bluuebunny/crossref_metadata_2025 huggingface dataset:
Formal caregivers’ perceptions of working in a home-based care for elderly
Authors: Laranjeira C. , Azeredo Z. , Guerra M. , Rodrigues C.
Published: May 2016

Introduction

Population aging is an issue increasingly gaining more prominence, as evidenced by the number of inquiries regarding the “problems” that this entails for society. This leads to a need to understand the role of caregiver for the elderly as the central figure of support in old age.

Aim

The purpose of this study was to describe formal caregivers’ perceptions of working conditions, difficulties and factors associated with quality of care in a Portuguese home-based care for elderly.

Methods

The participants were 8 formal caregivers whose profession falls under the categories of Direct Action Helper and Auxiliary Workers. The data were collected through individual face-to-face interviews and analysed using a content analysis following Bardin's method.

Results

The results show that the sample is female, aged from 32 to 53 years, with a professional exercise time between 8 and 16 years. Regarding the main conclusions of our research, we can say that our group of participants has a strong sense of team work which contributes to avoid situations of physical and emotional exhaustion; mostly caregivers can separate their personal and professional lives; there are some difficulties in communication between the caregivers and the elderly, however the most difficult situations are usually overcome due to the caregiver's understanding of the characteristics of institutionalized elderly; the matter of death is frequently seen as the most difficult situation to face.

Conclusions

The caregivers should have an awareness of the importance of kindness and respect, supporting positive thoughts and help the older people to retain control over their lives.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The meaning of fatigue compassion in the context of healthcare
Authors: Laranjeira C.
Published: May 2016

Introduction

Studies confirm that caregivers play host to a high level of compassion fatigue. Day in, day out, nurses struggle to function in care giving environments that constantly present heart wrenching, emotional challenges.

Aim

This concept analysis will aim to capture the current meaning of fatigue compassion in the context of healthcare and explore how it may be recognised and measured in education and clinical practice.

Methods

Using the same search terms, findings from a literature search in 2000 and from a follow-up search in 2014 were used to conduct the concept analysis. The Walker and Avant theorethical framework was used to develop a model case of fatigue compassion in nursing care. The attributes, antecedents, consequences and references were delineated.

Results

Four attributes of fatigue compassion were delineated. (1) Perceptual incongruence and appraising defines how an individual perceives role demand in relation to capabilities or resources. (2) Multidimensionality consists of physiological and psychological effects on a person. (3) Interactional feedback is the experienced acknowledgement/validation communicated by others during compassive stressful situations at a workplace. (4) Response pattern describes the coping mechanisms used by an individual experiencing fatigue compassion.

Conclusions

The concept analysis of fatigue compassion among nurses at the workplace recognized the vulnerability of the nursing discipline towards distress in general. There needs to be greater research within the field of role stress and nursing, specifically in the development of scales or tools to assist in the identification of fatigue compassion amongst nurses.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Hypersensitivity to electricity: What place in clinical psychiatry?
Authors: Maria Iulia V. , Diane B.D.
Published: May 2016

Hypersensitivity to electricity (EHS) is a self-defined syndrome where individuals experience symptoms while using or being in the proximity of equipment or devices that use electric, magnetic or electromagnetic fields. We present the case of a 45-year-old patient who received an EHS diagnosis several years ago. This patient was first sent to us for hospitalization in the psychiatric ward with mystic delusions and secondary behavior disorders. He had no remarkable psychiatric history and the thorough somatic examinations performed showed no anomaly. The EHS had first appeared 10 years ago with associated symptoms like fatigue, dizziness, headache, cognitive disturbances, as well as physically painful sensations. These symptoms had become gradually invalidating, preventing the patient from pursuing his professional activity. Nevertheless, he maintained his social and familial obligations, and, together with his wife, was still able to care for his 2 children. The patient presented, in the emergency ward, with delusions of mystical and persecuting nature of multiple mechanisms with total adherence. The initial symptomatology gradually improved under antipsychotic treatment without any real improvement of the EHS complaint. This case brought several questions. What is the place of the EHS diagnosis within the framework of a delirious episode? Is there a link between these two diagnoses and more generally is there a psychiatric profile more frequently found in EHS patients?

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Gynecomastia induced by trazodone: A case report
Authors: Sánchez García M.D. , Gómez Peinado A. , Cano Ruiz P. , Cañas Fraile S.
Published: May 2016

Introduction

Trazodone is a heterocyclic antidepressant that exerts its effect via the inhibition of selective serotonin reuptake and the antagonism of 5-HT2A and 5-HT2 C receptors. Antidepressant-induced gynecomastia and galactorrhea and increases in prolactin levels have rarely been reported.

