bluuebunny/crossref_metadata_2025 huggingface dataset:
Reasoning, critical thinking and attitudes toward substance abuse in adolescence: Explaining the mediator role of emotional intelligence
Authors: Rezaei H. , Shafiabady A. , Ghaedi Y. , Delavar A. , Esmaeili M. , Fattah Moghaddam L.
Published: June 2017

Introduction

Adolescence is frequently described as a golden time for prevention of substance abuse.

Aims

This study is aimed at determining the fit of structural equation modeling for change of attitude toward substance abuse based on the components of emotional intelligence (intrapersonal awareness, interpersonal awareness, adaptation, stress management, and general mood) and reasoning, critical thinking in female adolescents.

Objectives and methods

The data were collected in random multistage sampling from 800 senior high school students at 4 different regions of Tehran by using the Bar-on Emotional Intelligence Inventory, the adolescent-special revised inventory, Ricketts Critical Thinking Questionnaire, New Jersey Test of Reasoning Skills and Nazari's Questionnaire for Attitude toward Substance Abuse. In the 618 valid questionnaires were statistically analyzed.

Results

Path analysis and path coefficients in the structural equation model suggested that the strongest relation belongs to the reasoning skill, directly predicting attitude with a 61% level and also, has indirect, significant impacts on attitude through intrapersonal awareness, adaptation and stress management. The weakest relation belongs to general mood which, with a 21% level, predicts attitude toward substance abuse. Results of the fit indices in the final model also indicate that all indices are at a desirable level and the model has good fit to the data, implying that there is a linear relation between independent variables and between the moderating variables and a dependent variable.

Conclusions

It is reasonable to show the importance of attitude toward substance abuse in prevention programs for students.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The needs of children who have parents suffering from severe mental disorders
Authors: De Girolamo G. , Signorini G. , Candini V.
Published: June 2017

Objective

Mental illness in parents is a biological and environmental risk factor to which young people are exposed. Living with a parent suffering from a mental disorder may have a variety of detrimental consequences, including: (a) the reversal of caregiving (“parentification”); (b) the exposure to an adverse environment, where developmental needs of the child (emotional and practical) might be repeatedly neglected (lack of communication, high expressed emotion, etc.); (c) stigma and discrimination. We will provide a review of needs of these children and of possible interventions.

Methods

Systematic searches located studies reporting and assessing met and unmet needs of these children.

Results

Young people living in such families often have problems of internalizing and externalizing symptoms, cognitions of shame, guilt, and loneliness, perceptions of lacking social support and social acceptance. Children who have mentally ill parents are up to two and a half times more likely to experience poorer mental health outcomes than their peers. Compared to peers, children of parents with mental disorders are also at risk of poorer intellectual and social outcomes, of affect dysregulation, of behavioral problems, of impaired attention and reduced overall adaptive functioning, of higher rates of substance abuse and multiple diagnosis and finally of low occupational status, health risk behaviour and antisocial behavior.

Conclusions

Given the high toll paid by children having parents suffering from severe mental disorders, it is urgent to develop, test and implement structured programmes to help these children cope with stressful circumstances and improve their resilience.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Do not forget alcohol damage – Cognitive impairments related to alcohol
Authors: Lázaro M. , Carvalhão Gil L. , Ponte A. , Mota T.
Published: June 2017

Introduction

Chronic excessive alcohol consumption may lead to structural and functional damage of the brain. Alcohol-related cognitive impairments are well-established and confirmed by neuropsychological and neuroimaging studies. However, the influence of each neuropathological mechanisms is still under discussion. This topic is increasingly becoming focus of attention in psychiatry.

Objectives

Review the neuropathology, clinical features, neuropsychology and management of alcohol-related cognitive impairments.

Aims

Evaluate clinical impact, management and prognosis of alcohol-related cognitive impairments.

Methods

A literature search was performed on PubMed and Medscape database.

Results

According to our literature research, there is a debate concerning the relative contributions of the direct toxic effect of alcohol and the impact of thiamine deficiency on the alcohol-related cognitive impairments. Research about this issue is challenging, considering the multiple patterns of alcohol abuse, the personal and lifestyle factors, and the vulnerability of specific brain regions. The cognitive decline is linked to neuroanatomical alterations and primarily affects executive functions, episodic memory, and visuospatial capacities. These deficits may range from mild to severe but usually remain undiagnosed, unless they are specifically investigated. Maintenance of lasting abstinence is associated with cognitive recovery, but some impairments may persist and interfere with the prognosis.

Conclusion

Recognizing and screening for alcohol-related cognitive impairments is crucial to offer significant benefits to patients by optimising management strategies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Problematic Internet use and associated mental health issues in South Korean Internet users
Authors: Lee T.K. , Kim J. , Kim E.J. , Kim G. , Lee S. , Kang Y.J. , Lee J. , Nam Y. , Young-Mi K.
Published: June 2017

Introduction

The Internet is commonly used in modern society; however, Internet use may become a problematic behaviour. There is an increasing need for research on problematic Internet use (PIU) and its’ associated risk factors.

