bluuebunny/crossref_metadata_2025 huggingface dataset:
Body image and gender role perceived in gender dysphoria: Cross-sex hormone therapy effects
Authors: Corda E. , Bandecchi C. , Deiana V. , Pintore S. , Pinna F. , Pusceddu R. , Oppo A. , Mariotti S. , Argiolas A. , Carpiniello B.
Published: May 2016

The gender dysphoria (GD) refers to the distress caused by the incongruence between gender identity and biological sex. This occurs, especially in pre-treatment cross-sex hormone therapy (CHT), with a marked dissatisfaction with their body image.

The purpose of this study is to evaluate the role of perceived gender in a total of 20 subjects (9 MtFs and 11 FtMs), presented for initiation of CHT at the Psychiatric Clinic or Department of Endocrinology of University Hospital of Cagliari and deemed appropriate to take the transition path aimed at sex reassignment. On a subsample of 7 patients (2 MtFs and 5 FtMs) were then evaluated changes, in terms of improving the acceptance of body image, at 2 months after initiation of CHT, using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) (focusing on MF, Gm and Gf scale), the Bem Sex Role Inventory (BSRI), and the Body Uneasiness Test (BUT).

The MF scale shows a moderate elevation, which is reduced significantly as a result of correction for perceived gender rather than biological sex. MtFs get higher scores on the Gf scale and lower scores on the Gm scale than FtMs. This trend is confirmed by the average scores of BSRI: MtFs are more “feminine”; while the FtMs are less “masculine”. This denotes an excessive identification by MtFs with the female gender role. Before initiating the CHT, the BUT score was indicative of clinically significant distress, which decreased during the CHT.

In conclusion, CHT reduces evidently body discomfort, due to the progressive reduction of the discrepancy between biological and desired gender.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Military culture and sexual issues: The sex-stress phenomenon
Authors: French L.
Published: May 2016

Introduction

Sex abuse within the military has long been an open-secret afflicting both male and female veterans whose etiology is often attributed to character deficits (personality disorders or paraphilic disorders). Few studies look at the sex-stress phenomenon as a feature of military life itself and the role this plays in sex abuse within the military milieu. While much attention is focused on US forces, this problem in endemic within military cultures per se. The recent sex abuse scandal involving the French military in the Central African Republic illustrates the pervasiveness of the problem.

Objectives/aims

To explore the psycho-cultural mechanisms of stress and its sexual expression and how certain scenarios within the military milieu exacerbates this impulse-control reaction. To address the relationship of the availability of sex-release options – without and/or without the military population (and how increased enlistment of women has changed the nature of the target population in today's military).

Methods

Look at the problem historically (from WWII – present) with particular illustrations. Evaluate common (often failed) approaches to addressing the problem, including the fallacy that superior officer know best how to handle these cases. Explain the psycho/physiology of the sex-stress phenomenon – mechanism of the hypothalamic-pituitary-adrenal-gonad axis. Look at the relationship between sex-trauma and suicides among veterans.

Results/conclusions

Offer a viable assessment/diagnostic of sexual problems within the military culture along with a treatment model that offers both psychotherapeutic (cognitive-behavioral protocols…) as well as identifying acute clinical symptoms that may respond to psychotropic medications.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Diagnostic stability of acute and transient psychotic disorder: A systematic review and meta-analysis
Authors: Díaz Á. López , Rus S. Galiano , Iborte A. Soler , López J.I. Aznarte , González J.L. Fernández
Published: May 2016

Introduction

The validity and diagnostic stability of acute and transient psychotic disorder (ATPD) has been questioned by several authors, since its introduction in the International Statistical Classification of Diseases (ICD-10).

Objective

To determine the overall diagnostic stability of ATPD in scientific literature.

Method

A systematic review and meta-analysis of prospective studies and retrospective chart reviews. Computerized search was performed in MEDLINE/PubMed, EMBASE, and Google Scholar, using the terms: “acute and transient psychotic disorder”, or “acute psychosis”, and “stability”, or “outcome”, or “long-term”, or “follow-up”, or “course”. Search was restricted to works in English published between 1993 and 2015, according to ICD-10 criteria. Opinion articles, individual case reports, researches with less than ten subjects, and overlapping studies were excluded. Data analysis was conducted using MedCalc software, version 15.8. Statistical procedure was calculated for meta-analysis of proportions.

