bluuebunny/crossref_metadata_2025 huggingface dataset:
Time to relapse monotherapy and acquisition in a sample of schizophrenic patients over 3 years of follow-up
Authors: González Rivera P. , Benito Ruiz A.J. , Prados Gomez J. , Hidalgo Borreguero A. , Soto Laguna M. , Preckler Peña K. , Bolaño Mendoza S. , González Díaz F.J. , González Rivera V. , Fernando-Torija Daza M.
Published: May 2016

Introduction

Poor adherence to treatment is one of the main problems in health care to psychiatric patients. The second-generation antipsychotics, and the subsequent emergence of the depot forms (long acting formulations) have facilitated this aspect, increasing the time to clinical relapse in patients with schizophrenia.

Goals

Determine the time to relapse in a clinical sample of patients diagnosed with schizophrenia treated with paliperidone palmitate over 3 years. Other objectives include the possible reduction in hospital admissions, as well as the possible reduction of psychiatric emergency visits, concomitant medication (benzodiazepines and Biperiden) and the possible increase in drug monotherapy.

Methodology

This is a study with a sample of 101 patients with schizophrenia who had started treatment with PP (consecutive sampling). Quantified variables in the 12 months prior to the change of PP treatment with variables at 6, 12, 24 and 36 months after initiation of treatment with PP were compared.

Results and conclusions

At the end of the tracking, 72.22% (73 patients) remained clinically stable, with adequate adherence to treatment and there have been no clinical relapses. It has obtained a statistically significant reduction in the use of concomitant medication, emergency room visits and the average duration of revenues, with no clinical relapse should occur in patients of the sample in the second and third year.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Glycine transporter inhibitor sarcosine changes neuronal and glial parameters in the left dorsolateral prefrontal cortex and glutamatergic parameters in the left hippocampus in stable schizophrenia
Authors: Strzelecki D. , Podgórski M. , Kałużyńska O. , Kotlicka-Antczak M. , Gawlik-Kotelnicka O. , Gmitrowicz A. , Stefańczyk L. , Grzelak P.
Published: May 2016

Introduction

Sarcosine - glycine transporter inhibitor - increases glycine concentration around NMDA (N-methyl-D-aspartate) receptors. Function of the glutamatergic system in the prefrontal cortex and hippocampus is impaired in schizophrenia, which may lead to negative and cognitive symptomatology.

Aims

We evaluated the influence of sarcosine therapy on the concentration of metabolites (NAA, N-acetylaspartate; Glx, complex of glutamate, glutamine and γ-aminobutyric acid (GABA); mI, myo-inositol; Cr, creatine; Cho, choline) in the left dorso-lateral prefrontal cortex (DLPFC) and left hippocampus in patients with stable schizophrenia.

Methods

Fifty patients with schizophrenia, treated with constant antipsychotics doses, in stable clinical condition were randomly assigned (25 patients in each group) to administration of sarcosine (2 g) or placebo for six months. 1H-NMR spectroscopy (1.5 T) in both localisations and clinical evaluation (PANSS) was performed before and after sarcosine addition.

Results

Initially we noted no differences in metabolite concentrations between groups. In the left DLPFC, NAA/Cho, mI/Cr and mI/Cho ratios were significantly higher in the sarcosine than the placebo group after six months. In the sarcosine group, NAA/Cr, NAA/Cho, mI/Cr, mI/Cho ratios also increased compared to baseline values. In the placebo group, only the NAA/Cr ratio increased. In the left hippocampus Glx/Cr and Glx/Cho decreased in sarcosine group at the end of our study.

Conclusions

The addition of sarcosine to antipsychotic therapy for six months caused increase of neurons viability (NAA) and neurogilal activity (mI) markers in the left DLPFC and decrease of hyperglutamatergic overstimulation parameters in the left hippocampus with simultaneous improvement of clinical parameters including negative symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Selected metabolites of kynurenine pathway and response to antipsychotic treatment in schizophrenia
Authors: Szymona K. , Karakuła-Juchnowicz H. , Flis M. , Kocki T. , Urbanska A. , Kloc R. , Szymona Z. , Rosa W. , Urbańska E.M.
Published: May 2016

Introduction

Deficit of glutamatergic transmission and aberrant function of kynurenine pathway, with disturbed synthesis of glutamate receptors antagonist, kynurenic acid (KYNA) and neurotoxic metabolite of kynurenine, 3-hydroxykynurenine (3-OH-KYN) have been implicated in the pathogenesis of schizophrenia.

Objectives

Demonstrated by others higher level of KYNA in the brain may cause relative deficiency of glutamate-mediate transmission with resulting behavioural and cognitive changes.

Aims

Search for predictors of satisfactory response to antipsychotic treatment based on the analysis of KYNA and 3-OH-KYN serum levels.

Methods

Fifty-three patients with chronic schizophrenia and 46 healthy individuals were enrolled in the study. Quantitative analyses of KYNA and 3-OH-KYN were performed using high-pressure liquid chromatography (HPLC) and electrochemical detection, respectively. Clinical assessments (PANSS, SANS, SAPS) and blood analyses were conducted at 3 time-points: during the active phase of disease, after 4 weeks of modified pharmacotherapy, and after reaching remission.

