antidepressants, antiretrovirals. We selected randomized placebo controlled or active comparator control trials.

Results

Twelve studies for depression treatment and 2 studies for psychosis treatment in patients with HIV infection. Selective serotonin reuptake inhibitors (SSRI) especially fluoxetine and tryciclic antidepressants are effective in treating depressive symptoms in patients with HIV infection. Testosterone and stimulants have been used in patients with mild depressive symptoms, however studies with these agents had a small sample size. Haloperidol and chlorpromazine were effective for AIDS delirium, there are not controlled trials with other antipsychotics.

Conclusions

Psychiatrists must be concern about the clinical particularities of patients with HIV and depression or psychotic symptoms. The election of antidepressant or antipsychotic has to be made very carefully because of their side effects and interactions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Aspects of cardiac anxiety in patients with a myocardial infarction
Authors: van Beek M.H. , Oude Voshaar R.C. , Pop G. , Speckens A.E.
Published: May 2016

Introduction

When the heart is in danger – as is true during a myocardial infarction (MI) – this is life-threatening and as such can provoke specific fear: so-called cardiac anxiety. Both general anxiety and depression are associated with cardiac prognosis in MI-patients. However, as most treatment studies have not shown beneficial effects on cardiac prognosis, the need to examine specific aspects of anxiety and depression post-MI has been advocated.

Methods

We examined whether cardiac anxiety can be reliably assessed with the Cardiac Anxiety Questionnaire (CAQ) in 237 hospitalized MI-patients. Cross-sectional associations were explored, as well as possible trajectories of cardiac anxiety in the year post-MI (by latent class-analysis) and its association with quality of life. Finally, the prognostic association of cardiac anxiety with major adverse cardiac events (MACE) including all-cause mortality was examined with cox-regression-survival analysis.

Results

The CAQ is a valid and reliable instrument in MI-patients and assessed fear, attention, avoidance of physical exercise, and safety-seeking behavior. Higher cardiac anxiety was associated with more psychological distress but lower severity in cardiac injury. In the year post-MI four cardiac anxiety trajectories were identified; higher cardiac anxiety was associated with worse quality of life. CAQ score significantly predicted MACE in a five-year-follow-up period, even after adjustment for age, cardiac disease severity and depressive symptoms (HRbaseline: 1.60 [95% CI: 1.05–2.45], P = 0.029; HR3-months: 1.71 [0.99–2.59]; P = 0.054).

Conclusion

Cardiac anxiety is an important and potentially modifiable factor in the treatment of MI-patients: it is prevalent and associated with quality of life and cardiac prognosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Apotemnophilia: Psychiatric disorder, neurological disorder or not a disease at all?
Authors: Novais C. , Peixoto M.J. , Oliveira M. Mota , Côrte-Real A.
Published: May 2016

Introduction

Apotemnophilia or body integrity identity disorder (BIID) is deﬁned by the uncontrollable desire to amputate one or more healthy limbs or to be paraplegic.

Objectives/aims

We reviewed the available studies of this condition in order to enhance the comprehension of this disorder and the possible need of a multidisciplinary assessment.

Methods

Relevant papers from 2000 were identified using PubMed database, with the terms apotemnophilia, BIID and self-demand amputation.

Results

Reports of the phenomenon of amputee attraction trace back to 1933 in a series of letters and articles published in journals and magazines by erotically-obsessed persons who wanted to become amputees themselves. The first scientific report of this issue only appeared in 1977, when John Money described two cases that requested an amputation of a healthy limb, a condition he named apotemnophilia. Would-be amputees – or “wannabes” – may appear in thousands and they have their own websites. Until now, the explanation of this phenomenon has been in favor of a psychiatric etiology: a pathological desire driven by a sexual compulsion. Recently, a neurological explanation has been proposed and defends that might exist a dysfunction of the right parietal lobe, leading to a distorted body image and a desire for an amputation.