Case report

A 73-year-old man presented to the psychiatric clinic with depressive symptoms and insomnia that was the reason that his GP introduced paroxetine 20 mg/day three months before. One month later because the insomnia persisted, trazodone (100 mg/day) was added to the treatment. At a 2-month follow-up, the patient reported improvement in depressive symptoms but also presented gynecomastia on the left side that is non-tender on palpation. No other medications were noted. Laboratory testing was within normal limits, with the exception of on elevated prolactin level (38.2 ng/mL). Ultrasonography indicated normal results. Treatment included the tapering and discontinuation of trazodone with continued paroxetine therapy. Lorazepam was initiated for the treatment of insomnia. Two weeks later, the prolactin level was 13.1 ng/mL and gynecomastia was practically resolved. Lorazepam was initiated for the treatment of insomnia.

Conclusions

Effects of trazodone on PRL are unclear, there is one study reported that trazodone increases the PRL level, and another one reported that trazodone reduces them, in our case, the trazodone use led to hyperprolactinemia via hypothalamic postsynaptic receptor stimulation and it should be remembered that gynecomastia and galactorrhea may appear as a rare side effect of trazodone.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Group therapy based on mindfulness in a mental health center
Authors: Uría de los Ojos A. , Ballesteros López J. , Rico García P. , González Palacios A.B. , Domínguez García C.
Published: May 2016

Introduction

Mindfulness is defined as the ability of paying attention to the present moment with intentionality, moment to moment without making judgments of value.

Objectives

To describe the effectiveness of group therapy performed in our mental health center according to the results in the SOFI scale of patients. This scale is designed to assess different qualities, which evolve through training in meditation practice based on mindfulness.

Methods

Group therapy consisted of 12 weekly sessions of an hour and a half. A total of 11 patients, 7 of which having completed therapy. The questionnaires were answered in the first and final session of therapy.

Results

The questionnaire items were divided before and after treatment, into four categories with the following results: positive (friendly, happy, acceptance, compassion) to himself: 1.86 (0.54)/2.75 (0.78) and to others 3.57 (0.86)/3.89 (0.54); negative (hate, angry, cruel, bad) to himself: 2.92 (0.54)/2 (0.23); and to others: 2.28 (0.41)/1.96 (0.36)

Conclusions

In keeping with similar studies, the scale shows effectiveness of therapy in all sets of items, highlighting the variation of the aspects related to himself.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Comorbidity between delusional disorder and chronic physical conditions. Results from the Deliranda case register
Authors: Porras Segovia A. , Carrillo de Albornoz Calahorro C. , Guerrero Jiménez M. , Cervilla Ballesteros J.
Published: May 2016

Introduction

Mental disorders are often comorbid with chronic physical conditions. This relationship has been looked into in some mental disorders, such as depression or schizophrenia. However, very few studies have explored this comorbidity in the delusional disorder.

Objectives

The objective of this study is to establish the prevalence of common chronic medical conditions across delusional disorder.

Aims

The aim is to provide useful information regarding this frequent, often disregarded, comorbidity.

Methods

Our results proceed from the Andalusian delusional disorder case-register (DelirAnda). We reviewed 1927 clinical histories of patients diagnosed of delusional disorder. Upon having verified the diagnosis following DSM-5 criteria, we recollected data on the prevalence of 10 different medical conditions, which were defined based on clinical diagnosis.

Results

One thousand four hundred and fifty-two patients matched DSM-5 delusional disorder criteria. Among them, 49.8% of our sample were women. The overall prevalence of medical conditions was 66%. Thirty-one percent of the patients with delusional disorder had only one comorbid physical condition, 20% of them suffered from two conditions, and 15% of them had three or more chronic conditions. The most prevalent physical condition among delusional disorder patients was diabetes, affecting 16% of these patients.

Conclusions

Chronic physical conditions are highly prevalent among patients with delusional disorder. Comorbid physical conditions may have an important impact on the course of delusional disorder. A correct diagnosis and treatment of this comorbidity should be made to help improve the prognosis and life quality of these patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Parkinson disease psychosis – A case report
Authors: Ferreira M.D.C. , Varanda S. , Carneiro G. , Santos B. , Machado Á.
Published: May 2016

Introduction

Psychosis is one of the most prevalent non-motor complications in Parkinson's disease (PD). Risk factors for PD psychosis are advancing age, longer disease duration, severe motor symptoms, presence of dementia, sleep disorders, depression and autonomic dysfunction. Treatment is challenging in this setting because antipsychotic medications are known to worse motor symptoms.

Objectives

To highlight the therapeutic difficulties in PD-related psychosis.

Methods

Case description and literature review.

Results

We report a case of a 74-year-old woman with a 9-year history of PD, who presented a complex psychotic disorder consisting in auditory, olfactory and visual (gulliverian and lilliputian) hallucinations, persecutory and sexual delusions. Additionally, the patient presented euthymic mood, without evidence of cognitive impairment or impulse-control disorder. These symptoms began after dopamine agonist therapy (ropinirole 4 mg/day). Other medical conditions that could justify these symptoms were excluded. Initially, ropinirole was removed, but without psychotic remission. Then, she was treated with antipsychotic medication (clozapine 25 mg/day) with full psychotic remission and without significant worsening of motor symptoms.