Results

Twenty-six studies met the inclusion criteria (n = 10852). For methodological purposes, a distinction was made between short-term (less than 2 years), medium-term (between 2–7 years), and long-term stability (more than 7 years). For short-term group (k = 5), the overall stability was 60.69% (fixed effects model); Cochran's heterogeneity statistic Q = 14.9, I2 = 73.15%, P = 0.0049. For medium-term group (k = 15), it was 49.99%; Q = 181.6, I2 = 92.29%, P < 0.0001. For long-term group (k = 6), it was 61.86%; Q = 35.12, I2 = 92.29%, P < 0.0001.

Conclusion

The global stability of ATPD indicates at the validity of the construct, but should be redefined in future revisions of ICD, to clarify better diagnostic criteria, and more predictive power.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Post menopausal women's sexual satisfaction: Effect of oral capsule of mixed Tribulus Terrestris, Zingiber Officinale, Crocus Sativus and Cinnamomum Verum: A randomized controlled clinical trial
Authors: Taavoni S. , Nazem Ekbatani N. , Gooshegir S.A. , Haghani H.
Published: May 2016

Sexual satisfaction decreases during postmenopause life and may improve by various methods of complementary therapy such as use of herbal medicine.

Aim

To asses the effect of oral capsule of mixed Tribulus Terrestris, Zingiber Officinale, Crocus Sativus and Cinnamomum Verum on postmenopausal women's sexual satisfaction.

Methods

In this triple blind randomized control clinical trial, 80 healthy volunteer postmenopause women with age 50–60 years old in one of clinics of west of Tehran had been involved (year 2013–2014). Participants were randomly assigned to intervention and placebo group and received one month same shape capsules two times in a day. Tools of this study had two main parts of personal characteristics and sexual satisfaction. All ethical points were considered and approved by Ethics committee of Research Institute for Islamic & Complementary Medicine (RICM, IUMS).

Results

After a month intervention, there is significant increase in the mean score of sexual satisfaction between two groups (P = 0.01), but when sexual satisfaction compared with pre-menopausal time in two groups, t-test results showed no significant difference (P = 0.16).

Conclusions

Use of oral capsule of mixed Tribulus Terrestris, Zingiber Officinale, Crocus Sativus and Cinnamomum Verum two times a day for a month could improve sexual satisfaction in postmenopausal women. Referring to no significant change with comparing premenopause time, it sounds they have same satisfaction as premenopause time. There were no side effects during study and one month follow-up. It is suggested to do same research on sexual satisfaction and function with more month intervention.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Sleep quality among medical students
Authors: Gassara I. , Ennaoui R. , Halwani N. , Turki M. , Aloulou J. , Amami O.
Published: May 2016

Introduction

College students seem to be a population group that is increasingly recognized to be at risk of having sleep difficulties. Some studies revealed that medical students, in particular, are believed to be more stressed and sleep deprived than their non-medical peers.

Aim

The present work aimed at investigating the quality of sleep among medical students at the University College of Medicine in Sfax, Tunisia.

Methods

The study consisted of an anonymous, voluntary survey for a sample of 74 students. A two-part questionnaire was used, including demographic criteria and the Pittsburgh Sleep Quality Index (PSQI), a self-rated instrument that measures sleep habits for a month (a total score of 5 or greater is indicative of poor sleep quality).

Results

The average age was 24 years (range 19–33) with a sex ratio almost equal to 1. In 47.3% of cases, students were married. These latter had at least one child in 34.2% of cases. A total of 39.4% of the students reported being smokers, while 25.6% of them admitted having regular alcohol consumption.

Poor sleep quality was reported by 63.5% of students with a PSQI average score of 9.32 ± 3.64.

The most correlated factors with poor sleep quality were parenthood (P = 0.031), alcohol consumption (P = 0.004) and stressful studies (P = 0.02).

