bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying and Managing Mental Health Needs of Homeless Individuals
Authors: Bhugra D.
Published: June 2017

The economic downturn worldwide since 2008 has raised many issues, including an increase in homelessness. Individuals who are homeless are visible across the globe. Definitions of homelessness also vary. Living on the streets in all kinds of inclement weather, brings a different set of issues and problems including physical and mental illnesses. Here homelessness is defined as a lack of customary regular access to a conventional dwelling unit. It has been shown in several studies that nearly half were either depressed or had substance use disorders and half had traumatic brain injury. Homelessness is a social issue and the role of the psychiatrist in reaching these vulnerable individuals is a matter of critical importance. In the UK health services are geographically delineated making it more difficult for ‘out of area’ individuals to get help. The responsibility for looking after people who are homeless, have mental illness or physical co-morbidity, lies with policymakers as well. As clinicians we must advocate for vulnerable patients and psychiatry care needs to be in a joined-up manner. Early interventions and home treatments where and if available are suitable and can be effective but are often linked with secure addresses. Policies must take into account huge variations across cultures and societies and the contributions that unemployment and poverty can play in increasing homelessness. Whether psychiatric disorders lead to homelessness and whether homelessness leads to mental illness is a circular argument and this vicious downward spiral needs to be broken by adequate care and policy support.

Disclosure of interest

The author has not supplied his declaration of competing interest.
The Current Status of Women in Psychiatry in Europe
Authors: Frangou S.
Published: June 2017

For more than two decades, psychiatry has retained its position amongst the medical specialties with the highest proportion of women entering residency programs. The percentage of women in junior academic positions in psychiatry is also high and consistently higher than that of men. However, the number of women in positions of leadership remains disproportionally low at around 5% with no evidence of improvement over time. The phenomenon of female under-representation is not unique to psychiatry or academia. Women are under-represented in all fields of leadership and this is a matter of wider societal concern. In this presentation, I will discuss external and internal barriers that women face and detail positive actions that can help women succeed in their careers.

Disclosure of interest

The author has edited and co-authored a book on “Women in Academic Psychiatry: A mind to Succeed”
Forensic Care in Italy: Changes, Illusions and Realities
Authors: De Girolamo G. , Bulgari V.
Published: June 2017

Violence and the risk of violence posed by patients with severe mental illness is a major public health problem for many reasons. Firstly there is the obvious harm to victims, secondly the counter-therapeutic effect on patients of the violence itself, thirdly the restrictive measures typically deployed by services to manage the violence, and finally the significant additional financial cost of these specialist services. Within mental health services the sometimes inaccurate estimate of risk of violence posed by patients can lead to the frequent use of a variety of coercive measures including involuntary hospitalization, enforced medication, restraint and seclusion. These restrictive and costly interventions are almost unanimously perceived as traumatic by the patients and can, in turn, trigger frustration, therapeutic resistance and even aggression instead of treatment adherence and cooperation.

Services for the treatment of psychiatric patients who pose a risk of violence are developing and maturing across Europe. New models of care for this extremely complicated multiple needs clinical population exist. However across Europe intervention strategies and service organization and delivery for these patients are very different, and have never been comparatively evaluated. The lack of reliable comparative data has prevented many European countries benefiting from innovative strategies already tested in those countries which have made the greatest efforts in research and service innovation. In this workshop we will compare the organization and functioning of forensic mental health services in different countries; in particular this presentation will inform about the recent changes in forensic mental health services occurred in Italy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Comorbidity of Depression and Diabetes: Questions Recently Answered and Raised
Authors: Sartorius N.
Published: June 2017

This paper will present information about a multicentric international collaborative study, which explored the frequency of depressive disorders in people with diabetes Type 2. The study was carried out in 14 countries–5 in Asia (Bangladesh, China, India, Pakistan and Thailand), two in Africa (Kenya and Uganda), two in Latin America (Argentina and Mexico) and five in Europe (Germany, Poland, Russia, Serbia and Ukraine). The study found that depressive disorders and sub threshold depression are frequent in people with diabetes: one tenth of all the nearly 3000 patients examined had major depression and another 15% sub threshold depressive disorders. Depression was only rarely recognized by the physicians dealing with diabetes and those few who were recognized were not provided treatment of their depressive disorders. The presentation will draw attention to the need to improve skills of diagnosis and treatment of psychiatric disorders of physicians who are not psychiatrists.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Suicidal behavior among Portuguese psychiatry trainees: Comparison with the European situation
Authors: Marques J. Gama
Published: June 2017

Introduction

The aim of this paper was to assess the prevalence of suicide ideation and attempts in Portuguese psychiatry trainees (adult, child and adolescence), and compare the data with the general population and other European countries.