Results

In schizophrenia group, lower levels of KYNA (P = 0.002) and non-altered levels of 3-OH-KYN (p = 0.195), as compared to control, were detected during active phase of disease. Despite clinical improvement, no significant changes in the level of studied metabolites were observed later on. The initial level of 3-OH-KYN correlated negatively (r = –0.368; Spearman's rank) with clinical improvement (negative symptoms) (P < 0.05).

Conclusions

1. The peripheral dysregulation of kynurenine pathway metabolites in chronic schizophrenia manifests as relative increase in the ratio between neurotoxic 3-OH-KYN and neuroprotective KYNA. 2. The higher serum level of 3-OH-KYN during relapse of schizophrenia seems to predict poor response to antipsychotic treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The effects of fluvoxamine on cognition in patients with schizophrenia
Authors: Zamir S.M. , Haji Seyed Javadi S.A. , Farzaneh Khanshir Z.
Published: May 2016

Introduction

Schizophrenia is a severe disease which affects different aspects of behavior, including cognitive functions. The most important fields of cognitive disorders in schizophrenia are working memory, vigilance/attention, learning by oral and visual memory, argument and resolving, analysis rate and social knowledge.

Aims

This study was designed to assess the effects of fluvoxamine on cognitive functions of schizophrenic patients.

Method

Thirty-six patients with schizophrenia, all male, were treated with 100 mg fluvoxamine and a second generation anti-psychotic for 4 weeks and before and after treatment, their cognitive functions were assessed by Wechsler-3 memory scale (WMS-revised) and negative symptoms by scale for the assessment of negative symptoms (SANS).

Results

In our study, the average patients’ scores increased in Wechsler-3 memory scale (WMS-revised) before and after receiving fluvoxamine (P < 0.001). This study couldn’t show a statistically significant difference between the patients’ scores in negative symptoms (SANS test) before and after the treatment course (P = 0.59) There was a negative statistically significant correlation found between WMS score before and after the intervention and the level of education, living area and cigarette smoking. Increasing scores in the test was statistically correlated with lower education, cigarette smoking and living in rural area.

Conclusion

Augmented treatment with fluvoxamine, probably has effects on some parts of cognitive abilities of male schizophrenic patients which are assessable by Wechsler-3 memory scale. Therefore further studies on evaluation of fluvoxamine effects in other fields of cognitive abilities like concentration and attention in schizophrenic patients are still required.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicidal plan and dissociation
Authors: Preve M. , Mula M. , Degrate A. , Suardi N.E. , Godio M. , Colombo R.A. , Traber R.
Published: May 2016

Introduction

The social and economic impact of mood disorders and suicide is extremely high. In depression, suicide is included among the cognitive disturbances, together with guilt, paranoid and obsessive-compulsive symptoms, depersonalization/derealization and agitation [1,2]. The aim of this report is to study a sample of depressed patients with bipolar disorder or major depressive disorder, to evaluate the level of impulsivity and dissociation in a context of a suicidal plan.

Method

Twenty inpatients with suicidal plan were assessed with: the SCID-P for Axis I diagnosis, SCI-DER, DSS, HRSD, HAS, YMRS, GSR. We conducted a systematic literature review (PubMed, Embase, PsychInfo) using the key terms “depression”, “suicide”, “suicidal plan”, “depersonalization”, “derealization” AND “dissociation”.

Results

An independent sample T-Test analysis suggested that the patient with high sucidal plan present significant highter score at SCI-DER TOT (P = 0.015), DSS TOT (P = 0.037), BIS-11 motor perseveration factor (P = 0.023) and inversely significant HAS TOT (P = .029).

Discussion and conclusion

It's suggestive that when are lost the boundaries of the self, the clarity of suicidal's purpose reduces the levels of anxiety and suicide appears the only way to achieve the liberation of the suffering of depression. Methodological limitations, clinical implications and suggestions for future research directions are considered.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Post-partum depression risk factors in pregnant women
Authors: Ugarte A. , López P. , Serrulla C. , Zabalza M.T. , Torregaray J.G. , González-Pinto A.
Published: May 2016

Introduction

Postpartum depression has a prevalence of 15% and has consequences for mother and baby (delayed physical, social and cognitive development). It's essential to prevent the illness with an early identification of Risk Factors (RF).

Methods

Five hundred and seventy-two women in 3rd trimester of pregnancy were evaluated and selected those with ≥ 1 RF (n = 290). We re-evaluated in the postpartum with Edinburgh Depression Scale and selected those with subsyndromal depressive symptoms (≥ 7.5) (n = 57). Clinical, demographic and functional data were collected.