Conclusion

Poor sleep quality was pervasive among surveyed medical students and this seemed to be in relationship with some factors. This study points to the need for further evaluation of medical students’ sleep problems in order to improve their performance and their quality of life as well.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Description of the autolitic acts attended in a mental health unit in 2014
Authors: Alvarez Montoya A.M. , Diago Labrador C. , Ruano Hernandez T.
Published: May 2016

Objective

The objective of the study is the analysis and the description of patients who committed autolitic acts and were attended in a mental health hospital unit in 2014.

Method

We analyze the patient registry for the attended emergencies in our mental health hospital unit, extracting the following variables: gender distribution, age range, type of method applied in the attempt and diagnosis based on DSM-IV TR.

Results

The study reveals a larger share of autolitic acts in the feminine population between 14 and 69 years old. A total of 31 patients needed to be attended in an emergency hospital unit (11.74%). The most common method is the medical substance abuse (23 patients, 74.19% from the admitted patients in our Mental Health Hospitalary Unit). The diagnoses in order of frequency were; affective disorders (13 patients, 41.93%), personality disorders (8 patients, 25.80%), adaptative disorders (7 patients, 22.58%) and psychotics disorders (3 patients, 9.68%).

Conclusion

Our population-based sample confirms the epidemiologic data found in the consulted literature as well as in other population groups.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effects of negative autobiographical memories retrieval on corticospinal excitability and sensorimotor integration
Authors: Mineo L. , Concerto C. , Patel D. , Myorga T. , Coira D. , Chusid E. , Aguglia E. , Battaglia F.
Published: May 2016

Introduction

Previous transcranial magnetic stimulation (TMS) studies indicate that exposing the subjects to an emotionally valent stimulus results in larger motor evoked potentials (MEP). Up to date, no TMS studies have been conducted in order to investigate the effect of personal memories with emotional value on corticospinal excitability.

Objects

To investigate changes in corticospinal excitability and sensorimotor integration induced by retrieval of negative or neutral autobiographical memories (AM).

Aims

To contribute to a further characterization of neural circuits involved during the evocation of negative AM.

Methods

In 12 healthy volunteers, we recorded motor evoked potentials (MEPs) elicited by TMS pulses during the retrieval of negative AM or neutral AM. Furthermore, we also tested Short-interval Intracortical Inhibition (SICI), Intracortical facilitation (ICF), Short and Long afferent Inhibition (SAI and LAI) in the two different experimental conditions.

Results

Retrieval of negative AM induced a larger increase in MEP amplitude (35.01%) compared to neutral AM (F(1,22) = 7.04, P = 0.013). Furthermore we showed that retrieval of Negative AM increasedn ICF (F(1,22) = 5, P = 0.03) and decrease SAI (F(1,22) = 7.04, P = 0.039). The other TMS parameters were different between conditions.

Conclusions

Our results indicate that evocation of negative AM induce a complex modulation of excitatory and inhibitory sensorimotor networks. Further studies are needed to explore the link of these electrophysiological biomarkers with the strength, valence and specificity of negative AM.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Alcohol and substances acute intoxication in a population of suicide attempters
Authors: Di Marco S. , Coppola I. , Delicato C. , Gattoni E. , Venesia A. , Marangon D. , Avanzi G.C. , Castello L. , Gramaglia C. , Torre E. , Zeppegno P.
Published: May 2016

Introduction

The effects of psychotropic drugs and alcohol acute intoxication are important risk factors for attempted suicide among individuals with and without substance use disorder (SUD).

Aims

The first aim of this study is describing the socio-demographic features and clinical history of subjects who were acutely intoxicated when attempting suicide. The second aim is to compare their features with those of subjects without acute alcohol and substances intoxication at suicide attempt time.

Methods

Determinants of ER psychiatric consultations were studied prospectively during the period 2008–2014 at the “Maggiore della Carità” Hospital in Novara, Italy. For each patient, a data sheet was filled in by experienced psychiatrists, in order to gather demographic features, psychiatric history and present clinical issues like blood and urine dosage of amphetamine and methamphetamine, cannabinoid, cocaine and alcohol. Comparison of qualitative data was performed by means of the Chi2 test. Statistical significance was set at P ≤ 0.05.

Results

We collected a sample of 495 suicide attempters who referred to our ER. Statistical analysis of demographic and clinical data is still ongoing.

