bluuebunny/crossref_metadata_2025 huggingface dataset:
1108 – Esense 2 - Randomised Controlled 6-month Study Of As-needed Nalmefene: Subgroup Analysis Of Alcohol Dependent Patients With High Drinking Risk Level
Authors: van den Brink W. , Aubin H.-J. , Sørensen P. , Torup L. , Mann K. , Gual A.
Published: July 2013

Introduction

We describe the efficacy and safety of as-needed use of nalmefene in the subgroup of patients with a high drinking risk level (DRL; men:>60g/day; women:>40g/day); i.e. a group of patients with a great unmet medical need for.

Objectives

To evaluate the 6 month efficacy and safety of as-needed use of nalmefene 18mg versus placebo in a subgroup of alcohol-dependent patients with high DRL from a randomised controlled trial [NCT00812461].

Methods

All patients received a motivational and adherence-enhancing intervention (BRENDA) in combination with either nalmefene or placebo. Number of heavy drinking days (HDDs) and total alcohol consumption (TAC) were measured using the Timeline Follow-back method. Additionally, data on clinical improvement, liver function and safety were collected throughout the study.

Results

The study population consisted of 317 patients: placebo N=162; nalmefene N=155 (mean age 44.8±10.3 years; 69% men; mean HDDs: 22±6.2/month; mean TAC 111±47.9g/day). Mean number of HDDs decreased to 10 days/month and mean TAC decreased to 43g/day at month 6 in the nalmefene group. There was a superior effect of nalmefene compared to placebo in reducing the number of HDDs (-2.7 [95% CI: -5.0;-0.3];p=0.0253) and TAC -10.3 [-20.2;-0.5];p=0.0404). Improvements in clinical status and alanine amino transferase were greater in the nalmefene group compared to the placebo group (p< 0.05). Adverse events were more common with nalmefene; incidence of adverse events leading to dropout was at the placebo level.

Conclusions

As-needed nalmefene was efficacious in reducing alcohol consumption in patients with high risk for alcoholrelated harm.
1119 – The Impact Of Soluble Interleukin-2 Receptor As a Biomarker Of Delirium
Authors: Baranyi A. , Rothenhäusler H.-B.
Published: July 2013

Introduction

Much speaks in favour of searches for biomarkers that might help to predict the emergence of delirium. Advance warning of the threats of this condition could potentially reduce significant morbidity, mortality, and costs of hospitalising patients.

Aims

Our prospective study investigates for the first time the impact of soluble interleukin-2 receptor (sIL-2R) as a biomarker of delirium after cardiac surgery with cardiopulmonary bypass (CPB).

Methods

34 patients who underwent elective CPB at the Department of Cardiac Surgery, Ludwig-Maximilians-University of Munich, Germany, were enrolled. During the ICU stay and after discharge from the ICU, the delirious state was evaluated daily using the Delirium-Rating-Scale (DRS) by P. T. Trzepacz. sIL-2R was assayed before CPB, 24 h postoperatively and on the day before discharge.

Results

After the CPB, 11 patients (32.4%) developed delirium. During the study period the sIL-2R level decreased at 24h postoperatively and increased afterwards. In the subgroup of patients with a postoperative delirious state longer than 24 hours the sIL-2R level is statistically significantly elevated 24h postoperatively in comparison with CPB-patients without a postoperative delirious state. Furthermore, as shown by a Spearman's rank correlation, CPB patients with higher Delirium-Rating-Scale scores 72h, 96h and 120h postoperatively had significant higher sIL-2R levels 24h postoperatively.

Conclusions

High levels of sIL-2R appear to be a useful biomarker to identify patients with high risk of delirious state.
1120 – Self-image In a Sample Of Italian Women With Eating Disorders
Authors: Focà F. , Luci G. , Guarino G. , Moroni V. , Fanella F.
Published: July 2013

Introduction

Structural Analysis of Social Behaviour by L.S. Benjamin as revised by Scilligo represents self image by two axes: affiliation with love and hate as extreme points; interdependence with freedom and control as extreme points. Axes define a circumplex with 4 quadrants: loving freedom; hostile freedom; hostile control, loving control. Psychic wellness consists of high loving control and freedom and low hostile control and freedom. Quadrants are divided into 12 clusters: self-emancipation, self-affirmation, self-exploration, self-acceptance, self-protection, self-regulation, self-limitation, self-blame, self-attack, self-rejection, self-neglect, self-isolation.

Objective

The present study aims to enrich knowledge about intrapsychic world of people with Eating Disorders by analyzing self image of diagnostic subtypes.

Aims

Differentiating diagnostic subtypes self image in order to have a new key to choose therapeutic interventions.

Methods

250 women with ED, outpatients of the ED Unit of an Italian General Hospital, were administered the Intrex questionnaire, the operational definition of the 12 clusters. One-way ANOVA and post-hoc comparisons between diagnostic subtypes were performed.

Results

Results indicate that ED patients have negative self-image. Bulimics show the highest level of self-blame, self-attack and self-rejection and the lowest of self-affirmation, self-exploration, self-acceptance, self-protection; anorexics show the highest level of self-regulation and self-limitation together with poor self-affirmation, self-exploration, self-acceptance. BED and EDNOS profiles appear less self attacking and more self acceptant.