Results

A total of 50.7% had RF. A percentage of 48.6 had family history of mental illness (MI), 34.1%had personal history of (MI) and 34.1% had some pregnancy associated illness. Twenty percent had needed some assisted reproductive technique, 14.1% had little family support and 15.2% had little couple support, 3.8% showed anxiety-depressive disorders during pregnancy, 19.7% had depressive symptoms after delivery. The mean age was 33.67. No significant differences between patients with and without RF (T-1858, P 0.064). Among women with RF, 59.6% were married, 35.1% single and 3.0% had other situation. 89.5% live with their own family, 8.8% with their family of origin, 1.8% alone. 50.8% had university studies.

Conclusions

Assessing RF during pregnancy can help these women, since we see that the 19.7% will have serious risk of developing postpartum depression. The RF to take more into account are not those related to social-academic development, neither the presence of anxiety-depressive symptoms during pregnancy, but the family or personal history of (MI) and the presence of a pregnancy associated illness. Early detection and treatment may prevent the development of this disease improving the quality of life of mother and babies’ development.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cardiovascular risk assessment in psychiatric inpatient setting
Authors: Dahmer E. , Lokunarangoda N.C. , Romain K. , Kumar M.
Published: May 2016

Objectives

To assess the general cardiac health of inpatients in acute psychiatric units and to evaluate the practice of ECG use in this setting.

Aims

Overall cardiac risk is assessed using QRISK2. Clinically significant ECG abnormality detection by psychiatric teams are compared with same by cardiologist.

Methods

Ten percent of patients (n = 113) admitted to five acute psychiatric wards during a period of 13 months across three hospital sites, covering a population of 1.1 million, were randomly selected. Electronic health care records were used to collect all data, in the form of typed entries and scanned notes. An experienced cardiologist, blind to the psychiatrist assessments, performed ECG analysis. The QRISK2 online calculator was used to calculate 10-year cardiovascular risk as recommended by NIHR, UK.

Results

A score of 10% or more indicates a need for further intervention to lower risk.13.5% of patients had a QRISK2 score of 10–20%, 5.2% had a score of 20–30%, and 1 patient had a QRISK2 score > 30%. In total, 19.7% had a QRISK2 of 10% or greater. A total of 2.9% had prolonged QTC interval (> 440 ms), with 2.9% having a borderline QTC (421–440). A total of 34.3% of ECGs were identified by the ward doctors as abnormal, with action being taken on 41.6% of these abnormal ECGs. Cardiologist analysis identified 57.1% of ECGs with abnormalities of potential clinical significance.

Conclusions

One in five patients admitted to psychiatry wards have poor cardiac health requiring interventions. Though QTC interval prolongation is rare, half of patients may have abnormal ECGs that require further analysis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The F-Multidimensional Perfectionism Scale-18 (FMSP-18): Internal consistency, construct, concurrent and divergent validity
Authors: Soares M.J. , Pereira A.T. , Araújo A. , Silva D. , Amaral A.P. , Valente J. , Madeira N. , Bajouco M. , Macedo A.
Published: May 2016

Introduction

The FMPS is a 35-item self-report questionnaire to measure perfectionism. It evaluates: concern over mistakes/CM, doubts about actions/DA, parental criticism/PC and expectations/PE, personal standards/PS and organization/O.

Objectives

To develop a shortened version of FMPS and study its internal consistency, the construct, concurrent and divergent validity.

Methods

One hundred and ninety-two university students (78.1% females), aged 19.74 years (sd = 2.10) completed the Portuguese versions of the: FMPS, Hewitt and Flett MPS/H&FMPS, Life Orientation Test Revised/LOT-R, State-Trait Anxiety Inventory/STAI, and Profile of Mood States/POMS.

Results

Correlations between each item and corrected FMPS total scores/corrected total subscales scores were ≥ 0.20 for the items 13, 15, 25, 31, 35 and 10, 2, 25, and 26, respectively. The internal consistency of FMPS was high (α: .857) with 32 items contributing for this consistency (exceptions: 13, 25 and 31). The principal component analysis of the 35 items with factors varimax rotation was performed. The three items with higher loading in each factor that also contributed to the FMPS reliability were selected for the FMPS shortened version (FMPS-18). The principal component analysis of the 18 items with factors varimax rotation showed that six factors explained 74.6% of FMPS-18 total variance. These factors revealed adequate internal consistency (α: O = 0.740; PC = 0.859; PE = 0.847; PS = 0.726; CM = 0.740; DA = 0.832; total = 0.768). Convergent correlations between FMPS and the matched FMPS-18 scores were 0.839 to 0.971 (all P < .01). Correlations of the FMPS-18 and FMPS with H&F-MPS, STAI, LOT-R and NA/PA scores were of similar significance and valence.

Conclusion

FMPS-18 is a brief, reliable and valid instrument to measure perfectionism.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The H&F-Multidimensional Perfectionism Scale 13 (H&F-MSP13): Construct and convergent validity
Authors: Soares M.J. , Pereira A.T. , Araújo A. , Silva D. , Valente J. , Nogueira V. , Roque C. , Macedo A.
Published: May 2016

Introduction

The Hewitt and Flett Multidimensional Perfectionism Scale (H&F-MPS) is one of the most used measures of perfectionism. Their 45-items evaluate self-Oriented (SOP), Self-Prescribed (SPP), and Other Oriented (OOP) perfectionism.

