bluuebunny/crossref_metadata_2025 huggingface dataset:
The age of accountability of consultation liaison, an example from a big referral hospital
Authors: Aarabi Sobhan , Sharafi Seyedeh Elham , Shahi Mohammad-Hosein Pourgharib
Published: June 2017

CL is a subspecialty in psychiatry and provides a variety of consultation services including diagnosis, therapeutic and teaching efforts of a psychiatrist in none psychiatric units or hospitals.

Objectives

This is a retrospective descriptive study that evaluated the consultation liaison (CL) psychiatry services in Imam Khomeini hospital, during two recent years.

Methods

The information has been obtained from reviews of medical profiles of patients who attended the hospital.

Results

A total of 681 patients (365 patients were male) received CL services during the study period. The most prevalent diagnosis groups were mood disorder (37.91%), delirium (13.6%) and anxiety (12.64%). Our study revealed that cardiovascular unit, infectious disease unit and general surgery units frequently requested for consultations among all hospital wards. Pediatrics unit had the lowest request rate for psychiatric consultation.

Conclusion

CL is on the rise in general hospitals, specifically in internal medicine and surgery units which alarm us to pay more attention to preventive strategies focused on the most referred problems including mood disorders, delirium and anxiety disorders in patients who attended general hospitals.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Low frequency of request for liaison psychiatry: A difficulty in the early detection of mental disorders by medical assistants?
Authors: Machado M. Aguiar , Oliveira J. Gonçalves , Cunha E. Oliveira , Melo E. Vieira de , Oliva-Costa E.
Published: June 2017

Introduction

The liaison psychiatry (LP) is a feature used by the psychiatrist in order to improve the management of patients with mental suffering and/or mental disorder admitted to general hospital.

Objectives

To characterize the epidemiological profile of hospitalized patients at the university hospital of the federal university of Sergipe (HU-UFS) submitted to LP.

Methods

retrospective and observational study, through analysis of medical records of patients admitted in the wards of clinical medicine and surgery from the HU-UFS, in the period from January to December 2015, submitted to LP. The information collected fed a specific questionnaire developed by the authors, intended for research of socio-demographic data and clinical profile.

Results

the frequency of request for IP was of 3.5%, with the majority of applications was performed by clinical medicine (71.2%), while the surgical clinic was responsible for 28.8%. The main reason for the request of LP was the presence of depressive symptoms (49.1%). There was a predominance of females (52.5%) and the mean age was 45.9 ± 14.6 years.

Conclusions

The frequency of request for LP was very low, suggesting a difficulty in the early detection of mental disorders by physicians. This finding points to an underreporting of cases, since the prevalence of depressive symptoms in hospitalized patients is over 50% in this institution.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Attention, vigilance and visuospatial function in hospitalized elderly medical patients–relationship to delirium syndromal status and motor subtype profile
Authors: Daly C.
Published: June 2017

Objective

The early and efficacious detection of neurocognitive disorders poses a key diagnostic challenge. We examined how nine bedside cognitive tests perform across the spectrum of delirium and motor subtypes.

Methods

The performance on a battery of nine bedside cognitive tests were compared in elderly medical inpatients with DSM-IV delirium, subsyndromal delirium, and no neurocognitive disorder and in different motor subtypes of patients with delirium.

Results

One hundred and ninety-eight patients (mean age 79.14 ± 8.26) were assessed with no delirium (n = 43), subsyndromal delirium (n = 45), and full syndromal delirium (n = 110). The ability to meaningfully engage with the tests varied from 59% for vigilance B test to 85% for Spatial Span forward test and was found to be least in the full syndromal delirium group. The no delirium group was distinguished from the delirium groups for all the tests and from the full syndromal delirium group for the vigilance B test and global visuospatial function test. The subsyndromal delirium group differed from the full syndromal delirium group in respect of global visuospatial function test, spatial span backwards and vigilance A tests. Patients with full syndromal delirium were best identified using the interlocking pentagons test and clock drawing test. The ability to engage with testing was higher for those in the no subtype group.

Conclusions

Simple bedside tests of attention, vigilance, and visuospatial ability are useful to help to distinguish neurocognitive disorders namely subsyndromal delirium from other presentations.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Role of online technology and social networking site at workplace
Authors: Gupta H.
Published: June 2017

Background

Internet use has affected the pattern of working style at the workplace. Recent years have seen an increased use of online activities (especially pornography/gaming) at the workplace. It has been shown to affect productivity at the workplace. There is a dearth of literature from the Indian context in this area.

Aim

This study was conducted to explore the pattern of pornography use& gaming at the workplace and its dysfunctions. Setting and design: The present study was a cross-sectional prospective study

Materials and methods

The objective of the study was to assess the pattern of pornography use at the workplace. Five hundred employees having experience of Internet use for more than a year of various government/private sector organizations in Bengaluru were assessed using background data sheet, DSM V criteria, Internet addiction test & pornography addiction screening instrument. Users who were unwilling to participate were excluded from the study.