Objectives

This study aims to explore the prevalence and health correlates of problematic Internet use among South Korean adults.

Methods

We recruited the participants aged between 18 and 84 years old among the online panel of an online research service. The sample size of the survey was 500. Of these 500 participants, 51.4% (n = 257) were men and 48.6% (n = 243) were women. A participant was classified as a problematic Internet use (PIU) if his/her total score of Young's Internet Addiction Scale (YIA) was above 50. Stress Response Index (SRI), Fagerstrom test for nicotine dependence, lifetime average caffeine consumption, and sociodemographic query form were used in the collection of data. The t test and chi-square test were used for data analysis.

Results

One hundred ninety-seven (39.4%) of the participants was classified into the PIU group. There was no difference of gender and education between PIU and normal users. However, PIU group was younger (mean 39.5 years) than normal users (mean 45.8 years). PIU group was more likely to have high levels of perceived stress, nicotine dependence, and drink more often caffeinated beverages (P < 0.05).

Conclusions

These data indicate that problematic Internet use is associated with perceived stress level, nicotine and caffeine use in South Korean Internet users. More research is needed to better understand the relationship between Internet use and mental health issues.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
What are sweet dreams made of? Analysis of psychoactive substances into “gummies”: A retrospective descriptive study
Authors: Trabsa A. , Monteagudo E. , Mariona D.D. , Grifell M. , Galindo L. , González L. , Quintana P. , Palma Á. , Santiago P. , Sanagustin D. , Ventura M. , Torrens M.
Published: June 2017

Introduction

Although psychoactive substances has a long history in recreational settings, research on its composition has focused only on tablets, crystal and powder, even though new formulation for new psychoactive substances are readily available for users.

Objectives

To describe the presence of psychoactive substances and its characteristics in new formulations which had not previously been found in samples delivered to Energy Control from 2014 to 2015 in Spain.

Methods

A total of 8324 samples were analysed from June 2014 to December 2015. Only those samples in gummy formulation were studied (n = 9). Samples were analyzed by energy control, a Spanish harm-reduction NGO that offers analysis of substances to users. Analysis was done by gas chromatography-mass spectrometry.

Results

From 9 samples of psychoactive substances in gummy formulation, the analysis detected that 55.5% contained multiple psychoactive substances: 6 samples contained 25N-NBOMe (66.7%), 1 2C-E (11.1%), 1 2C-D (11.1%). Two allylescaline (20%), 1 cocaine (11.1%), 1 THC (11.1%), 1 canabinol (11.1%), 1 ketamine (11.1%), 1 caffeine (11.1%), 1 MDMA (11.1%), 1 N-acetyl-MDMA (11.1%), 1 metoxetamine (11.1%), 1 N-acetyl-MDMA), 1 2C-N (11.1%). The only substance found in active dosage was 25N-NBOMe. Six samples (66.67%) did not contain the substance expected by the consumer.

Discussion

Incipient presence of gummies as new psychoactive formulation was found. The most prevalent drug was 25N-NBOMe; 66.7% did not contain the substance expected. This may pose a risk for potential harmful effects. All the gummies were known to be drug-carriers when bought. This could represent the presence of new formulations from June 2014 in the Spanish recreational market.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Ethics of Mobile Health Technology
Authors: Galderisi S. , Caputo F.
Published: June 2017

Introduction

Mobile health (m-health) technology has been growing rapidly in the last decades. The use of this technology represents an advantage, especially for reaching patients who otherwise would have no access to healthcare. However, many ethical issues arise from the use of m-health. Health equity, privacy policies, adequate informed consent and a competent, safe and high quality healthcare need to be guaranteed; professional standards and quality of doctor-patient relationship in the digital setting should not be lower than those set for in-person practice.

Aims

To assess advantages and threats that may arise from the wide use of m-health technologies, in order to guarantee the application of the best medical practices, resulting in the highest quality healthcare.

Methods

A literature search has been conducted to highlight the most pressing ethical issues emerging from the spreading of m-health technologies.

Results

Few ethical guidelines on the appropriate use of m-health have been developed to help clinicians adopt a professional conduct within digital settings. They focus on the need for professional associations to define ethical guidelines and for physicians to take care of their education and online behavior when using m-health technologies.

Conclusions

The rapid spreading of m-health technologies urges us to evaluate all ethical issues related to its use. It would be advisable to produce an ethical code for the use of these new technologies, to guarantee health equity, privacy protection, high quality doctor-patient relationships and to ensure that m-health is not chosen over traditional care for merely economic purposes.

Disclosure of interest

SG received honoraria or Advisory board/consulting fees from the following companies: Lundbeck, Janssen Pharmaceuticals, Hoffman-La Roche, Angelini-Acraf, Otsuka, Pierre Fabre and Gedeon-Richter. All other authors have declared.
The ethno-cultural peculiarities of suicidal behavior in multinational Russia
Authors: Polozhy B.
Published: June 2017

Introduction

According to the data of 2015, suicide rate in Russia was 17.1 cases per 100,000 population. However, many aspects of the problem of suicidal behavior are not studied. This prevents the organization of the system of effective suicide prevention. In this regard, special attention deserves ethno-cultural factors, since they are essential to the moral and ethical attitude to the possibility of suicide and to potential willingness to formation of suicidal behavior.

