bluuebunny/crossref_metadata_2025 huggingface dataset:
Aberrant Salience and Alexithymia in Subthreshold Psychotic Experiences among Adolescent Migrants in Italy: A Comparison with Native Italian Adolescents
Authors: Pozza A. , Dèttore D.
Published: June 2017

Introduction

In this decade in the Italian context, there has been a significant increase of the immigration phenomenon. Consistent data indicated higher risk of psychotic experiences among migrants. Poor work investigated clinical variables associated with stronger subthreshold psychotic experiences among this population of adolescents. Aberrant salience, the biased assignment of significance to otherwise innocuous stimuli, and alexithymia, the difficulty identifying/describing feelings are believed to have a role in the onset and maintenance of psychotic symptoms. No study evaluated whether they could moderate the relation between migrant status and psychotic experiences among in adolescence.

Objectives

The current study investigated whether salience and alexithymia predicted more intense subthreshold psychotic experiences and moderated the effect of migrant status among migrant and native Italian adolescents.

Methods

Seventy-three adolescents born in other countries than Italy and 75 native Italian adolescents (mean age = 17.57, SD = 2.08, 47.30% females) completed the aberrant salience inventory, the Toronto Alexithymia Scale-20 and the screening for psychotic experiences.

Results

Migrant adolescents had higher levels of subthreshold psychotic experiences (F = 10.65, P < 0.01), alexithymia (F = 8.93, P < 0.01) and salience (F = 4.38, P < 0.05) than native Italian adolescents. A main effect of aberrant salience and alexithymia on subthreshold psychotic experiences emerged. An interaction effect between migrant status and alexithymia was found: migrant adolescents with stronger alexithymia had more intense subthreshold psychotic experiences.

Conclusions

Public health policies should consider migrant adolescents as a group at risk for stronger subthreshold psychotic experiences. Prevention programs could take into account alexithymia as a target of intervention for this population of adolescents.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Traumatic Experiences Affect Negative Emotion Processing in Bipolar Disorder
Authors: Sepede G. , Gambi F. , De Berardis D. , Di Iorio G. , Perrucci M.-G. , Ferretti F. , Santacroce R. , Romani G.-L. , Di Giannantonio M.
Published: June 2017

Introduction

Patients affected by bipolar disorder type I (BD-I) show a significant emotional impairment during both acute and euthymic phases of the illness, but the influence of negative life experiences is not yet fully understood.

Objectives

Aim of the present study was to investigate the role of previous traumatic events on negative emotion processing in euthymic BD-I patients.

Methods

Eighteen euthymic BD-I patients, 7 reporting past traumatic events (T-BD-I), but free of post-traumatic stress disorder (PTSD) symptoms at the moment of the evaluation and 11 never exposed to traumas (NT-BD-I), were compared to 24 not traumatized controls (NC). All participants performed a IAPS-based emotional task: they were required to identify vegetable items (targets) among neutral or negative pictures. Accuracy (percentage of correct responses) and mean reaction times (RT) were recorded.

Results

T-BD-I performed similarly to NC and significantly better than NT-BD-I in terms of accuracy (Fig. 1). No significant between-group effects were observed for mean RT.

Conclusions

A previous history of traumatic events, without current PTSD symptoms, may significantly impact the negative emotion processing in euthymic BD-I. Interestingly, traumatized patients showed a better accuracy when processing both neutral and negative images, thus suggesting that paying more attention to external stimuli may be a successful compensatory mechanism to cope with potential environmental threats.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A Simple Composite Dynamic Digital Tool to Communicate Complex Physical and Mental Health needs and Measure Outcomes: The Cornwall Health Radar
Authors: Shankar R. , Quick C. , Dawson J. , Annal P.
Published: June 2017

Introduction

Clinician-patient communication is a major factor in influencing outcomes of healthcare. Complexity increases if an individual has multiple health needs requiring support of different clinicians or agencies.

Aim

To develop and evidence a simple dynamic computerised tool to capture and communicate outcomes of intervention or alteration in clinical need in patients with multiple chronic health needs.

Method

A MS Excel algorithm was designed for swift capture of clinical information discussed in an appointment using pre-designed set of evidenced based domains. An instant personalized single screen visual is produced to facilitate information sharing and decision-making. The display is responsive to compare changes across time. A prototype was conceptually tested in an epilepsy clinic for people with Intellectual disability (ID) due to the unique challenges posed in this population.

Results

Evidence across 300 patients with ID and epilepsy showed the tool works by enhancing reflective communication, compliance and therapeutic relationship. Medication and appointment compliance was 95% and patient satisfaction over 90%.