Conclusions

Clozapine treatment is frequently delayed, mainly for fear of its side effects, particularly agranulocytosis. However, this antipsychotic drug presents many benefits regarding the management of PD-related psychosis, namely few motor effects and even improvement of motor fluctuations.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychiatric symptoms as a presentation of central nervous system involvement in Chagas disease, a case report
Authors: Martinez-Ales G. , Fraga A. , Bonan V. , Roman E. , Palao A. , Rodriguez-Vega B. , Bravo M.F.
Published: May 2016

Introduction

Psychiatric symptoms set forth brain dysfunction at several levels. Behavioral disturbances, although frequently associated to primary psychiatric disorders, call for a previous discard of neurologic treatable causes.

Case report

We report the case of a 30-year-old gentleman, receiving outpatient psychological treatment and follow-up for a 3-month history of low mood, abulia, apathy, generalized malaise, weight loss and insomnia. Non-structured jealous delusions were also present. No neurological deficit was found. After CT of the brain, a space occupying lesion, suggestive of glioblastoma multiforme, was found. Further studies, including biopsy and a MR, led to the diagnosis of central nervous system Chagas, related to a previously unknown HIV infection in AIDS status, and conditioning a secondary central hipothyroidism. Careful treatment of the etiological factors, along with symptomatic relieve with low dose paliperidone, led to the resolution of the symptoms.

Discussion

The majority of patients suffering from neurologic diseases develop psychiatric symptoms over the course of their illness, with or without the presence of classical disturbances, such as weakness, sensory loss or seizures. Modern psychiatry uses a complex disease model, therefore necessarily integrating anatomy, biochemistry and function during every diagnostic approach.

Conclusion

It is necessary to rule out frequent treatable causes, thus involving both psychopatological and neuroscientific approach to psychiatric disturbances. However, while underlying causes are often difficult to treat, psychiatric symptoms respond to existing pharmacologic and nonpharmacologic therapies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychotic symptoms in a patient diagnosed with temporal lobe epilepsy and schizoaffective disorder
Authors: Martinez-Ales G. , Baena V. , Rubio I. , Rodriguez-Vega B. , Bonan V. , Roman E. , Bravo M.F.
Published: May 2016

Introduction

Epilepsy is considered a complex neurological disorder, and its clinical picture can resemble many different cerebral dysfunctions, including those associated to major psychiatric disorders.

Case report

We report the case of a 52-year-old gentleman, with a 30-year history of schizoaffective disorder and of complex partial epilepsy with secondary generalization. He was admitted to an emergency room due to a voluntary overdose with 8 mg of clonazepam. The patient explained how he had recently experienced visual hallucinations and insomnia, symptoms that originally led to the psychotic diagnosis. He had previously presented these symptoms, along with stupor, delusions and lability, as a prodrome of complex motor epileptic decompensations. Thus, he took the overdose not to suffer seizures. After carefully reconstructing the clinical history, psychiatric admissions had shown seizures, and periods of clinical stability had been achieved by regulating antiepileptic medication. Eslicarbazepine and lamotrigine reintroduction, and quetiapine withdrawal, led to symptomatic remission.

Discussion

Epilepsy and major psychiatric disorders show a high comorbidity. There has been an effort to even include epilepsy and psychosis in a unique diagnosis (alternant psychosis). Furthermore, polimorphism and restitutio ad integrum may resemble classic cycloid psychosis. In this case, chronological study showed all symptoms could be explained by one disorder.

Conclusion

Epilepsy includes a variety of neuropsychiatric symptoms. It can be difficult to withdraw psychiatric diagnoses from patients after years of follow-up. However, a carefully taken medical history clarifies temporal criteria.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychological mechanisms of the formation of non-psychotic mental disorders in patients with hyperthyroidism
Authors: Pityk O. , Pityk M. , Kuzhda I.
Published: May 2016

The application of a comprehensive, integrative, systemic approach to the examination of patients with abnormal thyroid gland has to lie in the basis of planning strategies and tactics of medical programs such patients. On this point of view we consider that non- psychotic mental disorders are developing on the basis of both organic and adaptation levels. Population researches showed that the majority of patients with endocrinological pathology suffer from one of the three DCPR syndromes: irritant mood, demoralization thrown in (desperation), persistant somatization. The task of our work was to investigate mechanisms of psychological defense in patients with hyperthyroidism with non-psychotic mental disorders. One hundred and twenty-five patients were examined. Non-psychotic mental disorders with different syndromologic structure were found in 76% of patients (study group), among which anxious-asthenic (38.95%), anxiety and depression (23.16%) were dominant. The method of Robert Plutchik for assessment of the mechanisms of defense was used. In asthenic syndrome we found excessive functioning of negation and regression, inadequate functioning of intellectualization. In patients with astheno-anxious syndrome inadequate functioning of negation, intellectualization, compensation, and excessive repression contributed to the formation of the sensations of anxiety. Excessive compensation, projection, reactive formation generally affected the structure of the asteno-depressive syndrome. The lack of displacing of reactive formation, repression and excessive intellectualization in a complex influenced to the structuring of anxious-depressive syndrome. In hypochondrical syndrome projection, regression and negation were the basis of the formation of clinical picture. Thus, meaningful relationships between intrapsychic level of functioning and syndromological structure of non-psychotic disorders were installed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The experience and impact of stigma in Saudi people with a mood disorder
Authors: Alateeq D. , AlDaoud A. , AlHadi A. , AlKhalaf H.
Published: May 2016