Objective

Study of the rate of suicide among different nations of Russia.

Methods

Statistical analysis of suicide rate in constituent entities of the Russian federation from 2010 to 2015.

Results

The specificity of suicide situation in Russia is that suicide rates in different ethnic groups of the population has the distinction of reaching 21: from 2.8 per 100,000 in the Republic of North Ossetia to 59.7 per 100,000 in the Altai Republic. This is due to cultural peculiarities of different ethnic groups, including the historically established their relationship to suicide. Taking in consideration these factors were elaborated the differential programs for suicide prevention. That has allowed to lower suicidal rate in Russia in 1.4 times for the last 5 years. That indicates the possible beneficial effects of the ethno-cultural approach in suicide prevention strategies.

Conclusion

In planning programs suicide prevention in multinational countries should take into account the ethno-cultural characteristics of the residing peoples.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Surviving psychiatry on-calls
Authors: Holt C. , Mirvis R. , Butler S. , Howe A. , Lowe P. , Mullin J. , Mirzadeh D. , Sedgwick R. , Zacharia T.
Published: June 2017

Introduction

Out of hours, there is only one on-site junior doctor. First year psychiatry trainees (CT1s) and GP trainees may have no prior experience in psychiatry. On-call shifts are therefore potentially daunting for new trainees.

Objectives

Expand the resources available for trainees when on-call.

Methods

We issued questionnaires to CT1s asking if they would have appreciated more information about on-call scenarios and in what format.

Based on the questionnaire results we implemented some changes. These were:

– a printed “pocket-guide” summarising common on-call scenarios;

– a training video on common on-call scenarios.

The handout was given to new trainees in February 2016 and in August 2016. The video was shown to new trainees in August 2016. Trainees provided feedback on the resources.

Results

Of 24 CT1s, 15 (63%) were “neutral” or “disagreed” that they had felt prepared for on-calls.

CT1s wanted additional resources, especially a paper handout or phone download.

Feedback on the “pocket-guide” from trainees in February 2016 (n = 8) was positive (62.5% reported increased confidence in on-call situations). Feedback is also being collected from trainees who received the guide in August 2016.

Trainees in August 2016 (n = 36) liked the video – no trainees “disagreed” with statements asking if the video had been useful.

The video improved the confidence of trainees about on-call situations by an average of 2.8 points.

Conclusions

We have expanded available resources relating to on-calls and improved confidence. Further improvements would include making resources more easily available in downloadable formats.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Ecological momentary assessment and physiological self-evaluation improve mindfulness of stress-related events during interprofessional training. Meta-analysis of a pilot study
Authors: Lazzari C. , Masiello I.
Published: June 2017

Introduction

Self-reflective learning improves interprofessional education (IPE).

Objectives

Promoting ecological momentary assessment (EMA) of IPE via an online app. This shall allow contextual recording of students’ heart rate during and after pivotal moments of their training, thus improving mindfulness of stressful events (MSE).

Aims

To make health care students mindful of the effect of their anxiety about learning, patient safety and performance.

Methods

Thirty-two undergraduate students contextually recorded their heart rate with a pulse-oximeter before and after each learning moment: discussion of a clinical case during ward rounds (ClinDis), attending patients as an interprofessional team (BedPat) and self-reflective practice at the end of each day of training (SelfRef). Results were recorded on a dedicated app linked to an online survey. Meta-analysis with Tau squared (t2), Cochrane's Q and I2 provided the results.

Results

Meta-analysis (Fig. 1) of IPE events was significant at P = 0.003, with t2 = 16.515, Q (5d.f.) = 17.913, and I2 = 72.088%. The bedside care had the higher statistically significant heterogeneity in the before-after event with t2 = 53.275, P = 0.001, Q (5d.f.) = 10.803 and I2 = 90.74% due to an increase in heart rate after patient care (BedPatAft).

Conclusions

EMA reinforces self-reflection in IPE by making students mindful of the impact of educational emotions on team performance and patients’ quality of care.

Fig. 1

Results for contextual heart rate during interprofessional education.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
True story of Bangladeshi women with childhood trauma who heroically faced the trials of life
Authors: Hasan N.
Published: June 2017

Objectives

At the conclusion of this presentation, the participants will be able to know how three women victim of childhood trauma; terribly suffered and tackled their situation. They were born in a developing Muslim country.

This paper also intends to aware people about victims of childhood trauma and their need for mental and social support.

Methods

Personal interview with these three subjects who were close persons of the researcher. Description of their suffering and way of tackling it were noted. The words were carefully placed as a story.

Results

Two of the subjects sexually abused by close relatives in their childhood. The third one was abused for as long time as 17 years. All the subjects suffered severely from headache and flatulence from childhood, insomnia and terrifying dreams, sense of insecurity, depression, PTSD.

