bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychiatric premises for abortion in Poland - ethical, legal and clinical issues
Authors: Kosmowski W. E.
Published: August 2024

Introduction

After judgment of the Constitutional Tribunal of 22.10.2020, there are two premises for abortion: when pregnancy was caused by rape or pregnancy is the threat for health and life of a mother. Then some people indicated that the latter should be interpreted more broadly. So far, jurisprudence has interpreted health threats only in relation to physical health, currently – cases classified as mental health threats are included.

Objectives

The aim of this paper is first to analyze different aspects of this phenomenon: clinical, philosophical, including ethical and legal. The second goal is to point out the best actions for psychiatrists.

Methods

The methodology of this paper corresponds to the pastoral paradigm: diagnosis, reflection, action. At first, the arguments of opponents and proponents of the concept of psychiatric premises for abortion were extracted. Then they were assessed from a logical and essential point of view. Finally, some conclusions and guides were included to enable psychiatrists to act appropriately, including ethical, clinical and legal aspects.

Results

Statements and letters from various institutions and societies were analyzed, including the Presidium of the Supreme Medical Council, Polish Pediatrics Society, the Expert Team on Bioethics of the Polish Bishops’ Conference, the Bioethics Committee of the Polish Academy of Sciences, Patient’s Rights Ombudsman, Commissioner for Human Rights. The key arguments for psychiatric premises are presented in the Table 1.
Table 1.ArgumentDescriptionEtiologicalthe only cause of mental disorders during pregnancy is the pregnancy itself or fetal diseasesTherapeuticalabortion is a method of treating mental disorders during pregnancyPrognosticpossible long- and short-term complications after the abortion procedure do not pose a significant threat to the woman’s life and healthConsultation-Liaison
the task of the consultant psychiatrist is to indicate what actions other doctors should takeEthicalthe value of the fetus’s life is negligible compared to values such as the mother’s mental state or well-being
Politicalsuch conduct is beneficial to state policy and the good of societyLegalsuch procedures are legal

According to opponents, using the premise of mental health risks to terminate a pregnancy would be an example of the psychiatrization of life and the abuse of psychiatry for political purposes. There would be a danger of associating psychiatry as a tool for performing abortions, which would perpetuate the phenomenon of stigmatization – of both doctors and patients. Each of the arguments for this has been negated.

Conclusions

This problem illustrates an attempt to replace the paradigm of traditional personalistic ethics with utilitarianism. The concept of psychiatric premises for abortion is contrary to the principles of double effect and proportionality. It is also against the Polish Code of Medical Ethics: art. 39 and art. 54.

Disclosure of Interest

None Declared
Reaching the limits of antipsychotic treatment: the upper end of severe schizophrenia in forensic institutions - a case report
Authors: Watzal V. , Stompe T.
Published: August 2024

Introduction

Severe schizophrenia is often closely related to delinquency resulting in relative overrepresentation of these manifestations of disease in forensic institutions.

Objectives

The aim of the present work is to report the therapeutic challenges in a case of severe schizophrenia in a forensic institution from a clinical viewpoint as a basis for discussion.

Methods

The case report is based on the available clinical documentation, exploratory interviews as well as a structured clinical interview (PANSS).

Results

Presenting a case of a 41-year-old, male Caucasian inpatient suffering from a catatonic schizophrenia, we report the challenges in treatment of chronic, major schizophrenic disease resistant to antipsychotic medication. Without any previous criminal convictions, he has been instutionalized in a forensic psychiatry after a bodily harm to a random stranger about three years ago. Regarding medical history, information is limited to a few inpatient admissions prior to detention documenting intravenous opioid and cocaine abuse. Initially, the patient presented sexual disinhibition and ongoing endangerment of others with frequent assaults to other patients and prison guards. From a psychopathological viewpoint several phenomenona such as delusional intuition, acoustic, tactile and coenaesthetic hallucinations, echolalia, mannerisms and thought diffusions reflect the severe course of the disease (PANSS: P 34/49, N 38/49, G 73/112; total 145/210). Therapeutic attempts with an antipsychotic combination of risperidone, olanzapine and quetiapine as well as valproic acid resulted in insufficient recovery with persistent physical assaults and florid psychosis. In reaction to that zuclopenthixol for impulse control was added. As from the beginning of this year a switch of medication by gradually replacing risperidone and zuclopenthixol with haloperidol and clozapine showed modest success. Under the current medication and therapeutic drug levels the patient does not pose endangerment to others. However, regular tonic-eye fits require supplementary treatment with biperiden, and the patient still presents frequent periods of self-harm punching himself, verbal lack of impulse control and the psychopathological phenomenona described before. In addition to pharmacological treatment the patient receives psychotherapeutic one-on-one conversations. Despite approaching all limits of the available antipsychotic repertoire, psychopathology is only insufficiently controlled leading considerations to electroconvulsive therapy as a treatment of last resort.

Conclusions

Certainly, the present case is exemplary for a severely ill population of patients reaching – after a long and untreated course of disease - a chronic stage that does not sufficiently respond to a multitude of treatment attempts despite proper compliance raising the urgent need for further treatment options.