Conclusion

To discuss all influencing health factors in a consultation is a communication challenge esp. if the patient has multiple health needs. A picture equals 1000 words and helps address the cognitive complexity of verbal information. The radar offers an evidenced based common framework to host care plans of different health conditions. It provides individualised easy view person centred care plans to allow patients to gain insight on how the different conditions impact on their overall well being and be active participants. The tool will be practically demonstrated.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Anticipating Outcome: Predictors of First and Subsequent Relapses in Schizoprenia. A 3-year Follow-up
Authors: Gomez Revuelta M. , Gajardo Galan V. , Juncal Ruiz M. , Porta Olivares O. , Landera Rodriguez R. , Santayana Jenaro G. Pardo De , Garcia Ayala L. , Sanchez Blanco L. , Fernandez Rodriguez M. , Crespo Facorro B.
Published: June 2017

Introduction

Relapse prevention during early stages after psychosis onset is a key factor for long term outcome. While factors associated with first relapse have been widely studied, factors associated with subsequent relapses are poorly described.

Objectives

To determine predictive factors of first and subsequent relapses among patients recruited from a cohort of PAFIP Early Intervention Program.

Material and methods

We analyzed socio-demographic and clinical data of a cohort of 393 first episode psychosis (FEP) patients that were recruited since February 2001 to May 2011. Of these, 341 achieved clinical remission and were, therefore, considered to be at risk of relapse. They were followed-up for 3 years. A wide range of potential factors were included as possible predictors of relapse. Test univariate, analysis logistics of regression, regression of Cox and analysis of survival of Kaplan-Meier were carried out.

Results

Poor adherence to medication was the main predictor associated to first relapse (ExpB: 2.979; P < 0.001). After the first relapse, only 56 patients (33.9%) underwent a second relapse, being the diagnosis (ExpB: 1.975; P = 0.074), the age of onset, (ExpB: 1.078; P = 0.003) and a low level of positive symptomatology (ExpB: 0.863; P = 0.03) the predictors of associated with a second relapse.

Conclusions

After a FEP, non-adherence to medication is the main predictor of first relapse. Second and subsequent relapses relate with non-modifiable factors such as age of onset or schizophrenia diagnosis. This subgroup of patients could have greater predisposition to relapse related with the severity of the disease itself.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Analysing CYP2D6*4 Allele frequency in Patients with Schizophrenia
Authors: Djordjevic V. , Jevtovic Stoimenov T.
Published: June 2017

Introduction

Schizophrenia is treated with antipsychotics and other psychotropic medications, many of which are substrates for the highly polymorphic CYP2D6 enzyme. The most frequent variant allele is CYP2D6*4- leading cause of poor metabolism (PM) phenotype. PM causes the reduction of therapeutic response, increase the risk of adverse drug reactions and increase the plasma concentration of both drug and its metabolites above the levels of toxicity.

The Aim

Analysing CYP2D6*4 allele frequency among schizophrenic patients for further individualisation and rationalisation of therapy.

Patients and methods

Research was conducted on 38 schizophrenic patients and 110 healthy individuals. CYP2D6*4 allele was detected with allele specific PCR.

Results

Both wild type allele carriers are 55% of the schizophrenic patients, 45% are wild type/*4heterozygous, and *4/*4 homozygous are not identified. There is a statistically significant difference in the genotype distribution (P < 0.05) between schizophrenic patients and healthy individuals. Significantly higher *4 allele frequency (37%) comparing to healthy individuals (P < 0.0001) indicates the necessary caution in administration of CYP2D6 substrates. A lower frequency of PMs in schizophrenic patients than in healthy individuals could be explained with CYP2D6 neuroactive substrate metabolism. Forty-five percent of the schizophrenic patients are intermediate metabolisers carrying the higher risk of adverse response to CYP2D6 substrates comparing to wild type homozygous. As none of the analyzed patients was PM, exceeded plasma concentrations of medications above toxic levels are not expected when administrating the right dosage.

Conclusion

Altered CYP2D6 metabolism may contribute to the vulnerability, clinical severity and treatment outcome of schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Verbal Learning and Memory in At-risk Mental State and First Episode Psychosis Patients and Their Correlates to Brain Structural Alterations
Authors: Egloff L. , Lenz C. , Studerus E. , Heitz U. , Menghini-Müller S. , Harrisberger F. , Ittig S. , Beck K. , Leanza L. , Andreou C. , Riecher-Rössler A. , Borgwardt S.
Published: June 2017

Introduction

Patients with a first episode psychosis (FEP) have repeatedly been shown to have gray matter (GM) volume alterations. Some of these neuroanatomical abnormalities are already evident in the at-risk mental state (ARMS) for psychosis. Not only GM alterations but also neurocognitive impairments predate the onset of frank psychosis with verbal learning and memory (VLM) being among the most impaired domains. Yet, their interconnection with alterations in GM volumes remains ambiguous.

Objective

To evaluate associations of different subcortical GM volumes in the medial temporal lobe with VLM performance in ARMS and FEP patients.

Methods

Data were collected within the prospective Früherkennung von Psychosen (FePsy) study, which aims to improve the early detection of psychosis. VLM was assessed using the California Verbal Learning Test (CVLT) and its latent variables Attention Span (AS), Learning Efficiency (LE), Delayed Memory (DM) and Inaccurate Memory (IM). Structural images were acquired using a 3 Tesla magnetic resonance imaging scanner.