Conclusions

Eating disorder diagnostic subtypes seem to have distinct intrapsychic profiles that can be reflected in different interpersonal behaviours. Such knowledge may help the therapist to choose the better interpersonal position to support therapeutic change.
1127 – Evolution Of Addictive Comorbidities In a Group Of Patients Diagnosed With Schizophrenia During Atypical Antipsychotic Treatment
Authors: Vasile D. , Macovei R.A. , Vasiliu O. , Mangalagiu A.G. , Tudor C.
Published: July 2013

Background

Drug-related disorders are observed in 30–50% of the patients diagnosed with schizophrenia and is therefore an important problem to be adressed in clinical practice. There are many reasons for the overlap between addictive disorders and schizophrenia: the tendency to alleviate antipsychotic-related side effects, the need to decrease anxiety or depression, to interfere with sensory gating defficits etc.

Objective

To assess the effects of atypical antypsychotic treatment in decreasing the drug of abuse consumption in a population of schizophrenia diagnosed patients.

Methods

A group of 23 patients, diagnosed with schizophrenia and a drug related disorder (dependence 52.1%, polisubstance dependence 17.4%, substance abuse 26%, other 4.5%), according to DSM IV TR criteria, were monitored for 6 months, while being treated with atypical antipsychotics (olanzapine 43.4%, risperidone 34.7%, aripiprazole 17.4%, amisulpride 4.5%), using Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Clinical Global Impressions (CGI) and Inventory of Drug Taking Situations (IDTS) every 4 weeks.

Results

The evolution of IDTS scores were not parallel to the PANSS evaluations: while the psychotic symptoms decreased continuously during the 6 months of the study (-40.5% at week 12 and -67.5% at endpoint), the IDTS decreased initially (- 33.2% at week 12) but increased slightly to the end of the study (-31.2% at endpoint). The CGI-I score has a decrease of 50.4% at week 12 and of 55.6% at week 24.

Conclusions

The evolution of drug related disorders during the atypical treatment of schizophrenia doesn’t correlate with the severity of psychosis and necessitates a specific management.
1134 – Integrated Assessment The Effectiveness Of Therapy By Cipralex In Patients With Rheumatoid Arthritis With Anxiety And Depressive Disorders
Authors: Spikina A. , Sofronova M. , Sofronov A.
Published: July 2013

Rheumatoid arthritis (RA) is one of psychosomatic diseases, the clinical picture which is the important place occupied by psychiatric disorders. Anxiety and depressive symptoms may have a primary character and provoke the development of the disease or is secondary occur against the background of a long course of the disease and its exacerbations.

Purpose of the study

Differentially study the effect of antidepressant Cipralex on higher cortical function and on affective patients with rheumatoid arthritis.Characteristic of the material: For the study groups were formed with the diagnosis rheumatoid arthritis, remission. All patients received standard therapy non-steroidal anti-inflammatory drugs and antidepressant Cipralex.

Discussion

Should first be noted that the study confirmed the clinical efficacy of the Cipralex in therapy of anxiety and depressive disorders in RA. Therapeutic results were achieved in most cases. (98%)

In summary, these data show the effectiveness of the complex treatment of RA. The quality of life in patients with RA affects of factors, including not only the patient's medical condition, but also affective and cognitive areas. The study found the optimizing effect of the drug on cognition. This is evidenced by the fact that on the background of therapy by Cipralex was reduction in the total amount of time required to perform the test tasks and reducing the number of mistakes.

Results obtained in the study of data leads to the conclusion that Cipralex may be included in the complex therapy of patients with RA.
1135 – Mental Health Distress And Alcohol Misuse Associated With Prevalence Of Sexually Transmitted Infections Among Adolescents In Care
Authors: Haley N. , Lambert G. , Jean S. , Frappier J.-Y. , Otis J. , Roy E.
Published: July 2013

Introduction

Every year 4,000 to 5,000 adolescents reside in Quebec Youth Protection Centers (YPCs). Many youth have risky behaviours and mental health issues that put them at risk for sexually transmitted infections (STIs).

Objectives

Document the prevalence of STIs (chlamydia and gonorrhoeae) among adolescents aged 14-17 years old entering Quebec residential YPCs and identify associated risk factors.

Methods

In 2008–2009, adolescents residing in six YPCs completed a questionnaire covering sexual and substance use behaviours, as well as other health issues affecting their well-being. Urine samples were collected for Chlamydia trachomatis (CTGI) and Neisseria gonorrhoea (NGGI) genital infections.

Results

Among 578 participants, 14-17 years old, 89% were sexually active. Risk behaviours included: early sexual initiation (66% < 14 years); multiple partners (median: girls 5, boys 8); group sex (girls 38%, boys 43%); sex for money or goods (girls 27%, boys 8%). Half of sexual relations were under the influence of drugs/alcohol. Regular substance use (3x weekly and +) was: tobacco: 75.0%; cannabis: 63.1%; alcohol: 24.2%; amphetamines: 16.7%; and cocaine: 7.4%. Prevalence of CTGI: 9.3% girls, 1.9% boys; NGGI: 1.7% girls, 0% boys. In multivariate analysis, factors significantly associated with chlamydia infection among girls were: alcohol intoxication hospitalisation or history of suicide ideation with plan.