Disclosure of Interest

None Declared
Evaluating emotional competencies in health professionals in a city in Colombia
Authors: Ruiz Gonzalez E. P. , Muñoz Argel M. N. , Garcia S. , Sierra A.
Published: August 2024

Introduction

Emotional competencies, according to Bisquerra Alzina & Escoda (2007), refer to “knowledge, skills and attitudes necessary to understand, express and appropriately regulate emotional phenomena” (p. 22) in the management of emotions with oneself and with the other.

Objectives

Measure the emotional competencies Empathy, Emotional Expression and Emotional Regulation in health professionals in healthcare centers.

Methods

Quantitative descriptive. The Inventory of Emotional Competencies for Adults (Mikulic, Crespi, Radusky, 2015) was applied to 30 participants (doctor, psychologist, nurse, dentist).

Results

The grouped measurements show skills at a medium and high level.
Table 1.

Measurement of empathy capacity, emotional regulation capacity and emotional expression capacity

FrequencyPorcentEmpathyMedium2790,0High310,0Emotional RegulationMedium1550,0High1550,0Emotional ExpressionMedium2686,7High413,3Total30100,0

The emotional reaction of congruence with the emotional state of the other, empathy, shows a medium level (Table 1), a result consistent with the study by Ruiz González (2019), in the Colombian population, where a medium level of empathy is observed in doctors.

In the strategy for management, support, increase and suppression of the current affective state to self-soothe and find a state of relaxation, it is at an average value between medium and high (table 1.)

In the ability to start and maintain conversations, express one’s own thoughts and feelings clearly, both in verbal and non-verbal communication, and demonstrate to others that they have been well understood, the level is mostly medium (table 1.)

Conclusions

The levels of emotional competencies evaluated are mostly in the middle in the assessment by dimensions, empathy registered a lower level in contrast to other dimensions.Taking into consideration professional practice, response to organic and mental human vulnerability, it is a field for promoting the well-being of the health professional.

Disclosure of Interest

None Declared
Resilience and burden in family caregivers of patients with severe mental disorders
Authors: Masmoudi R. , Abid W. , Ben Salem E. , Ouali R. , Feki I. , Baati I. , Masmoudi J.
Published: August 2024

Introduction

Family caregivers of patients suffering from severe psychiatric disorders may present with health problems, lower quality of life, and painful emotions, which can seriously compromise their well-being when they do not receive appropriate professional support.

Objectives

The aims of this study were to assess the level of burden and resilience in family caregivers of patients with severe mental disorders and to determine associated factors.

Methods

We conducted a descriptive and analytical cross-sectional study among family caregivers of patients followed at the psychiatry outpatient clinic of the Hedi Chaker University Hospital in Sfax, during the period from February 2022 to July 2022.

We used the Connor–Davidson Resilience Scale (CD-RISC) to assess resilience and the Zarit Burden Inventory to assess the level of burden. Higher scores indicate higher resilience and greater burden.

Results

The sample included 90 family caregivers of patients with severe mental disorders. The average age was 50.68. They were the parents of patients in 40% of cases. Professionally active caregivers accounted for 57.8% of cases. Thirty family caregivers had a somatic disorder history (33.3%).

The median age of patients was 42 years. Ten patients (11.1%) were financially independent. The diagnosis was schizophrenia in 68.9% of cases. The mean duration of illness was 16.23 years. Irregular follow-up was noted in 10 patients (11.1%).

The mean scores of the Zarit Burden scale and the CD-RISC were 41.86± 10.33 and 58.46± 9.18 respectively.

Unemployed caregivers and parents experienced a higher burden (p=0.001, p=0.03 respectively). The level of burden was higher in caregivers taking care of financially dependent patients (p=0.03), with a duration of the disease greater than 15 years (p=0.04), and with irregular follow-up (p=0.008).

A low level of resilience in caregivers was correlated with spousal relationship (p=0.001), cohabitation with the patient (p=0.05), widowhood (p=0.01), low level of education (p=0.02), the presence of a somatic disorder history in the caregivers (p=0.04).

A negative correlation was observed between CD-RISC and Zarit scores (p=0.04; r=-0.21).

Conclusions

Family caregivers of mentally ill patients experienced a significant level of caregiver burden, and it was lower in caregivers with higher levels of resilience. Psycho-educational programs directed toward family caregivers are highly recommended.

Disclosure of Interest

None Declared
Assessing Personality Disorders of People Who Abuse Family Members
Authors: Mihai A. , Otilia B. , Dan Valeriu Nicolae M.
Published: August 2024

Introduction

Men’s violence against women continues to be a major public health problem worldwide. The long-term consequences require a proper management of resources and a thorough screening protocol. The most extensive study on domestic violence was published in 2005 by the World Health Organization (WHO) and has been updated regularly ever since.

Objectives

The aim of this study was to outline a personality profile for people who could be considered domestic abusers and to provide statistical data on personality disorders which are most common among this group of population.

Methods

The quantitative data was collected by administering two scales SCID II and Karolinska Scale.

Inclusion criteria: People who are physically aggressive with family members.