Objectives

To study the internal consistency and convergent validity of the H&F-MSP13.

Methods

One hundred and ninety-two university students (78.1% females), aged 19.74 years (sd = 2.10; range: 17–28) completed the Portuguese versions of H&F-MPS (Soares et al., 2003) and of Frost et al. MPS (F-MPS) (Amaral et al., 2013). Thirteen items were selected from the Portuguese version of the H&F-MPS, based on their loading in the factor (0.60 and over) (Soares et al., 2003).

Results

The H&FMPS13 revealed good internal consistency (α = 0.816). The corrected item-total subscale Spearman's correlations were high (from 0.418 to 0.820). The principal component analysis with factors varimax rotation produced three factors, which revealed acceptable/good internal consistency (SOP: explained variance/EV = 35.4%, α = .900; SPP: EV = 16.3%, α = 0.695; OOP: EV = 10.8%, α = 0.709). The correlations between the H&F-MSP13 scores and the matching scores of the H&F-MPS were high (from r = 0.745 to r = 0.945, all P < .01), suggesting that both scales measure similarly the constructs. The H&F-MSP13 and the H&F-MPS total scores demonstrate good convergent validity with the total score of F-MPS, as indicated by the correlations (r = 0.581/r = 0.636, respectively). The correlations similarities between the H&F-MSP13 and H&F-MSP dimensions and the F-MPS dimensions and total scores were also considerable.

Conclusions

The H&F-MSP13 is a valid instrument to measure perfectionism that reveals convergent validity with the F-MPS, retaining the adequate psychometric properties of the H&F-MPS and its administration is less time consuming.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The tension between identity and competency: Comparing behavioural and constructionist approaches to professional formation
Authors: Brittlebank A.
Published: May 2016

Contemporary approaches to medical education emphasize the importance of doctors in training demonstrating the acquisition of competencies. This approach to educating doctors has been criticized on a number of grounds, not least because a solely behavioural focus risks trivializing medical professionalism. An alternative approach is to look at the formation of professional identity as a legitimate goal of training.

In this presentation, I will describe the behavioural and constructionist approaches to medical education and their implications for psychiatry training. I will make a plea for psychiatry training to renegotiate the balance between the two approaches.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Is addiction medicine part of psychiatry?
Authors: Orsolini L. , Papanti D. , Valchera A. , Vecchiotti R. , Corkery J. , Schifano F.
Published: May 2016

Addiction medicine/psychiatry, a medical subspecialty founded on October 1991 by the American Board of Psychiatry and Neurology, was granted as subspecialty within psychiatry. It mainly deals with medical assessment, diagnosis and treatment of subjects who suffer from an addiction (i.e. drug and/or alcohol addiction; gambling; sexual addiction; game addiction; and so on). Addiction psychiatry also deals with subjects in dual diagnosis, i.e. individuals with addiction issues along with co-occurring psychiatric disorders. However, despite its well established “dignity” to be part of psychiatry, most mental health's professionals believe that it is not a primarily psychiatric field due to the frequent co-occurrence of internistic/medical issues. In addition, the situation of psychiatric training specifically addressed to addiction is widely diversified across the European countries. Therefore, most psychiatrists do not possess specific qualifications and formation on this increasing field of psychiatry. The present lecture aims at providing an insight into the issues related to the diatribe between psychiatry and medicine on addiction medicine/psychiatry, specifically focusing on differences across European countries.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The synthetic psychosis substances induced: A clinical case study
Authors: DiPetta G.
Published: May 2016

The presentation intends to examine a new kind of clinical psychiatric syndrome, called by the author “synthetic psychosis”, which can occur in people who abuse novel psychoactive substances (NPS). This syndrome will be considered from both a psychopathological and a phenomenological perspective. The contemporary trend of poly-abuse of NPS in young people can lead to a sort of very intense paraphrenic state characterised by continuous hallucinations and formed by a mental automatism syndrome and by secondary (interpretative) delusions. The clinical case of G., discussed in this paper, is an exemplary case of this synthetic psychosis. The psychopathological understanding of the core symptomatology of the patient examined has been fundamental for the successive therapeutic approach. If this attempt at understanding is ineffective, the frequent consequences include: the worsening of the psychopathology and addiction; the patient's admission into a psychiatric hospital; his/her arrest for crimes related to antisocial behaviour; a diffusion of infective diseases commonly found in addicts; more frequent overdoses; aggressive behaviour; an increase in the costs of public health system and, finally, the suicide of the patient [1].

Disclosure of interest

The author has not supplied his declaration of competing interest.
Protecting the cardiometabolic health of young people experiencing psychosis
Authors: Shiers D.
Published: May 2016

This presentation will highlight how the early phase of major mental illness may provide a critical window of opportunity in which to prevent future life-restricting and life-shortening physical comorbidities.