Conclusion

Serious alcohol misuse or mental distress were significantly associated with STI infections among adolescents. Mental health professionals are encouraged to provide sexual health and substance use counselling with adolescent patients given the highly woven interaction between mental distress and risk of sexually transmitted infections.
1136 – Bridging The Gap: An Audit Of The Transitions Of Young People In Mental Health Services
Authors: George D. , Prasad K. , Denton R. , Routledge D. , Sweet D.
Published: July 2013

Introduction

Transitions from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) can often be problematic due to high eligibility thresholds, inconsistent support during transition and limited participation from young people. The TRACK Study highlighted several clinical, organizational and policy related reasons for Services to develop and implement transition protocols effectively.

Aims and objectives

This audit aims to examine whether the Trust's Transitions Policy is adhered to during transitions of young people across services. It also aims to review the qualitative experience of young people and professionals involved.

Method

A Questionnaire Survey method was used to collect quantitative and qualitative data from involved professionals and young people who moved from CAMHS into AMHS (Aug11–Jan12). The data was analyzed against the audit criteria, which relate to specific aspects of the Transitions Policy.

Results

A variable response rate showed that majority of the young people and involved professionals were satisfied with the planning and transfer of care with high policy adherence rates. Young people wished for better communication, more information on the nature of services offered and greater support, while professionals hoped for greater consideration of engagement levels and joint working. Alternative support was requested for declined referrals.

Conclusions

Improved adherence to the Transitions Policy can be achieved through proper planning, better communication, more joint working and regular feedback from young people and professionals. It can also help to achieve higher standards and continuity of clinical care to meet the needs of young people.
1144 – Crimes And Mental Elderly Patients In Psychiatric Hospital Of Razi In Tunisia
Authors: Mâamri A. , Chennoufi L. , Hadj Salem M. , Melki W. , Ridha R.
Published: July 2013

Introduction

Few scientific studies have been devoted to the study of crime among the mentally ill elderly, however, all the studies agree on the importance of recognizing risk factors associated with passage to forensic action in elderly patients.

Aims

The objectives of our work are to clarify the sociodemographic, clinical and forensic characteristic of mental elderly patients who commit forensic acts.

Methodologie

Our work has focused on all patients older than 60 years hospitalized under the mode of office between 1995 and 2012 in the service of forensic Razi hospital according to article 29 of the law n° 92–83 of the third of August 1992 as amended by the law 2004-40 of 3 May 2004, following a non-legal place due to insanity within the meaning of the 38 article of the Tunisian Penal Code.

Results

Our study included 25 patients, their ages ranged between 60 and 90 years. They mostly had a low socio-economic level (64%), a low educational level (48%) and a marital status of married (64%).

All patients had a neuropsychiatric disease: schizophrenia and other psychotic disorders in 48% of cases, dementia and Delirium nonspecific in 32% of cases, mood disorder in 16% of cases and mental retardation in 4% of cases. The medico-legal act was murder or attempted murder in 40% of cases, sexual crimes in 16% of cases, aggression against property in 16%, violence against people in 8% of cases and different offenses in the remaining cases.
1152 – Formalized Consensus Guidelines For Use And Management Of Antipsychotic Depots
Authors: Samalin L. , Guillaume S. , Abbar M. , Courtet P. , Lancrenon S. , Llorca P.-M.
Published: July 2013

Introduction

As part of a process to improve the quality of care, the Association for Biological Psychiatry and Neuropsychopharmacology (AFPBN) developed recommendations for the use and management of Long Acting Injectable (LAI) Antipsychotics in clinical practice.

Methods

Based on a literature review, a written survey was prepared that asked about 539 options in 32 specific clinical situations. We contacted 64 national experts, 42 (65,6%) completed the survey. According to the answers for each situation based on a 9-points scale, a categorical rank (first-line/preferred choice, second-line/alternate choice, third-line/usually inappropriate) was assigned to each option. First-line option was defined as a strategy rated as 7–9 (extremely appropriate) by at least 50% of the experts.

Results

For French experts, LAI Antipsychotics are indicated in patients with schizophrenia, schizoaffective disorder and bipolar disorder. According to their efficacy and tolerability risperidone LAI then olanzapine LAI are recommended as first line for maintenance treatment in schizophrenia, even after the first episode. Depot neuroleptics are recommended as second line for maintenance treatment in schizophrenia. LAI Second Generation Antipsychotics are recommended as second line in bipolar disorder. Several clusters of patients are identified, characterizing a specific profile for the use of LAI. Recommendations for the use of LAI and switch from oral to injectable formulations are suggested.

Conclusion

The use of LAI has advantages as maintenance treatment but their prescription rate is generally below 30% in different countries. Specific guidelines for the use and management of this formulation could improve their use in clinical practice.
1162 – Vascular Factor In The Etiology And Pathogenesis Of Alzheimer’s Disease
Authors: Maksimovich I.V.
Published: July 2013

Introduction

Vascular factor is very important in the development of AD. The research investigates the changes in the cerebral angioarchitectonics at various AD stages.

Methods

The research included 92 patients of which:

Test Group: 47 aged 34–79 suffering from AD different stages including:

4 with preclinical stages or high risk of disease development (TDR-0);

15 with mild dementia (TDR-1);

20 with moderate dementia (TDR-2);

8 with severe dementia (TDR-3).