Results

Seven to nine percent reported preference for Internet to work, meals, personal hygiene, sleep, and interaction with family members and effects on productivity. Three to four percent have excessive use of pornography & game.

Conclusions

The present study has implications for evolving psychoeducational modules for the promotion of healthy use of technology.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Coordinating primary care and mental health
Authors: Garnica V.Martí , Garcia M.D. Ortega , Lopez M.A. Bernal , Leon J.R. Russo de , Garcia S. Marin
Published: June 2017

Through the analysis of a case report to analyze the importance of the coordination between primary care and mental health service for a better management of an outpatient. It is known that primary care is the gateway to the patient in the health system. Therefore, the role of physicians headers is essential for diagnosis, for the start of drug treatment and referral to specialized care. It is known that one of every four patients have mental health problems. To meet the standards of primary care, physicians should ensure personalized assistance, integrated, continuous and permanent. Therefore, in relation to the accessibility of patients, it is essential to establish the diagnosis as soon as possible and initiate appropriate treatment to alleviate the symptoms of this type of psychiatric disorders and should track patients and their caregivers. For all this, it is essential that there is proper coordination between primary and specialty care in mental health. The interdisciplinary approach in these situations can assist the patient and family from a holistic perspective. This approach strengthens and reinforces the subsequent treatment, not only care but also evolutionary. Thus arises the interdisciplinary work as an opportunity to access the new and complex this social situation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Prevalence of depressive symptoms among inpatients at the university hospital of Sergipe, Brazil
Authors: Oliveira J. , Machado M. , Cunha E. , Mansilla K.M. , Melo E. Vieira , Oliva-costa E.
Published: June 2017

Introduction

Depressive Symptoms (DS) generate a public and economic health problem, with decreasing productivity, labour market withdrawal and increased demand for health services. Studies show that in hospitalized patients, DS rates are higher than in the general population, in medical practice, however, they are under diagnosed or under-treated. Consultation Liaison Psychiatry (LP) can prevent aggravation of the psychic symptoms by early identification of them and by integration of psychiatry with the other medical specialties.

Objectives

To estimate the prevalence of DS and associated factors in inpatients and the frequency of consultation LP.

Methods

A cross-sectional study was carried out in March 2016, with 87 patients hospitalized in the clinical and surgical wards at the University Hospital (Sergipe/BR), through two instruments: (1) Structured Questionnaire prepared by the authors, (2) Beck Depression Inventory (BDI). Data analysis through descriptive and analytical statistics with final step of logistic regression.

Results

The prevalence of DS were 54%, of which 24% correspond to moderate and severe symptoms, and only 3.4% of the patients had a LP. In Logistic Regression, the only factor associated with DS was the reason for hospitalization. Clinical causes (87.2%) were 9.24 times more likely to develop DS than surgical causes.

Conclusions

Results suggest a high prevalence of inpatients with some psychic symptom. Physicians did not detect these symptoms and, therefore, LP request was low. These data reinforce the importance of LP for early identification of DS that should be stimulated during medical training.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The impact of coping on self-esteem and mental status of patients with COPD
Authors: Papava I. , Bredicean A.C. , Dehelean L. , Romosan R. , Romosan A.M. , Tudorache E. , Timar B. , Oancea C. , Enatescu V.R.
Published: June 2017

Introduction

COPD (chronic obstructive pulmonary disease) is a chronic illness associated with psychological distress. Self-esteem and the associated comorbidities, like depression and anxiety, can influence its evolution.

Objectives

To analyze how predominant coping styles associated with different levels of self-esteem and mental status in patients with COPD.

Aims

To demonstrate that different types of coping-styles have an impact on self-esteem, depression and anxiety.

Methods

To a lot consisting of 28 subjects with COPD, was applied the COPE scale to assess the style of coping, to rate anxiety and depression The Hospital Anxiety and Depression Scale (HADS) and for self-esteem the Rosenberg Self-Esteem Scale. According to their higher coping sub-scale score, they were classified to one dominant coping type as follows: patients with problem-focused coping type (n = 9), emotion-focused coping (n = 10), social support-focused coping (n = 6), respectively avoiding coping type (n = 3).

Results

Patients with dominant problem-focused coping had the most elevated self-esteem compared to patients with social-focused coping (22.0 vs. 16.2; P = 0.039), the depression score was the highest in patients with dominant avoidance-type coping and the lowest in patients with dominant problem-focused coping (11.0 vs. 5.6; P = 0.042) respectively anxiety, was the highest in patients with dominant social-focused coping and the lowest in patients with dominant emotion-focused coping (11.6 vs. 5.0; P = 0.006).