Material and Methods

A structured and anonymous questionnaire was sent by email to 159 Portuguese trainees of adult psychiatry, child and adolescence psychiatry with questions about personal history of suicidal ideation and suicide attempts, as well as family history of suicide attempts and completed suicides. This is part of the BoSS Study (Burnout Syndrome Study) performed in 21 countries worldwide. Data was analyzed in SPSS v.19.

Results

From the inquired population, 62 trainees (40.3%) partially responded, and 46 (29%) were complete responders - these entered the final analysis. There was a ratio of 2:1 (female: male) and a mean age of 29 years. The suicidal ideation was present in passive form in 44% and in active form in 33%; also, 4.3% of respondents had previous suicide attempts. In first-degree relatives, 22% had attempted suicide and 13% completed suicide.

Discussion

The results are worrying and may be associated with some factors to which this population is exposed.

Conclusion

It is necessary further research to better understand this phenomenon, its causes and potential modifiers.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Maternal Mental Illness and Early Parenting Interventions
Authors: Sutter-Dallay A.L.
Published: June 2017

The importance of the “1001 critical days” (conception to age 2) underlies the need to act early in life to enhance children's developmental outcomes. Lack of intervention is likely to affect the children of today but also the generations to come. For adults, transition to parenthood is a major stressful life event. The strong emotional load of this experience can make this transitional period much more challenging for adults with psychological, social and economic vulnerabilities, and lead to unadjusted interactions.

Then, applying the “transactional model of development” (Sameroff, 2009) to the early perinatal period helps us to understand how the needs of infants can easily affect a parent's mental state and induce inadequate parenting behaviors. These in turn make the infant's interactions more difficult and the infant's development more likely to be impaired. Perinatal mental health is thus an important public health challenge for it is essential to provide services to enhance maternal and infant emotional well-being at a moment that is simultaneously when the mother's social and emotional vulnerabilities are at their height and a critical time in the child's development.

Perinatal mental health policies, including joint care of parents and infants, must provide positive support for the potential virtuous circle between the skills and vulnerabilities of the infant and the parents.

This presentation will explore the different types of joined perinatal care for parents and infants that cover a range of services, from parent-infant psychotherapies to joint mother-baby hospitalizations.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Psychiatric Trainees’ Experience of their Training in Perinatal Mental Health
Authors: Sönmez E. , Dias M. Casanova , Costa M. Pinto Da
Published: June 2017

Introduction

Approaching and offering treatment to a patient in perinatal period might be complicated. Often, it is regarded as one of the most difficult aspects in psychiatry. Given the increasing trends in the number of female patients of childbearing age consulting to psychiatric services, it has become an issue that specialists of today and tomorrow need to be well aware of.

Objectives

To better understand the impact of perinatal mental health training on psychiatric trainees from different countries in Europe who receive such training.

Methods

The European Federation of Psychiatric Trainees conducts annual surveys, directing questions to national trainee representatives, to assess the situation of psychiatric training. EFPT representatives of the countries where perinatal mental health training was reported to be included in psychiatry and/or child and adolescent psychiatry training programmes, namely Germany, France, Malta, Finland and Ireland, were contacted. Qualitative interviews focusing on the confidence (or in confidence) trainees feel when a patient who is planning pregnancy, pregnant or breastfeeding consults to them and the impact of training in perinatal mental health on their attitudes as clinicians were explored.

Results

Although theoretical training in perinatal mental health is considered as an important aspect of psychiatry training in general, practical training or rotations are not found as essential. However, being able to benefit to more than one generation was perceived as a source of motivation.

Conclusions

Perinatal mental health is appreciated as a critical part of theoretical education by trainees and in countries where a clinical rotation is available, it enhances making more use of resources and consultation possibilities.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Identifying Service and Care Needs from the Users’ Perspective in Treatment-Resistant Schizophrenia
Authors: Rubinstein K.
Published: June 2017

Exploring service and care needs of patients with treatment-resistant schizophrenia is necessary for a better understanding of their psychosocial functioning, in order to develop rehabilitation goals as well as to provide them with better care.

m-RESIST is an innovative project aimed to empower patients with resistant schizophrenia, to personalize treatment by integrating pharmacological and psycho-social approaches, and to develop knowledge related to the illness using predictive models designed to exploit historical and real-time data, based on environmental factors and treatment outcomes.

m-RESIST is a system based on computer and cellular applications and wearable computing devices. The system will serve patients, caregivers and clinicians, and include the following functions: Information, Assessment, Monitoring, Communication, and Intervention.