Conclusions

Preliminary results point out that acute alcohol and drugs intoxication at suicide attempt time is much more frequent in subjects without a SUD. Implications will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Developing interventions for prevention of self-harm for British South Asian women: A qualitative study
Authors: Husain N. , Lunat F. , Gire N. , Bin Bilal Hafi S. , Husain M.I. , Walker T. , Syed A. , Chaudhry N.
Published: May 2016

Introduction

It has been estimated that the global burden of suicide is a million deaths per year (WHO, 2014). Rates of self-harm in British South Asian (BSA) women are higher compared to their white counterparts. Limited evidence is available on effective preventative strategies and culturally sensitive interventions for these patients.

Objective

To understand common perceptions about self-harm, identify any barriers to accessing services and service improvement recommendations including appropriate interventions for BSA women.

Aim

To examine the views of health professionals on the culturally adapted problem solving therapy (C-MAP) in BSA women.

Methods

The design was a qualitative study using focus group discussion. This is part of a larger exploratory trial, to test a culturally adapted problem solving therapy (C-MAP) in British South Asian women who have a history of self-harm (Husain et al., 2011). Three focus groups were held with Asian lay members of the community, health professionals and service users. The data was analysed using a manual content analysis and indexing technique.

Results

Results showed lack of identification of self-harm by health professionals. Common self-harm methods reported were serious overdoses, use of household chemicals, burning and cutting. Lack of trust in GP s was one common reason for non-disclosure of self-harm behaviour. Need for increased awareness, working along with local Imams, better cultural sensitivity among health professionals and non-judgmental support were some solutions offered to address these barriers.

Conclusion

The results of this study have provided insight into developing strategies to prevent and manage self-harm in British South Asian women.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Who are the suicide reattempters?
Authors: Gattoni E. , Gramaglia C. , Delicato C. , Di Marco S. , Coppola I. , Venesia A. , Marangon D. , Castello M.L. , Avanzi G.C. , Torre E. , Zeppegno P.
Published: May 2016

Background

History of previous suicide attempts is one of the most important risk factors for a subsequent completed suicide. Suicide reattempters (SR) has been long associated with demographic and clinical risk factors for suicide, such as unemployment and psychiatric disorders, however a recent review of the literature has not supported a specific age and gender profile of SR, but rather underscored that, as far as diagnosis is concerned, SR were more likely to have a personality disorder. According to literature, 16%–34% of the subjects repeat a suicide attempt within the first 2 years after the previous one.

Aim

The purpose of our study was evaluating clinical and socio-demographic characteristics and the outcome of psychiatric consultation among subjects referring to an emergency room for recommitting a suicide attempt.

Methods

We considered a sample of SR aged > 16 years. We extracted data from the database including all patients requiring psychiatric evaluation in the emergency room, and eventually compared the features of SR and patients with a single suicide attempt. For each patient, we gathered socio-demographic features, psychiatric history and current clinical issues, suicidal intent and suicidal behaviors.

Results

Data collection and statistical analyses are still ongoing. Preliminary results show that, compared to patients with a single suicide attempt, SR were more frequent female, unmarried, employed, with a low level of instruction; they had a psychiatric disease (axis I – anxiety disorder, somatoform disorder; axis II – histrionic personality disorder); they are under the care of mental health services and under psychopharmacological treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Autism and suicidality: Review of risk factors in literature
Authors: Hooijer A. , Sizoo B.
Published: May 2016

Introduction

There is emerging evidence that suicide and suicidal behavior frequently occur in people with autistic spectrum disorders (ASD), although this topic is largely understudied. We have little understanding of suicidal behavior among individuals with ASD and there are no empirical data to guide practitioners in the treatment of suicidality in persons with ASD. There is a need to investigate risk factors associated with suicidal behavior in persons with ASD, to improve prevention strategies and interventions.

Objectives

To get an overview from literature of risk factors for suicidality in individuals with ASD.

Methods

Review of the literature using Cochrane Collaboration Centre, Embase, Medline, PsychINFO, PubMed, and Web of Science.