Conclusions

Apotemnophilia is a rare, uncommonly studied condition, which blurs the limits between psychiatry and neurology. We must be aware that this disorder is more frequent in unusual places like websites and others. A better understanding of this condition is crucial for the development of effective treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychosocial and clinical characteristics of depressed patients with metabolic syndrome
Authors: Martinac M. , Babić D. , Pavlović M.
Published: May 2016

Introduction

Depression is a complex disease associated with sleep, appetite and body weight disturbances as well as with the level of physical activity, all of which may be the risk factors for the development of metabolic disorders. Different physiological mechanisms as well as psychosocial factors such as gender, age, smoking, stress level, nutrition and level of physical activity can affect the metabolic syndrome (MS) development in depressed patients. It is considered that chronic stress causes depression and subsequent poor lifestyle that can lead to the MS development, which results in increased incidence of cardiovascular disease.

Aim

To determine the psychosocial and clinical characteristics of depressed patients with MS diagnosis.

Methods

Cross-sectional study was conducted on a sample of 80 patients suffering from depressive disorder. The structured socio-demographic questionnaire, MINI questionnaire, Hamilton Rating Scale for Depression (HAMD-17) and the Clinical Global Impression Scale (CGI) were used as diagnostic instruments. MS diagnosis was made according to NCEP/ATP III criteria.

Results

Depressive patients with MS diagnosis had a significantly higher frequency of suicide attempts, while MS diagnosis significantly more frequently was present in female patients. Increased intake of carbohydrates was an important characteristic of the depression as well as MS.

Conclusion

Further studies are needed in order to explain the observed gender differences, and whether interventions focused on the treatment of depression may contribute to the acceptance of healthy lifestyles, particularly in changing of dietary habits, and thus indirectly contribute to the reduction of MS frequency.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Self-esteem and emotional distress in a population of unemployed persons
Authors: Medhaffar K. , Feki I. , Sellami R. , Baati I. , Trigui D. , Abida I. , Masmoudi J.
Published: May 2016

Introduction

For most individuals, basic life requirements are met through employment. It can satisfy creative urges, promote self-esteem, and provide an avenue for achievement and self-realization.

Objective

To assess the level of depression, anxiety and self-esteem in a population of unemployed persons.

Method

It was a cross-sectional study involving unemployed people we met in the office of employment of Sfax in Tunisia. The level of anxiety and depression was assessed by the Beck depression and anxiety inventories. The self-esteem Rosenberg scale allowed us to evaluate the level of self-esteem of our population.

Results

The average age of oursubjects was 33 years six months. The average duration of unemployment of our population was 4 years 7 months and 38.2% of them had never worked before. The anxiety level was moderate in 38.2%, while moderate to severe depression was found in 47%. Self-esteem was low to very low in 47.1%. A low level of depression was positively correlated with a low socioeconomic level (P = 0.000), a low level of anxiety (P = 0.000) and a high self-esteem level (P = 0.000).

Conclusion

People with strong support systems and greater self-esteem seemed to experience less unemployment stress. Identifying those who are at high risk for psychological and physical problems and finding ways of preventing them from suffering the adverse effect of unemployment are important areas for further study.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Antidepressant-induced hyponatremia
Authors: Rodríguez Andrés L. , Gómez Sánchez S. , Rodríguez Campos A. , Hernández Antón R. , Gallardo Borge L. , Álvarez Astorga A.
Published: May 2016

Introduction

Hyponatremia is one of the electrolytic disorders most comonly observed among general hospitalized populations (2% of hospitalized patients). A form of hyponatremia is the syndrome of inappropriate antidiuretic hormone secrection (SIADH). One of its diverse causes is medication. Selective serotonine reuptake inhibitors (ISRSs) can cause hyponatremia due to SIADH, particularly among elderly population.

Clinical case report

A 81-year-old female treated with paroxetine 20 mg/day because of depression. Two weeks later she starts feeling nausea, somnolence and motor inhibition. The sodium level previous to the onset of treatment was normal but after two weeks it has decreased to 121 mEq/L, pointing to SIADH induced by ISRSs.