Despite many recent advances in our understanding of severe mental illnesses, those affected still lose 15–20 years of life on average compared to the general population. Most premature deaths arise from the same common disorders that affect the general population such as cardiovascular disease, infections and cancers. Of these cardiovascular diseases is now the single biggest cause, far greater than suicide. Shockingly the mortality gap is still widening as the reduction in CVD morbidity and mortality seen in the general population over the last three decades continues to elude people with severe mental illnesses, for whom the prevalence of CVD, obesity and diabetes are now of epidemic proportion.

And yet, much of this epidemic can be predicted. High rates of tobacco use, physical inactivity and poor nutrition point to underlying health inequalities. Furthermore, initiation of antipsychotic treatment is associated with aggressive weight gain and metabolic disturbance from the early phase of psychosis, and yet often these adverse effects remain unmonitored and untreated.

This presentation will argue that these potentially modifiable risk factors provide natural targets for prevention from the onset of psychosis and its treatment. Extending the early intervention paradigm to embrace a far more holistic body & mind approach is overdue.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Are attention-deficit/hyperactivity disorder symptoms associated with a more severe course of substance use? A longitudinal study with young Swiss men
Authors: Moggi F.
Published: May 2016

Introduction

Adults with attention-deficit/hyperactivity disorder (ADHD) symptoms show higher prevalence rates for substance use disorders (SUD).

Objectives

Few longitudinal studies have been conducted to observe the course of substance use among adults with ADHD.

Aims

This study examined the predictive value of ADHD symptoms during the course of substance use in a population sample.

Methods

In two waves data from a representative sample of 5103 Swiss men in their early 20s were collected (baseline and 15-month follow-up) in the longitudinal “Cohort Study on Substance Use Risk Factors” (C-SURF). ADHD symptoms and substance use were assessed using the adult ADHD Self-Report Scale (ASRS-v1.1) and self-administered SUD questionnaires, respectively. Individuals who screened positive for ADHD (ADHD+) were compared to those who screened negative (ADHD−).

Results

At baseline, the 215 individuals in the ADHD+ group (4.2%) showed considerably higher prevalence and frequency of substance use and prevalence of alcohol, tobacco, and cannabis use disorders relative to the ADHD− group. While alcohol, tobacco, cannabis, and heroin use remained stable from baseline to follow-up, the ADHD+ group was more likely to begin using illicit drugs (i.e. amphetamines, speed, ecstasy, hallucinogens, and cocaine) and initiate nonmedical use of prescription drugs (i.e. stimulants/amphetamines, hypnotics, and tranquilizers) relative to the ADHD− group.

Conclusions

Young men with ADHD symptoms displayed more severe substance use patterns and were at a high risk of initiating drug use within 15 months. The identification of ADHD symptoms during early adulthood may be relevant in early interventions to lower the risk of drug use.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Psychological pain and interpersonal theory of suicide
Authors: Apter A.
Published: May 2016

Psychological pain is an important variable in the understanding of suicidal individual.

This presentation describes the how psychological pain interacts with problems in communication to set up risk for serious suicidal behavior and describes some empirical studies supporting a model for using this concept in suicide prevention strategies.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Pain perception in self-injurious behaviours
Authors: Schmahl C.
Published: May 2016

Borderline personality disorder (BPD) is characterized by affective dysregulation and non-suicidal self-injurious behaviour (NSSI), which is closely linked with reduced pain perception. Several experimental studies revealed reduced pain sensitivity in BPD as well as significant correlations between pain perception, aversive inner tension and dissociation. Psychophysiological experiments revealed no deficit in the sensory-discriminative pain component in BPD. However, neurofunctional investigations point at alterations of the affective-motivational and the cognitive pain component in BPD. Preliminary evidence suggests that disturbed pain processing normalizes when patients stop NSSI after successful psychotherapeutic treatment. We could demonstrate that pain leads to a decrease in affective arousal and amygdala activity in patients with BPD and to an increase in amygdala-prefrontal connectivity. We are currently investigating the role of seeing blood and the importance of self-infliction of pain in the context of NSSI.

Disclosure of interest

The author has not supplied his declaration of competing interest.
International research on social withdrawal
Authors: Teo A.R.
Published: May 2016

Introduction

Since the 1990s the term “Hikikomori” has emerged as a way to describe a modern form of severe social withdrawal first described in Japan. Recently, there have been increasing reports of Hikikomori around the globe.

Objectives

To describe operationalized research criteria for Hikikomori, as well as epidemiologic, diagnostic, and psychosocial features of the Hikikomori in international settings.

Methods

Participants were recruited from sites in India, Japan, Korea, and the US. Hikikomori was defined as a six-month or longer period of spending almost all time at home and avoiding social situations and social relationships, associated with significant distress/impairment. Lifetime history of psychiatric diagnosis was determined by the Structured Clinical Interview for the DSM-IV Axis-I and Axis-II Disorders. Additional measures included the Internet Addiction Test, UCLA Loneliness Scale, Lubben Social Network Scale (LSNS-6), and Sheehan Disability Scale (SDS).