Exclusion criteria: people who are diagnosed with psychosis, people who show aggression with people other than family members

Results

We included 70 people who admit to having committed acts of l physical aggression directed towards family members, who agreed to take part in the study. The scales which were applied are Karolinska scale and SCID II. We identified, using SCID II, DSM IV TR and ICD 10 the following personality disorders types in the 70 intrafamilial aggressors - 10% antisocial personality disorder, 27% borderline personality disorder of which 14% with impulsive emotional instability, 3% obsesive-compulsive personality disorder, 1.4% mixed personality disorder anxious and paranoid.

Conclusions

Being able to recognise a personality pattern shows great benefits for screening the patients at risk to develop an aggressive behaviour directed towards family member, thus being a great tool in prevention of long-term consequences associated with living in a hostile environment.

Disclosure of Interest

None Declared
Between Delusions and Borders: Diagnosing Delusional Disorder in Migratory Contexts
Authors: Carrasqueira L. M. , Pereira M. D. , Marques I. , Silva M. , Laureano C.
Published: August 2024

Introduction

The mental health of immigrants is a significant, yet often overlooked, aspect of public health. This case study highlights the intersection of migration and mental health, focusing on a patient with delusional disorder. It is particularly relevant for psychiatrists due to the unique challenges in diagnosing and treating mental health conditions in migrant populations, who often face cultural, linguistic, and systemic barriers in accessing care.

Objectives

The primary objective of this case study is to elucidate the diagnostic and clinical challenges encountered in managing delusional disorder in a migrant patient. The case study presented aims to provide insights into how delusional beliefs can precipitate and perpetuate the process of migration.

Methods

The case study was developed through comprehensive psychiatric interviews during the patient’s stay in a Psychiatric Inpatient Unit, supplemented by a targeted literature review on PubMed using “delusion disorder” and “immigration” as keywords.

Results

The patient, a 44-year-old Indian male, was a functional young adult until 2007 when he began exhibiting symptoms of delusional disorder. His delusions progressively evolved from local scenarios to national and eventually to a global scale. The initial delusions were focused on personal and professional conspiracies within his home country, leading to his first internal migration. As the condition worsened, his delusions expanded, fueling a belief in a widespread conspiracy that transcended national borders. This escalation of delusional beliefs became the primary motivation for the patient’s international migration. He changed countries four times, each move driven by an attempt to escape the perceived threats and conspiracies associated with his delusional disorder. The patient’s journey through various countries was a direct result of the intensifying nature of his condition.

Conclusions

This case study accentuates the profound impact that a delusional disorder can have as a driver and catalyst of international migration, influencing the individual’s decision-making process and shaping the migratory experiences. It emphasizes the necessity for psychiatrists to consider the unique socio-cultural contexts of migrant patients in diagnosis and treatment. The case study advocates for a comprehensive treatment approach, integrating psychiatric care with a nuanced understanding of the migrant’s experiences and challenges. This multifaceted approach is crucial in addressing the complex needs of patients with delusional disorder in migrant populations.

Disclosure of Interest

None Declared
Altered Cortical Gyrification Morphology in Nonsucidal Self-injury
Authors: Choi S. , Moon H. , Hur J.-W.
Published: August 2024

Introduction

Nonsuicidal self-injury (NSSI) is defined as deliberate and direct damage to one’s body tissues without any suicidal intent. NSSI is now recognized as a major risk factor for suicide and is prevalent among adolescents, with prevalence rates ranging from 7.5% to 46.5%, leading to increased interest in the pathophysiology of NSSI. This study aimed to examine cortical gyrification morphology, a neurobiological index of cortical folding and patterning, among unmedicated individuals with NSSI, which is prevalent in adolescents and young adults.

Objectives

The main objective of this study is to compare cortical morphological abnormalities between individuals with NSSI and controls in terms of the local gyrification index (LGI), the ratio of the smooth cortical surface area at each vertex to the corresponding sulcal folds. In addition, we hypothesized that the LGI, a stable neurodevelopmental marker of cortical and subcortical circuit intergrity, would correlate with clinical measures in youth with NSSI.

Methods

A total of 101 individuals with NSSI and 100 age-, gender-, and handedness-matched controls completed self-report questionnaires and structural magnetic resonance imaging (MRI) data were acquired on a 3T Siemens scanner. A surface-based analysis was conducted using the Computational Anatomy Toolbox (CAT12) in Statistical Parametric Mapping (SPM12). Partial correlation analysis was also performed using R software to investigate the association between the LGI values extracted from the region of interest (ROI) and clinical symptoms, including depression, anxiety, emotion dysregulation, and anhedonia in individuals with NSSI.

Results

Individuals with NSSI showed significantly increased LGI in the right insula sulcus and left superior temporal sulcus (STS), along with decreased LGI in the right calcarine and left superior parietal sulcus (SPS), compared to controls (5000 permutation correction, threshold-free cluster enhancement with a threshold of p < .05). In addition, higher LGI in left STS was correlated with greater scores of the Beck Anxiety Inventory (r = 0.22, p < .05) and of the Impulse Control Difficulties subscale of the Difficulties in Emotion Regulation Scale (r = 0.34, p < .001). Conversely, reduced LGI of the right calcarine was associated with a higher score on the Anhedonia subscale of the Beck Depression Inventory (r = -0.23, p < .05) within individuals with NSSI.