Conclusions

In patients with COPD, problem-focused and emotion-focused copings are adaptive, while avoidance and emotion-focused copings are maladaptive on self-esteem and mental status. Such as, the coping represents a psychological dimension with an impact on the evolution of the disease, and the patients with COPD should be assessed and addressed multidisciplinary.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cardiovascular risk factors, anxiety symptoms and inflammation markers: Evidence of association from a cross-sectional study
Authors: Rioli G. , Tassi S. , Mattei G. , Alboni S. , Mancini S. , Artoni C. , Galletti M. , Giambalvo N. , Galli G. , Marchi M. , Minarini A. , Montardi G. , Perrone D. , Pollutri G. , Roncucci L. , Saraceni S. , Spiga G. , Visentini C. , Galeazzi G.M. , Ferrari S.
Published: June 2017

Introduction

Anxiety disorders and Cardiovascular (CV) diseases, among the most common disorders in Western World, are often comorbid. A chronic systemic inflammatory state might be a shared underlining pathophysiological mechanism.

Aims

To investigate the association between anxiety symptoms, CV risks factors and inflammatory markers in an outpatient sample.

Methods

Cross-sectional study. Inclusion criteria: outpatients aged ≥40 years, attending colonoscopy after positive faecal occult blood test, negative medical history for cancer. Collected data: blood pressure, glycaemia, lipid profile, waist circumference, BMI, PCR (C Reactive Protein), LPS (bacterial Lipopolysaccharide). Psychometric tests: HADS, TCI, IMSA, SF36. Statistical analysis performed with STATA13.

Results

Fifty four patients enrolled (27 males, 27 females). Sixteen patients (30.19%) were positive for anxiety symptoms. Thirty-three patients (61.11%) had hypertension, 14 (25.93%) hyperglycaemia and 64.81% were overweight, with frank obesity (BMI≥ 30) in 11 subjects (20.37%). Anxiety symptoms were associated with low hematic HDL values (OR = 0.01; P = 0.01) and high concentration of triglycerides (OR = 0.023; P = 0.02) at the multiple regression model. At the univariate logistic analysis, anxiety was associated with LPS (OR = 1.06; P = 0.04).

Conclusions

Further evidence over the epidemiological link between common mental disorders and CV diseases was collected, with possible hints on pathophysiology and causative mechanisms related to inflammation. The importance of screening for anxiety and depression in medical populations is confirmed. Suggestions on future availability of screening tools based on inflammatory-related indicators should be the focus of future research.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychiatry intervention in cerebellar cognitive affective disorder: Case report
Authors: Rodriguez O.E.
Published: June 2017

Background/objectives

Cerebellar cognitive affective syndrome (CCAS) is a condition that arises from cerebellar lesions. CCAS can easily be overlooked by medical teams; therefore a bibliographic review will facilitate the understanding of symptoms in order to effectively diagnose and provide a holistic early treatment approach.

Methods

A case report of a 72-year-old woman with bilateral cerebellar lesions with high pre-morbid function presented with classic symptoms of CCAS. Multidisciplinary workup included medical, psychiatric, neuropsychological assessment (R-BANS (Form 1), Digit Span, Verbal fluency tests, the Hayling Test, the Delis-Kaplan Executive Function System) as well as other investigations (neuroimaging and blood tests) were conducted on the patient to confirm CCAS and exclude other differential diagnoses.

Results

The results from the medical assessments conducted showed symptoms of cerebellar dysfunction. A psychiatry and neuropsychological review revealed aggression, irritability, disinhibition, deterioration in cognitive function and personality changes. A multidisciplinary team was formed to rehabilitate the patient however patient was non-compliant with therapy. The patient was prescribed Seroquel 50 XR and she responded well to the medication.

Conclusion

This case review illustrates the challenges associated with engaging a CCAS patient in rehabilitation activities due to cognitive and mood disorders. The use of psychotropic medications can be an effective method in improving cognition and mood disorders in CCAS patients. Early psychiatry and psychological intervention can significantly improve the overall outcome of a patient diagnosed with CCAS.

Funding source

Nil.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Neuropsychiatric and behavioural manifestation in a rare lysosomal storage disorder (Fabry's Disease): A case study
Authors: Roy D.
Published: June 2017

Introduction

Case presentation of a young woman Ms. SH, with neuropsychiatric presentation in a rare Lysosomal Storage Disorder (Fabry's disease).

Case report

A 19-year-old female with Fabry's disease (FD) presented initially with symptoms of obsessions of dirt and contamination and compulsions of washing and also with overvalued persecutory ideas of being followed. Since the age of 14, she had suffered from various psychiatric symptoms increasing in frequency and intensity. Routine examinations including cognitive testing, electroencephalography and structural magnetic resonance imaging revealed no pathological findings. During the course of a year, her OC symptoms improved significantly with the use of Fluoxetine 40 mg mane. However, she then became more depressed and psychotic (despite continuing on Fluoxetine). Addition of Risperidone (gradually increased to 2 mg nocte) led to attenuation of her symptoms and she recovered completely over a course of another 6 months.