Results

In the literature, we found that, among already known risk factors like comorbid depression, an underlying vulnerability in personality may be a risk factor for suicidal behavior. Several studies showed that a high score on the temperament factor ‘novelty seeking’ and ‘harm avoidance’ is associated with suicidality. In other studies, where suicidality was not an object of study, adults with ASD showed high scores on ‘harm avoidance’ and low scores on ‘novelty seeking’. This suggests that personality profiles may be of predictive value for suicidality in adults with ASD. A study proposal focused on this possible association be presented.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Optimizing the assessment of suicide attempters with a decision tree
Authors: Lopez-Castroman J. , Delgado-Gomez D. , Courtet P. , Baca-Garcia E.
Published: May 2016

Background

Optimizing psychiatric assessments could help to standardize the use of structured instruments in clinical practice. In recent years, several research groups have applied Computerized Adaptive Tests (CATs) to simplify assessments in depression, anxiety and also suicidal behaviors. We aimed to construct a shortened test to classify suicide attempters using a decision tree methodology that allows the integration of relevant clinical information, namely the history of past suicide attempts, in the construction of the test.

Methods

The sample was composed of 902 adult participants in three subsamples: first-time suicide attempters, psychiatric inpatients that never attempted suicide and healthy controls. The performance of a decision tree built using the items of a previously developed scale for suicidal risk was examined. The history of past suicide attempts was used to separate patients in the decision tree. The data was randomly divided in a training set and a test set. The test set, that contained 25% of the data, was used to determine the accuracy of the decision tree. Twenty-five cross-validations of this set up were conducted.

Results

The first four items of the decision tree classified correctly 81.4% of the patients.

Conclusion

As a result of a methodology based on decision trees that, contrary to CATs, can incorporate relevant information in building the test we were able to create a shortened test capable of separating suicidal and non-suicidal patients. Using all the information that is available improves the precision and utility of instruments adapted for psychiatric assessments.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Attempted suicide attention at an emergency room: A hospital-based descriptive approach
Authors: Torres D. , Martinez-Ales G. , Quintana M. , Pastor V. , Bravo M.F.
Published: May 2016

Introduction

Suicide causes 1.4% of deaths worldwide. Twenty times more frequent, suicide attempts entail an important source of disability and of psychosocial and medical resources use.

Objective

To describe main socio-demographical and psychiatric risk factors of suicide attempters treated in a general hospital's emergency room basis.

Aims

To identify individual features potentially useful to improve both emergency treatments and resource investment.

Methods

A descriptive study including data from 2894 patients treated in a general hospital's emergency room after a suicidal attempt between years 2006 and 2014.

Results

Sixty-nine percent of the population treated after an attempted suicide were women. Mean age was 38 years old. Sixty-six percent had familiar support; 48.5% had previously attempted a suicide (13% did not answer this point); 72.6% showed a personal history of psychiatric illness. Drug use was present in 38.3% of the patients (20.3% did not answer this question); 23.5% were admitted to an inpatient psychiatric unit. Medium cost of a psychiatric hospitalization was found to be 4900 euros.

Conclusion

This study results agree with previously reported data. Further observational studies are needed in order to bear out these findings, rule out potential confounders and thus infer and quantify causality related to each risk factor.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Immigration and suicide in Spain: Literature review
Authors: Rodrígue Vargas S.
Published: May 2016

Objectives and method

Although it is increasingly an immigrant country, we can not forget that for years has been a world leader as a meeting place of many nationalities. It has carried out a review of the literature about the number of suicides that occur in the immigrant population of our country.

Results

Cultural factors that influence suicidal behavior are religion, socio-demographic factors (inverse relationship between socioeconomic status and suicide attempts), conflicts, alcohol/drugs, and social and family support as emigration entails fostering emotional and cultural rootlessness isolation and increased risk. Stresses in young Filipinos (20%) and American Indians (19%) than for any other ethnic group. Among the immigrants, I returned to their country of origin, the Germans have a 30% rate of suicides. And if we consider the length of stay, a clear decrease in rates seen since the frequent change of residence results in an increased risk. In the comparison of nationality and gender, it shows that the rate for suicides is very high among Moroccan women aged between 10 and 24 years.