Conclusions

This study identified hypergyria in the right insular and left STS and hypogyria in the right calcarine and left SPS in individuals with NSSI. The former pattern was associated with anxiety and impulse control difficulties, and the latter was with anhedonia. This study is the first to alter distinct neurodevelopmental patterns of local gyrification and their correlations with clinical manifestations in individuals with NSSI.

Disclosure of Interest

None Declared
Sleep disorders comorbid with ADHD: an overview of the clinical presentation and management
Authors: Wynchank D. S. R.
Published: August 2024

Sleep disorders are the commonest comorbid conditions in adult ADHD. This presentation will begin with an overview of the relationship between ADHD and sleep as well as the impact of disturbed sleep on concentration, impulvity and hyperactivity. Next, we will discuss the clinical characteristics of the sleep disorders, how to screen for them and their pharmacological and non pharmacological management. By the end of the session, participants will have a clear idea of how to investigate the various sleep disorders, to distringuish and treat them.

Disclosure of Interest

None Declared
Anterior insular cortex and the perception of internalized stigma and its components: a scoping review.
Authors: Lutova N. , Gerasimchuk E. , Khobeysh M. , Bocharova M. , Makarevich O. , Sorokin M.
Published: August 2024

Introduction

Personality neuroscience employs a broad range of methods to identify the neurobiological mechanisms of complex psychological phenomena. The role of the insula is often associated with its involvement in emotion processing.

Objectives

The study aims to identify the associations between neural activity in the anterior insula cortex (AInC) and self-stigma (or its components) in a scoping review.

Methods

We searched in PubMed (MEDLINE), PsychINFO, EMBASE via the Ovid platform through September 21st, 2022. Included studies had to use fMRI to assess neurophysiological markers in AInC, and to include a measure of association between fMRI results and a measure of self-stigma and/or its components as assessed by a scale or questionnaire in participants aged 18-65 y.o. The PRISMA-ScR checklist was used.

Results

After full-text screening 10 of 206 original researches were chosen for the final analysis (Table 1).
Table 1:

Included studies in the analysis.

1DeWall et al. Soc Cogn Affect Neurosci. 2012; 7(2): 184-192.2Masten et al. Neuroimage. 2011; 55(1): 381-388.3Kross et al. Proceedings of the National Academy of Sciences. 2011; 108(15): 6270-6275.4Bolling et al. Neuroimage. 2011; 54(3): 2462-2471.5Lindner et al. PLoS One. 2014; 9(1): e85014.6Achterberg et al. Soc Cogn Affect Neurosci. 2016; 11(5): 712-720.7Muscatell et al. Brain Behav Immun. 2016; 57: 21-29.8Sankar et al. Front Behav Neurosci. 2019;13.9Cáceda et al. Clin Neurosci. 2020; 270(5): 619-631.10Landa et al. J Psychosom Res. 2020; 128: 109881.

In 5 studies, the results were presented with MNI-space coordinates. Figure 1 illustrats the regions of local activity change maxima according to MNI-space coordinates based on the results of the included studies in the analysis.

Neural activation in the regions of the AInC was positively associated with greater levels of social rejection sensitivity and other components of self-stigma in 9 studies. Reduced activity was observed in only one study (Lindner et al., PLoS One. 2014; 9(1): e85014) among highly self-stigmatized patients with schizophrenia. This finding may reflect a biological manifestation of deficits in self-awareness and affective processing in schizophrenia.

Image:

Conclusions

Associations between neural activity changes in specific brain regions and levels of self-stigma and/or its components, as reported in included neuroimaging studies, have the potential to shed light on the neurobiological mechanisms underlying such a complex psychological phenomenon as stigma.

Disclosure of Interest

None Declared
Young Adults On Mental Health Instagram and TikTok: Self-Care, Self-Diagnosis and Performances of The Mentally Healthy Self
Authors: Bailie A.
Published: August 2024

My PhD research critically examines the contemporary U.K politics of mental health and Illness and mental illness amongst young adults via social media.

This presentation examines the way in which social media, like Instagram and Tiktok allows young adults to explore, express and share their selfhood and identity around ideas of mental health and illness through videos, posts and online interactions. I will briefly explore how young adults use social media content to learn, experience and criticise their lived experiences, care for and treatment of mental health and illness. Arguing that these new developments in language and social practices around mental health and illness via social media need to be further explored, acknowledged and addressed in social science and this can be supported by work in the field of psychiatry.

To illustrate this, I will share empirical data from interviews conducted in 2021 and 2022 with young adults who speak about their mental health and illness online and have engaged with psychiatric services, for example, in-patient settings. Instagram and Tiktok have become important arenas for young adults because of the informative role they play in young adults’ understanding of what a healthy person looks like, or their ideas of the mentally healthy self. A concept I introduce in my research of which I will explain and explore through the presentation. In young adults’ understandings of mental health and illness there is a movement towards social practices that are intended to achieve (an idea of
) mental health and this is created in a powerful digital environment that is affected by capitalism, neoliberal discourse and exists in a context of multiple political and health crises in the U.K and globally. Overall, the presentation argues that these mental health and illness social practices have transformed young adults’s experiences by responsibilisation in self-care that both isolates and empowers their experiences.