Control Group: 45 aged 28–78 with various types of brain lesions accompanied by dementia but without Alzheimer’s disease including:

15 with chronic cerebrovascular insufficiency of atherosclerotic genesis and moderate dementia;

12 with severe vascular dementia;

14 with atherosclerotic parkinsonism;

4 with Parkinson’s disease.

Each patient underwent MRI, CT, SG, REG, MUGA.

Results

At AD different stages, changes in angioarchitectonics and microcirculation show themselves in:

lack of expressed atherosclerotic lesions of intracranial vessels - 47 (100%) patients,

reduction of capillary bed in the temporal and frontoparietal regions - 47 (100%),

development of multiple arteriovenous shunts in the same areas - 47 (100%),

corresponding early venous shunts - 47 (100%),

abnormal development of venous trunks receiving blood from arteriovenous shunts - 42 (89.4%),

venous congestion at frontal and parietal region border - 43 (91.5%),

increased loop fromation of intracranial arteries - 37 (78.7%).

Control group patients had no combination of such changes.

Conclusions

We named the vascular factor in AD “the discirculatory angiopathy of Alzheimer’s type” (DAAT).
1173 – The Results Of a Smoking Cessation Center - a Preliminary Study
Authors: Hacihanifioglu S.B. , Yazici E.
Published: July 2013

Aim

Smoking is still one of the important public health problems. Utilizing professional support for cessation increases the rates of success. A retrospective analysis of one year data of a smoking cessation center (SCC) is presented in this study.

Methods

Data obtained from 92 patients by using sociodemografic questionnaire and Fagerstrom test for nicotine dependence (FTND). Quitting or remaining in the program and success rates of cessation were determined.

Results

Female/male ratio was 52.2% /47. 8% (mean age 40.67 ± 11.18). The mean FTND score was 5.23 ± 1.76. 66.3% of participants had no previous psychiatric treatment. 18.5 % of participants had history of psychiatric treatment and 15.2% had ongoing treatment. Smokers received pharmacotherapy and CBT; CBT alone or pharmacotherapy alone. After first examination, 33% of all participants continued to their treatment program. There was no difference between the attendants or quitters of the program for sociodemografics, treatment history or FTND scores. Seven attendants in the program (32 % of the attendants) quitted smoking; nine attendants (41%) decreased daily number of smoking more than 50%. Six attendants (27%) had no change. There was no difference between the quitters or no quitters for sociodemografics, psychiatric treatment history or FTND scores.

Conclusions

We presented a preliminary analysis of our SCC program data. It is reported that psychiatric disorders are related with higher rates of smoking and lower rates of cessation. In this study the anamnesis of psychiatric disorders had no negative influence on cessation of smoking.
1178 – Correlation Study Of Apoptosis-related Genes Bcl-2, Bax And Ptsd In Rat Medial Prefrontal Cortex Neuronal Apoptosis
Authors: Li Y. , Han F. , Shi Y.
Published: July 2013

Post-traumatic stress disorder (PTSD) is a significant problem,The medial prefrontal cortex (mPFC) is known to be significantly involved in emotional adjustment.

Objective

To discuss the issue of post-traumatic stress disorder (PTSD) rat apoptosis-related genes Bcl-2, Bax and medial prefrontal cortex (mPFC) neuronal apoptosis, and to provide experimental evidence to reveal PTSD pathogenesis.

Methods

The single-prolonged stress(SPS) method was used to set up the rat PTSD models There were five groups after SPS 1 day 4 days 7 days 14 days groups and control group Serum corticosterone level was determined with chemiluminescence, mPFC neuronal apoptosis changes and detection of apoptotic index were detected with transmission electron microscopy, hoechst 33342 staining and in situ nick end labeling method (TUNEL) staining. Immunohistochemistry, immunofluorescence, RT-PCR and western blotting were used to detect the expressions of Bcl-2 and Bax in the medial prefrontal cortex neuronal.

Results

PTSD rat mPFC neuron cell apoptosis, the number of apoptotic cells gradually increased with time and reached a peak at 7 days after SPS stimulates. Bcl-2 expression reached a peak at 4d and Bax expression reached a peak at 7d after SPS stimulates, Bcl-2/Bax ratio transient increased and then gradually decreased, reached a lowest point in seventh days after SPS stimulates.

Conclusions

The expression of apoptosis related genes Bcl-2 and Bax increase and their ratio imbalances are likely to be one of the reasons that lead to PTSD in rat mPFC neurons apoptosis, which may provide the pathophysiology basis for PTSD.
1182 – Rcts Schizophrenia Quality In Russian Speaking Patients: a Systematic Review Of Quetiapine Comparison Trials
Authors: Orlova N. , Shkliar M.
Published: July 2013

Objective

The systematic review help determinated of RCT’s quality at Russian speaking patients.

Materials and methods

Were search the Russian Scientific Journals in Consilium medicum Database for RCTs comparing quetiapine with any other pharmacotherapy or placebo in the treatment of patients with schizophrenia. Effect sizes were combined in a fixed-effects model. To quantify heterogeneity was used the Q test. Funnel plots, regression tests were used to evaluate publication bias. Analyses were performed using RevMan 5. Methodological quality of controlled trials was assessed by Jadad score.