Introduction

Self-stigma plays a powerful role in attitudes toward mental illness and seeking psychological services. Assessing stigma from the perspective of people with mood disorders is important as they were ranked as major causes of disability.

Objectives

To determine the extent and the impact of stigma experience in Saudi patients with mood disorder and compare them between depression and bipolar disorder patients. To test if stigma is a universal experience and has similar psychosocial impact across cultures.

Aim

It's a part of multicenter international study comparing its results to the universal experiences inthe perspectives of individuals with mood disorder.

Methodology

We randomly interviewed 94 individuals with mood disorder at King Khalid University Hospital using valid reliable tool, Inventory of Stigmatizing Experiences (ISE), which has two components: Stigma Experiences Scale (SES) and Stigma Impact Scale (SIS).

Results

ISE was validated in a population of Saudi patients with mood disorder. There were no significant differences in stigma between patients with bipolar or depressive disorder on SES or SIS. However, over 50% of all respondents tried to hide their mental illness from the others, and to avoid situations that might lead them to be stigmatized. In comparison with the Canadian population, Saudi participants scored lower on both SES and SIS, which may be due to cultural differences.

Conclusion

Stigma associated with mood disorder is serious and pervasive. It's important first to understand how patients perceive stigma in order to conduct successful anti-stigma programs. The ISE is a highly reliable instrument among cultures.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Can somebody listen to me?
Authors: Cortázar Alonso E. , Guillén Rodrigo H. , Remesal Cobreros R. , Alonso Díaz R.
Published: May 2016

Given the increase in depressive symptoms, as a mental disorder combined with an organic disease, we suggest a therapeutic approach based on group therapy. The effectivity of this kind of therapy has been confirmed by multiple studies as a way to decrease the pressure in mental health units. The results reached in various studies confirm at least an equal effectivity as individual psychotherapy, thereby it optimizes the increasingly limited public health resources. The objective of the group therapy is to promote an active attitude in the patients and make them responsible of their condition and their treatment process too. The program is aimed to female patients with various kinds of clinical depression, ranging from 40 to 60, who come to the USMC Hospital Vazquez Diaz in Huelva. The group had 12 participants, it was led by a Clinical Psychologist with the help of the Clinical Psychology residents. The program consisted in 8 bimonthly sessions of 90 minutes with an assessment test/retest at the beginning and end of it. The work in the group therapy was based on the constructivist orientation. Different areas were treated as: identification and adaptive expression of emotions, strengthening self-esteem and providing adaptive coping strategies to the psychological distress. As a conclusion we can see how the individual changes in the patients go socializing and enhancing the change in the rest of the participants in a mutual support that promote a more active role that take the patients away of the initial passivity.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Apathy and depression: Which clinical specificities?
Authors: Palaric J.
Published: May 2016

Introduction

Apathy is a transnosographical symptom that is often described in psychiatric and neurological illness. The most known definition, proposed by Marin (1991), is a lack of goal-directed voluntary behavior. Apathy and depression may be present together but they are clinically independent. The confusion between signs of apathy and those of depression might reveal diagnostic and treatment issue. Our aim is to define a clinical profile of apathetic patients (Ap) with depression, hypothesizing there is a different clinic profile than non-apathetic patients (NAp).

Method

Seventy adults diagnosed with depression were included in a comparative, non-randomized and open cohort, since November 2014. Clinical assessments targeted clinical scale evaluations (MINI, AES, MADRS, STAI, SHAPS). Patients were separated in two groups, Ap VS NAp, using a 42 points cut-off at AES score.

Results

Ap represent 30%; n(Ap)= 21, n(NAp)= 49. Depressive severity scores (MADRS) are lower in the Ap group; W-test= 672, P= 0,044. State anxiety scores (STAI-A) are lower in Ap group; W-test= 739, P = 0,004. Anhedonia scores (SHAPS) are lower in Ap group; W-test= 412, P= 0,004. Pearson test show negative correlation between AES/STAI-A (r = -0,27; P= 0,02); AES/SHAPS (r= -0,45; P= 0,001).