Conclusions and discussion

Migration can alter the development and adaptation of people and sometimes increase the risk of suicide especially when migration occurs alone. Attempted suicide is an exceptional crisis that requires special attention. Progress in research will deepen the psychological effects of migration in adults and in children migrated.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Online mindfulness as therapy for fibromyalgia patients
Authors: Garrido-Torres N. , Viedma A.S. , Rodriguez A. , Reina M. , Fernandez S. , González C. , Prieto I.
Published: May 2016

Introduction

Fibromyalgia is a chronic disease. This diagnosis has been controversial in scientific society. However, there is one fact: there are women who feel not only uncontrollable and non-specific body pain, but also psychological symptoms.

Objective

To compare the efficacy of online sessions versus in onsite sessions. To demonstrate that online mindfulness sessions could help to reduce pain in patients with a diagnosis of fibromialgya.

Method

A website created to give education and advice to women with fibromyalgia related to the disease was used as a platform to offer online mindfulness sessions.

Two hundred and thirty-four patients with fibromyalgia asked to participate in the online sessions, but only 13 were included in the study. Nineteen other women received onsite mindfulness sessions. Patients were evaluated before and after intervention. Two analyses were undertaken: intragroup and intergroup.

Results

No differences were found between online mindfulness session and onsite mindfulness session. In both cases, an improvement in the questionnaire scores was demonstrated. Mindfulness as a kind of psychotherapy helped patients to control pain and symptoms of anxiety.

Discussion

The new ICTs offer a huge of possibilities in medicine and mental health. With respect to psychiatry, not only intervention, like psychotherapy, can be offered but also psychoeducation. However, there are factors such as age and educational level that make online intervention difficult.

Conclusion

In the near future, most people will interact with technology and it would be easier to supply online interventions and psychoeducation e-patients already exist, so e-doctors and e-psychiatrists should be online soon.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Online psychoeducation: E-patients are looking for e-doctors
Authors: Garrido-Torres N. , María R. , González C. , Hernandez L. , Rodríguez-Santana L. , Torres-Sánchez S. , Prieto I.
Published: May 2016

Method

A website was designed to offer psychoeducation and advice to women who demand more information about health after traditional visit to GPs. A total of 564 patients visited the website in three months. Women asked for information and interacted with different topics on the platform. Only the women who completed all the form (age, previous diseases, current treatment) were analyzed. A total of 226 e-patients were included.

Results

The most demanded information was about: excess weight, fibromyalgia, depression, anxiety, bipolar disorder and the menopause although other topics related to medicine such as HTA, breast cancer, and pregnancy were part of the website contents.

Discussion

Even when many topics about medicine were available on the website, women were more interested in, and showed the need for information about mental health.

Online psychoeducation could help the clinician to save time at the personal consultation and could be especially useful in following the patient for a long time.

However, there are technological barriers and at least one first face-to-face interview is required in complicated cases to determine a correct diagnosis.

Conclusions

A high demand for e-mental online health education does exist. It would be useful for professionals to be trained in information technology in order to cover that demand and avoid misinforming patients.

It would be interesting to undertake a meta-analysis with all the studies around the world and determine the profile of the patient that could be helped through online attention.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
TechCare: Mobile-assessment and therapy for psychosis: An intervention for clients within the early intervention service
Authors: Gire N. , Chaudhry I.B. , Naeem F. , Duxbury J. , Riley M. , McKeown M. , Taylor C.D. , Taylor P.J. , Emsley R. , Caton N. , Kelly J. , Kingdon D. , Husain N.
Published: May 2016

Introduction

In the UK, mental illness is a major source of disease burden costing in the region of £105 billion pounds. mHealth is a novel and emerging field in psychiatric and psychological care for the treatment of mental health difficulties such as psychosis.

Objective

To develop an intelligent real-time therapy (iRTT) mobile intervention (TechCare) which assesses participant's symptoms in real-time and responds with a personalised self-help based psychological intervention, with the aim of reducing participant's symptoms. The system will utilise intelligence at two levels:

– intelligently increasing the frequency of assessment notifications if low mood/paranoia is detected;

– an intelligent machine learning algorithm which provides interventions in real-time and also provides recommendations on the most popular selected interventions.

Aim

The aim of the current project is to develop a mobile phone intervention for people with psychosis, and to conduct a feasibility study of the TechCare App.