Results

From 25 relevant trials only 5 trials were finally included in the review; None of that trials were identified in main Western data bases. All studies were randomized; None of the authors reported about study blinding; Only 2 studies reported about withdrawals and dropouts; None of the studies reported voluntary participation. Median Jadad score - 3 (57%). Quality of the study in most trials was low, and sample sizes were small. Mean quetiapine dose was slightly lower than in Western studies. Quetiapine at Russian speaking patients with schizophrenia was more effective and better tolerated than haloperidol but had no differences in those parameters between risperidon and olanzepine.

Was found: low quality of RCTs in Russian speaking patients; comparative antipsychotics had similar profiles of tolerability and safety for positive, negative symptoms and patient’s compliance. Coming RCTs must be thoroughly planned for studying in initial criterion safety and tolerability of all antipsychotics for schizophrenia treatment. We need further long-term studies for side effects monitoring.
1186 – Phobic Postural Vertigo - a Blurred Sign For Anxiety Disorder, Results Form a Case Series
Authors: Feffer K. , Gordon C. , Fennig S.
Published: July 2013

Phobic Postural Vertigo (PPV) is the 3rd most common cause for vertigo, characterized by the combination of a dizziness and subjective disturbance of balance in the absence of objective findings during routine Neurological evaluation. In most cases the clinical presentation is indistinguishable from agoraphobia. Despite this, most clinical data does not support direct correlation between anxiety disorder and PPV.

In this case series 10 patients who suffer from PPV went through psychiatry interview after a neurologist check up has been made to confirm the diagnosis of PPV. ACQ, BCQ and HDRS were filled for all patients.

Result

According to this preliminary case series evidence for anxiety/somatization disorder were evident in 50% (5/10) before the development of PPV while in 30% (3/10) anxiety symptoms appeared in parallel or sequential to the development of PPV. In 20% (2/10), no signs for anxiety symptoms detected during evaluation.

The results of this case series suggest that PPV is a heterogeneous diagnosis that in part includes patient with previous anxiety/somatization disorder and patient in which vertigo is the presenting sign of anxiety disorder.

Farther research is needed in order to farther characterize PPV patients and promote suitable interventions.
1189 – Kleine-levin Syndrome And Lithium
Authors: Yelmo S. , Morera-Fumero A.L. , Díaz-Marrero G. , Suárez-Benítez N. , González-González I. , Quandt-Herrera P.
Published: July 2013

Introduction

Kleine-Levin syndrome (KLS) is a rare disease characterized by recurrent episodes of hypersomnia, hyperphagia and behavioural symptoms, mainly hypersexuality.

Objectives

We report the clinical course of KLS in a 18-year-old male. The clinical onset and evolution are described.

Aims/methods

The boy was diagnosed as having KLS after two episodes of hypersomnia lasting for 13 to 15 days each one. When awake, he was depressed and with megaphagia. He also had phases of hypersexuality. The initial interval between episodes was 6 weeks. After the second episode was treated with lithium and remained free of symptoms for 11 months. He had a third episode that lasted 6 days. Serum lithium level was low. In this third episode he had only hypersomnia. He had a relapse two years later with a duration of 4 days, without further relapses.

Results

KLS is more frequent in young males with a mean duration of 8 years and around 7 episodes that lasted 10 days. The pathogenesis remains unknown. It has been related with functional disturbance in the hypothalamus, viral infections, triggering stimulus...Some authors consider KLS as a variant of bipolar disorder. Treatment includes methylphenidate, neuroleptics, antidepressants and mood stabilizers as lithium. With lithium has been reported fewer relapses, shorter duration of episodes and disappearance of behavioural symptoms.

Conclusions

Despite being a rare disease, is thought to be underdiagnosed, because diagnosis is mainly clinical, and tests such as EEG, PSG and MSLT reinforce the diagnosis but are not pathognomonic. Today, lithium is the best treatment option.
1192 – Investigation Of Psychological Characteristics Of Greek Doctors Specializing In General-family Medicine And In Internal Medicine
Authors: Pappas P. , Gourgoulianis K. , Hatzoglou C. , Kotrotsiou E. , Gouva M.
Published: July 2013

Introduction

The relatively recent propagation of the specialty of Family Medicine in Greece has created a new reality in the Greek society. This resulted in the “co-inhabitation” of the Family Medicine specialists and the Internal Medicine specialists in various Primary Care units of the country.

Objectives

To investigate the internal and external shame of the residents in Family Medicine and Internal Medicine and the comparison of both groups.

Aims

To demonstrate the distinct role that Family doctors must have in Primary Care.

Methods

102 Greek resident doctors, 52 specializing in Family Medicine and 50 specializing in Internal Medicine participated in the study. The scientific tools used were: a)the Other As Shamer Scale, b) the Experience of Shame Scale, c) the Hostility and Direction of Hostility Questionnaire, d) The Symptom Checklist-90-R, e) Eysenck Personality Questionnaire.

Results

Comparing the two groups using the T-Test, it was observed that the residents of Family Medicine showed a statistically significant higher mean value compared to the residents Internal Medicine in the subscales of: characterological shame, behavioral shame, bodily shame, total shame, emptiness, criticism of others, self-criticism, guilt, intropunitiveness, total hostility, neuroticism and an statistically lower mean value compared to the residents of Internal Medicine in the subscales of: mistakes, Anxiety, Phobic Anxiety and Psychotism.