Despite all the grief and pain, these three became highly educated, holding well position in the society and directly indirectly working for distressed women.

Conclusions

The author concludes that childhood trauma can damage a victim in many ways in her entire life.

Social support, sharing the incidents with others, counseling may reduce her pain.

Religious acts like prayer, reading Holy Book, remembrance of Allah, serving humanity and helping distressed women may console the victim.

These three women's heroic lives may give motivation for women with childhood trauma. Even they may inspire others to act like heroes in hardship of life.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Body shape perception among obese Tunisian women
Authors: Sellami R. , Moalla M. , Affes L. , Feki I. , Mnif F. , Abid M. , Masmoudi J.
Published: June 2017

Introduction

In today's societies, pressures from the idea of thinness are omnipresent and lead to a corporal dissatisfaction with an excessive preoccupation of the body's image. Obese persons are often targets of stigmatization and are vulnerable to negative feeling about their physical appearance.

Aims

To evaluate the worries towards the weight and the shape of the body among obese women.

Methods

Our study was a transversal study, descriptive and analytic. A total of 42 obese women were included. Obesity was defined by body mass index (BMI) ≥ 30 and divided into 3 classes: class I: moderate obesity (30 ≤ BMI ≤ 34.9); class II: severe obesity (35 ≤ BMI ≤ 39.9); class III: morbid obesity (BMI≥40). Patients were studied by mean of body shape questionnaire (BSQ-34) (Considering score BSQ < 80 lack of altered body image perception and score > 140 excessive preoccupation).

Results

The mean age of participants was 33.6 years. The average BMI was 37.42 kg/m2 (30.45–56.26 kg/m2). Third (35%) of women had a high educational level, 41.4% were inactive, and 70.8% had an average socioeconomic level.

The average BSQ score was 108.31 (47–188). The majority of women (78.1%) had excessive preoccupation about their body image. The BSQ score was correlated to morbid obesity (P = 0.014). Women aged between 20 and 3 years were significantly more preoccupied about their body image (P = 0.046).

Conclusion

Majority of obese women were preoccupied about their body image. Young women and those having morbid obesity seemed more preoccupied about their body image.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
When Your Patient Dies by Suicide; Aftermath and Implications
Authors: Sadock B.
Published: June 2017

Over fifty percent of psychiatrists will have at least one patient die by suicide while in treatment and some will have more than one patient suicide during the course of their career. The impact of patient suicide on the personal and professional lives of those psychiatrists can be profound. Personally, many suffer a grief reaction than can progress to depression in some cases. Almost all experience a sense of shock upon first learning of the event. Feelings of guilt are also common. Professionally, many fear disapproval from peers and may never again treat a suicidal patient. Some psychiatrists leave the field completely or go into administration so that they never have to treat patients again.

Surveys of training programs have found that most provide training in the assessment of suicide risk and in the management of the suicidal patient but there is minimal training in how to deal with the aftermath of a patient suicide. There is a need to teach and to help practicing psychiatrists, at whatever stage in their career, cope with the stress that occurs when one of their patients dies by suicide during the course of therapy. Important issues are how and when to contact family members and other survivors, whether or not to attend a funeral or memorial service and what and what not to do regarding discussing the case with others. The risk of litigation also is influenced by how psychiatrists behave after patient suicide occurs. The case of Ernest Hemingway is used as an example to illustrate some of these concepts.

Disclosure of interest

The author declares that he has no competing interest.
Comparing the Effects of Cognitive Behavior Therapy or Regular Physical Exercise on Sleep in the Treatment of Patients with Panic Disorder
Authors: Hovland A. , Nordhus I.H. , Martinsen E. , Sjøbø T. , Gjestad B. , Johansen H. , Pallesen S.
Published: June 2017

Introduction

Seventy percent of patients with panic disorder (PD) have sleep impairment. Cognitive behavior therapy (CBT) effectively treats PD, but the concomitant effect on sleep is understudied. Physical exercise (PE) improves sleep, but this has not been investigated in patients with PD.

Objective

To compare the effects of CBT or PE on sleep in PD-patients, and to determine potential mechanisms of action.

Methods

Thirty-six PD-patients were randomized to either group CBT for PD or regular PE. Sleep was assessed pre/post with the Pittsburgh sleep quality index. Effects were investigated with repeated measures ANOVA and t-tests. Expected mediators were added to the general linear model to assess mediation.

Results

The effect of time was significant, F(1.33) = 10.11, P = 0.003, but not the interaction (Time × group), F(1.33) = .48, P = 0.49. Symptoms were significantly reduced from pre- to post-treatment: PE, t(16) = 3.03, P = .008, and CBT, t(17) = 2.18, P = 0.044. CBT-patients changed significantly (P < 0.05) on Sleep quality, t(17) = 2.47 and Sleep disturbance, t(17) = 2.38. PE-patients changed significantly on sleep duration, t(16) = 2.58 and sleep disturbance, t(16) = 2.58. A significant interaction with change in fear of bodily symptoms, F(1.16) = 5.53, P = .032, and with change in depression-level, F(1.16) = 12.13, P = 0.003 was only found for CBT. A significant interaction with change in physical fitness, F(1.15) = 5.01, P = .041, was only found for PE.