The first step in the development process included definition of the end user needs and preferences, in order to involve users in the design of the system. Outpatients with treatment-resistant schizophrenia, informal carers (relatives), and clinicians were included in the sample. There were a total of 9 focus groups, 3 in each pilot country. Each group was composed of one of the participant profiles. Additionally, 35 individual interviews were performed, which were unevenly distributed throughout the 3 institutions.

The current workshop section will present the outcomes of this process: perceived advantages and disadvantages of the technological solution, as well as conclusions for further development. In addition, methodological issues, future challenges, relevant for the evolution of the m-RESIST project, in particular, as well as technological developments in the field of mental health, in general, will be discussed.

1

Disclosure of interest

The author has not supplied his declaration of competing interest.
Elucidating the Neural Circuitry Underlying Individual Differences in Response to Reward-associated Cues
Authors: Flagel S.
Published: June 2017

Stimuli in the environment that have been associated with reward can gain control over behavior and, in some cases, lead to maladaptive behavior. Reward cues acquire inordinate control when they are attributed with incentive salience or transformed into “motivational magnets” (i.e. incentive stimuli). Individuals vary considerably in the extent to which they attribute incentive motivational value to reward cues, and we can capture this individual variation using an animal model. When rats are exposed to a Pavlovian conditioning paradigm, in which the presentation of a lever-cue is immediately followed by the delivery of a food reward, some rats preferentially approach the lever (sign-trackers, STs) while others approach the food cup (goal-trackers, GTs). Importantly, while the lever is a predictor for both STs and GTs, only for STs does it become an incentive stimulus. Thus, this model allows us to parse the neurobiological mechanisms underlying predictive vs. incentive learning processes. Using this model, we have demonstrated that dopamine is critical for incentive, but not predictive, learning and that the cortico-thalamic-striatal “motive circuit” is engaged only by incentive stimuli. In addition, we have identified the paraventricular nucleus of the thalamus (PVT) as a central node that differentially regulates sign- and goal-tracking behaviors. We have begun to utilize a chemogenetic approach (i.e. DREADDs) in combination with in vivo microdialysis to further elucidate the neural circuitry underlying individual variation in cue-motivated behaviors. Findings suggesting that STs rely primarily on subcortical mechanisms, whereas GTs utilize more “top-down” cortical processes will be presented and discussed.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Age at the Onset of a First Episode of Psychotic Mania: Does it Have an Impact on Outcome?
Authors: Conus P. , Cotton S.M. , McGorry P.D.
Published: June 2017

Purpose

Studies conducted in child psychiatry suggest that patients with earlier onset of psychosis have poorer outcome. Similar findings have been published regarding onset of bipolar disorder. However, few studies have been conducted in youth mental health program where these patients may actually receive treatment. Identification of subgroups with distinct need and outcome among first episode mania patients would facilitate the development of specific treatment strategies better suited to the actual needs of patients.

Methods

Sixty-seven patients with a first episode of psychotic mania were followed up over 12 months after recovery from this initial episode. Syndromic and symptomatic outcome were determined with the brief psychiatric rating scale, functional outcome with the quality of life scale and premorbid adjustment scale sub items.

Results

While 90% of patients achieved syndromic recovery (disappearance of manic syndrome) at 6 and 12 months, 40% had not recovered symptomatically, still presenting with depression and anxiety. Return to previous level of functioning was achieved only by 34% of patients at 6 months and 39% at 12 months. Age at the time of first manic episode with psychotic features was a significant predictor of recovery of functional level.

Conclusions

While manic symptoms reduce quickly in most patients after a first episode of psychotic mania, an important number of patients still display symptoms of depression and anxiety after 12 months and 2/3 do not reach functional recovery. Younger age at first episode predicts risk of poorer functional outcome.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Epidemiological Study Between Greek People and Immigrants with Regard to Diagnosis in a Greek Hospital in Athens
Authors: Lyrakos G. , Menti D. , Dimitriou A. , Spyropoulos I. , Spinaris V.
Published: June 2017

Introduction

Differences between the most frequently reported diagnoses of Greek people and immigrants in Greece are expected due to the different underlying factors which are associated with mental health issues.

Objectives

Examine differences in diagnoses between Greek people and immigrants.

Aims

To investigate whether Greek people and immigrants had significant differences with regard to reported diagnoses in a Greek hospital.

Methods

The patients who participated in this study are 5551, among them 2760 (49.7%) were males and 2791 (50.3%) were females. The mean age of the sample was 45.54. The sample consisted of 455 (8.3%) immigrants and 5,042 (91.7%) Greek people. Convenience sampling method was used and the sample was collected at the General Hospital of Nikaia, “Ag. Panteleimon” in Athens, Greece, between 01/01/2012 and 31/12/2015.