Conclusion

Apathetic patients suffering from depression seem to present different clinical pattern in term of anxiety and anhedonia. These results are high of interest for therapeutic and further studies focus on pathophysiological issues.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
The role of augmentation treatment with second-generation antipsychotics in major depression disorder–current evidence in the literature
Authors: Pereira E. , Coutinho F. , Marinho M. , Hipólito-Reis C.
Published: May 2016

Introduction

Major depressive disorder (MDD) is a chronic mental illness with a considerable lifetime prevalence in adult men and women. Only a third of MDD patients remit following adequate antidepressant treatment, while most suffer from significant core depressive or residual symptoms during their clinical course. Augmentation treatment with second-generation antipsychotics (SGAs) has been one of the suggested approaches to overcome this shortage of efficacy of antidepressant therapy.

Objectives

To review the role of SGAs as an augmentation strategy to antidepressant therapy in MDD.

Methods

A search of the MEDLINE/Pubmed database was conducted for articles from 2010 to 2015, using the MeSH terms “antypsichotics”, “depression” and “treatment”.

Results

There is a general consensus in the literature that antidepressant augmentation treatment with SGAs is more effective than placebo in the management of patients with MDD who failed to respond adequately to antidepressant therapy alone. The majority of studies found no significant differences between the different studied drugs (namely, aripiprazole, quetiapine, olanzapine and risperidone). On the other hand, discontinuation rates due to adverse effects are also higher with SGAs versus placebo. However, it remains unclear if augmentation with SGAs is more effective than other therapeutic strategies, such as combination or switching to other antidepressant or augmentation with other psychotropics.

Conclusions

There is strong evidence that SGAs augmentation is an effective and generally safe therapeutic approach to patients with MDD who respond poorly to antidepressants. Nevertheless, more studies are needed to understand the efficacy of this treatment comparing other therapeutic approaches.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Differential profile amongst patients with depressive disorder (DD) and adjustment disorder (AD)
Authors: Martínez Arnaiz J. , Vallejo-Sánchez B. , Garcia Blanco C. , Pérez-García A.M.
Published: May 2016

Introduction

Adjustment disorder (AD) is a condition that includes both emotional or/and behavioral symptoms and occurs when individual is unable to cope with stress. It is a common diagnosis but few studies have been done due to controversial diagnosis related to their diagnostic criteria definition. It is often difficult to establish differential diagnosis with condition such as depressive and anxiety disorders or even normal reaction to stressful situations. There are limited tools to evaluate such condition and its definition is focused or based on lack of severity.

Objectives

Study objective target is to analyse the differences between two groups, a first group with AD and another one with Major Depressive Disorder (MDD) (with different sociodemographic, clinical and triggering individual factors such as vulnerability or copying management).

Aims

We try to have a better comprehension and management of depressive conditions.

Methods

Two groups that belongs to Mental Health Community Team are compared. The first one with a diagnosis of AD, and another group with the diagnosis of MD. They have been diagnosed through a structured clinical interview and standard questionnaires to evaluate personality copying management. Other pathologies (such as psychotic, organic,…) were excluded through a structured clinical interview. We analyzed variables considered through variance analysis.

Results

Significant differences between groups were found in some of the variables considered.

Conclusions

This study have important implications regarding evaluation, differential diagnosis and psychotherapeutic approach to patients with AD and MD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Oxytocin secretion in anorexia nervosa and bulimia nervosa: Investigation of its relationships to temperament personality dimensions
Authors: Nigro M. , Monteleone A.M. , Steardo L. , Patriciello G. , Di Maso V. , Cimino M. , Volpe U. , Monteleone P.
Published: May 2016

Introduction

Some temperament characteristics of personality seem to be modulated by oxytocin. Patients suffering from eating disorders (EDs) display aberrant personality traits.

Objectives and aims

We investigated the relationships between plasma oxytocin levels and personality dimensions of patients with anorexia nervosa (AN) and bulimia nervosa (BN) and compared them to those of healthy controls.

Methods

Plasma oxytocin levels were measured in 23 women with AN, 27 women with BN and 19 healthy controls and assessed their personality traits by means of the Cloninger's Temperament and Character Inventory-Revised (TCI-R).

Results

AN patients showed plasma levels of the hormone significantly lower than BN and healthy controls. In healthy women, plasma oxytocin levels resulted significantly correlated negatively with novelty seeking scores and positively with both harm avoidance (HA) scores and the attachment subscale scores of the reward dependence: these correlations explained 82% of the variability in circulating oxytocin. In BN patients, plasma oxytocin resulted negatively correlated with HA, whereas no significant correlations emerged in AN patients.

Conclusions

These findings confirm a dysregulation of oxytocin secretion in AN but not in BN and show, for the first time, that the association of circulating oxytocin to patients’ temperament traits is totally lost in underweight patients with AN and partially lost or even inverted in women with BN. These findings suggest a role of oxytocin in certain deranged behaviours of ED patients, which are influenced by the subjects’ personality traits.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Trends of hospitalization for anorexia nervosa in USA: A nationwide analysis
Authors: Mansuri Z. , Rathod M. , Bansal P. , Mansuri U. , Shambhu S.
Published: May 2016

Objectives

Anorexia Nervosa (AN) is an important cause of morbidity and mortality in hospitalized patients. While AN has been extensively studied in the past, the contemporary data for impact of AN on cost of hospitalization are largely lacking.