Conclusion

The results of the study are supporting the common belief that the specialty of Family Medicine has not yet obtained a specific and distinct role and furthermore has not yet gained the necessary recognition by the Greek society.
1193 – Comorbid Autism Spectrum Disorder And Problem Behaviours: a Case Study Of Home-based Sensory Integrative Therapy
Authors: Lam P.W.K.
Published: July 2013

Background

The vast majority considered pharmacological intervention as a legitimate treatment for behavioural problems in adults with Autism spectrum disorder (ASD) and intellectual disabilities (ID). Yet, sensory integrative therapy (SIT) has in recent years acquired increasing attention with regard to its improvements in functioning.

Aim

To report a case of ASD and ID presented with severe problem behaviors. To present and discuss the effect of a combined intervention of home-based SIT and pharmacological therapy on daily functioning.

Method

Case study and literature review.

Results

A 24-year-old male with moderate grade ASD and ID was referred to a home-based training service. He exhibited poor attention, daily self-stimulating behaviors and self-injurious behaviors (SIB). He was treated with 1/2 mg/day of Apohaloperidol. Home-based SIT (Wilbarger Deep Pressure and Proprioceptive Technique) which evokes calming was first started on a weekly interval for five months and then on a daily basis for another five months. Improvement was first demonstrated by a reduction in temper tantrum and SIB during weekly treatment. When treatment became daily, he was able to demonstrate increasing attention in self-care activities as well as reducing frequency and duration of self-injurious and stimulating behaviors.

Discussion

Despite paucity of published evidence, our findings lend initial support to the effectiveness of SIT as a complimentary approach to treat behavioural problems and enhance daily functioning. Hence, SIT can be incorporated into treatment plan on behavioural problems. Further research using experimental design is called for given the promise of the present findings.
1194 – Traumatic Experiences And Dissociative Symptoms In Schizophrenic Inpatients
Authors: Keyvan A. , Esenkaya Ö. , Erkoç ş. , Fistikçi N.
Published: July 2013

Introduction

There is emerging evidences that presence of dissociative symptoms could be a significant co morbid condition in a proportion of schizophrenic patients with a history of traumatic events.

Aim

The purpose of this study is to analyze the effects of traumatic experiences and the intensity of co morbid dissociative symptoms in the course of schizophrenia.

Method

80 inpatients diagnosed with schizophrenia according to DSM IV and being treated in acute psychiatry clinics at Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery were enrolled to the study. Socio- demographic Data Form, Traumatic Experiences Check List, Dissociative Experiences Scale (DES), Dissociative Disorder Interview Schedule were performed.

Findings

39 of the patients (48.8%) were found to be exposed to traumatic events at least once in their childhood or adulthood. Significant positive correlation was found between the average DES scores and total number of traumas (r= 0,683; p< 0, 01), the number of psychiatric diagnosis during the course of the disorder (r= 0,374; p< 0, 05), the number of change in treatment due to inadequate response (r= 0,505; p< 0,01) and the number of suicide attempts (r= 0,447; p< 0,01). Moreover, significantly positive correlation was found between the mean DES scores and the number of treatment change due to insufficient response (r= 0,404; p< 0, 01) among the patients without trauma.

Results

The results of this investigation claim that the high scores of DES, independent of traumatic life experiences, may cause resistance to treatment in schizophrenic patients.
1198 – The Role Of Micrornas In Major Affective Disorders And Suicidal Behavior
Authors: Serafini G. , Pompili M. , Innamorati M. , Girardi P.
Published: July 2013

Major affective disorders are common conditions associated with severe psychosocial impairments and suicidal risk in the general population. At least 3-4% of all depressive individuals die by suicide. Many hypothesis about the patophysiology of these disorders have been formulated and at a molecular level, affective disorders and suicidal behavior have been recently associated with disturbances in structural and synaptic plasticity. A recent hypothesis suggested that small non-coding RNAs (ncRNAs), in particular microRNAs (miRNAs), play a critical role in the translational regulation at the synapse. miRNAs putative subcellular localization and sites of action are supposed to be in mature neurons when they may exert a specific role in neurogenesis, synaptic plasticity, pathological stress changes, major affective disorders and suicidal behavior. miRNAs have also played a fundamental role in the evolution of brain functions. The perturbation of some intracellular mechanisms as well as impaired assembly, localization, and translational regulation of specific RNA binding proteins may affect learning and memory, presumably contributing to the pathogenesis of major affective disorders and perhaps suicidal behavior. Furthermore, miRNA dys-regulation has also been linked to several neuropsychiatric diseases. However, further evidence are needed in order to directly clarify the role of miRNAs in major affective disorders and suicidal behavior.
1202 – Involvement Of Noradrenergic’s Projection In The Post-traumatic Stress Disorder, a Demonstration By An Alpha-1 Adrenergic Antagonist, The Prazosin
Authors: Rousseau P.-F. , Simon P.-Y.-R. , Clervoy P.
Published: July 2013

Introduction

In the United States of America, lifetime prevalence of the post-traumatic stress disorder (PTSD) varies between 8 and 11 %. The pathophysiology of PTSD is complex, involving the prefrontal cortex, the limbic system which amygdala and the locus coeruleus. We don’t have a specific treatment for this pathology but just a symptomatic treatment.