Results

Thirty-six participants meeting diagnostic criteria for Hikikomori were identified, with cases detected in all four countries. Avoidant personality disorder (41%), major depressive disorder (32%), paranoid personality disorder (32%), social anxiety disorder (27%), posttraumatic stress disorder (27%), and depressive personality disorder (27%) were the most common diagnoses. Sixty-eight percent had at least two psychiatric diagnoses. Individuals with Hikikomori had high levels of loneliness (UCLA Loneliness Scale M = 55.4, SD = 10.5), limited social networks (LSNS-6 M = 9.7, SD = 5.5), and moderate functional impairment (SDS M = 16.5, SD = 7.9).

Conclusions

Hikikomori exists cross-nationally and can be assessed with a standardized assessment tool. Individuals with Hikikomori have substantial psychosocial impairment and disability, and a history of multiple psychiatric disorders is common.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Gastroenterology issues in schizophrenia: Why the gut matters
Authors: Severance E.
Published: May 2016

Numerous risk factors for schizophrenia can be reconciled through a common enteric source. These risk factors include systemic and localized inflammation, compromised endothelial barriers, IgG sensitivities to food antigens, exposure to viral and parasitic pathogens, and autoimmunity. The gut in a homeostatic state equates with a functional digestive system, cellular barrier stability and properly regulated recognition of self and non-self antigens, as managed by a complex community of resident microbes. Our studies address how environmental and genetic factors relate to GI dysfunction, impact the resident gut microbiota and result in dysregulation of processes in the host central nervous system. We hypothesize that disturbance to GI equilibria activates peripheral immune factors including complement pathway components that function in synaptic pruning. We evaluate these issues with peripheral immune biomarkers and deep sequencing in a number of case-control psychiatric cohorts that include antipsychotic-naïve individuals. Although certain medications and lifestyle factors might affect GI functioning, our findings support a GI pathology inherent to the schizophrenia disease process and a role for the gut-brain axis in complex brain disorders. The identification of those individuals affected by GI-related risk factors will enable appropriate and individualized treatments to be designed and tested for efficacy of both gut and brain-related symptoms.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Antipsychotic medication and outcomes in schizophrenia from a lifespan perspective
Authors: Koponen H.
Published: May 2016

Introduction

Antipsychotic medications play an important role in schizophrenia, and their efficacy in the relapse prevention and treatment of acute psychotic symptoms is clear-cut.

Objectives

Data on the long-term use of antipsychotics and impact on prognostic issues is limited, although some previous studies noted a high risk of relapse during the first two years after the first acute psychosis.

Aims

Our aim was to study the characteristics and clinical course of medicated and unmedicated schizophrenia patients.

Methods

The study population consisted of schizophrenia patients from the Northern Finland 1966 Birth Cohort (n = 70). Use of antipsychotics was examined in the follow-up interview by asking about the subjects’ medication history during the previous three months. The sample was divided into a non-medicated group (n = 24) and a medicated group (n = 46).

Results

Relapses during the follow-up were equally frequent between non-medicated and medicated subjects (47% vs. 53%). Not having been hospitalised during previous five years, but not previous two years, before the interview predicted long-term successful antipsychotic withdrawal without relapse. Fifteen of the subjects in the non-medicated group (63%) and 9 in the medicated group (20%) were in remission.

Conclusions

The present results imply that there are some individuals with schizophrenic psychoses not using antipsychotic medication whose psychotic illness and clinical course are so favourable that they do not necessarily need medication permanently. Changes in the antipsychotic dosing should not be made too fast and the patient and relatives should be able to contact without delay if exacerbation of psychotic symptoms is suspected.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Studies on PA in schizophrenia: What did we learn? What is effective?
Authors: de Girolamo G. , Bulgari V.
Published: May 2016

Schizophrenia is frequently associated with abnormal physical activity (PA) per se (e.g., hypokinesia, motor retardation, etc.) or related to antipsychotic medications (e.g., extrapyramidal symptoms including bradykinesia, tremor, etc.). Daily amounts of PA for subjects diagnosed with schizophrenia tend to decrease over the illness course and contribute to metabolic and cognitive disturbances. PA intervention for schizophrenia patients may result in increased well-being, improved cognitive functioning, fewer negative symptoms and increased self-efficacy, leading to improved management of psychosocial life domains. However, PA trials conducted among people suffering from schizophrenia show several methodological limits: small sample sizes, lack of randomized patients’ allocation, heterogeneity of interventions and inappropriate outcome measures.