Discussion

Mental and behavioural symptoms in Fabry Disease symptoms usually begin during late childhood or adolescence but may not become apparent until the second or third decade of life. Early symptoms include episodes of severe burning pain in the hands and feet and skin lesions. The psychiatric manifestations can be varied, e.g. the index patient, initially presented with what appeared like an Obsessive Compulsive disorder but later as a depressive illness (Muller et al,. 2006) with psychotic symptoms.

Conclusions

To showcase mental and behavioural symptoms associated with a rare disorder like Fabry's disorder and treatment options may be helpful.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Study of vitamin D deficiency in depression patients-is it the reason for high rates of somatic presentation of depression?
Authors: Sanyal D. , Mukherjee B.
Published: June 2017

Introduction

Vitamin D receptor (VDR) is widely distributed in the human brain including areas that are assumed to be involved in the pathophysiology of depression. Vitamin D deficiency may cause physical symptoms like pain.

Objectives

See if somatic presentation of depression has any correlate with vitamin D deficiency.

Aims

To compare prevalence of vitamin D deficiency between depressed and non-depressed subjects and see if somatic presentation of depression has any correlate with vitamin D deficiency.

Methods

Sixty diagnosed MDD patients consenting to participate in the study from a large private hospital selected, provided they were non-smoker, 18–65 years, free from chronic illness and not taking anti-depressant control (60 subjects) comprised of close family members of patients. FSC (functional somatic complaints) was assessed using local language version of Bradford Somatic Inventory (BSI), while severity of depression was assessed using HDRS-17. Based on the total score, FSCs are categorized into 3 grades ((>40 ‘high, 26–40 ‘middle, and 0–25‘low’ range).

Results

Vitamin D status (deficiency: insufficiency: sufficiency) was 70: 30.0: 0.0% in depressed, which significantly worse compared to control subjects (55%: 25: 20%). Patients with higher BSI scores (i.e. more somatisation) showed non-significantly lower vitamin D level. These results were more prominent for female subjects.

Conclusions

Vitamin D deficiency is more common in depression subjects, which might thus need to be looked for and treated. However, no significant link between somatisation and vitamin D deficiency could be established.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Somatic symptoms, drinking, and mental distress among Russian female patients with rheumatoid arthritis: A pilot study
Authors: Yoshimasu K. , Takemura S. , Myasoedova E. , Myasoedova S.
Published: June 2017

Introduction

Drinking has been shown to be a protective factor against the risk of rheumatoid arthritis (RA). On the other hand, high prevalence of depressive symptoms has been observed among RA patients.

Objective

To evaluate the association between depressive symptoms and somatic factors as well as drinking habits in RA patients.

Methods

Drinking habits and physical symptoms in 182 female RA outpatients in Ivanovo, Russia (average [standard deviation] of age, 62.0 [11.7] years), were investigated. Drinking status was classified as current drinkers (alcohol consumption within the previous 12 months) and others. Depressive symptoms were evaluated with MINI, HADS and CES-D questionnaires. Outcomes were (a) presence or history of major depressive disorder, presence of melancholic major depressive disorder, presence of dysthymia, or 1 point or greater of suicidal risk score in MINI, (b) 8 points or greater in HADS-depression, (c) 8 points or greater in HADS-anxiety, and (d) 16 points or greater in CES-D. Stepwise logistic regression was used to evaluate somatic factors associated with depressive symptoms, with age and drinking status included.

Results

Drinking was rather protective against depression, but did not reach statistical significance. Symptomatic parts in the extremities associated with the outcomes were shoulders for MINI, elbows and knees for HADS-depression, shoulders for HADS-anxiety, and hands, elbows and shoulders for CES-D. In the stepwise selection, some symptoms in the extremities were positively associated with the outcomes.

Conclusion

Symptoms chiefly in large joints contributed to depressive symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Does psychiatry link culture and symptoms?
Authors: Garcia Ayala L. , Gomez Revuelta M. , Martin Requena C. , Gonzalez Hernandez B. , Laborde Zufiaurre M. , Garcia de Acilu E. Saez de Adana , Aranzabal Itoiz A. , Porta Olivares O. , Juncal Ruiz M. , Zubia Martin M. , Nuñez Morales N. , Gonzalez-Pinto Arrillaga A.M. , López Peña M.P.
Published: June 2017

Introduction

Transcultural psychiatry is a branch of psychiatry where cultural context for psychiatric symptoms is studied. It emerged as a consequence of migration of diverse ethnic groups and questions whether international diagnosis classifications fit in different cultures.

Objectives

The aim of this review is to make professionals aware of the importance of cultural context for the way mental disorders present themselves depending on the patient's origin.

Materials and methods

We report the detailed case of a 23-year-old Moroccan woman, attended for the first time by the mental health services when she was 8. Since that moment, she felt herself possessed by a strange being. Auditory hallucinations appeared. It was only when her father or her husband were at home that she felt the “being” was gone. Her husband, as formerly his father, represented a symbol of protection against that evil being and indeed against her mental disorder, which was directly related to her cultural beliefs.