Results

Data from 59 ARMS and 47 FEP patients were analysed. Structural equation models revealed significant associations between the amygdala and AS, LE and IM; thalamus and LE and IM; and the caudate, hippocampus and putamen with IM. However, none of these significant results withstood correction for multiple testing.

Conclusions

Although VLM is among the most impaired cognitive domains in emerging psychosis, we could not find an association between low performance in this domain and reductions in subcortical GM volumes. Our results suggest that deficits in this domain may not stem from alterations in subcortical structures.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Impact of Relapses in Acute Schizophrenia's Clinical Outcome: A Descriptive Cross-sectional Analysis
Authors: Carreira Figueiredo I. , Pereira D. , Cargaleiro I. , Aguiar P.
Published: June 2017

Introduction

Recent studies suggest that most of schizophrenia's first-episode patients have the potential for long-term remission. Conversely, some meta-analysis estimate the actual median recovery rate to be 13.5% [1]. Relapses may contribute to the emergence of increased morbidity and treatment resistance.

Objectives

To evaluate possible relationships between the numbers of previous admissions, years of diagnosed disease and hospitalization length.

Methods

A cross-sectional retrospective study on all patients (n = 202, 150 men and 52 women) admitted at an acute inpatient unit throughout the year of 2015, diagnosed with schizophrenia (ICD-9, 295). Collection of socio-demographic data, number of previous admissions (PA), years of diagnosed disease (YDD) and hospitalization length (HL). Descriptive statistical analysis, Spearman rank correlation and Mann-Whitney U test.

Results

Overall, the sample's mean age was 44.3 years old (std 12.7), being lower in men (42.5 versus 49.7). The average of admissions was 1.2 per year. PA and YDD were significantly associated (P < 0.0001). Contrarily, there was no statistical association between the number of PA and HL (P > 0.1), as well as between YDD and HL (P > 0.1) was found.

Conclusion

This study provides additional evidence for schizophrenia's early onset in men. There seems to be no association between relapses and treatment resistance, considering PA, YDD and HL as valuable soft outcomes. Future understanding of relapses’ pathophysiological mechanisms is warranted in order to explain schizophrenia's low median recovery rate.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Muscular strain as risk factor of somatic symptom of mix anxiety and depression
Authors: Bhadar M. , Asghar S. , Mukhtar Z.
Published: June 2017

Introduction

Somatic symptoms in depression are not uncommon. There is increased sicidality, poor prognosis, and increased risk of relapse. Neurological and l muscloskeletal symptoms can be explained on basis of increased muscular tension in the body.

Methods

An internet search was made using key words muscular tension, SSRIs depression, anxiety, somatic symptoms.

Results

Ninety-eight percent patients reported at least one of somatic symptoms. Forty-five percent reported six somatic symptom. GIT symptoms in 67% patients. Fatigue in 78% % of patients. Weakness in body parts 45% and headache in 43% to 65%. Chest pain more common in male. Patient over 40 showed pain in limbs or joints. Number of symptoms was directly related to severity of depression.

Discussion

Increased muscular tension is one component of mix anxiety and depression. Main nerves and their branches pass in between muscular bellies. When there is increased muscular tone, it puts extra compression on major nerves and their branches. This will cause dysesthesia in body parts. Stretching of muscles produce pain due to hypoxia. This produces headache, strain neck and backache pain in chest. Fatigue is result of over consumption of energy due to hypertonia. One of their side effect is of SSRIs is muscular hypertonia which will not be very helpful for these symptoms. Drugs like tricyclics, SNRI can have better results when used alone, gabapentine, pregabline tinazidine used as adjunct can alleviate symptoms. Non-pharmacological treatment includes massage, relaxation technique, and warm water therapy.

Conclusion

Somatic symptoms of mix anxiety and depression should be important consideration in its treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The cortisol awakening response in anxiety disorders and personality disorders and changes in salivary cortisol level after psychotherapy
Authors: Dembinska E. , Rutkowski K. , Sobanski J. , Cyranka K. , Mielimaka M. , Citkowska-Kisielewska A.
Published: June 2017

Introduction

The hypothalamus—pituitary—adrenal axis (HPA axis) dysregulation plays an important role in the pathophysiology of anxiety disorders. Salivary cortisol level is a useful indicator of HPA axis dysfunction.

Objectives

Most data suggests elevated cortisol awakening response (CAR) in anxiety disorders, but there are studies indicating opposite pattern (flat CAR).

Aim

Goal of this study was to determine whether patients with anxiety and personality disorders show a specific daily cortisol patterns and weather this pattern changes after 12 weeks of intensive predominantly psychodynamic combined group and individual psychotherapy.

Method

The studied population comprised 77 patients, mainly females (72.7%), with primary diagnosis of anxiety disorder 40.9% or personality disorder 59.1%. The Symptom Checklist “0” was used to assess the pre- and post-treatment levels of patients’ symptoms. Pre- and post-treatment cortisol levels were measured in three saliva samples collected during one day (at awakening, 30 min after awakening, at 22.00).