Firth et al. (2015) have recently conducted a systematic review and meta-analysis of 11 trials on structured PA in schizophrenia (n = 659, median age of 33 years). The conclusions of this recent review are the following:

– aerobic exercise (for instance exercise bike) of moderate-to-vigorous intensity done at least 90 minutes per week is effective in improving cardiovascular fitness; studies (n = 7) using VO2max as an assessment of fitness have reported clinically significant increases in VO2max, “defined as sufficient to reduce cardiovascular disease risk by 15% and mortality by 20%”;

– several low-dose aerobic interventions did not shown any effect;

– there was a “strong effect of exercise on total psychiatric symptoms” (both positive and negative symptoms were reduced);

– total attrition rate was 32%. Group exercise showed a much lower attrition rate than solitary exercise;

– caregivers’ supervision increased compliance as compared to unsupervised intervention;

– in the only study that compared per-protocol and intention-to-treat analysis, a significant improvement in fitness, psychiatric symptoms and overall functioning only occurred in participants who attended > 50% of exercise sessions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pharmacological treatment of sex offenders
Authors: Thibaut F.
Published: May 2016

Most people recognize that incarceration alone will not solve sexual violence. Indeed, treating the offenders is critical in an approach to preventing sexual violence and reducing victimization. In most cases, a diagnosis of paraphilia is associated with sexual violence. This review is intended to present and summarize the first recently published international guidelines about pharmacological treatment of paraphilias. Pharmacological interventions should be part of a more comprehensive treatment plan including psychotherapy and, in most cases, behavior therapy. Antiandrogens, and mostly GnRH analogues, significantly reduce the intensity and frequency of deviant sexual arousal and behavior. GnRH analogue treatment constitutes the most promising treatment for sex offenders at high risk of sexual violence, such as pedophiles or serial rapists, however informed consent is necessary. SSRIs remain an interesting option in adolescents, in patients with depressive or OCD disorders, or in mild paraphilias such as exhibitionism.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Large-scale suicide prevention by pharmacological treatment of mood disorders
Authors: Isometsa E.
Published: May 2016

Introduction

In psychological autopsy studies, at least half of suicides have suffered from depressive or bipolar disorders at time of death. Improving access to care and provision of evidence-based pharmacotherapies can be important preventive measures.

Objectives

To examine suicide risk and pharmacoepidemiology in mood disorders; evidence for efficacy of pharmacotherapies in mood disorders and in preventing suicidal behaviour in them, and limitations to effectiveness of treatment due to problems of adherence.

Aims

To evaluate potentials for suicide prevention in mood disorders by improved access to treatment, improved quality of treatment provision, improved adherence, or by specific pharmacotherapies.

Methods

Selective review of literature.

Results

Risk of suicide death and attempts in mood disorders clusters into major depressive and mixed illness episodes, and time spent in them is a major determinant of risk, but direct evidence for preventive effects of effective pharmacotherapies remains limited. Observational and randomized studies indicate lithium treatment to reduce risk of suicide deaths and attempts. Ecological evidence from Europe shows increasing sales of antidepressants to consistently associate with declining regional suicide rates. Forensic chemical studies still find majority suicides negative for antidepressants. Poor adherence is a central problem in treatment provision.

Conclusions

Positive impact of increase in pharmacotherapy provision in the last few decades on suicide mortality remains uncertain. Lithium is the pharmacological agent with best evidence for preventive utility, but underused. Providing treatments for those at risk, improving quality and continuity of treatment, and integrating them with psychosocial approaches is likely to be beneficial for suicide prevention.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Age and pharmacotherapy of suicidal depressed bipolar patients
Authors: Oquendo M.A. , Galfalvy H.
Published: May 2016

The mortality and morbidity due to suicidal behavior associated with bipolar disorder is the greatest among psychiatric diagnoses. To address this problem, it is essential to find predictors of future risk as well as protective factors. Studies from several international teams have demonstrated that for bipolar disorder, the presence of a depressive episode is the most robust predictor and risk increases as does depression severity. Protective factors such as older age and religious affiliation are also key moderators. The role of pharmacotherapy in suicidal behavior has been studied mostly utilizing data that are either observational and naturalistic, rather than experimental. Only one randomized, double-blind clinical trial has been conducted to date, although another one is underway. The comparison of lithium and valproate in terms of effect on suicidal behavior revealed no differences. Although the trial was not powered to detect small effect sizes, results suggest that the Relative Risk ratio generated from meta-analytic studies (RR∼ 5) is too optimistic. The trial also suggested that younger individuals may respond differently to pharmacotherapy, suggesting opportunities to personalize treatment approaches. Robust pharmacotherapy targeting both mood stabilization and depressive symptoms is essential and may assist in the quest against suicidal behavior.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A systematic review of service transitions in people with ADHD
Authors: McNicholas F. , Tatlow-Golden M. , Gavin B. , Singh S.
Published: May 2016

Background

Young people (YP) with attention deficit hyperactivity disorder (ADHD) are recognized to be a group who are particularly vulnerable to falling through the gap regarding transitioning from Child and Adolescent Mental health Services (CAMHS) to Adult Mental Health Services (AMHS). This presentation will combine a systematic review of the literature with some clinical examples of the pathway for a number of YP with ADHD who reach the transition boundary (TB).

Method

(1) Databases (e.g., PubMed, PsycINFO, AMED, CINAHL, EMBASE, Web of Knowledge), and grey literature, were searched systematically with database-specific key words, variants and truncations, to cover six subject areas: ADHD; transition or transfer; age; experiences or views; service development; and policies or protocols. Hand searching of key journals, ancestry and forward searches of references, and expert consultation were conducted. Two reviewers critically evaluated studies using a validated appraisal tool for mixed methodologies and findings were synthesized. (2) Following ethical approval, CAMHS clinicians from 9 clinics in Republic of Ireland identified all cases where a YP with ADHD had reached the TB, and identified referral/service outcomes (n = 20).