Disclosure of Interest

None Declared
The role of immunity and inflammation in obsessive-compulsive disorder and related conditions
Authors: Palermo S. , Gurrieri R. , Annuzzi E. , Gambini M. , Arone A. , Coccoglioniti A. , D’Angelo G. , Marazziti D.
Published: August 2024

Introduction

In recent years, there has been a growing interest in the potential consequences of disruptions in the inflammatory and immune systems on the onset of obsessive-compulsive disorder (OCD) and associated conditions, such as Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS) and Tourette syndrome (TS). While this area of inquiry is undeniably captivating, the available data remain somewhat controversial and limited in scope.

Objectives

The aim of this paper is to conduct an exhaustive examination and evaluation of the existing body of literature concerning aberrations in inflammatory and immune system processes within the context of OCD, PANDAS, and TS.

Methods

This narrative review entailed a comprehensive search of English language papers on PubMed and Google Scholar from January 1985 to July 31, 2023.

Results

The data collected up to this point suggest that the underlying mechanisms at play may differ depending on the age of the patients and the specific disorder being investigated. Notably, PANDAS seems to have a stronger connection with infections that trigger autoimmunity, which may not necessarily be limited to those resulting from Group A beta-haemolytic streptococcal (GABHS) infections, as previously assumed. In the case of TS, autoimmunity appears to play a significant role, especially when combined with individual susceptibilities stemming from both genetic and environmental factors. As for adult OCD, while the available data are somewhat scattered and occasionally based on relatively small groups of patients, they do indicate that the immune system and inflammatory processes are involved in the disorder’s pathophysiology. However, it remains uncertain whether these processes are primary driving forces or secondary reactions.

Conclusions

In summary, when viewed collectively, the current research findings unveil promising avenues for exploring the underlying causes of OCD and related disorders. They also hold the potential for the development of innovative therapeutic approaches that go beyond the current pharmacological paradigms.

Disclosure of Interest

None Declared
Neuropsychological functions as endophenotype markers in ocd: a long term follow-up
Authors: Puialto M. , Segalas J. , Alonso M. D. P. , Real E.
Published: August 2024

Introduction

Obssesive Compulsive Disorder (OCD) is characterized by impaired neuropsychological functions that are also influenced by clinical variables and aging.

According to the literature, several of these neuropsychological deficits could be potential endophenotype markers.

Objectives

The present study aimed to study what kind of cognitive deficits OCD patients have and how aging and clinical course modify their cognitive profiles campared with general population.

Methods

This study examined a sample of 60 adult outpatients with OCD diagnosis, who were matched with 70 healthy controls (HC). Cognitive performance in both groups was assessed using a neuropsychological battery including Rey-Osterrieth complex Figure (ROCF) and Digit Span Test (DGS). Based on previous research on neuropsychology of OCD, it was specified that these neuropsychological measures could be divided in two composites. The first composite, Executive function, includes Total Digit Span and the domain of organization of ROCF. The second composite, Non-Verbal Memory, includes the copy of ROCF, immediate recall, delayed recall and recognition of ROCF.

Severity of OCD symptoms was assessed by YBOCS and HDRS was used for symptoms of depression.

Both cognitive performance and clinical data were documented before and after a follow-up of 11 years.

During analysis, group differences between patients with OCD and HC regarding demographic and clinical characteristics at baseline and follow-up were calculated with independent t-tests and Pearson tests.

The main analysis tested if the change in cognitive function over time differed between patients and controls. To this end, a linear mixed model was used, examining the interaction between age, gender and time in both groups.

Results

Older age, in patients with OCD and HC, was associated with poorer performance on executive function and nonverbal memory. Executive function was influenced by severity of OCD, and non-verbal memory by depressive symptoms at baseline. While, after the follow-up, as obsessive and affective symptoms improve along de follow-up, there is no significant change in the neuropsychological pattern.

At baseline, patients with OCD showed a poorer performance than HC in areas of nonverbal memory and executive function. After de follow-up, there is a poorer performance in the cognitive function in both groups, as they get older. However, there is no significant difference in this change between patients and HC.

Conclusions

Results suggest that OCD is characterized by the existence of dysfunction in several neuropsychological areas that are influenced by time and clinical variables.

Nevertheless, this alteration is no solely attributable to these factors, as they remain stable through time compared to the general population. Therefore, certain neuropsychological functions might be endophenotype traits of the disorder.

Disclosure of Interest

None Declared
Skin picking disorder in the elderly- What is the available evidence?
Authors: Vasiliu O. , Mangalagiu A. G. , Petrescu B. M. , Candea C. A. , Tudor C. , Ungureanu D. , Miclos M. , Florescu C. , Draghici A. I. , Bratu-Bizic R. E. , Dobre M. , Fainarea A. F. , Patrascu M. C.
Published: August 2024

Introduction

Excoriation disorder (ExD) is a pathology recognized by DSM-5, and it is considered a part of the obsessive-compulsive spectrum. ExD is associated with a high rate of psychiatric comorbidity (e.g., depression, ADHD, substance use disorders, etc.).