Objectives and methods

The present review analyzes the results of referenced outcome studies in Medline. The efficacity of prazosin, an alpha-1 adrenergic antagonistis is an evidence to this deregulation.

Aim

Confirm the hypothesis of a noradrenergic dysregulation in PTSD.

Results

Of share its projections with the amygdale, the hippocampus and the prefrontal cortex and the reticular formation, the locus coeruleus is one of the main brain noradrenergic structure. It regulates the vigilance and attention in the alert situations and regulates the fear and anxiety. The locus coeruleus regulates the wakefulness-sleep cycle with this projection with the raphe nuclei and the paraventricular nuclei of hypothalamus. During a stress, activation of locus coeruleus causes a release of norepinephrine responsible for symptoms of avoidance, hyper-arousal, re-experiencing and trauma nightmares. Prazosin, significantly decreases the main clinical symptoms of PTSD and improve global clinical status to placebo in all studies. This results constitutes a harmul evidence to the implication of norepinephrine in the PTSD.

Conclusions

Norepinephrenine is a major actor in the pathophysiology of PTSD. The prazosin is led to become the first-line treatment of PTSD but longer studies in larger samples are necessary to confirm these preliminary findings.
1210 – Clinical Comorbidity And Demographic Patterns In Court Ordered Mental Health Inpatients
Authors: Delgado G. , Magallon L. , Cebamanos J.M.
Published: July 2013

Comorbidity in forensic psychiatry describes the co-occurrence of two or more conditions or psychiatric disorders, known in the literature as dual diagnosis. There is a close relationship between violent offenders and comorbid substance abuse confirmed by numerous studies in the field of forensic psychiatry. Comorbidity also strongly contributes in the process of establishing psychiatric diagnosis of diminished mental capacity or insanity at the time of the offense, in the course of clinical assessment and evaluation of violent offenders.

The aim of this study was to perform a descriptive analysis of a sample of patients admitted in a long-stay unit, in compliance with a court ordered criminal sentence. We analyzed the comorbidity and demographic patterns among inpatients admitted during a period spanning from 2007 to 2012. We also contemplated the typology of offenders and reviewed risk assessment scales, based on illness onset pre-dating the first offense.

In conclusion, our results are congruent with other similar published studies. Due to the high prevalence of dual diagnosis in violent offenders their management requires a multilevel approach to the patient. In civilian psychiatric units, which also admit court ordered inpatients, the implementation of risk assessment scales in clinical practice is strongly recommended.
1211 – Self-report And Hetero-evaluation Of Insight And Medication Adherence In Severe Mental Illness - Correlation And Clinical Interest
Authors: Madeira N. , Roque C. , Pereira A.T. , Nogueira V. , Soares M.J. , Macedo A. , Marques M. , Valente J. , Bós S.
Published: July 2013

Introduction

Insight and treatment adherence in serious mental illness, namely psychotic disorders, are well recognized as strong predictors of prognosis; several psychometric instruments have been developed for their evaluation.

Objectives and aims

To analyze the relation between self and hetero-evaluated insight and treatment attitudes in a clinical sample of psychiatric patients, besides assessing it's clinical correlates and relevance.

Methods

60 patients with serious mental illness (schizophrenia and bipolar disorder with psychotic features) were assessed using the Portuguese versions of the ‘Insight Scale' (IS), ‘Medication Adherence Rating Scale’ (MARS) and ‘Insight and Treatment Attitudes Questionnaire’ (ITAQ). General psychopathology and functioning scales were also applied, such as the BPRS, BDI-II and FAST. Relevant sociodemographic and clinical variables were also obtained. Statistical analysis was conducted using SPSS version 19.

Results

Self-reported insight using the IS was not correlated with the insight subscale of the ITAQ, a hetero-evaluation instrument. Similarly, we found no correlation regarding attitudes to treatment when comparing self-report (MARS) and hetero- evaluation (treatment attitudes subscale of the ITAQ). Nonetheless, patients with a history of medication non-compliance and worse clinical outcomes had significantly lower (p< .05) scores in hetero-evaluation measures of insight and treatment attitudes (ITAQ), yet exhibited no differences in the self-evaluation measures of those dimensions.

Discussion and conclusions

Insight and treatment attitudes assessments can be valuable in clinical practice, contributing to decisions in both in- and outpatient settings involving treatment planning and level of monitoring. Clinician-rated instruments are probably more reliable, with clearer prognostic relevance.
1212 – Audit On The Management Of Patients With Alcohol Withdrawal Within Inpatient Setting In Relation To The Local Guidelines (based On Nice Recommendations)
Authors: Gribben K. , Mohammed Z.
Published: July 2013

Introduction

Alcohol dependency can cause serious complications if not managed appropriately.

Objectives

To evaluate if the local guidelines (based on NICE) for the management of acute withdrawal are followed at the Bede Unit/South Tyneside. These advises a three day course of intramuscular Pabrinex and seven days reducing regime of benzodiazepine (commonly Chlordiazepoxide) with additional PRN (as required) benzodiazepine.

Aim

The project's main objective is to identify how the guidelines can be delivered more effectively.

Method

Retrospective data collection from all kardex for all patients (21 identified) who received a reducing regime of benzodiazepines between Oct/11 & Jan/12, for alcohol withdrawal symptoms, examining if they were prescribed bezodiazepines regularly, ‘as required’ or both to treat withdrawal symptoms. Vitamin supplementation as part of their management of alcohol withdrawal was also reviewed.