Results

The obtained results were partly similar to previous research. We found four different daily CAR patterns: decreased (drop 30 min after awakening), flat (rise 0–49% 30 min after awakening), normal (rise 50–75% 30 min after awakening) and elevated (rise over 75% 30 min after awakening), two of them (flat and elevated) were considered as typical for anxiety disorders. Groups of CAR pattern differed significantly in the level of sleep symptoms, dysthymia symptoms and avoidance/dependency symptoms. The changes in the CAR pattern after psychotherapy were not significant.

Conclusions

Anxiety disorders and personality disorders are characterized by more than two specific daily salivary cortisol patterns.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Association of arterial stiffness burden with anxiety and depression in different stages of hypertension
Authors: Mermerelis A. , Kyvelou S.M. , Akke V. , Papageorgiou C. , Stefanadis C. , Douzenis A.
Published: June 2017

Introduction

There has been an attempt to associate anxiety and depression with arterial stiffness. In the present study, we assessed differences in arterial stiffness among 3 groups of hypertensive patients compared to control normotensives as well as possible association with anxiety and depression scoring system.

Methods

The study cohort comprised of 127 patients (75 male, mean age 54 ± 14) who underwent assessment of their blood pressure levels and were divided in four groups: group I (normotensives, n = 34), group II (stage 1 HTN, n = 33), group III (stage 2 HTN, n = 30) and group IV (stage 3 HTN, n = 30). The evaluation of anxiety disorder was made by means of Hospital Anxiety Depression Scale (HADS), while the evaluation of depression was made with the Beck Depression Inventory (BDI). Arterial stiffness evaluation was done with Cardio-Ankle Vascular Index (CAVI). Statistical analysis was done with SPSS for windows. P-value was set at 0.05 for differences to be considered significant.

Results

Both CAVI R and CAVI L indices were significantly higher as the severity of hypertension progressed (P < 0.001). BDI score was significantly correlated with CAVIR (Pearson r = 0.53, P < 0.0001) and CAVI L (Pearson r = 0.39, P < 0.0001). HADS score was also significantly correlated with both CAVIR (Pearson r = 0.53, P < 0.0001) and CAVIL (Pearson r = 0.43, P < 0.0001).

Conclusions

There is a burden in the arterial stiffness of this population with the increase of the levels of BP which is not surprising. However, the new finding is that there is a strong correlation with arterial stiffness indices and both anxiety and depression scoring system.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Parenting styles and anxiety disorders in children – A study in an Albanian clinical population
Authors: Alikaj V. , Skendi V. , Zenelaj B. , Allkoja B.
Published: June 2017

Introduction

About 20% of children suffer from an anxiety disorder and symptoms may persist in adulthood. About 13 in every 100 children from 9 to 17 years old experience anxiety disorders, girls seem more vulnerable than boys. Theoretical models of anxiety emphasize the effect of parenting on development and maintenance of child anxiety.

Objectives

This research aims to study the nature of correlation between parenting styles and anxiety in children who attend Tirana Child & Adolescent Psychiatric Service.

Methods

One hundred and seventy-five children and 175 their parents filled Spence Children Anxiety Scale (SCAS) and Parenting Styles & Dimensions Questionnaire (PSDQ) was found a significant correlation between parenting styles and anxiety in children.

Conclusions

Parental overprotection produces vulnerable children who become adults ready to give up in front of life difficulties therefore; it is necessary parents’ awareness in practicing a balance in their parenting styles, in order to reduce children's anxiety.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Knowledge of kindergarten and elementary schools’ teachers regarding attention deficit hyperactivity disorder
Authors: Almutairi S. , Almutairi M. , Al Harbi A. , Alsuhaibani M. , Alkeaid N. , Albatti T.
Published: June 2017

Background

Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders that manifest among children. Despite the fact that the teacher's role is essential in the assessment and management of pupils with ADHD and the recommendation of participation of teachers for the success and efficiency of diagnoses and treatment, the vast majority of teachers have neither understanding nor knowledge of ADHD.

Objectives

The current study explores the kindergarten and elementary school teachers’ knowledge regarding early detection and management of ADHD.

Methods

Cross sectional survey using stratified random sampling technique was carried out in governmental and private elementary and kindergarten schools in four cities of Qassim region, Saudi Arabia.

Results

The study included 1095 teachers, 711 (59.3%) did not get information about ADHD during undergraduate studies. Teachers’ overall ADHD knowledge mean was 21.7 + 5.5 out of 38 marks. Teachers with high qualification degree and kindergarten specialty scored 56.4% and 60.2%, respectively. Teachers who attended conferences related to ADHD scored 64.5%, while teachers who read about ADHD or have been ever asked to diagnose/teach an ADHD student had 59.4% and 62.1%, respectively. The sources for those who got their information through reading were statistically significant in overall knowledge, general knowledge and treatment dimensions. As scientific studies and books were the highest with percentage of 24.6% and 23.3%, respectively, 4% and 3.6%, respectively, 3% and 3%, respectively. The level of ADHD knowledge perception showed that 76% of teachers were knowledgeable in relation to overall ADHD perception.