Methods

We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998-2011 using the ICD-9 codes for AN. Severity of co-morbid conditions was defined by Deyo modification of Charlson co-morbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, chi-square test, t-test and Cochran-Armitage test were used to test significance.

Results

28,150 patients were analyzed. 93.94% were female and 6.06% were male (P < 0.0001). 88.67% were white, 2.93% were black and 8.4% were of other race (P < 0.0001). Rate of hospitalization decreased from 1530/million to 1349.5/million from 1998-2011. Overall mortality was 0.78% and mean cost of hospitalization was 25,829.82$. The in-hospital mortality reduced from 0.95% to 0.44% (P < 0.0001) and mean cost of hospitalization increased from 11,956.55$ to 39,831.51$. Total yearly spending on AN related admissions increased from $145.33 million/year to $420.61 million/year.

Conclusions

While mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $145.33 million/year to $420.61 million/year, which leads to an estimated $275.28 million additional burden to the US health care system. In the era of cost conscious care, preventing AN related Hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for AN related hospitalization.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Trends of hospitalization for bulimia nervosa in USA: A nationwide analysis
Authors: Mansuri Z. , Rathod M. , Bansal P. , Sutaria A. , Shambhu S.
Published: May 2016

Objectives

Bulimia Nervosa (BN) is an important cause of morbidity and mortality in hospitalized patients. While BN has been extensively studied in the past, the contemporary data for impact of BN on cost of hospitalization are largely lacking.

Methods

We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998-2011 using the ICD-9 codes. Severity of co-morbid conditions was defined by Deyo modification of Charlson co-morbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, chi-square test, t-test and Cochran-Armitage test were used to test significance.

Results

19,441 patients were analyzed. 94.13% were female and 5.87% male (P < 0.0001). 85.72% were white, 4.55% black and 9.73% of other race (P < 0.0001). Rate of hospitalization decreased from 1136.99/million to 802.47/million from 1998-2011. Overall mortality was 0.20% and mean cost of hospitalization was 15,496.82$. The in-hospital mortality reduced from 0.23% to 0.15% (P < 0.0001) and mean cost of hospitalization increased from 8,194.53$ to 22,547.86$. Total spending on BN related admissions have increased from $73.96 million/year to $139.93 million/year over the last decade.

Conclusions

While mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $73.96 million/year to $139.93 million/year, which leads to an estimated $65.97 million/year additional burden to US health care system. In the era of cost conscious care, preventing BN related Hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for BN related hospitalization.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Severity of traumatic events in patients with eating disorders. A case-control study
Authors: Pignatelli A.M. , Loriedo C. , Biondi M. , Girardi P. , Vanderlinden J. , Piacentino D.
Published: May 2016

Introduction

A high proportion of individuals with eating disorders (EDs) report childhood abuse and neglect. The prevalence of traumatic events in ED patients has been extensively investigated; less is known about their self-perceived–and reported–severity. Objectives/Aims: We aimed to assess in ED patients vs. healthy controls the severity, i.e., duration, perpetrator, and subjective impact, of sexual, physical, and emotional traumas suffered from 0 to 18 years, paying particular attention to emotional neglect.

Methods

Fifty-seven consecutive DSM-V ED patients (91.2% females; age range: 18–42 years) were recruited at the Psychiatric Outpatient Clinic of our University Hospital. Ninety controls (78.9% females; age range: 20–39 years) were also recruited. Among ED patients, 43.9% had restrictive anorexia nervosa (AN), 29.8% binge/purging AN, 26.3% bulimia nervosa. Individuals completed the Eating Disorder Inventory-2 (EDI-2) and the Traumatic Experiences Checklist (TEC).

Results

The severity of all traumatic events, according to the TEC total score, was significantly higher in ED patients than controls (P < 0.001). Moreover, ED patients showed significantly higher scores with regard to emotional neglect (P < 0.001) and emotional abuse (P < 0.001). The same can be said for physical traumas (P < 0.01) and physical abuse (P < 0.01), although with a lower significance, and for sexual abuse (P < 0.05), with an even lower significance. No difference in the severity of sexual harassment was found.

Conclusions

All types of traumas, especially neglect, can occur in ED patients and controls, however they are reported as more severe by ED patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Internet and smartphone application usage in eating disorders: A descriptive study in Singapore
Authors: Tan T. , Kuek A. , Goh S.E. , Ng K.W. , Tan S.M. , Gudi A. , Lee H.Y. , Lee E.L. , Victor K.
Published: May 2016

Introduction

Eating disorders are associated with significant morbidity and mortality. The Internet is a popular medium for individuals with eating disorders to discuss and reinforce their affliction. However, the available literature on Internet usage and eating disorders is scarce, especially in the area of social media and smartphone application (“app”) usage.