Methods

The study consists of both qualitative and quantitative components. The study will be run across three strands:

– qualitative work;

– test run and intervention refinement;

– feasibility trial.

Results

Preliminary analysis of qualitative data from Strand 2 (test run and intervention refinement) in-depth interviews with service users (n = 2) and focus group with health professionals (n = 1), highlighted main themes around security of the device, multimedia and the acceptability of psychological interventions being delivered via the TechCare App.

Conclusions

Research in this area can be potentially helpful in addressing the demand on mental health services globally, particularly improving access to psychological interventions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pregabalin augmentation in the treatment of borderline personality disorder with partial therapeutic response – case report
Authors: Duisin D. , Milovanovic S. , Batinic B.
Published: May 2016

Introduction

Emotional dysregulation is one of the core problems of borderline personality disorder (BPD). Forty-one year-old married female diagnosed with BPD at the age of 21, was admitted to the partial hospitalization unit due to a depressive symptoms and emotional dysregulation and poor overall functioning.

Objective

Patient was previously treated with numerous psychotropic agents: antipsychotics (AP) – fluphenazine, levomepromazine, risperidone, clozapine; antidepressants (AD) sertraline, mirtazapine, maprotiline, amitriptyline; psychostabilizers – carbamazepine/valproate) without achieving the full therapeutic response. After switching to combination of clomipramine and aripiprazole, we have reached partial clinical response.

Aim

The aim of this treatment was to improve clinical response and achieve emotional stability by augmentation with neuromodulator pregabalin.

Method

Augmentation strategy was realized by gradual titration and tapering of pregabalin (300 mg/d) over a two-week period. We started with pregabalin dose of 75 mg/d, followed by gradual increase to the dose of 300 mg/d. The Beck Depression Scale (BDS) and the Emotional Dysregulation Scale-short form (EDS) have been used for efficacy monitoring.

Results

Mental state before augmentation therapy: the BDS (score 30-moderate depression) and the EDS-short form (score 127). Parameter status after augmentation with pregabalin: BDS score 16-mild mood disturbance, EDS score 87.

Conclusions

Augmentation strategy with pregabalin have improved emotional control, maintained affective and behavioral stability, with significant reduction of feelings of emptiness, as well as the achievement and maintaining of emotional attachment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Long-acting injectable aripiprazole. Clinical experience in a case series
Authors: Sánchez J.M. Hernández , Botello M.C. Cancino , López M.F. Molina , Serrano D. Peña , Vera M. Machado
Published: May 2016

Introduction

The use of long-acting injectable antipsychotics is useful in patients with low therapeutic compliance.

Objective

To present the demographic and clinical data of a case series in which long-acting injectable aripiprazole has been prescribed in an ambulatory Mental Health Center.

Methods

Systematic review of the related literature and clinical history of patients in which long-acting injectable aripiprazole had been prescribed from January to March 2015 in a Mental Health Center.

Results

We found 10 patients, whose diagnosis were schizophrenia (4), non-specified psychosis (2), personality disorder (1), bipolar disorder (1), schizoaffective disorder (2), of whom 7 were men and 3 women, with a mean age of 43.8 years old. The mean of years since diagnosis was 15.1 years. In 7 patients, we found concomitant treatment with another antipsychotic agent (low dose quetiapine in all of them); antidepressants in 1 patient, benzodiazepines in 6; mood stabiliser in 5 and biperidene in 1. In relation to previous antipsychotic drugs, we found: aripiprazole 15 mg/day oral (4); long-acting injectable paliperdidone 150 mg/28 days (2) paliperdone 6 mg/day oral (1); combination of paliperidone 6 mg/day oral plus olanzapine 5 mg/day oral (1). Only 4 patients had used long-acting injectable drugs previously in their lifetime. The reason of having initiated treatment with long-acting injectable aripiprazole was sexual disturbance (3); lack of compliance (4); clinical inestability (2) and motor side effects (1).

Conclusions

In our series, we can observe a chronic patient profile, predominantly men with diagnosis of psychotic spectrum.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Uncommon effects of clozapine
Authors: Jerónimo J. , Santos J. , Bastos L.
Published: May 2016

Introduction

Clozapine is the first option for treatment-resistant schizophrenia, affecting about 20–30% of all patients. Weight gain, sedation, hypotension and hypersalivation are common and well-known adverse effects associated with clozapine. However, it is also important to be aware of uncommon adverse effects, like parotitis.