Conclusion

Teachers who have higher qualifications or training in identifying ADHD children scored higher in our study.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Is there a relationship between Gilles de la Tourette and psychosis? A case report considering the continuum psychosis perspective and vulnerability model
Authors: Barbagelata R. , Muñoz Negro J.E.
Published: June 2017

Introduction

There has been no evidence so far about significant relationship between Gilles de la Tourette and psychosis. Perhaps a continuum psychosis perspective and the vulnerability model could improve the comprehension of our patients.

Objectives

To describe a case in which motor and obsessive symptoms evolve to schizophreniform symptoms and important psychosocial deterioration.

Methods

Single case report and literature review.

Results

A 20-year-old man, with clinical record of Gilles de la Tourette, and a psychosis episode 6 months before, is brought by his family with a syndrome consistent in motor retardation, whispered speech, poor visual contact, social withdrawal, hygiene neglect, abulia, apathy and blunted affect. In the one-year tracing conceptual disorganization and poor idea association are in the first place. Within child history, we found symptoms congruent with Gilles de la Tourette, obsessive symptoms and others that may be called mild psychotic symptoms (which did not fit in any diagnosis at that moment). We also found a pathological relationship between his parents and among him, as well as a poor economic and social condition.

Conclusions

According to the continuum perspective, psychotic symptoms could be found within the obsessive spectrum. Related to the vulnerability model, we found in our case external factors that affected the clinical evolution: family dynamics affected, communication deviation, social and economic impairment, social withdrawal and vital aim loss. These factors should be attended in first place, as they are not only related with the triggering of illness but they also are the main way to recovery.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mother-reported and prescription registry data on use of hypnotics for children 0–18 months as a risk factor later development of ADHD
Authors: Holdø I. , Skurtveit S. , Handal M. , Bramness J.G.
Published: June 2017

Introduction

Sleep problems are common in infancy. Some infants are prescribed sleep-inducing drugs even if not approved for the age group. Poor sleep as toddler is a risk factor for development of behavioral problems in childhood. It is unknown if this is true also for attention deficit and hyperactivity disorder (ADHD).

Objectives

To evaluate two sources of information on toddler drug use (mother-reported questionnaire-data and prescription database for hypnotic drugs for children aged 0–18 months) and see if these predict receiving a later diagnosis of ADHD.

Aims

Are sleeping problems as measured by the use of hypnotics in toddlers a risk factor for ADHD?

Methods

Prescription database information data was collected for 47,413 children participating in the Norwegian Mother and Child Cohort, where mothers report on toddler drug use. These two datasets were used as predictors of diagnoses of ADHD as seen in the Norwegian Patients Registry in a 7-year follow up period.

Results

Agreement between mother-reported drug use and hypnotics use as measured was less than 50% for all hypnotics (min 19% and max 48%). The two datasets will be further used to investigate the relationship between toddler drug use and a later childhood diagnosis of ADHD.

Conclusions

Considering the low to moderate agreement between mother-reported survey data and data from prescription databases it is of value to use both data sources in a study looking at the predictive value of sleeping problems and hypnotics use in toddlers on later development of ADHD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Teenagers with addictive behaviour: Characteristics of the addiction and the psychiatric comorbidities
Authors: Jihene J. , Olfa M. , Ahmed B.H. , Haifa Z.
Published: June 2017

Introduction

Addiction at a young age constitute a problem of public health. Adolescence is a period at risk for the addicting conducts.

Objectives

To establish the characteristics of the addiction and the psychiatric comorbidities.

Methods

We led a retrospective descriptive study which concerned 62 teenagers, having addicting conducts, followed in the outpatient clinic of the hospital Razi between January, 2013 and December, 2014.

Results

Tobacco is the most consumed product with 90,3% of users, followed by the alcohol (59.7%).

Fifty percent consumed the cannabis.

Benzodiazepin, Trihexyphenidyl chlorhydrate, buprenorphin with high dosage and the organic solvents were raised respectively to about 14.5%, 22.6%, 12.9% and 14.5% of the patients.

The average age of initiation for tobacco was 12 years.

The most frequent motive for consultation was behaviour disorders (37.1%).

Among our patients, 43.5% had psychiatric family history, 11.3% had undergone sexual abuse during their childhood, 17.7% had histories of suicide attempts.

The found diagnoses were the dependence in a substance (25.8%), followed by the major depressive episode (14.5%), the adjustment disorder with depressed mood (11.3%) and the bipolar disorder (8.1%).

Seventeen percent of them had personality traits who would evoke the borderline personality and 11.3% antisocial personality.

Conclusion

It is essential to diagnose and to take care of the teenagers having addicting conducts, as early as possible, to avoid transition to a chronic state in the adulthood.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A study on adolescent suicide ideation consulting in emergency
Authors: Moalla M. , Feki I. , Sellami R. , Ktata A. , Feki S. , Masmoudi J.
Published: June 2017

Introduction

Suicide is one of the most leading cause of death for teenagers in the world. Suicide ideation is known risk factor for suicide completion. Suicidal adolescents rarely asked for help. The contact with the health care system is an opportunities to screen for suicidal ideation.

Aims

The aim of this study is to examine the prevalence and the risk factors of suicidal ideation among adolescents consulting in emergency.