Objectives & aims

To look at the Internet and smartphone app usage patterns of participants who presented with an eating disorder in Singapore, and whether it corresponded to severity of illness.

Methods

Individuals who presented to the Eating Disorders clinic at the Singapore General Hospital from 13th June 2013 to 20th December 2013 completed a self-reported questionnaire on Internet and app usage. They also completed the EDE-Q, EAT-26 and CIA 3.0.

Results

Fifty-five participants completed the study. A total of 41.8% had anorexia nervosa, 34.5% had bulimia nervosa, and 9.1% were ED-NOS. 41.8% felt that apps helped to perpetuate their illness, while 32.7% felt that apps were helpful for recovery. Overall, any smartphone application usage was associated with younger age and greater eating disorder psychopathology and psychosocial impairment. While 30.9% had encountered eating disorder-related content on Facebook, only 12.75 visited Facebook groups related to eating disorders. For YouTube, “Cooking and Food” and “Beauty and Fashion” videos were among the top 3 types of videos that participants watched.

Conclusions

Internet and smartphone app usage is significant, and they are used to prolong or worsen eating disorder behavior in those with greater severity of illness. It is necessary to include interventions in this aspect as part of treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Delirium symptoms’ development during the intensive care unit post-surgery staying is related with reduced intraoperative cerebral oxygen saturation in the elderly subjected to cardiac surgery
Authors: Bellido I. , Aldana E. , Valverde J.L. , Medina S. , Green C. , Campos V. , Gomez-Luque A.
Published: May 2016

Goal of study

Our aim was to examine whether cerebral frontal cortex O2 desaturation may be related with the development of delirium symptoms’ after cardiac surgery in the elderly during the intensive care unit (ICU) staying.

Materials and methods

A prospective, before and after, longitudinal study in II-IV ASA class patients scheduled for cardiac surgery and undergoing intravenous general anesthesia with remifentanil plus propofol was done. Clinical and surgical parameters, cardiopulmonary function, intraoperative cerebral oxygen saturation (rSO2) and bispectral index were continuously recorded and corrected throughout the surgery. Severity of delirium was represented as a score of the Intensive Care Delirium Screening Checklist (ICDSC) during the patients’ stay in the ICU under the assumption that higher ICDSC score indicated severe delirium.

Results and discussion

Patients, n = 44, 77.3% male, aged 59.9 ± 1.9 years old, scheduled to coronary (36.4%), aortic valve replacement (18.2%), mitral valve replacement (13.6%), coronary plus valve replacement (13.6%) and others (18.2%) surgery, on pump 98.4% were enrolled. A reduction of the rSO2 higher than 10% at the end of the surgery compared with basal values was detected in a 46.5% of the patients. Reduction of rSO2 higher than 10% at the end of the surgery was related with significantly higher values of delirium symptoms’ development during the intensive care unit post-surgery staying (rSO2 higher ≥ 10% 68.8 vs. rSO2 higher < 10% 31.3%, P < 0.05).

Conclusion

Delirium symptoms’ development during the intensive care unit post-surgery staying is related with reduced intraoperative cerebral oxygen saturation in the elderly subjected to cardiac surgery.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Association between mental health problems of stunted children and common mental disorders of their mothers in Brazil: A case control study
Authors: Miranda C. , Santos L. , Paula C.S. , Ribeiro W. , Florencio T.
Published: May 2016

Introduction

In deprived environments, mental health problems for both the mother and her stunted child may be related.

Objective

To verify possible association between a child's nutritional and mental health status with common maternal mental disorders (and associated impairment).

Aims

To contribute to management of malnutrition and mental health in low-income populations.

Methods

Case-control study in which 48 malnourished children (aged 48 to 72 months) were compared with 50 eutrophic children. The child's nutritional status, the children's mental health, the maternal mental health, and the associated disability were evaluated by using the WHO criteria, the “Strengths and Difficulties Questionnaire” (SDQ), the “Self-Report Questionnaire”-20 (SRQ-20), and the “Sheehan Disability Scale” (SDS), respectively. In addition, selected socio-economic aspects were considered.

Results

Variables with significant odds ratio (OR) in the univariate analysis were: maternal education (OR: 2.96, 95% CI: 1.30–6.75), number of residents in the household (OR: 0.32, 95% CI: 0.14–0.74), number of children in the household (OR: 0.25, 95% CI: 0.10–0.61), and social class (OR: 2.30, 95% CI: 1.02–5.18). The only SDQ dimension that tended to be associated with malnutrition was conduct problems (P = 0.08). The disability associated with probable common maternal mental disorders (CMD) also showed statistically significant association (P = 0.02). In the logistic regression, child malnutrition remained associated with child conduct problems and disability associated with probable CMD.