Results

All patients were prescribed chlordiazepoxide. Seventeen of these were prescribed both regular and PRN chlordiazepoxide, while one received regular only and three patients received PRN only. Period of treatment ranged from 2-11. Five received the recommended seven days reducing regimen.

Only one patient was managed in accordance with local guidelines (three days of intramuscular Pabrinex/seven days reducing chlordiazepoxide/PRN benzodiazepine)

There was inconsistency in the use of PRN benzodiazepine.

Conclusion

There might be doubts about patients’ knowledge regarding as required medication, and on how withdrawal symptoms are monitored.

The reducing regime of benzodiazepines is limited to the format of the kardex, which made it difficult to identify drug errors or omissions and hence increased the margin for medication errors.
1214 – Emptiness In a Life Full Of Experiences: Major Depression In a 66-year-old Man
Authors: Ribeiro B. , Ribeiro Â. , Ribeiro J.P. , von Doellinger O.
Published: July 2013

Introduction

Depression is a common, recurrent, often underdiagnosed and undertreated disorder in older people. 10-15% of the elderly present depressive symptoms and 3% of that same population meet criteria for a major depressive episode.

Several factors, such as psychosocial changes, may be related to the onset of depressive episodes. Retirement (often accompanied with feelings of loss of status, both in the family and in the society), the decrease of social contacts with a tendency to isolation, and the difficulties to adapt to new activities and routines, all lead to feelings of inadequacy, worthlessness and a poor self-esteem.

Objectives/aims

The aim of this poster is to show and discuss the importance in recognizing some psychosocial factors that can predict the onset of depressive symptoms in the elderly.

Methods

We report a case of a 66-year-old man, without previous psychiatric history, who presented a major depressive episode with psychotic features, after an important life event (retirement).

Results/conclusion

Depression in older people has severe consequences, afflicting not only patients but also the caregivers. The amplification of previous disabilities associated with medical and cognitive disorders, the increased rate of mortality by suicide and the increased costs to the health care system are common consequences.

To reduce such threats we propose a clinical and social approach that evaluates and regards the different stages of the life cycle and valorize the achieved experiences of older patients.
1221 – Rescripting Or The Traumatic Or Distresing Stories From Childhood In Imagination
Authors: Prasko J. , Vyskocilova J. , Cerna M. , Grambal A. , Jelenova D. , Kamaradova D. , Latalova K. , Ociskova M. , Sedlackova Z. , Sigmundova Z.
Published: July 2013

Introduction

Many of patients suffering with psychiatric disorder describe significant stressful experiences from childhood. Many of them suffer as children with unsatisfactory fulfilled basic child's needs, such as security, acceptance or approbation.

Method

We describe approach in processing these painful events during the therapy. Among basic principles in the treatment of the patients who developed psychiatric disorder and have stressful events in childhood or adolescence belongs the creation of collaborative therapeutic relation, explanation and psychoeducation what happens with the patient and reducing or correct stigmatization and guilt feelings. Therapist helps the patient to understand, how symptoms connected with the events from childhood and how they are interconnected with actual problems in life. The transcription of traumatic or stressful events follows after cognitive restructuralization of core schemas and conditional assumptions. Therapeutic process can be divided into of several steps:

(a)

creation of therapeutic atmospheres (with feelings of security and control, acceptance, approbation);

(b)

exposition to the painful memories in imagination;

(c)

expression of negative emotion to the aggressors, or persons that the didn’t guard against stress or trauma;

(d)

formulation the needs of the child to significant adult person;

(e)

experience better end in imagination - transcription of the story;

(f)

general calm down.

The aim of therapist is to help the patient memorizing the stressful events and expressing affective experience and then help him/her to rescript experience to less painful.

Results

There are some case examples of traumatic rescription in the article.

Supported by IGA

MZ CR NT 11047-4/2010.
1228 – Regional Metabolic Brain Requirements Comparison In Selected Anxiety Disorders
Authors: Grambal A. , Prasko J. , Horacek J. , Vyskocilova J. , Grambalova Z. , Kamaradova D.
Published: July 2013

Introduction

Positron emission tomography (PET) detects indirect signs of higher or Loir neuronal activity and we suppose relation between the activity and the brain fiction. Though the anxiety disorders have many common characteristics, but there are also some differences. In our work we compare silent regional brain requirements in some anxiety disorders.

Method

Patients suffering from anxiety disorders were studied with 18FGD PET during rating state before systematic treatment. We studied 25 patients with agoraphobia, 21 with panic disorder, 40 with OCD and eleven with PTSD. Data were analyzed using SPM 99.

Results

There was higher uptake of FDG in patients suffering with OCD compared with PD and AP patients in left side basal ganglia. There was also higher uptake of FDG in patients with PD and AP compared with OCD in right frontal areas. The patients with OCD developer higher uptake compared with PTSD in middle temporal gyrus bilaterally. PTSD patients showed higher uptake of FDG in comparison of OCD in right anterior cingulate. There was higher uptake of FDG in PD an AP patients in comparison with PTSD patients in right inferior temporal gyrus.

Conclusion

There were differences in regional brain activities in FDG between various types of anxiety disorders.

Supported by IGA

MZ CR NT 11047-4/2010.