Methods

Our study was a transversal type, descriptive and analytic. It was conducted with 106 adolescents consulting in emergency for somatic complains. Each participant filled out demographic questionnaire and suicidal ideation questionnaire (SIQ). The SIQ is a self-report instrument for suicidal ideation, appropriate for adolescents. The SIQ has 30 items. The respondent is asked to choose from a 7-point continuum (6 = “Almost every day” to 0 = “I never had this thought”) to assess the frequency of that particular thought within the last month. Cut-off score for the SIQ is a sum of 41 and higher, indicating the presence of serious suicidal ideation.

Results

Adolescents were aged between 12 and 19 years with an average age 16.34 ± 2.54 years; 47.2% were boys. According to the SIQ, the prevalence of suicide ideation during the last month were 14.2%.

The risk factors for suicidal ideation among Tunisian adolescents were the female gender, middle school level, low family income, parents’ divorce, parental neglect, family conflicts and previous psychiatric disorder.

Conclusion

General physicians should regularly screen for suicidal thoughts in their adolescent patients with these characteristics.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Anxiety-depressive disorders in children: Neurobiological and neurohormonal aspects
Authors: P.T.  , Mykhailova E. , Matkovska T. , Reshetovska N. , Goloborodko A.
Published: June 2017

Objective

The need for diagnosis and correct classification of depression among children is dictated by its burdeness with age, high risk of recurrence at further stages of child development and propensity to suicidal behavior.

Materials and methods

One hundred and sixty adolescents with ADD were included in our study. The study design comprised: clinicopsychopathological, somatoneurological, psychological and neurohormonal methods.

Results

Clustering symptom of anxiety and depression have shown that for children in early puberty is typical more formation of somatic (35.2%), behavioral (21.6%), phobic (21.6%) variants of depression, less-anxiety (13.5%), asthenia (8.1%). For children in puberty – apathetic (30.1%), anxiety (28.9%), dismorfofobic (27.7%), behavioral (13.3%) variants. The proportion of suicidal behavior of depression increases in proportion to age, mainly due to suicidal thoughts, sayings, auto-aggressive behavior. Analysis of the formation conditions of anxiety and depression in children showed a significant correlation of genetic, biological and socio-environmental components.

Symptoms of the minimal brain dysfunction (MBD) at an early ontogeny (prognostic value = +4.8), loaded natal period (PV = +4.2), frequent colds in the medical history (PV = 3.7), signs of cerebro-organic failure (PV = +3.8) and obesity as an endocrine disorder (PV = +2.1), sex and age of the manifestation of the first depressive episode in the early stages ontogenesis in boys aged 7 years (PS = +5.3), in girls aged 9 years (PS = +3.9) have been registered among biological risk factors for the ADD formation. Prognostic significance of neurohormonal parameters as regards the risk for ADD formation in adolescents is based on a decreased serotonin level in patients with depressive anxiety (PV = +2.8) and a reduced melatonin level, irrespective of the variant of clinical depression (PV = +2.4).

Conclusion

Determination of neurobiological and neurohormonal risk markers for the development of the ADD makes it possible to carry out psychoprophylactic measures.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Self-mutilations – an addictive behavior?
Authors: Velasco Rodrigues R. , Mesquita Reis J. , Queiroga L.
Published: June 2017

Introduction

Self-mutilations are defined as an intentional behaviour that involves direct aggression to the person's body, without aware suicide intention. The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) included self-mutilation as part of the diagnostic criteria for the other specified disruptive, impulse-control, and conduct disorder or borderline personality disorder. Later, the DSM-5 suggests that this behavior constitutes a separate diagnostic entity. Despite the growing concern regarding the increased incidence of self-mutilation among adolescents, there is still no consensus on the pathogenesis of this behavior. Recent studies have suggested that, in some cases, non-suicidal self-injurious behavior may be understood as an addictive behavior. Based on this hypothesis, several researchers have conducted genetic, neurobiological and clinical studies, to verify the existence of common pathways between these two nosological entities.

Objectives

The aim of this study is to conduct a literature review of studies that propose an additive model for self-injurious behavior, discussing its implications in the diagnostic and therapeutic interventions.

Methodology

Articles indexed in the Pubmed database were analyzed as well as book and studies published in scientific journals.

Conclusion

A better understanding of the pathogenesis of self-mutilation is crucial to our diagnostic and therapeutic interventions. Unfortunately, studies done on this topic in the past were inconclusive. Further clarification, through new studies, is needed in order for us to help adolescents with this behavior in a more effective way.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Depression across DSM and ICD editions: Psychiatric nosology's ‘Black Dog’
Authors: Leite R. , Macedo P. , Borges J. , Santos T.
Published: June 2017

Introduction

The diagnosis of depressive disorders has suffered important modifications throughout DSM and ICD editions. The history of those modifications is an important subject to fully understand the current diagnostic criteria and classification, with milestones often set not by scientific or theoretical data but rather by political decision and conflicting interests.

Objective

The authors propose a review of how the concept of major depression has evolved along the several DSM and ICD editions.