Results

There were significant differences between Greek people and immigrant with regard to diagnosis as χ2 (20): 136.875, P < 0.001. More specifically, among Greek people, the most frequently reported diagnosis was psychotic disorder (26.2%), followed by depression (24.7%), general anxiety disorder (9.9%) and substance abuse (8.4%). Among immigrants, the most frequently reported diagnosis was psychotic disorder (22.9%), followed by substance abuse (21.3%), depression (17.4%) and general anxiety disorder (12.1%).

Conclusions

The differences between Greek people and immigrants with regard to diagnoses showcase the different needs between the two populations with regard to mental health. Especially, the higher prevalence of anxiety disorders and substance abuse problems among immigrants highlight the need for protective measures to improve their well-being and reduce their risk of mental health issues.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Impact of EU Political Ambiguity Towards Migrant Crisis on the Mental Health of Migrants
Authors: Kulovic S. Veceric
Published: June 2017

For last couple of years, EU is facing migrant crisis that is challenging its capacity to help and its unity to decide the modes of assistance. Such political context brings additional uncertainty and insecurity into migrants’ lives which causes extreme experiences that are often damaging migrants’ mental health. In humanitarian plans regarding assistance for migrants, mental health is a cross cutting issue. Status of mental health is a result of complex intertwining of genetics, developmental and current life experiences. The experience of migration is a current life event which highly determines migrants’ mental health. Hardships of travel along migration route are worsened by often hostile reception by authorities at borders of countries that are on the way to desired rich EU countries. On migrants’ way to desired safety, there are countries like Slovenia and Hungary which protect their borders with wire. Therefore, migrants are stuck in countries, like Greece and Croatia, which are not their desirable destination. While waiting to get free passage, migrants are exposed to various political rhetoric of politicians of EU countries who hold their destiny in their hands. Migration experience does not make migrants mentally ill but it does make them vulnerable in that respect. Migrants’ vulnerability is highly challenged by ambiguity of political decisions, media coverage influenced by the same policies and concomitant changes in immediate surrounding. It is crucial to make publicly clear that political decisions mean life or death, health or mental disorder to migrants and that therefore they at least carry ethical responsibility.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Identity, Culture and Psychosis: A Non-systematic Review
Authors: Xavier S. , Correia A.F. , Barbosa S. , Dindo V. , Maia T.
Published: June 2017

Introduction

Given the results of multiple epidemiological studies showing a greater incidence of schizophrenia in migrants, especially in second-generation migrants, many researchers tried to investigate which factors could be associated to these findings, in order to have a better understanding of the migration process itself and simultaneously to contribute to improve knowledge about schizophrenia. In line with the research suggesting that social factors are important contributors to psychological suffering and vulnerability to psychosis, several authors pointed cultural identity as a possible mediator between migration and psychosis.

Objectives

To review different perspectives on the current literature about the relationship between cultural identity and psychosis.

Methods

Non-systematic review searching on the database MEDLINE and additional searches through secondary references.

Results

Concepts like identity clarity and identity value attributions are closely related to psychological well-being and may influence vulnerability or resilience to severe mental illness. Simultaneously, these concepts are also regarded as closely linked to social and cultural identity. Feelings of uncertainty between multiple existential positions that may arise for migrants (especially if hierarchical and unequal relationships of power are established) could compromise the sense of meaning and coherence of the self and compromise identity structure, thereby predisposing to psychotic experiences.

Conclusions

Even taking into account the heterogeneity of the reviewed articles, there seems to be some consensus regarding the importance of culture on how individuals experience themselves and others and that preservation of a solid and coherent cultural identity may be a crucial aspect to take into account when studying resilience against severe mental diseases.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Rural and Urban Childhood Environment Effects on Episodic Memory
Authors: Zhang X. , Yan H. , Shah S. , Yang G. , Zhao X. , Zhu J. , Zhang X. , Li J. , Zhang Y. , Chen Q. , Mattay A. , Yue W. , Weinberger D.R. , Zhang D. , Tan H.
Published: June 2017

Introduction

Childhoods in urban or rural environments may differentially affect risk for neuropsychiatric disorders. Here, we leveraged on dramatic urbanization and rural-urban migration since the 1980s in China to explore the hypothesis that rural or urban childhoods may differentially influence memory processing and neural responses to neutral and aversive stimuli.

Objectives

Explore the underlying mechanisms of childhood environment effect on brain function and neuropsychiatric risk.

Methods

We examined 420 adult subjects with similar current socioeconomic status and living in Beijing, China, but with differing rural (n = 227) or urban (n = 193) childhoods. In an episodic memory paradigm scanned in a 3 T GE MRI, subjects viewed blocks of neutral or aversive pictures in the encoding and retrieval sessions.