Discussion

Every country has a different culture and every migration brings with it a new environment. The way people adapt to it may result in mental illness. We want to discuss if symptoms fit international diagnosis classifications.

Conclusion

Psychiatrists should become aware of the limitations of the international classifications when used on different ethnic groups. We should have a cultural approach in order to treat the diverse populations from all around the world.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
‘The Good Parent’ and ‘The Other Parent’: Medicalization, othering and social exclusion in Israeli professional discourse regarding learning disorders and difficulties
Authors: Katchergin O.
Published: June 2017

This lecture seeks to uncover the various textual techniques through which binary representations of ‘parenthood’ are constructed in the framework of clinical professional discourse of Israeli learning-disorders experts. Historically this discourse has constructed two contrasting parenthood representations: ‘parenthood of learning-disordered children’ on the one hand, and ‘parenthood of cultural deprived children’ on the other hand.

The lecture posits the following main questions: Which textual representations of ‘parenthood’ were constructed in the framework of the aforementioned discourses? Which affinities can be identified between the textual representations and the contextual characteristics of social class, culture, ethnicity and educational capital? And which affinities can be identified between these representations and the explicit or implicit normative messages of ‘blame’, ‘responsibility’ and ‘agency’ embedded in the texts? Discourse analysis was implemented in order to uncover the mutual and contradictory construction processes. The analysis also reveals the stereotypical imputation of ‘normative’ parents with a well-off, well-educated and western origin population, as well as the stereotypical imputation of ‘problematic’ parents with a low class, little educated and eastern origin population. The lecture concludes by situating the texts in the social and historical context of their formulation: The processes of psychocultural othering which operated on low class, little educated and eastern origin parents are interpreted on the historical background of the class and ethnic hierarchical structure of the Israeli society. The conclusion also raises a conjecture regarding a rising new medicalizing ‘othering’ potential, a potential, which was already implicitly embedded in the analyzed historical texts.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Reflection of local and universal historical time in symptoms of paranoid schizophrenia
Authors: Molchanova E. , Tsoy R. , Sim I.
Published: June 2017

Psychopathological signs reflect general and significant phenomenon, the whole “extract” of a particular historical time, consisting of a bizarre set of events, influential characters twisted in an individual history of a patient. Except detailed “real” clinical picture reflecting socio-political events, authors consider formatting mechanisms of “unreal” content of hallucinatory-delusional symptoms. In such cases, main heroes are mythological characters for example gins or intimidating heroes of modern movies like vampires and zombies. Events in the social sets, such as Facebook and Instagram are also reflected in experiences of patients. Authors focus their attention on a paradox of logical reflection of events in the context of delusional symptoms versus paralogical interpretations. Research is based on clinical cases, and shows up a spectrum of mechanisms of how events are either included or ignored in the forming a content of psychopathological experiences.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
In patients with major depressive disorders, depression, stress axis activity and problem solving skills as a proxy of executive functions are unrelated
Authors: Brand S. , Hatzinger M. , Hemmeter U.M. , Bahmani D. Sadeghi , Holsboer-Trachsler E.
Published: June 2017

Introduction

Major depressive disorders (MDD) are among the most prevalent psychiatric disorders worldwide. While there is abundant literature showing that an increased cortisol secretion, understood as a proxy of the deteriorated hypothalamus-pituitary-adrenocortical axis activity (HPA AA), and poor cognitive performance are tightly related, less is known as regards to the HPA AA and higher cognitive information processes such as problem solving.

Aims

Investigating the association between cortisol secretion and problem solving performance among patients with MDD.

Methods

Fifteen inpatients with MDD (HDRS > 24; mean age: 59 years; 80% females) underwent a pharmacologic HPA AA challenge both at baseline and six weeks later to assess the cortisol secretion. They were treated with standard antidepressants at therapeutic dosages. Further, they learned how to solve the Tower-of-Hanoi problem-solving task (ToH-PS-T) and how to apply the problem solving strategy to other tasks (transfer). Testing occurred both at baseline and six weeks later. Outcome variables were symptoms of depression, cortisol secretion and the performance to transfer the acquired ToH-PS-T.

Results

Both symptoms of depression and cortisol secretion decreased over time, and transfer performance increased over time. Neither at baseline nor six weeks later, symptoms of depression, transfer performance and cortisol secretion were statistically related.

Conclusions

The pattern of results suggests that cortisol secretion as a proxy of physiological stress regulation, symptoms of depression, and higher order cognitive performances seem unrelated. Given that cognitive information processing performance substantively increased regardless from depression and cortisol secretion, problem-solving skills need to be focused separately.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Depression and chronic immune system dysfunction–a longitudinal study in patients with lupus
Authors: Figueiredo-Braga M. , Bernardes M. , Figueiredo M. , Terroso G. , Poole B.
Published: June 2017

Introduction

Depression is a common companion of systemic lupus erythematosus that substantially contribute to patient's suffering and a decreased quality of life. The relationship between depressive symptoms and disease immune processes is not well understood.