Conclusion

Both interventions improve sleep in PD-patients, but differently. The findings also suggest that these changes are related to different mechanisms for PE and CBT.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Utilization Unspecialized Care of Patients with Anxiety Disorder
Authors: Marachev M. , Avedisova A.
Published: June 2017

Introduction

The greatest social and economic burden is divided between the three main anxiety disorders: social phobia (SF), generalized anxiety disorder (GAD) and panic disorder (PD).

Objectives

To examine the pathways of patients with PD, SF and GAD since the beginning of the first anxiety symptoms and before the first course of a standardized treatment in a specialized mental health facility.

Aims

To evaluate the period of delay in seeking specialized care and to identify the main ways of seeking medical/non-medical care.

Methods

Retrospective study (n = 80). Structured interview were based on WHO instruments: WHO WMH CIDI and WHO Pathways to care encounter form.

Results

Average age was 38 years, more females (72.5%). The delay period was 7 years (GAD = 8.7; SF = 8.2, PD = 5.9), during which at least 2 episodes of the disease. The most popular specialists were: neurologists (19%), psychiatrists (17%) (one-time visits to which were not accompanied by the appointment of a standardized course of treatment for an adequate period of time) and therapists (15%). Non-medical care was 10% of all studied (psychologists–5%, healers–3%, priests–2%). SF–psychiatrists (43%), therapists (14%), psychologists (14%); GAD–psychiatrists (22%), neurologists (19%), psychotherapists (11%), ambulance doctor (11%); PD–therapists (22%), neurologists (22%), ambulance doctor (17%), cardiologists (9%).

Conclusions

The findings suggest that patients with anxiety disorders have a long period of delay in receiving specialized care that causes the value of the social and economic burden of anxiety disorders in the community.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
First Psychotic Episode and Predictors of Bipolar Disorder Progression
Authors: Halouani N. , Yaich K. , Guermazi F. , Ennaoui R. , Chouayekh S. , Aloulou J. , Amami O.
Published: June 2017

Introduction

Many studies on the identification and early treatment of psychotic disorders have focussed less on a solution to the issue of the evolution of an acute psychosis.

Objective

To identify some predictive elements of an evolution to bipolar disorder during a first psychotic episode.

Methods

We proceed with a retrospective study concerning 55 patients having developed a first psychotic episode and admitted in the psychiatry B department during the period extending between January 2010 and December 2015. Data were collected on a predetermined questionnaire exploring the following items (socio-demographic data, personal and psychiatric family antecedent, prodromes and psychotic episode symptomatology).

Results

Our sample was composed by 55 patients divided into 74% (n = 41) men and 26% (n = 14) women with a mean age of 26.5 ± 6.27 years. The evolution to a bipolar mood disorder concerned 22% of patients. The prodromal phase was always present. Prodromes correlated with progression to bipolar disorder are: thymic symptoms 44.1% of patients (P = 0.001), modification of volition 42.9% (P = 0.05), anger/irritability 66.7% (P = 0.032) and sadness 83.3% of patients (P = 0.05). Psychotic episode's symptoms correlated with the evolution towards a bipolar disorder corresponded to thymic symptoms. The latter was present in 44.1% of patients (P = 0.01).

Conclusion

Through our study, we were able to identify some factors positively correlated with a progression towards bipolarity during a first psychotic disorder. So it would be important to monitor closely and to educate our patients and their families about the evolutionary potential of a first psychotic episode.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Treatment with Risperidone vs. Olanzapine in Naturalistic Study of Bipolar Manic Inpatients
Authors: Ibanez Plans I. , Nieto E. , Biel S.
Published: June 2017

Introduction

There are very few comparative controlled trials of risperidone versus olanzapine in manic patients. No previous naturalistic study has compared the efficacy of these two antipsychotics in the natural environment of manic inpatients.

Objective

The aim of this retrospective and naturalistic study was to evaluate the efficacy of acute treatment with risperidone vs. olanzapine in Bipolar I manic inpatients.

Methods

(1) Patients: the study includes all the inpatients diagnosed with bipolar I manic episode (DSM-IV) who were admitted during the years 2009 to 2014. Patients treated with risperidone and olanzapine concomitantly (n = 6) and patients not treated with risperidone or olanzapine (n = 129) were excluded.

The patients finally included (n = 183) were separated in two groups:

– treated with risperidone (n = 89);

– treated with olanzapine (n = 94).

(2) The Student-T test was used to compare, between the groups, the mean of scores in YMRS and CGI-S scales and the mean of length of stay.

Results

Baseline characteristics were similar between the groups. The majority of patients were also treated with mood stabilizers (46% with lithium and 45% with valproate).

The mean decrease in CGI-S scores from baseline to the day of discharge was significantly (P < 0.003) higher in the risperidone group (−2.81 vs. −2.36). The length of stay was significantly (P < 0.004) lower in the olanzapine group (mean of 23.03 days vs. mean of 30.3).