Conclusions

Conduct problems in stunted children are positively associated with CMD and related disability. Longitudinal studies are necessary to confirm these hypotheses.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The projected number and prevalence of dementia in Japan: Results from the Toyama Dementia Survey
Authors: Sekine M. , Suzuki M. , Kido H. , Yamada M. , Tatsuse T.
Published: May 2016

Purposes

The increasing number of dementia is of major public health concern. This study aims to calculate the projected number and prevalence of dementia in Japan, using data from the Toyama Dementia Survey.

Methods

The Toyama Dementia Survey was conducted 6 times in 1983, 1985, 1990, 1996, 2001, and 2014. In the 2014 survey, the subjects were randomly chosen from residents aged 65 or more in Toyama prefecture, with a sampling rate of 0.5%. Of those, 1303 men and women agreed to participate (participation rate: 84.8%). An interview with a screening questionnaire was conducted by public health nurses. Psychiatrists and public health nurses further investigated for the suspected cases of dementia and diagnosed whether the cases had dementia. The 1985–2001 surveys were conducted in a similar way, and, therefore, data from the 1985–2014 surveys were used in the analysis.

Results

The prevalence of dementia in Toyama prefecture increased from 4.7% in 1985 to 15.7% in 2014. Using the age and sex-specific prevalence of dementia in the 2014 survey, the projected number of dementia is approximately 4.8 million (prevalence rate: 14.1%) in 2015, 6.1 million (16.7%) in 2025, and 7.2 million (19.2%) in 2035. Using the age and sex-specific prevalence of dementia as estimated by linear regression models, the projected number of dementia is approximately 4.7 million (13.9%) in 2015, 7.1 million (19.5%) in 2025, and 9.7 million (25.8%) in 2035.

Conclusions

The number of dementia in Japan could double in the next 20 years, which corresponds to 1 in 4 elderly people.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Legal problems and substance use among HIV-infected patients
Authors: Parro Torres C. , Hernández Huerta D. , Ochoa Mangado E. , Madoz Gúrpide A. , Moreno Zamora A.M.
Published: May 2016

Introduction

There are many studies of HIV-infected patients where have found higher prevalence of substance use disorders than in general population. Moreover some factors, like presence of legal problems, substance abuse and HIV are also frequently related with poorer clinical results.

Objectives/aims

The aim of this study is to analyze the relationship between substance consumption and presence of legal problems among HIV-infected patients.

Methods

Our study is a cross-sectional case-control survey. Cases were defined as HIV-infected patients who referred presence of legal problems in a sociodemographic questionnaire. Controls were defined as HIV-infected patients who denied presence of legal problems. Both groups were interrogated about illegal substance use (cocaine, heroin, cannabis, stimulants or benzodiazepines) and alcohol problematic use during previous year. Logistic regression was employed as statistical analysis. Results were adjusted for age, gender and race.

Results

Our sample was compound by 63 patients: 44 controls and 19 cases. A statistical signification was found between illegal substance use variable and presence of legal problems (P = 0.003) but not with alcohol problematic use. The condition of illegal substance use during previous year increased the risk to have legal problems 5.353 times. Another important result was found in gender, the condition of male increased the risk to have legal problems 2.32 times than female condition.

Conclusions

In our sample, substance use (cocaine, heroin, cannabis, stimulants or benzodiazepines) during previous year was related to have more legal problems. Gender, specifically male condition, also was linked with more risk to have legal problems.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
When residents are assaulted
Authors: Nuria N. , San Román A. , Gómez-Coronado N. , Sevillano I. , Hervias P. , Prieto V. , Llanes C. , Puertas S. , González-Pinto A.
Published: May 2016

Introduction and objective

Description through a survey of physical aggressions suffered by Spanish Medical Trainees of all specialties.

Methods

We developed a survey through an online platform that was distributed to all Spanish trainees of all medical specialties. In that survey, we ask residents if they ever have been physically assaulted, for how many times, the year of residence when it occurred, if they have in their hospital an aggression protocol, and if it included a specific topic for trainees. We also asked them about their feelings after they have been assaulted.

Results

We collected 282 answers from the survey. We could observe that 12.9% of respondent trainees had been assaulted as least once. Fifty-one percent of times, it occurs during the first year of residency. Among assaulted residents, 25.5% were psychiatric trainees, and 44.4% were medical trainees, but no psychiatrist. Twenty-three percent were psychiatric trainees, and the 35% of them had been assaulted once. Only 25.2% of the residents knew the aggression protocol of their work center, but the majority (65.5%) did not know it. About how do they feel after being assaulted, most of them responded that they felt anxiety, helplessness, fear and they had even thought of leaving de residency or change it.

Conclusions

Aggressions during the trainee period seems to be prevalent (12,9%). Most trainees don’t even know if there is a aggression protocol in their hospitals, we think that a prevention and supporting guideline should be design for improve this prevalent situation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.