Discussion

The incidence of hyponatremia among elderly patients treated with antidepressants of ISRSs class has increased. The prevalence varies between 0.5 and 25%. Although half of the patients are asymptomatic, the mortality is rate may reach 25%. It generally develops during the first month of treatment and is reversible between 2 and 28 days after the suspension of the ISRSs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Attachment style and salivary cortisol awakening response in eating disorders
Authors: De Riso F. , Giugliano R. , Monteleone A.M. , Nigro M. , Pellegrino F. , Calvanese M. , Patriciello G. , De Stefano V. , Volpe U. , Monteleone P.
Published: May 2016

Introduction

Early life experiences can influence hypotalamus-pituitary-adrenal (HPA) axis regulation and adult attachment styles. Furthermore, several studies showed that in patients with eating disorders (EDs) there is a prevalence of insecure attachment. However, the relationship between adult attachment style, HPA axis functioning and onset of EDs is largely unknown.

Objectives and aims

In order to evaluate possible associations between attachment styles and HPA axis functioning in EDs, we investigated Cortisol Awakening Response (CAR) in ED patients with different attachment styles.

Methods

Twenty adult patients with EDs were classified in three groups, according to the Experience in Close Relationship questionnaire (6 with secure attachment, 6 with anxious attachment and 8 with avoidant attachment). Saliva samples were collected at awakening and 15, 30 and 60 minutes after.

Results

There was a significant difference among the groups in both awakening and post-awakening cortisol concentrations. In particular, compared to secure and avoidant groups, the anxious group exhibited lower cortisol concentrations at awakening and post-awakening with a preservation of the timing of the CAR.

Discussion

Present findings demonstrate that anxious attachment style is linked to flattened CAR in EDs. This pattern has been associated with other psychiatric disorders. Therefore, attachment style could influence the HPA functioning and it could play, although not specifically, a role in pathophysiology of EDs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Changes in the electrical properties of the tissues in patients with anorexia nervosa measured by bioelectrical impedance analysis
Authors: Karakula-Juchnowicz H. , Teter M. , Kozak G. , Makarewicz A. , Kalinowska J. , Małecka-Massalska T.
Published: May 2016

Introduction

Monitoring patient with anorexia nervosa (AN) include clinical, biological and psychological factors. In recent years many researchers criticize the BMI as useful measure for controlling evolution of AN.

Objectives

Bioelectrical impedance analysis (BIA) is one of the main methods for nutritional status assessment.

Aims

The aim of this study was the assessment of the nutrition status in a group of patients with anorexia nervosa in comparison to healthy population (HP).

Methods

The study involved 37 participants: 21 patients with AN and 16 healthy volunteers constituting the control group (HP). The patients were divided into two groups according a BMI: I group 14 < BMI < 15,5 (n = 11; age 18.0 ± 4.37) and II group: 15,5 < BMI < 17,5 (n = 10; age 17.82 ± 3.68). The mean age of HP was 17.68 ± 1.57 and BMI 20.56 ± 1.16 kg/m2. BIA was performed by using ImpediMed bioimpedance analysis SFB7 BioImp. The parameters: phase angle (PA), TBW%, ECW, ICW, ECW/ICW were analyzed.

Results

PA was decreased significantly in the I (4.5°±0,6) and II group (4.7°±0,6) of AN patients’ in comparison with HP (5.6°±0,7). TBW was 9% higher in I group and ECW was increased 6% in the both AN groups compared with HP (P < 0.01). Additionally ECW/ICW ratio indicated the higher transfer of water into the extracellular compartment in AN group (P < 0.01).

Conclusions

BIA is accurate tool to indicate the valuable indicators of detecting malnutrition in AN. Further studies are needed to validate the significance of these parameters for the full identification of the nutrition status of AN patients’.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Current and emerging drugs treatment for night eating syndrome
Authors: Martellini M. , Barchiesi M. , Oriani M.G. , Nardi B.
Published: May 2016

Introduction

The night eating syndrome (NES) is a categorized in the diagnostic and statistic manual (DSM-5) as an “Other Specified Feeding or Eating Disorder” and it is characterized by a reduced feeding during the day, evening hyperphagia accompagned by frequent nocturnal awakenings associated with conscious episodes of compulsive ingestion of food and abnormal circadian rhythms of food and other neuroendocrine factors. Frequently it is associated with obesity and depressed mood.

Objectives

The purpose of this review is to investigate the state of art concerning the psychopharmacological treatment of NES.