Conclusions

(1) The CGI-S scores in manic patients treated with risperidone decreased more than in patients treated with olanzapine during admission. (2) The length of stay was significantly lower in patients treated with olanzapine.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Disruptive Behavior Disorders in Childhood and Adolescence: Attachment Models and Post-traumatic Symptomatology
Authors: Bizzi F.
Published: June 2017

Introduction

In line with a consistent literature, young patients with disruptive behavior disorders in childhood and adolescence have experienced some traumatic events, such as abuse, rejection and violence assisted. Recent studies are focusing the attention on the role of attachment and post-traumatic symptomatology for a better evaluation of this clinical condition.

Objective

This study investigates attachment models and post-traumatic symptomatology in young patients with disruptive behavior disorders.

Aim(s)

The following objectives are set by the present study: – to evaluate attachment models in a group of children diagnosed with disruptive behavior disorders;

– to evaluate their post-traumatic symptomatology;

– to test the extent of the association between post-traumatic symptomatology and attachment organization in young patients with disruptive behavior disorders.

Method

Forty-two Italian patients aged from 8 to 15 previously diagnosed with disruptive behavior disorders are compared to 42 healthy control subjects. We administer the child attachment interview and trauma symptom checklist for children-adolescent.

Results

Insecure attachment are found in more than half of the patients diagnosed with disruptive behavior disorders and disorganization are highly over-represented. Furthermore, low levels of post-traumatic symptoms are found in young patients with disruptive behavior disorders.

Conclusion

This study suggests that attachment organization may be a fundamental element to be assessed in the evaluation of disruptive behavior disorders in children and adolescents. Nevertheless, traumatic experiences do not seem expressed through psychic symptoms. The clinical implications are discussed.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Association of Inter-individual Differences in Imaging Markers with Schizophrenia Phenotypes
Authors: Pergola G. , Quarto T. , Papalino M. , Di Carlo P. , Selvaggi P. , Gelao B. , Blasi G. , Bertolino A.
Published: June 2017

Introduction

Neuroimaging studies have identified several candidate biomarkers of schizophrenia. However, it is unclear whether the considerable variability in these neurobiological correlates between patients can be translated into the clinical setting.

Objectives

We aimed to identify neuroimaging predictors of clinical course in patients with schizophrenia. Combined with the identification of genetically determined markers of schizophrenia risk, our studies aimed to elucidate the biological basis and the clinical relevance of inter-individual variability between patients.

Methods

We included over 150 patients with schizophrenia and 279 healthy volunteers across five neuroimaging centers in the framework of the IMAGEMEND project [1]. We performed multiple studies on MRI scans using random forests and ROC curves to predict clinical course. Data from healthy controls served to normalize the data from the clinical population and to provide a benchmark for the findings.

Results

We identified ensembles of neuroimaging markers and of genetic variants predictive of clinical course. Results highlight that (i) brain imaging carries significant clinical information, (ii) clinical information at baseline can considerably increase prediction accuracy.

Conclusion

The methodological challenges and the results will be discussed in the context of recent findings from other multi-site studies. We conclude that brain imaging data on their own right are relevant to stratify patients in terms of clinical course; however, complementing these data with other modalities such as genetics and clinical information is necessary to further develop the field towards clinical application of the predictions.

Disclosure of interest

Giulio Pergola is the academic supervisor of a Hoffmann-La Roche Collaboration grant that partially funds his salary.
Emotional and Behavioral Problems in Early Adolescents and Association with Socio-demographic Risk Factors
Authors: Dostovic Hamidovic L.
Published: June 2017

Aim

The aim is to analyse the frequency emotional and behavioural problems early adolescents and association with socio-demographic risk factors.

Subject and methods

We analysed a group of 240 early adolescents (11–15 years) from the area of Tuzla Canton, Bosnia and Herzegovina, in the general population. For the assessment of children's emotional and behavioural problems, the Strength and Difficulties Questionnaire – SDQ is used. Data were processed by descriptive statistics. For the assessment association between socio-demographic risk factors and emotional and behavioural problems in early adolescents we used Pearson correlation test.

Results

The result show that the frequency of emotional and behavioural problems are present in 3% of cases, The results of correlation sociodemographic risk factors and emotional and behavioral problems, showed that unemployed mothers have a significant increased risk of developing behavioral disorders in early adolescents (P < 0.05). Low family economic status leads to a significantly higher frequency of emotional symptoms in early adolescents, poor attitude towards society and significantly higher overall difficulties (P < 0.05). Higher levels of parental education was significantly associated with a higher frequency of behavioral problems and illness in the family leads to a much more emotional problems (P < 0.05).

Conclusion

The obtained results of this study indicate that early adolescents showed low levels of emotional and behavioral problems. There is a significant correlation between socio-demographic risk factors and emotional and behavioral problems early adolescents.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Growth and Sexual Maturation in a 2-year, Open-label Clinical Study of Lisdexamfetamine Dimesylate in Children and Adolescents with ADHD
Authors: Hernández Otero I. , Banaschewski T. , Johnson M. , Nagy P. , Soutullo C.A. , Zuddas A. , Yan B. , Coghill D.R.
Published: June 2017

Introduction

Individuals with attention-deficit/hyperactivity disorder (ADHD) may require long-term medication.