Results

Episodic memory accuracy for neutral stimuli was less than for aversive stimuli (P < 0.001). However, subjects with rural childhoods apparently performed less accurately for memory of aversive but not neutral stimuli (P < 0.01). In subjects with rural childhoods, there was relatively increased engagement of bilateral striatum at encoding, increased engagement of bilateral hippocampus at retrieval of neutral and aversive stimuli, and increased engagement of amygdala at aversive retrieval (P < 0.05 FDR corrected, cluster size > 50).

Conclusions

Rural or urban childhoods appear associated with physiological and behavioural differences, particularly in the neural processing of aversive episodic memory at medial temporal and striatal brain regions. It remains to be explored the extent to which these effects relate to individual risk for neuropsychiatric or stress-related disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Emotional Intelligence Features at a Pathology of Corpus Callosum (CC)
Authors: Kovyazina M. , Ksenia F. , Varako N. , Dobrushina O. , Martynov S.
Published: June 2017

Introduction

Dependents of human behavior on the hemispheric interaction quality is extremely interesting question. The СС impairments are observed at schizophrenia, autism, Tourette syndrome, ADHD, etc. Difficulties in the sphere of emotional intelligence are typical at not only frontal zones disorders and right hemisphere of brain.

Aims

Analyze the emotional intelligence of the patients with CC pathologies.

Methods

Method for the recognition of facial expression (faces and gestures); Video test “estimation of another person emotional condition”; Survey for the estimation of emotional intelligence (EmIn); ten people with different CC pathologies participated.

Results

Results of the person with the CC pathologies were different from normative indexes of the first two methods. They did not recognize the shown emotion: the sign of emotional expression was not identified, the gestures were not distinguished and three positive characteristics out of 24 suggested for the designation of emotion modality were used. The emotions of heroes from video test were recognized mistakenly. The indexes were normative for all scales of EmIn survey. However quite noticeable negative correlation of

“emotion control” and “interpersonal emotional intelligence” survey indexes with the index of emotional recognition video test was obtained.

Conclusions

Weak emotional tone, leading to incorrect estimation of the emotional sign, is observed at CC pathology. This doesn’t exclude the violation of face emotional expressions analyze criteria. The situational context does not help the another person condition recognition. The answers on the EmIn test questions are based on subjective visions of the patient about themselves, those witnesses about the criticism reduction.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effect of Prenatal Exposure to Alcohol on the Development of Brain Vessels in Human Embryos and Fetuses
Authors: Solonsky A. , Shushpanova T.V. , Solonskaya E.G. , Bokhan N.A. , Logvinov S.V.
Published: June 2017

Introduction

Human embryos are most susceptible to exogenous effects during the first weeks of development.

Aim

Study the effects of prenatal alcohol intoxication on morphometric measures of developing vessels in the human embryonic and fetal cerebrum.

Methods

Embryos and fetuses (7–12 weeks): 23 obtained from alcoholic women with stage II alcoholism (the experimental group) and 30 from healthy women (the control group). The research involved electron microscopy, computer morphometry, parametric method of variational statistics and Scion software to determine mean vascular cross-sectional area, the relative cross-sectional area of vessels, the number of vessels per unit area, and the perimeter of vessels.

Results

From 10 weeks, vessels in the human brain start to differentiate into arteries and veins. At 12 weeks, capillary basal membranes were already clearly visible. We established a series of characteristics distinguishing brain tissues in the experimental group vs. that in controls: mean vessel cross-sectional areas and vessel perimeters were significantly reduced by 11 weeks vs. controls. The tendency persisted at 12 weeks. Relative vessel cross-sectional area in the experimental group was greater than in controls.

Conclusions

Maternal alcoholization during pregnancy significantly influences the development of the cerebral circulatory system, manifesting mainly in changes in the vascularization of the growing brain.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
REMOVED: Do Impulsive Individuals Respond Better to Cognitive Bias Modification Treatment for Alcohol Dependence?
Authors: Staiger P. , Manning V. , Leung D. , Hall K. , Verdejo-Garcia A. , Hughes L.
Published: June 2017

This has been removed as it was published accidentally. The authors listed wish it to be known that this article was not presented at the conference for which this volume is the proceedings.

The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
Correlation Between Depression and Cognitive Decline in Elderly Outpatients: A Preliminary Study
Authors: Gogos A. , Papageorgiou G. , Kavourgia E. , Papakyrgiaki E. , Mitsokali A.
Published: June 2017

Introduction

Depressive disorder is common psychiatric morbidity among the elderly outpatients. It is also evident that cognitive disorders, ranging from mild cognitive impairment to severe dementia, are widely prevalent in the elderly coexistence of the above is quite common. Treatment for both conditions is quite challenging, aiming at symptomatic relief and improvement in functional status.