Results

The search yielded 27 studies, covering areas of service review and recommendations (7), guidelines (3), medication (5), case note audit (3), professional's views (5), pilot transition clinics (2). A further set of papers covered the perspective of the young person (4) and parent (2). Overall these highlighted the less than optimum experience by both clinicians and service users of the experience with suggestions for future developments. These findings were mirrored in the review of clinical notes and individual interviews of YP identified through their CAMHS. Of the 20 young people identified, only 1 was directly transferred to AMHS. Eight were retained in CAMHS, on average for over a year. A significant number (7) refused onward referral. A perception from CAMHS clinicians, that AMHS did not accept such cases or lacked relevant service/expertise, may have contributed to the low rate of referral.

Conclusion

Both the extant literature and the specific study presented highlight the lack of clear cut consensus about the appropriate management of young people with ADHD have who reach the transition boundary. Low rates of AMHS transfer may come from CAMHS clinicians’ perceptions of AMHS, and preferences of young people and families. Before assuming the very low rate of referral by CAMHS clinicians is poor practice, clinical outcomes need to be identified, young people's reasons for refusing transfer explored and service options identified.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neurostimulation in alcohol dependence: The effect of repetitive transcranial magnetic stimulation on brain function and craving
Authors: Jansen J. , van den Heuvel O. , van der Werf Y. , De Wit S. , Veltman D. , van den Brink W. , Goudriaan A.
Published: May 2016

Background

Alcohol dependence has long been related to impaired processing and handling of negative emotions. This is the first study to compare emotion regulation (ER) at a behavioral and neural level in alcohol dependent patients (ADPs) and healthy controls (HCs). It also examines the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) on ER abilities and related craving levels in ADPs.

Method

Thirty-six ADPs and 32 HCs matched on age, sex, and education, were included in a within-subject fixed-order study with one functional magnetic resonance imaging (fMRI) session and one rTMS plus fMRI session, with high-frequency (10 Hz) rTMS over the right dorsolateral prefrontal cortex (dlPFC). An fMRI emotion regulation task (ERT) was administered during both sessions and craving was measured before and after each ERT.

Results

ADPs were impaired in the regulation of negative emotion and showed a higher activation of ER related brain areas compared to HCs. Furthermore, active rTMS improved ER abilities in both ADPs and HCs, but was accompanied by a decrease in anterior cingulate and left dlPFC activity only in ADPs. In addition, the ERT-induced increase in craving levels in ADPs was trend-significantly reduced by active rTMS, with a large effect size.

Conclusions

ADPs are impaired in the regulation of negative emotion and show enhanced neural activity in the ER brain circuit. High-frequency rTMS improves ER in ADPs and HCs and normalizes neural activity and tends to reduce craving in ADPs. Future studies are needed to test the long-term effects of (multiple session) rTMS on ER, craving, and drinking.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Translational perspectives in addiction psychiatry
Authors: Schellekens A.
Published: May 2016

Background

Heritable factors account for approximately 50–60% of the risk for alcohol dependence. However, which genes confer this risk remains to elucidate. Moreover, genetic association studies are hampered by non-replication. Several strategies can be applied to approach this issue. One option is the application of intermediate phenotypes. Neurobiological measures that are closely related to the addiction phenotype may be more directly related to genetic variation. Intermediate phenotypes related to dopamine function seem particularly suitable, given the strong dopamine hypothesis in addiction. Another strategy is to include environmental factors, such as childhood adverse experience, in genetic association studies. We tested the effect of COMT Val158Met and DRD2 Taq1A genotypes, as modulators of brain dopamine function in the context of self-reported environmental factors, like childhood adverse experience.

Methods

Alcohol-dependent patients (n = 110) and healthy controls (n = 99) were genotyped for the COMT Val158Met and DRD2 Taq1A genotypes. Childhood adversity was measured using self-report questionnaires. Dopamine sensitivity was assessed using an apomorphine challenge with cognitive performance and plasma growth hormone levels as main outcome measures.

Results

COMT genotype modulated the effect of apomorphine on cognitive performance, but was not directly associated with alcohol dependence. Yet, the interaction between childhood adversity and COMT genotype did predict alcohol dependence. DRD2 genotype modulated the effect of apomorphine on plasma growth hormone levels and was also not directly associated with alcohol dependence. Yet, the interaction between parental rule setting and DRD2 genotype did predict alcohol use in a separate population-based sample of adolescents.

Conclusion

This study provides evidence for a role of COMT and DRD2 genotypes in alcohol dependence using both the GxE and intermediate phenotype approach. This confirms that both an intermediate phenotype approach and GxE interaction analyses can be useful tools in understanding mechanisms mediating addiction vulnerability. The clinical relevance of dopamine genes and intermediate phenotypes for staging and profiling of alcohol use disorders remains to be investigated.

Disclosure of interest

The author has not supplied his declaration of competing interest.