Objectives

To measure growth and sexual maturation of children and adolescents with ADHD receiving lisdexamfetamine dimesylate (LDX) in a 2-year trial (SPD489-404).

Aims

To investigate the impact of long-term LDX treatment on growth and maturation.

Methods

Participants (6–17 years) received dose-optimized, open-label LDX (30–70 mg/day) for 104 weeks. Weight, height and BMI z-scores were derived using the Centers for Disease Control and Prevention norms [1]. Sexual maturation was assessed using the Tanner scale (participant-rated as closest to their stage of development based on standardized drawings).

Results

Of 314 enrolled participants, 191 (60.8%) completed the study. Mean z-scores at baseline and last on-treatment assessment (LOTA) were 0.53 (standard deviation, 0.963) and 0.02 (1.032) for weight, 0.61 (1.124) and 0.37 (1.131) for height, and 0.32 (0.935) and–0.27 (1.052) for BMI. In general, z-scores shifted lower over the first 36 weeks and then stabilized. At LOTA, most participants remained at their baseline Tanner stage or shifted higher, based on development of hair (males, 95.5%; females, 92.1%) or genitalia/breasts (males, 94.7%; females, 98.4%).

Conclusions

Consistent with previous studies of stimulants used to treat ADHD [2], z-scores for weight, height and BMI decreased, mostly in the first year, then stabilized. No clinically concerning trends of LDX treatment on sexual maturation or the onset of puberty were observed.

Disclosure of interest

Study funded by Shire Development LLC.

Dr Isabel Hernández Otero (Alicia Koplowitz Foundation, Eli Lilly, Forest, Janssen-Cilag, Junta de Andalucia, Roche, Shire, Shire Pharmaceuticals Iberica S.L., and Sunovion).
Cortical and Sub–cortical Volumetric Abnormalities in Bipolar Disorder
Authors: Andreassen O.
Published: June 2017

Previous MRI studies of bipolar disorder (BD) are often limited by small sample sizes and heterogeneity exists with regard to neuroimaging markers. To address these limitations, the ENIGMA Bipolar Disorder Working Group collected the largest BD neuroimaging data set ever studied (n = 6,500). Here, we review findings from sub–cortical volume and cortical thickness and area analyses.

ENIGMA harmonized analysis methods were applied to 28 international pooled study samples of MRI data and involved sub–cortical and cortical imaging analyses. We assessed differences between BD and healthy controls (HC) using both mega and meta–analytic multiple linear regression models, adjusting for standard covariates (age, sex, etc.), and correcting for multiple comparisons.

Sub–cortical volume analysis revealed we found consistent volumetric reductions in BD patients for hippocampus and thalamus and enlarged lateral ventricles in patients. In BD, cortical gray matter was thinner in frontal, temporal and parietal regions of both brain hemispheres. BD had large general effects on mean gray matter thickness in both left and right brain hemispheres. Further we found that psychopharmacological treatment showed significant associations with cortical thickness and surface area.

The ENIGMA pipeline allows for identification of brain MRI abnormalities in BD in the largest analysis ever conducted. The results suggest a pattern of brain structure abnormalities, which provide novel insight in pathophysiology of BD, and potential effects of mood stabilizing agents.

Disclosure of interest

Received speaker's honorarium from Lundbeck, Lilly, Otsuka
Is it Time to Characterize Burnout as a Depressive Syndrome? A Review of Recent Research
Authors: Bianchi R. , Schonfeld I.S. , Laurent E.
Published: June 2017

Introduction

More than 40 years after the introduction of the construct in the literature, the status of “burnout” remains unclear. Whether burnout is anything other than a depressive syndrome has been increasingly discussed in recent years.

Objectives

We examined the extent to which burnout can be considered distinct from depression.

Methods

We reviewed the literature dedicated to burnout-depression overlap over the last decade.

Results

Recent research suggests that burnout and depression overlap in terms of (a) etiology, with (chronic) unresolvable stress a common, key causal factor, (b) clinical picture and course, with burnout and depressive manifestations inextricably linked such that they increase or decrease together over time, (c) cognitive biases, with burnout and depressive symptoms similarly predicting increased attention to negative stimuli and decreased attention to positive stimuli, (d) dispositional correlates (e.g, neuroticism, rumination, pessimism), and (e) allostatic load—an index of the biological cost of adaptation to life adversity. Hypocortisolism has been linked to both burnout and depression with atypical features—a highly prevalent form of depression. The often-invoked argument that burnout is singularized by its job-related character is actually invalid given that (a) depression can also be job-related and (b) the “job-relatedness” of a syndrome is not nosologically discriminant in itself.