Objectives

To investigate the coexistence of depression and cognitive impairment in aged depressive outpatients, 65 years or older. Correlation of cognitive level and depressive symptomatology was measured.

Method

We used hamilton depression scale (HAM-D) and MMSE in 35 (mean age 68.2 years) depressed outpatients over 65-year-old. We excluded depressed schizophrenics and bipolar patient.

Results.

On a preliminary basis, a correlation between low MMSe and HAM-D (P < 0.05) was found. An interesting finding, though not measured primarily, was that low MMSE was accompanied with a low compliance with medication.

Conclusions

The mental deterioration that accompanies cognitive impairment is being widely studied and it is real complex. In our ongoing study previous findings are confirmed and can be interpreted both ways, i.e. depression is a risk factor for dementia and also the fact that existing dementia is positively correlated with a low HAM-D.

Compliance to medication is affected, among other variables, by the patients’ mental state.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pain Assessment in People with Dementia
Authors: Feki I. , Hentati S. , Sallemi R. , Baati I. , Masmoudi J.
Published: June 2017

Introduction

Assessing and quantifying the experience of pain in elderly with cognitive impairment is particularly challenging and important.

Objectives

To describe the overall profile and to identify the prevalence and characteristics of pain among demented elderly.

Methods

A descriptive study including 60 institutionalised elderly aged 65 and older in the retirement home, Sfax, Tunisia. Data collection was conducted using questionnaire exploring socio-demographic and medical data. Mini-mental state examination (MMSE) and Katz index of independence in activities of daily living (ADL) were used to assess respectively mental status and dependence for ADL. Verbal Descriptor Scale (VDS) and elderly behavioural scale (ECPA) were used to evaluate pain. Thirty-two elderly were included and the inclusion criteria were: Age ≥ 65 and MMSE score ≤ 20.

Results

The average age of cognitively impaired residents was 74.2 years with a slight male predominance (57%). They were mostly illiterate (83%) and 56.3% of subjects were single. Almost two-thirds were admitted voluntarily and the average length of stay was 4.8 days. The ADL scale has shown that 65.6% were dependent. According to the VDS, the majority of demented subjects (93.8%) did not feel and express pain, 3% of residents with dementia had mild pain, 2.2% had moderate pain and 1.1% had severe pain. Whereas, the hetero evaluation (ECPA) concluded that 72% of demented elderly actually had pain with severe pain in 18.8% of cases.

Conclusion

Pain in elderly persons with dementia is a significant problem. This underlines high needs of research as well as excellent implementation concepts for assessment and treatment of pain.

Disclosure of interest.

The authors have not supplied their declaration of competing interest.
Voltage Gated Potassium Channel Antibody(VGKC)-associated Encephalopathy and Psychiatric Symptoms (case report)
Authors: Narayana U. , Nirodi P.
Published: June 2017

Introduction and Objectives

The limbic system is primarily responsible for modulating behaviour, emotions and neuro-endocrine functions. Limbic encephalopathy involves this part of the brain and is characterised by the acute or sub-acute onset of seizures, recent memory loss, confusion and psychiatric symptoms. Here we describe an unusual presentation of a well-functioning elderly man, who presented with sudden onset of confusion, cognitive impairment, treatment resistant hyponatremia, seizures and psychiatric symptoms.

Methods (Presentation)

This 79 year old gentleman, previously well and independent was admitted to the acute hospital with a 3 week history of sudden onset of confusion, odd behaviour and weight loss. On admission he was hyponatremic (Na-118), developed treatment resistant seizures and progressive cognitive impairment. He was referred to the Liaison Psychiatry team with increasing paranoia, agitation and persecutory delusions.

Results

MRI and CT brain remained normal. Lumbar puncture revealed a positive VGKC antibody and his blood titres for VGKC was more than 3000. His hyponatremia and seizures remained chronic, but improved with plasmapheresis, oral corticosteroids and cyclophosphamide. He was commenced on aripiprazole for psychiatric symptoms, but was transferred to the acute psychiatric unit after being detained under section 2 of the MHA due to risks of aggression and absconsion.