Objectives

The main objective of this review was to explore the available evidence to support the diagnosis and treatment of skin picking in elderly population.

Methods

A literature review of the available sources reporting on ExD in elderly patients, realized by searching three electronic databases (PubMed, Cochrane, Clarivate/Web of Science) but also the grey literature. All papers published between January 1990 and July 2023, including the terms “excoriation disorder”, “compulsive skin picking”, “dermatillomania” and “elderly” or “old-age patients” were reviewed.

Results

The information about ExD was extracted almost exclusively from reports on elderly patients with neurocognitive disorders. Tactile hallucinations, delusions of contamination, social isolation and focusing on own bodily sensations, and organic causes- dehydration, allergies, renal insufficiency, hepatic and pancreatic diseases, as well as toxic causes- e.g., adverse events of certain drugs should be investigated in elderly patients exhibiting signs of ExD. A differential diagnosis is very important in this population in order to find the most adequate treatment. Behavioral treatments, serotonergic antidepressants, and glutamatergic modulators have been explored in patients with ExD, although specific trials for elderly patients with this disorder are still lacking. However, case reports support the utility of several serotonergic antidepressants in the elderly.

Conclusions

ExD is a less explored disorder in the elderly, where an extensive differential diagnosis and screening for somatic/psychiatric comorbidities are needed. Trials exploring the potential treatments for ExD in old-age patients are also required for evidence-based case management.

Disclosure of Interest

None Declared
Meta-analysis of generalization reliability of the Montreal Cognitive Assessment (MoCA) questionnaire in cognitive impairment
Authors: Fernández Fernández R. , Izquierdo de la Puente Á. , del Sol Calderón P. , Vizcaíno da Silva M. , Rodríguez Rodríguez A.
Published: August 2024

Introduction

Dementia is a syndrome of high prevalence and health impact. The Montreal Cognitive Assessment (MoCA) questionnaire is a screening tool whose use has increased in recent years, especially in cases of mild cognitive impairment. Some studies suggest that its ability to detect cognitive impairment, especially in early or mild stages, seems to be greater than gold-standard instruments (Ciesielska et al., 2016).

Objectives

We have performed a meta-analysis of reliability generalization to see if different adaptations and use in different contexts show consistent results.

Methods

We performed a literature search in PyscINFO and Medline with the terms “Cognitive impairment” AND “internal consistency” AND “Cronbach”, using the following inclusion criteria:

1.

Be a study in which the MoCA scale was applied to a population sample.

2.

Studies published in the last 10 years.

3.

Studies that provide the reliability coefficient or sufficient data to calculate them.

4.

Be written in English or Spanish.

We have limited our study to the last 10 years and the English language has given us a total of 19 results in Medline and 132 results in PsycINFO. Subsequently, we completed this search by snowball sampling.

A random effects model was assumed for the statistical calculations and the transformation of our values using the Hakstian and Whalen (1976) proposal. Statistical analysis was performed with the MAJOR package of the Janovi program, based on the R environment.

Results

We obtained a mean reliability for the transformed test scores of 0.42 (95% CI: 0.38 - 0.45), as well as high heterogeneity measured by Cochran’s Q statistic and the I2 index, which is attributed after analysis of moderating variables to the geographical adaptation of the questionnaire and the type of patient on whom it is applied. Our Funnel Plot graph indicates that we do not appear to have committed a publication bias.

Conclusions

Our meta-analysis shows high heterogeneity, mainly explained by the population of origin, both geographically (continent) and clinically (presence of primary cognitive impairment or not), with special incidence in those with impairment secondary to other pathologies, mainly neurological. However, we should consider the high probability that we have not included important variables in our analysis that could increase the explanatory power of our model.

Disclosure of Interest

None Declared
Schizoaffective Disorder and Parkinson’s Disease: a case report
Authors: Izquierdo De La Puente A. , del Sol Calderón P. , Fernandez Fernandez R.
Published: August 2024

Introduction

We present the case of a patient with schizoaffective disorder and Parkinson’s disease (PD), requiring treatment adjustment, with the use of high doses of quetiapine for the treatment of psychotic symptomatology.

Objectives

The aim is to briefly review the treatment of dopaminergic psychosis in the elderly.

Methods

Patient aged 86 years, institutionalised, presenting severe episodes of behavioural alteration, high anxiety and delusions of harm, together with auditory and visual hallucinations. As relevant physical history, the patient has AHT, aortic insufficiency, and bladder cancer operated on in 2012. As psychiatric history of interest, the patient has been diagnosed since his 30s with schizoaffective disorder, Parkinson’s disease and moderate-severe cognitive impairment secondary to the previous two.

As usual treatment, in addition to anticoagulation and antihypertensive therapy, the patient has been receiving L-dopa for his PD for years, antidepressant treatment with escitalopram 10mg, haloperidol 80 drops a day, divided into three doses, and lormetazepam 2mg as a hypnotic.