Conclusions

Robust evidence that burnout overlaps with depression has accumulated in recent years. The burnout construct is unlikely to capture a distinct pathological phenomenon. We propose that burnout be characterized as a depressive syndrome for the sake of conceptual parsimony, theoretical clarity, and effective public health policies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Antidepressants Augmented with Aripiprazole in the Treatment of Major Depressive Disorder
Authors: Bise S. , Sulejmanpasic G. , Begic D. , Ahmic M.
Published: June 2017

Introduction

Major depressive disorder (MDD) does not consistently respond to any single antidepressant (AD) therapy. Adjunctive therapy with atypical antipsychotics (AA) showed higher response rates compared with AD monotherapy. Aripiprazole, an oral quinolinone, is the first AA agent to be approved in the US as adjunctive treatment in adult patients with MDD.

Aim The aim was to evaluate the efficacy and safety of adjunctive low-dose aripiprazole combined with AD versus AD monotherapy in patients with MDD with minimal improvement after 4 weeks of prior AD monotherapy.

Methods

Ten patients with MDD and a history of minimal improvement to 4 weeks of AD monotherapy (escitalopram 10–15 mg/day, sertralin 50–100 mg/day) were included in this study. The patients were randomly assigned to 2 groups: one (n = 5) with AD plus aripiprazole 5–7.5 mg/day and the other (n = 5) with AD alone. After baseline assessment, the subjects were followed up at weeks 2, and 4. The primary efficacy was the mean change in (HAM-D17) and CGI-I.

Results

The aripiprazole group exhibited significantly better efficacy than the AD group in mean total score changes of HAM-D17 and CGI from the baseline to weeks 2, and 4. The item “work and social activities” of HAM-D 17 showed significant improvement at week 4, and the item “somatic symptoms (GI)” showed significant improvement at week 2.

Conclusions

Adjunctive aripiprazole therapy significantly improved depressive symptoms in MDD who didn’t respond to AD monotherapy. Aripiprazole augmentation is an efficacious, well-tolerated and safe treatment for patients with MDD.
Remote Cognitive Behavior Therapy for Obsessive-compulsive Disorder in Egypt: A Randomized Trial
Authors: Aly R.
Published: June 2017

Introduction

Recently, cognitive behavior therapy has gone from being a promising new treatment to the most well established psychological treatment. In several hundreds of randomized controlled trials, it has shown effectiveness in treating obsessive-compulsive disorder. In addition, CBT is thus a highly promising treatment from a societal cost-effectiveness perspective.

Objectives

Several forms of CBT have been developed using remote communication methods, the general idea is that CBT delivered through the Internet or using telephone communication reflects the content of conventional CBT, but is administered as a form of therapist-guided treatment protocol.

Aims

Estimation of applicability and efficacy of remote cognitive behavior therapy for treating patients suffering from obsessive-compulsive disorder in Egypt.

Methods

A group of patients suffering from obsessive-compulsive disorder was randomized into two groups; one received CBT as usual and the intervention group received CBT using telephone and/or the Internet. Both groups were assessed pre– and post treatment using the Yale Brown Scale for OCD symptom severity and Beck depression inventory for symptoms of associated depression. The quality of life scale was also applied to all patients participating in the study.

Results

Pre– and post-study measures indicated a statistical and clinically relevant change in patients of two groups.

Conclusions

Delivering CBT for patients suffering from OCD in Egypt using remote communication methods appears to be effective in alleviating symptoms and improving the quality of life. Yet some adaptations to the standardized treatment protocol are mandated to render the protocol applicable through remote communication and enhancing cultural reception.
Forensic Psychiatric Assessment of Individuals with Mental and Behavioral Disorders Due to Use of Alcohol, who Committed Homicide
Authors: Survilaite A.
Published: June 2017

Introduction

The rate of pure alcohol consumption per capita in Lithuania is reported to be one of the highest in Europe Union. Many studies illustrate the relationship between alcohol and violent crimes. Though dual diagnosis of severe mental disorder and alcohol dependency is common.

Aim

To evaluate peculiarities of mental status of individuals with mental disorders due to use of alcohol, who had committed homicide.

Methods

Forensic psychiatry examination reports in alcohol consumption cases and homicide acts (n 110) were taken from archive of national service of forensic psychiatry in Lithuania, 2010–2014.

Results

In total, 93% (n 91) men and 100% (n 12) women at the time of homicide act were under the influence of alcohol. A total of, 83% (n 91) of cases reported impulsiveness, emotional lability and personality degradation due to long term of alcohol consumption; 52% (n 57) of cases motives for violence remained unclear: offenders indicated they remember nothing because of alcohol intoxication, also possible malingering was evaluated. In total, 100% women (n 12) and 97% men (n 95) were criminally responsible. Only 2 individuals committed homicide as a result of psychosis due to paranoid schizophrenia and 1 individual had significant intellectual deficiency due to moderate mental retardation, which lead them to inability to appreciate the dangerous nature of their acts and to control their behavior. Compulsory medical treatment was recommended to all three of them.

Conclusion

Impulse control deficiency and emotional lability are prevalent amongst homicide offenders with mental disorders due to use of alcohol. Only 3 individuals were irresponsible for their criminal acts as a result of severe mental disorders.