Objectives

To further understand the relationship between lupus and depression, a patient cohort was examined for correlations between clinical presentation, biological parameters and psychosocial evaluation.

Methods

Seventy-two lupus patients were screened for depressive symptoms, clinically and psychologically characterized using a battery of instruments, including assessments for depression, anxiety, fatigue, pain and overall health. Scores from these assessments were correlated with lupus clinical profile and biological parameters namely the immune profile.

Results

Forty-two percent of the patients had scores indicative of depression using the HADS Depression scale. Strong correlation was found between pain and depression. Moderate correlation was found between several lupus symptoms, such as mouth ulcers, rash, and arthritis, and psychological evaluation. There was low to moderate correlation between complement levels, C-reactive protein and psychological indicators, but no other lab tests correlated well with the psychological tests.

Conclusion

The correlation of depressive symptoms, complement and C-reactive protein with depressive symptoms suggests that these may be mediated by disease activity and share pathophysiological mechanisms. The overall weakness of correlations with biological markers demonstrates that more specific tests need to be developed. The study of lupus associated depression may, furthermore clarify the role of immune dysfunction in the pathophysiology of this psychiatric disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Association of activation syndrome with life-time hypomanic symptoms and Ghaemi criteria
Authors: Gökçen O. , Özer S.
Published: June 2017

Objective

Activation syndrome consists of 10 suicides associated symptoms, which is induced by antidepressant treatment. These are anxiety, agitation, manic episodes, sleep disruption, irritability, hostility, aggressiveness, impulsivity, akathisia and mania/hypomania. This syndrome is reported to be associated with a bipolar disorder diathesis. The aim of this study is to evaluate lifetime hypomanic symptoms with major depressive disorder, who are prescribed antidepressant medication, and to investigate whether there is a relationship between these symptoms and the development of AS.

Methods

Sixty consecutive outpatients with the diagnosis of major depressive disorder who were naturalistically given antidepressant treatment were examined prospectively. Patients were assessed three times; at baseline, 2 and 4 weeks later. At baseline visit, clinical characteristics of patients including Ghaemi criteria were assessed, life-time history of hypomanic symptoms were assessed with the Hypomania-Checklist-32. In all three interviews, Barnes Akathisia Rating Scale, Hamilton Rating Scale for Depression, Hamilton Anxiety Rating Scale and Young Mania Rating Scale were applied to detect the symptoms of AS. The patients who present at least one of the 10 symptoms were considered to have AS.

Results

Of the 60 patients 25(41.7%) developed AS. The most prevalent symptoms of AS are insomnia (31.7%), anxiety (25%) and irritability (15%). Significant difference was found between patients with and without AS, with regard to HCL-32 test scores. A moderate correlation between the number of AS symptoms and HCL-32 test scores were determined. AS was found to be significantly more frequent in patients with mere hypersomnia and both increased appetite and hypersomnia those without these symptoms.

Disclosure of interest

The findings of this study suggest that certain features of BPS might be associated with the development of AS. Antidepressant treatment of depressive illnesses in this spectrum which are misdiagnosed as unipolar may reveal these symptoms that will complicate the current episode and destabilize the longitudinal course. For this reason, clinicians should evaluate the patients who present antidepressant induced symptoms meticulously and be careful not to overlook the characteristics of BPS.
Efficacy of hypericum extract Ws® 5570 compared with paroxetine in patients with a moderate major depressive episode–a subgroup analysis
Authors: Holsboer-Trachsler E. , Seifritz E. , Hatzinger M.
Published: June 2017

Introduction

Various studies showed the efficacy and tolerability of WS® 5570 (Hyperiplant® Rx, Dr. Willmar Schwabe GmbH & Co. KG) for the treatment of acute mild-to moderate depression. Beneficial effects of WS® 5570 have been also shown in patients with moderate-to-severe depression.

Objectives/aims

We present a subgroup analysis of a double blind, randomised trial to compare the therapeutic efficacy of WS® 5570 with paroxetine in patients suffering from a major depressive episode with moderate symptom intensity. This analysis on moderately depressed patients treated with WS® 5570 tries to support the hypothesis that WS® 5570 is an effective remedy in patients with major depression and moderate symptom intensity.

Methods

Moderate depression was defined by a baseline Hamilton Depression Rating Scale (HAM-D) total score between 22 and 25. Sixty-four patients received, after a single blind placebo run-in phase of 3–7 days, either 3 × 300 mg/day WS® 5570 or 20 mg/day paroxetine for six weeks. The change of the HAM-D total score was used to describe the efficacy of WS® 5570 compared with paroxetine in the subgroup of patients with moderate depression.