Conclusions

Psychiatric symptoms related to this form of encephalitis have not been emphasised in literature. His aggression improved over time on aripiprazole, but was transferred to a residential care home setting due to persisting cognitive deficits and social care needs This case highlights the importance of recognising multimorbidity, joint working and more research required in the area.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Health-related Quality of Life in Old Age Institutionalized Patients with Neurocognitive Disorders
Authors: Vasiliu O. , Vasile D. , Vasiliu D.G. , Vasile F.
Published: June 2017

Health-related quality of life (HRQOL) is an important indicator of how a patient perceives hi/her own physical and mental status. Evaluating this dimension in old age patients which are institutionalized for neurocognitive disorders is useful from several perspectives: (1) determination of an initial value for HRQOL parameters could help the case manager in structuring an individualized therapeutic intervention, adapted for psychological, somatic or psychosocial needs of each patient; (2) monitoring the evolution of HRQOL dimensions could help in improving through feedback the quality of therapeutic intervention(s), especially if the case manager is permanently in contact with the patient, as is usually the case of institutionalized subjects; (3) correlation between HRQOL and other important variables, like therapeutic adherence, regression of comorbidities, daily functioning etc. could modulate the therapeutic intervention. We suggest a plan for HRQOL evaluation in institutionalized patients diagnosed with neurocognitive disorder, consisting in monthly scoring of SF-36 or EuroQoL questionnaire, corroborated with MMSE and ADAS-Cog scoring. Psychotherapeutic interventions tailored to the needs identified through HRQOL periodic evaluations could be useful in this population, for example a perceived isolation could be compensated by increasing the rhythm of social interaction by group therapy under the direction of a counsellor, a reduced self-efficacy could be compensated by activation techniques, music or art-therapy, while dissatisfaction with own memory capacities could be mitigated using reminiscence therapy. Switching from a paternalistic way of perceiving the patient as the object of an intervention, to a more interactive style of communication, involves obtaining feed-back through HRQOL instruments.

Disclosure of interest

COI: The presenting author was speaker for Bristol Myers Squibb and Servier, and participated in clinical research funded by Janssen Cilag, Astra Zeneca, Eli Lilly, Sanofi Aventis, Schering Plough, Organon, Bioline Rx, Forenap, Wyeth, Otsuka Pharmaceuticals, Dainippon Sumitomo.
Older Adults’ Adjustment to Aging: The Impact of Sense of Coherence, Subjective Well-being and Socio-demographic, Lifestyle and Health-related Factors
Authors: Von Humboldt S. , Leal I.
Published: June 2017

Introduction

Literature lacks of studies assessing correlates of adjustment to aging (AtA) among older populations.

Objective

The aim of this study was to build a structural model to explore the predictors of adjustment to aging (AtA) in a community-dwelling older population.

Methods

A community-dwelling sample of 1270 older adults aged between 75 and 102 years answered a questionnaire to determine socio-demographic (sex, age, professional and marital status, education, household, adult children, family's annual income, living setting and self-reported spirituality), lifestyle and health-related characteristics (perceived health, recent disease, medication and leisure). Several instruments were used to assert psychological variables, namely AtA, sense of coherence and subjective well-being. Structural equation modeling was used to explore a structural model of the self-reported AtA, encompassing all variables.

Results

Significant predictors are self-reported spirituality (β = .816; P < .001), perceived health (β = .455; P < .001), leisure (β = .322; P < .001), professional status (β = .283; P < .001), income (β = .230; P = .035), household (β = -.208; P = .007), sense of coherence (β = -.202; P = .004) and adult children (β = .164; P = .011). The variables explain 60.6% of the variability of AtA.

Conclusions

Self-reported spirituality is the strongest predictor of AtA. This study emphasizes the need for deepening the variables that influence older adults’ AtA, in particular perceived health and further lifestyle-related characteristics, as being relevant for promoting aging well in later life, within a salutogenic context for health care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clinical-qualitative Study on Emotional Aspects of Practices and Learning, Interviewing Brazilian Nurses from a Hemato-oncological Unit who Work with Patients in Risk or Death Process
Authors: Bastos R.A. , Turato E.R. , Quintana A.M.
Published: June 2017

Introduction

There is no clear limit between the personal and professional dimension, when the health worker cares for patients who have no prospect of cure. This shadowing of the personal dimension causes high emotional demands of the professional in the face of the experiences with the death.

Objectives

In face of troubles which surround the nurse in the context of death, this article aimed to identify the learning and self-care practices experienced by nurses who work with patients in risk or in death process, in a haematology-oncology unit.

Method

This is a clinical-qualitative study, conducted through individual interviews. The participants were 6 nurses from haematology-oncology unit of a university hospital, covering the sectors of chemotherapy clinic and children's unit.

Results

The results highlight two phenomena built by the experiences of nurses: long learning experiences with the team work through the maturity arising over time or even with constant monitoring of the death situations; and self-care practices as self-preservation phenomenon through the development of pain by speaking and listening in groups, the motivation through professional achievement and the well-being caused by the charity care each other.

Conclusions

Work towards the personal development of nurses as professional who deals with ethical conflicts should be focused on promoting opening spaces for speaking and listening of these nurses. This allows them to create ways of dealing with situations of death, which are professionally responsible.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
New method and new access to the grieving and clinical tool of the thanatology
Authors: Färber S. , Färber M.
Published: June 2017

Introduction

Educational advice for coping with loss and resolution of grief: VIVER®, proposes new method of research and action in the field of thanatology and grief psychology through systematic meetings, group in which the intervention takes place under the simultaneous care professionals of thanatology and psychology.