In addition to the symptoms described above, the patient had episodes of confusional features, as well as marked stiffness in the cogwheel and significant gait disturbance, having suffered several falls without serious repercussions.

Results

Due to the comorbid neurological pathology, it was decided to progressively modify the treatment, withdrawing the benzodiazepine due to the risk of confusional disorder and replacing it with trazodone. Antipsychotic treatment was gradually replaced by extended-release quetiapine, reaching a maximum dose of 800mg. Likewise, escitalopram treatment is replaced by sertraline.

With this adjustment, there was an improvement in the psychotic symptoms, as well as in the anxious symptoms. Episodes of distress are NOT observed, and the patient’s functionality improves, allowing him/her to participate in daily activities, both cognitive stimulation and physiotherapy.

Conclusions

The Spanish Society of Psychogeriatrics recommends that before using antipsychotics, it is advisable to first treat the underlying potentially treatable causes (pain, infections, toxic effects of drugs…), assess non-pharmacological interventions and always, if the use of antipsychotics is required, assess the risk-benefit ratio.

In relation to the above, it is not surprising that in the elderly, the use of second-generation antipsychotics is recommended in the first place, as opposed to the classical ones. The latter are only recommended in emergency situations where an almost immediate effect is required.

For dopaminergic psychosis, there are only controlled trials with clozapine. However, due to prescribing difficulties, aripiprazole or quetiapine is recommended in the first instance.

Disclosure of Interest

None Declared
Platelet enzymatic activities in patients with late-onset schizophrenia spectrum disorders
Authors: Prokhorova T. , Boksha I. , Savushkina O. , Tereshkina E. , Vorobyeva E. , Burbaeva G.
Published: August 2024

Introduction

Impairments in energy metabolism, glutamate neurotransmitter and antioxidant systems contribute substantially in development of schizophrenia spectrum disorders, especially in late-onset psychosis (LOP).

Objectives

Revealing subgroups of patients with LOP by determining activity of platelet enzymes of energy, glutamate, and glutathione metabolism.

Methods

62 women of 52-89 years old were studied, with late onset schizophrenia spectrum disorders (F20.0, F25, F22.0, F06.2 by ICD-10). PANSS with its subscales was used to assess the severity of psychotic symptoms. Scores by PANSS and activity levels of platelet cytochrome c-oxidase (COX), glutamate dehydrogenase (GDH), glutathione reductase (GR) and glutathione-S-transferase (GST) were evaluated twice: before and on the 28-th day of antipsychotic treatment. Activities of COX, GDH, GR, and GST were measured in 37 women of 50-84 years old comprising the control group.

Results

Clustering of patients by the enzymatic activities resulted in 2 clusters (C1 and C2) significantly different by COX and GST (p<0.001). In C1 (n=40), as compared with control, reduced level of GDH activity before and after treatment (p=0.049 and p=0.032, respectively) and a reduced level of GR activity before treatment (p=0.026) were revealed. In C2 (n=22), as compared with the control, COX activity was increased before and after treatment (p=0.0001), GDH activity was decreased before and after treatment (p=0.0002 and p=0.0001, respectively), and GST activity was decreased before and after treatment (p=0.029 and p=0.0029, respectively). GR activity was not significantly changed in both clusters. Significant correlations were found between enzymatic activities and scores by psychometric scales: in C1, GR activity positively correlated with the score reduction (delta) by PANSS-Pos (R=0.45, p=0.004), by PANSS-Psy (R=0.44, p=0.005), and by PANSS (R=0.47, p=0.002), and GST activity – with the score reduction by PANSS-Psy (R=0.315, p=0.048). In C2 (n=22), GDH activity negatively correlated with the score reduction by PANSS-Pos (R=-0.41, p=0.050) and by PANSS (R=-0.49, p=0.021).

Conclusions

The different correlations revealed in two separated clusters between enzymatic activity levels and clinical measures characterizing the antipsychotic treatment efficacy will allow us to approach differentiated predicting the effectiveness of pharmacotherapy using the biochemical parameters.

Disclosure of Interest

None Declared
Avoidant personality disorder through the lens of ICD 11
Authors: Bogdanovska Toskic A. , Arsova Hadzi-Angjelkovska S.
Published: August 2024

Introduction

With the new dimensional diagnosis of personality disorders in ICD 11, the categorical model has been abandoned. The types of personality disorders in the new dimensional model should show certain common characteristics. According to the recognition of the common characteristics of individual types of personality disorders, as well as determining the severity, a transition from the categorical to the dimensional diagnostic system can be made.

Objectives

To analyze and present the trait domains specifiers in persons with avoidant personality disorder and to facilitate the adoption of the new diagnostic criteria.

Methods

An unsystematized literature review was made, with key words: avoidant personality disorder, ICD 11, ICD 10, traits; and a case was presented.