Results

The reduction of the HAM-D total score was significantly more pronounced in patients treated with 3 × 300 mg/day WS® 5570 compared to 20 mg/day paroxetine. After six weeks, responder (87.1%) and remission rates (60.6%) to WS® 5570 were significantly higher than to paroxetine (71%/42.4%).

Conclusions

After six weeks, patients treated with WS® 5570 showed a higher reduction in depression severity score and yielded greater response and remission rates compared with patients treated with paroxetine.

Disclosure of interest

Supported by Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
Clinico-psychopathological features of the resistant depression
Authors: Lukmonov S. , Yadgarova N.
Published: June 2017

Objective

To study the clinical - psychopathological characteristics of patients with resistant depression.

Materials and methods

We examined 96 patients aged 18–48 years (mean age 34.7 0 ± 1.0 years). The investigated patients were divided into two groups: 1st -TRD with positive affectivity - 59 (61.4%); 2nd - curable depression - 37 (38.6 %). Selection of patients was made according to following criteria: ICD - 10: (F31) - bipolar disorder; (F32) - depressive episode; (F33) - recurrent depressive disorder.

Results

In group 1 patients received amitriptyline (TCA) - 50 mg - 2 times/day in one of 2 consecutive courses (within 6 weeks) and they showed no clinical benefit. In group 2 patients received amitriptyline - 50 mg 2 times/day for 2 consecutive courses. When analyzing the number of depressive episodes the statistically greater number was observed 1-3 episodes in group 2 - in 45.9% of patients than in group 1 - 16.9%, predominant 5-8 episodes - in 44.1% of patients in group 1, than in group 2 - 13.5%. Remissions, observed in group 2, were characterized by longer duration and have a higher quality than in patients of group 1. There is a tendency to shorten remission especially in group 1.

Conclusion

The highest correlation dependence showed such factors as: frequency of depressive episodes, duration of episode 1, severity of depressive episode 1, quality of remission after depressive episode 1, number of responders at early stages of antidepressant therapy of I-st attack.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Comparison of behavioral activation therapy and treatment as usual among depressed patients in secondary psychiatric care
Authors: Luoto K. , Koivukangas A. , Lassila A. , Leinonen E. , Kampman O.
Published: June 2017

Introduction

Evidence-based brief therapies are needed to reduce a marked heterogeneity affecting treatment of depression within the public psychiatric care. They should be easy to implement and use for a large group of patients.

Objectives

To develop and implement an effective brief treatment protocol for depressed patients treated in public psychiatric secondary care.

Aim

To explore and compare the outcome of depressed patients receiving either behavioral activation therapy (BA) or treatment as usual (TAU).

Methods

Two hundred and forty two depressive patients referred to adult public secondary psychiatric care formed the BA treated study group. The TAU treated control group (n = 205) was collected from the hospital districts database and matched by the hospitalization rate, Alcohol Use Disorders Identification Test (AUDIT) and Beck Depression Inventory (BDI). All patients received anti-depressive medications. In the study group, Montgomery–Åsberg Depression Rating Scale (MADRS) was conducted four times within 24 months follow-up. In both groups, the ability of functioning was controlled by Global Assessment of Functioning scale (GAF).

Results

In the study group, depressive symptoms alleviated systematically and significantly during follow-up (Table 1). The improvement in GAF scores was significantly better in the study group throughout the follow-up (Table 1).

Conclusions

BA can be implemented and used effectively for depressive patients in public psychiatric secondary care. BA is superior to TAU in terms of functional recovery.

Table 1

1Mean change (decrease) in Montgomery–Åsberg Depression Rating Scale (MADRS) compared to baseline.

2Mean score in Global Assessment of Functioning scale (GAF) during the given follow-up period.

3Within study groups compared to baseline.

4Between groups.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
C-reactive protein as predictor of antidepressant response in late onset depression
Authors: Mishra D.K. , Sardesai U. , Razdan R.
Published: June 2017

Introduction

Late-onset depression has been associated with history of vascular disease and atherosclerosis. As immune dysregulation is critically involved in vascular disease. We hypothesized that responsiveness of late onset depression can be associated with level of inflammatory markers in these subjects.

Objective

Role of inflammatory mediator in antidepressant responses in late onset depression.

Aim

To study C-reactive protein as predictor of antidepressant response in late onset depression.

Methods

Depressed patient (as per ICD 10 DCR) age > 60 years recruited from department of psychiatry and complete clinical assessment done and base line depression severity measure on Hamilton Depression Rating Scale (HDRS). C reactive protein level was assessed at base line. Patient prescribed antidepressant medication and at 8 week follow up re assed for depression severity in HDRS. Data analyzed with spss.21 and spearman correlation was used.

Result

Mean age of responder (n = 6) 63.5 ± 4.9 year and HDRS at base line 16 ± 1.9. Mean age of partial responder or non-responder (n = 19) 65.1 ± 6.1 year and HDRS at base line 18.5 ± 3.9. Continuous decrease in depression severity during study period and antidepressant response rate was 24%. Base line CRP level had negative correlation with antidepressant responsiveness (r = –0.6, P < 0.05).