Objective

To present the principles that underlie the research typology and grief subject, its implications in the grieving process and the service to the mourning proposed by VIVER® assistance.

Methods

Thanatological hermeneutics and literature review were used to develop this work.

Results

The educational assistance VIVER® offers a useful tool in the care of the mourning by the method, created by Färber and Färber, composed of two pillars: the presentation of educational content about loss and grief, and artistic, playful and expressive experiences.

Conclusion

The work on operational groups listening and intervention assists the development of losses and reinterpretation of the history of the participants.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychological and physical impact of violence in psychiatric nurses
Authors: Fattah Moghaddam L. , Memari A. , Bamdad M.
Published: June 2017

Introduction

Violence in therapeutic centers, especially psychiatric wards is much higher than other units. In healthcare provider groups, nurses are at high risk of patient's aggression in the workplace.

Aims

The aim of this study is to evaluate the effect of violence on the health of nurses in Razi Hospital in Tehran, Iran.

Method

In this cross-sectional study a total of 312 nurses working in psychiatric hospitals completed a GHQ28 questionnaire.

Results

The results demonstrated that there is a statistical significant correlation between violence of patients (including physical violence and disrespect) to physical symptoms, anxiety and sleep disorder in nurses (P < 0.05). Also, increased frequency of disrespect by family of patient correlated to higher physical symptoms, anxiety, and sleep disorder in nurses. However, there was not any significant correlation between symptoms of depression, social function with aggressive patients.

Conclusion

Patients and their relative's violence affect the health of nurses. Therefore, it is necessary the therapeutic interventions for the prevention of physical and mental diseases in nurses and decreased desire to leave the organization.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Asenapine in the treatment of trichotillomania with comorbid bipolar disorder: A case report
Authors: Francis B. , Jambunathan S.T. , Gill J.S.
Published: June 2017

Trichotillomania has been found to be associated with mood disorders, particularly bipolar disorder. Trichotillomania has shared similarities with bipolar disorder by virtue of phenomenology, co-morbidity, and psychopharmacologic observations. In the past, trichotillomania with comorbid bipolar disorder was treated with lithium and sodium valproate. There has been little, if any, literature on using asenapine to augment treatment in patients with trichotillomania with comorbid bipolar disorder. A patient presented with hair-pulling episodes for a year, resulting in bald scalp patches. She had no mood symptoms prior to this. She developed low mood, anhedonia, poor sleep and poor appetite subsequently as she could not stop pulling her hair. She was started on escitalopram 10 mg daily for he depressive symptoms. Three years later, she developed hypomanic symptoms such as irritability and spending sprees. Her hair pulling behaviour worsened at this time. At this point, a diagnosis of bipolar disorder type 2 was considered and she was started on lithium 300 mg daily. Her escitalopram was discontinued. As her mood was still labile 10 months later, asenapine was added to augment lithium in the treatment of the bipolar disorder. With asenapine, her hair pulling frequency started to decrease rapidly. Asenapine was increased to 10 mg daily and her hair pulling ceased. Her mood also stabilized and she no longer had erratic periods of mood lability. In conclusion, asenapine augmentation of lithium has potential to be used in patients who have trichotillomania with comorbid bipolar disorder due to its unique receptor profile.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
“Dangerous relationships”: Family dynamics among members with severe mental illness. about a case
Authors: Santillan G. Hernande. , Ballesteros E. Martin
Published: June 2017

A 51-year-old woman from a Mediterranean location with a history of a brother diagnosed with schizophrenia, moved thirty years ago, away from her family of origin, when marrying a man suffering from severe untreated OCD, who in turn, has two brothers, both with OCD, and a nephew with OCD. She says that her husband is very unsociable, spends most of the day at work and comes home at night to clean for a long time until he does not see lint on the floor or a crumb on the table literally. They have a fifteen-year-old son, with needy materials, very attached to the mother and very little to the father. The patient consults, motivated by a former sister-in-law and a friend, because they have noticed deterioration in their self-care and tendency to isolation, which the patient explains because in the last year she has noticed exacerbation of the comments by her neighbours and even unknown people that tell her “look how dirty, your husband has to come after work to clean your house, and makes noise.” The companions are also concerned that the child has had school and social problems and admits hearing the same as his mother. Now, What possible diagnoses do we propose in this patient: Folie a deux, delusional disorder, paraphrenia, other? (Figure 1)

Disclosure of interest

The authors have not supplied their declaration of competing interest.