Methods

The results were obtained searching literature included on the platforms PubMed, Google Scholar, PsycINFO and Psychology and Behavioral Sciences Collection.

Results

The current diagnostic entity lacks validity and utility and that is an obstacle to both scientific research and clinical practice.

Conclusion

The authors also discuss alternative models which may contribute to a paradigm shift more suitable to clinical reality and to provide a useful framework for all levels of research.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychotic and obsessive symptoms: A case report
Authors: Montes Reula L. , Portilla Fernández A. , Saiz García H.
Published: June 2017

A 28-year-old patient who began three months of symptoms of low mood, apathy and anhedonia. The patient in this last month had accepted a job but the first day had left by “feeling incapable”. He asked for specialized help. He was diagnosed with severe depressive episode and antidepressant treatment. Some weeks of patient treatment did not improve. He began to voice greater feelings of hopelessness and ideas of active death secondary to his process. He was admitted a partial hospitalization for further control and evaluation. In his evolution, visual hallucinations and a mild delusional ideation of unstructured surveillance and injury were observed. The patient verbalized with little repercussion these sensoperceptive alterations. Neuroleptic treatment was given but we could not manage high doses because of poor tolerance and side effects of treatment. The symptomatology did not improve and the patient's anguish increased. In the moments of greater distress, the patient performed superficial cuts on his forearms that he criticized. During the following months, symptoms of an obsessive type were observed, which had already pre-entered but had been reactivated. He began to perform rituals of verification with important repercussion.

Discussion

In the scientific literature the relationship between psychosis and obsession has been studied on many occasions, without reaching firm conclusions. In 2004, Poyurosvsky postulated the possible diagnosis of a subgroup called “schizo-obsessive” that included both disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Comparison of insight in bipolar disorder with and without co-morbid substance use disorders
Authors: Mustapha S. Ben , Homri W. , Jouini L. , Labbane R.
Published: June 2017

Aims

Compare the level of insight in bipolar disorder (BD) with and without substance use disorders (SUD).

Methods

Case-control study during a period of six months from July 2015 to December 2015. One hundred euthymic patients with BD (type I, II or unspecified) were recruited in the department of psychiatry C Razi Hospital, during their follow-up. Two groups were individualized by the presence or not of SUD co-morbidity. We evaluated and compared insight with Birchwood IS scale (with its three sub-scales),

Results

The mean age was 40.6 years (±16.4). The sex ratio was 2. Sixty-six percent of patients were diagnosed with bipolar disorder type 1 and type 2 bipolar disorder remains.

There is no statistically significant difference between bipolar with and without SUD in terms of quality of insight.

As for the subscales, bipolar patients with comorbid SUD had lower scores of awareness of any symptoms, whereas there was no significant difference regarding the awareness of illness and the need for treatment between the two populations.

Conclusions

Co-morbid SUD can affect the quality of insight in individuals with BD. Patients with this co-morbidity should be targeted for intensive psycho-educational measures and psychotherapeutic interventions focused on the improvement of insight.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The interesting case of a woman who gets eating satisfaction through a gastrostomy tube
Authors: Christodoulou I. , Tsiompanou F. , Peitsidis N. , Dounias G. , Tsakiridis I. , Kelesidou V.
Published: June 2017

Aim of this study is to show how people are getting accustomed to alternative ways of eating in cases of illness and eating disability. Case report presentation: A 60-year-old woman was admitted in the Intensive Care Unit due to an acute upper airway obstruction. The woman was tracheostomized before entering the ICU and presented a large goiter and thus she was operated two days later and a thyroidectomy was executed. Post-operatively, it was diagnosed that a tracheo-esophageal fistula was present and the patient was obliged to live with a gastrostomy for months. During the first attempts for eating via a nasogastric tube at first and later via a gastrostomy, she had various problems with enteric nutrition, most prominent of which was osmotic diarrhea. The patient asked soon to stop eating enteral nutrition and preferred to eat food of her choice according to her appetite. She insisted that she was able to receive eating satisfaction, even by eating through a gastrostomy, because her bowels gave to her a positive feedback with the form of abdominal comfort after lunches. She said that the only food that would not harm her was real food and she chose food on her own with the help of her sister. This woman never presented any kind of psychiatric disorder in the past, neither she lost her courage inside hospital, although she was forced to live with a tracheostomy and a gastrostomy for more than 6 months.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Alcohol use and bipolar disorder comorbidity: Synthesis and perspectives
Authors: Dahdouh A. , Semaoune B. , Tremey A. , Samalin L. , Flaudias V. , De Chazeron I. , Llorca P.M. , Brousse G.
Published: June 2017

Objective

Alcohol use disorders and bipolar disorder commonly co-occur and both are associated with more pejorative outcomes, thus constituting a major public health problem. We undertook this synthetic review to provide an update on this issue in order to clarify the nature of the relationship between the two disorders, improve clinical outcomes, prevent complications and therefore optimize management of patients.

Methods

We conducted an electronic search by keywords in databases MEDLINE, EMBASE, PsychINFO, published in English and French from January1985 to December 2015.