Discussion

Late onset depression was less responsive to antidepressant medication and poor antidepressant response rate was associated with higher level of CRP in late onset depression.

Document not received.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Core self-evaluation and depression among caregivers of Alzheimer disease patients
Authors: Wojtyna E. , Pyszkowska A. , Cembrzyńska M. , Wiszniewicz A.
Published: June 2017

Introduction

Caregivers of Alzheimer Disease (AD) patients suffer from chronic stress and psychophysical burden, which often lead to depression symptoms. It seems that core self-evaluation (CSE), coping with stress and social support might be modifying factors in coping with situation of caregiving.

Aims

The aims of the study were to examine: (1) level of depression; (2) relationships between CSE, style of coping with stress, social functioning and depression severity among caregivers.

Methods

The study involved 60 caregivers of AD patients who were children of the sick and have been caring for at least one year. It was cross-sectional and assessed by questionnaires. Following tools were used: Core Self-Evaluation, Beck Depression Inventory, Coping Inventory for Stress Situations, Distress Thermometer and an original questionnaire assessing the situation of caregiving.

Results

A total of 51.7% of responders demonstrated severity of depression symptoms, associated to at least one mild clinical depression episode. The factors introduced to the model explained 65% variance of depression symptoms. Predictors of greater depression symptoms proved to be: low CSE (ΔR2 = 0.32; β = −0.12), low social support (ΔR2 = 0.08; β = −0.27), low life satisfaction (ΔR2 = 0.02, β = −0.26), high levels of distress (ΔR2 = 0.12, β = 0.31), coping style focused on emotions (ΔR2 = 0.12, β = 0.17).

Conclusions

In the area of caregivers’ psychological assistance and depression therapy, interventions leading to increase of CSE and providing adequate social support that contributes to better care provision and maintaining proper self-image, should be taken into consideration.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A cognitive and behavioural group therapy for binge eating disorder: An original 12 sessions design
Authors: Boulet F.
Published: June 2017

The Binge Eating Disorder (BED) consists in binge eating with a loss of control and guilty feeling. Weigh excessive preoccupation, psychiatric comorbidities and psychosocial impairment are associated to BED. BED prevalence is 3 to 5%, which is the more frequent eating disorder. The efficacy of CBT is well-known with several publications.

Method

We have proposed 12 sessions of 1.30 hours for a 6 to 8 patients group, managed by a psychiatrist trained to CBT. Each session approaches a different topic (eating behavioural, self-esteem, problem resolution, stigmatization, emotion coping, cognitive therapy…).

Assessment

Patients are evaluated before and after therapy with Eating Disorder Inventory version 2 and Rathus Scale for self-esteem. Thirty patients were included.

Results

Patients improve eating behavioural and other topics like self-esteem, social functioning, problem resolution and emotion coping. It appears that 12 sessions group CBT could be effective with patients who suffer of BED. Others studies are needed to evaluate the long-term outcome.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Investigation of endocannabinoids and endocannabinoid-related compounds in obese subjects during an hedonic eating experimental test
Authors: Ruzzi V. , Monteleone A.M. , Monaco F. , Fico G. , Cervino A. , Volpe U. , Monteleone P.
Published: June 2017

Introduction

Hedonic eating refers to the consumption of food just for pleasure and not for energetic needs. Endocannabinoids and endocannabinoid-related compounds play an important role in food-related reward and are likely involved in hedonic eating.

Objectives

In a previous study we found that in normal weight healthy subjects plasma levels of 2 arachidonoylglycerol (2-AG) decreased progressively after food ingestion in both hedonic and non-hedonic eating condition, but they were significantly higher in hedonic eating. Plasma levels of anandamide (AEA), oleoylethanolamide (OEA) and palmitoylethanolamide (PEA), instead, progressively decreased in both eating conditions without significant differences.

Aims

In order to investigate the physiology of endocannabinoids in obesity, we assessed the responses of AEA, 2-AG, OEA and PEA to hedonic and non-hedonic eating in obese individuals.

Methods

Fourteen satiated obese patients consumed favorite (hedonic eating) and non-favorite (non-hedonic eating) foods in two experimental sessions. During the tests, blood was collected to measure peripheral levels of AEA, 2-AG, OEA and PEA.

Results

Plasma levels of 2-AG progressively decreased in non-hedonic eating whereas they gradually increased after hedonic eating. Plasma levels of AEA decreased progressively in non-hedonic eating, whereas they initially decreased after the exposure to the favorite food and then returned to baseline values after its consumption. The responses of OEA and PEA to favorite and non-favorite food did not show significant differences.

Conclusions

These findings demonstrate that, compared to normal weight healthy subjects, obese subjects exhibit different responses of peripheral endocannabinoids to the ingestion of food for pleasure and this could have implications for the onset/maintenance of obesity.

Disclosure of interest

The authors have not supplied their declaration of competing interest.