Results

This is the case of a 26-year-old student who has had no friends since his school days. During his secondary education, on the initiative of another person, he got together with several other people, but he was not fully accepted. During the studies, the communication with the colleagues took place only at the university and around the responsibilities. About a year ago, he had reduced willpower and suicidal thoughts, when he took antidepressant and adjuvant antipsychotic therapy for some time. He is now being examined due to severe tension, dissatisfaction, lack of friends, repeated suicidal ideation. According to researches, people with avoidant disorder have prominent trait domains – negative affectivity, detachment and reduced dissociality (Bach et al. BMC Psychiatry 2018; 18:351), negative affectivity, detachment and anankastia (Simon et al., Front. Psychiatry 2023, 14:1175425), negative affectivity and detachment (Bach et al. Borderline Personality Disorder and Emotion Dysregulation 2022, 9:12). In our case, assessments of trait domains were made with PSQ-11 and PiCD. On the PSQ-11, an increase in the negative affectivity, detachment and anankastia on critical score was obtained, while on the PiCD, an increase in negative affectivity, detachment, anankastia, and a decrease in dissociality was obtained. Mild personality disorder was scored on the Rating Scales for Severity of Disorder (SASPD, LPFS-BF 2.0).

Conclusions

The types of personality disorder can be represented by certain common trait domains specifiers, which will be useful in adopting the diagnostic criteria in ICD 11 for personality disorder. Assessment of the severity of the disorder provides additional information on treatment strategies and prognosis. The most significant features of avoidant personality disorder are negative affectivity and detachment, while anankastia is on the borderline score and has a reduction in dissociality.

Disclosure of Interest

None Declared
Mental disorders: exploring normality models to distinguish what is normal from what is illness
Authors: Fernandes A. , Gomes M.
Published: August 2024

Introduction

When reading about psychopathology what we find described are experiences similar to our own. Psychiatry deals with anguish, fear, motivation, choice, and many other aspects that makes us human. However, even though psychopathology is rooted in common human experience, mental disorders are often outside the experience of those who don’t suffer from it. Therefore, the distinction between normality and disease is central to psychiatry. The DSM proposes that mental disorders are necessarily linked to distress and/or impairment. However, it adds that the syndrome or pattern must not be an expectable response to an event - it excludes “normal” experiences and responses from the realm of mental illness. But how do we distinguish normal distress from illness? This review investigates how different meanings of normality can help us discern the fine line between mental illness and ordinary human experience.

Objectives

We intend to critically examine and compare different models of normality. Additionally, we seek to discern the implications of these models for distinguishing mental disorders from normal mental experiences.

Methods

Review of the literature.

Results

We analyzed definitions and models of normality throughout the literature and selected the most relevant ones according to their popularity and/or strength of argument. Different models of normality (e.g. Biostatistical, Process, Health, Ideal, Biological advantage, etc.) were examined and compared, and the conceptualization of mental disorder was examined through the lens of each of these frameworks. Our investigation reveals the multifaceted nature of normality, with different models offering unique perspectives on mental health. From statistical approaches to cultural considerations, each model contributes distinct criteria for distinguishing what is normal from what is illness. By synthesizing these results, we gain a comprehensive view of the factors influencing the conceptualization of normality in the context of mental health.

Conclusions

This review emphasizes the importance of adopting a nuanced, cautious and multifactorial approach when discerning mental disorders from normal experiences. Rather than relying on a singular definition, our analysis suggests that a comprehensive understanding of normality can help us to better discern what is normal and what is illness.

Disclosure of Interest

None Declared
Person-centered approach to suicide ideation in posttraumatic stress disorder in veterans: a latent profile analysis
Authors: Vilibić M. , Nadalin S. , Aukst Margetić B. , Šurina Osmak Ž. , Peitl V. , Karlović D.
Published: August 2024

Introduction

While most research on suicidal ideation (SI) in veterans adopts a variable-oriented perspective, this approach often fails to capture the complex interplay of symptoms and comorbid disorders. We hypothesised that a person-centred approach can identify distinct subpopulations of veterans with varying profiles of SI, PTSD symptoms, depression, and agitation.

Objectives

To examine whether distinct subpopulations of veterans exists, characterized by different profiles of PTSD severity, depression and agitation, and intensity of SI.

Methods

We conducted a cross-sectional study in one big University Hospital Centre in Croatia on the sample of men, war veterans aged 30-65 years, undergoing treatment for chronic PTSD. Latent profiles indicators included the Clinician-Administered PTSD Scale (CAPS), Beck Scale for Suicide Ideation (SSI), Hamilton Depression Rating Scale-17 (HDRS-17) and Corrigan Agitated Behaviour Scale (CABS).

Results

We included 203 male participants with a median age of 47 (IQR 43-45) years. The optimal model, allowing variances of indicators to vary between profiles while constraining covariances to zero, yielded five distinct latent profiles. Notably, the highest SI was found in a subpopulation with elevated CABS scores, but moderate PTSD and depression symptoms (13% of participants). Next in SI intensity were 11% of veterans with severe symptoms across all assessed disorders. Next in SI severity were 21% of veterans with low levels of agitation but high levels of depression. The last two profiles, one with mild symptoms of all assessed disorders (43%) and the other with high agitation (12%), have low SI severity.

Conclusions

Our findings affirm the utility of a person-centred approach in identifying nuanced subpopulations of veterans with diverse symptom profiles related to SI. This stratification can inform targeted interventions, thereby enhancing the efficacy of suicide prevention strategies.

Disclosure of Interest

None Declared