Results

The AUD prevalence is important among BD patients in whom the effects of alcohol are more severe. However, in terms of screening, it appears that the comorbidity is not systematically sought. The concept of co-occurrence finds its clinical interest in the development of specific screening and therapeutic strategies. To date, there are only few recommendations about the management of dual diagnosis and the majority of them support “integrated” approaches.

Conclusions

Recommendations should emphasize this strong co-occurrence and promote systematic screening and offered integrated cares.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Temporal tumor as a cause of bipolar-like disorder?
Authors: Domingues S. , Cotter M. , Amado I. , Massano R.
Published: June 2017

Introduction

The relationship between brain tumours, temporal epilepsy and psychiatric symptoms are historically known.

Objectives

To report a case of mania in a patient with previous diagnosis of bipolar disorder, temporal tumour and temporal epilepsy.

Methods

Clinical records. Research on PubMed, using “lateral temporal epilepsy” or “brain tumour” and “mania”.

Results

A 52 years old man was conducted to the emergency department by the police. He was found with psychomotor agitation at the Sanctuary of Fátima. He was apparently hyperthimic with flight of ideas. He had a history of epilepsy and temporal tumour and two previous manic episodes. It was assumed as a maniac episode.

During inpatient evaluation, patient had memory for the occurrence. He described a sudden onset on the day before, after drinking wine. He described delirant atmosphere, persecutory and mystic delusional beliefs “this is the third secret of Fátima being revealed”, followed by ecstasy and psychomotor agitation. Remission was obtained in one week on psychotropics. MRI documented the lesion. Electroencephalography performed one month later revealed “slow waves.”

Conclusions

Organic causes should be excluded before consider a psychiatric disorder. The hypothesis of epilepsy-related psychosis or mania and other effects of a temporal tumour should be considered in etiology. However, co morbidity with bipolar disorder cannot be excluded.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Kynurenine pathway in pancreatic carcinoma
Authors: Blesl C. , Tmava A. , Baranyi A. , Meinitzer A. , Painold A. , Holl A. , Stadlbauer-Köllner V. , Kapfhammer H.P. , Mörkl S.
Published: June 2017

Introduction

Pancreatic carcinoma (PC) belongs to the most aggressive tumours worldwide, with a five year survival of 7%. Mostly, diagnosis is made in late stages, as by now no early detection method is available. Symptoms of depression occur frequently before diagnosis of PC. PC and depression are both known to go along with changes in the kynurenine-pathway.

Objectives

This study aimed to examine the kynurenine pathway (Figure 1) and evaluate a possible depression in newly diagnosed PC patients in comparison to healthy controls (HC).

Methods

26 PC patients and 26 age and sex matched HC participated in this study. We investigated serum-levels of kynurenine, kynurenic-acid, quinolinic-acid and tryptophan. To diagnose features of depression SKID-II and BDI were used.

Results

None of the participants fulfilled criteria of a depressive episode. Regarding BDI-scores, 2 PC-patients showed features of mild depression. PC patients showed significantly lower tryptophan-levels (P = 0.05) and significantly increased quinolinic-acid levels (P = 0.01) compared to HC. Quinolinic-acid levels were correlated with BDI (r = 0.23, P = 0.02).

Conclusions

Our study results imply IDO-activation and kynurenine-pathway activation by showing decreased tryptophan and high quinolonic-acid levels in our PC patients compared to HC. Larger studies are needed to gather further insight in the kynurenine pathway in PC.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Figure 1
Mood disorders in HIV infection
Authors: Martínez L. , Boix E. , González L. , Esteban R. , Davi E. , Flores P. , Masferrer C. , Macías C. , Orejas O.
Published: June 2017

Introduction

Psychiatric disorders, particularly mood disorders, have a profound effect on the use of and adherence to highly active antiretroviral therapy (HAART) among patients with human immunodeficiency virus (HIV) infection.

HIV infection and mood disorders have features in common, and each is a significant risk factor for the other.

Objective

The objective is to highlight the clinicians on the importance of screening and treating affective disorders among patients with HIV infection.

Methods

Two cases of HIV infected patients with comorbid mood disorder and torpid evolutions by poor adherence to treatment are reported.

A brief literature review on this subject is done.

Results

Major depression has been shown to alter the function of killer lymphocytes in HIV-infected patients and may be associated with the progression of HIV disease.

HIV-positive patients with mental disorders are less likely to receive and adherence to antiretroviral therapy.

First case-report: a man 52 years old, HIV-positive since 1985 with a comorbid bipolar disorder, with recurrent depressions and poor adherence to both treatment with a rapidly exitus laetalis.

Second case-report: man 45 years old, HIV-positive since 1992 with a comorbid depressive disorder, non-adhered to both therapy and HIV-associated dementia.

Conclusions

Depressive disorders are common in HIV infection. Antiretroviral regimens for HIV-infected patients require strict adherence. Untreated depression has been associated with medication nonadherence. Understanding the contribution of depression and its subsequent treatment on antiretroviral therapy adherence might direct clinicians toward earlier identification and more aggressive treatment among this population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.