Methods

A Medline enquiry of published articles from 2005 to October 2015 was performed using the following keywords: “NES, pharmacological treatment, SSRI, antidepressants, antipsychotic, sertraline, citalopram, escitalopram, duloxetine, venlafaxine, paroxetine, fluoxetine, fluvoxamine, topiramate”. Reviews, single case studies and RCT were also analyzed.

Results

Only few studies met the selection criteria. A recent 8-week double-blind placebo controlled study, in 34 patients with NES, has confirmed the efficacy of sertraline. Sertraline was associated with significantly greater improvement than placebo in overall symptomatology.

Conclusions

SSRIs should be considered the drug of choice for the treatment of NES not only because of evidence in the literature but also since they display the best pharmacological profiles with fewer adverse events. More evidence of efficacy is shown for some SSRIs such us paroxetine, fluvoxamine and especially sertraline. Topiramate should be reserved for cases resistant to treatment with SSRIs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Perfectionism in eating disorders: Temperament or character? Does perfectionism improve on treatment outcome?
Authors: Rodriguez Cano T. , Beato Fernandez L. , Mata Saenz B. , Rojo Moreno L. , Vaz Leal F.J.
Published: May 2016

Introduction

Perfectionism is considered a risk factor and is very close related to Eating Disorders (EDs). It estimates heritability of 29-42%. However, it has also been related to psychosocial factors such as the insecure attachment style.

Objectives

To study the relationship of perfectionism with personality dimensions, its likelihood of improvement and its treatment.

Aims

To analyze if Perfectionism is associated with dimensions of Temperament or dimensions of Character and therefore more psychosocial.

Methods

Participants were 151 female outpatients who consecutively started treatment at the Eating Disorders Unit (Ciudad Real University General Hospital). Personality was assessed by using the Temperament and Character Inventory (TCI). Perfectionism was assessed by using the Edinburg Investigatory Test (EDI-2) subscale (t0). One year later, patients were re-assessed with the EDI-2 (t1).

Results

The scores on Perfectionism significantly improved from t0 to t1, (repeated measures ANOVA, F = 6.6, P < 0.01). At baseline, Perfectionism was related to any of the Temperament dimensions, but the Character variable Purposefulness (SD2) (β = .25 95% CI .17, 98), 2.7% of variance). Responsibility (SD1) and Self-Aceptance (SD4) were inversely associated with Perfectionism. At t1, Responsibility still was a protective factor for Perfectionism, regardless the effect of Perfectionism at t0.

Conclusions

Perfectionism is also related to psychosocial and developmental factors. People with an internal locus of control tend to take responsibility for their own actions and are resourceful in solving problems. Thus, Self-directedness, mainly Responsibility for their own actions, is a protective factor for Perfectionism in EDs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicide attempts in emergency department
Authors: Hajji K. , Marrag I. , Ben soussia R. , Zarrouk L. , Younes S. , Nasr M.
Published: May 2016

Introduction

The suicide attempt is a real challenge for the clinician who works at the emergency department in order to identify and propose an adequate care.

Aims

To estimate the prevalence of the suicide attempts, to describe the sociodemographic and clinical characteristics and to identify the predictors of recurrence.

Methods

Our cross-sectional study was conducted at the medical emergency department of the university hospital of Mahdia and lasted for 12 months. Data were collected using a questionnaire of 51 items exploring the general and clinical characteristics and providing information of the treatment.

Results

Among the 513 consultants, 90 had attempted suicide (17,5%). We found an average age of 26 years old, a sex-ratio (M/F) of 0,3, a secondary education level (53,3%), an unemployment and a single status (38,9% and 75,6%). The presence of psychiatric personal history and/or suicide attempts was found in 31,1% and 33,3% of cases. Suicide attempts were taken place in all cases at home, between 18 and midnight (43,3%), without premeditation (82,2%), in the presence of triggering factor (95,6%), during the last 3 months of the year (34,4%). In 70,2% of cases, the type of the suicide attempts was a drug intoxication. 67,8% of the suicide attempters regretted and criticized their acts.

Conclusion

A good assessment of the suicide risk determines the type of intervention that should be established and allows an adequate care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.