Objective

We report a case of clozapine-induced parotitis.

Methods

Literature was accessed through Pudmed, using the search terms parotitis and clozapine.

Results

A 36-year-old male with paranoid schizophrenia, whose psychotic symptoms have responded only slightly to two antipsychotic trial, with both haloperidol and olanzapine. Therefore, he began treatment with clozapine with the dose titrated to 400 mg/day. At first, the only registered adverse effect was hypersalivation. Eventually, after 3 months of treatment, he developed a unilateral swelling of the left parotid gland. Bacterial and viral parotitis were ruled out and the diagnosis of clozapine-induced parotitis was evoked. Patient scored 5 in the Parotitis-Specific Criteria Modified Naranjo Probability Scale. Symptomatic medication was initiated with paracetamol and a non-steroidal anti-inflammatory with a favorable outcome.

Conclusion

There are few reports of clozapine-induced parotitis, a very rare and poorly known adverse effect with an unknown pathophysiology. Early recognition and proper management are essential to reduce morbidity associated with the treatment. There is no consensus how to manage these adverse effect, however, generally it is not necessary to discontinue the treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Lamotrigine induced DRESS syndrome in bipolar disorder: Multiple snares behind a potentially life-threatening adverse reaction
Authors: Oriolo G. , Brugués A. , Goikolea J.M. , Pintor L.
Published: May 2016

Background

Lamotrigine is widely used to prevent bipolar depression. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare, potentially life-threatening adverse effect. The long latency between drug exposure and disease onset, added to the high variability of its clinical presentation, can increase the risk of misdiagnosis lamotrigine withdrawal delay.

Objective

To highlight potential risk factors that can be related to a worse clinical onset and evolution of lamotrigine-induced DRESS syndrome.

Methods

We report the case of a 25-year-old-man, with a type I bipolar disorder, treated with lithium and lamotrigine 50 mg per day during the first 13 days of treatment, progressively increase up to 200 mg. Thirty-five days after the treatment initiation, a pruritic rash appeared in his upper arms, and scabies infestation was diagnosed. After 72 hours, the patient required urgent hospitalization due to hemodynamic instability.

Results

On admission, facial edema and erythrodermia were involving 70 to 80% of the body surface. DRESS diagnosis due to lamotrigine was made following RegiSCAR criteria (Table 1). Psychiatric medication was stopped and DRESS treatment established. Complete recovery without recurrence was achieved after 2 months.

Conclusions

The lamotrigine up titration faster than recommended may have facilitated the DRESS syndrome reaction. Moreover, the latency between lamotrigine introduction and the rash onset could have increased the possibilities of misdiagnosis. In light of this, physicians need to consider at least the last 3 months treatment history when assessing a rash, as the delay of DRESS syndrome diagnosis can fastly lead to a fatal event.

Table not available.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Acute dystonia and dyskinesia progressing in the patient with fibromyalgia upon the use of duloxetine
Authors: Tüz C.
Published: May 2016

Purpose

In this article, a case who was prescribed duloxetine (30 mg capsule) upon the fibromyalgia diagnosis by a physical therapist and had acute dystonia and dyskinesia after approximately 1.5 hours from duloxetine intake shall be presented.

Case

It was learnt that a married female patient aged 38 consulted a physical therapist with the complaint of back pain and duloxetine (30 mg capsule) was prescribed. It was reported that, the patient applied to our hospital with the compliant of involuntary movements around the mouth, on the lips and neck, spasm, inability to open the mouth completely, spasm in jaw, gritting teeth, mumbling and aphasia after approximately 1.5 hours from her duloxetine intake. The patient was conscious. Her psychomotor activity was natural. As a result of cranial MR, EEG, BT examinations hemogram and the routine biochemistry examinations, any abnormality in zinc and iron levels was not detected. Complaints of the patient regressed after 1 hour from the discontinuance of duloxetine and the administration of biperiden 5 mg/mL ampoule 1000 cm3 in SF. After 72 hours, any symptoms were not found.

Discussion

Dopamine neurotransmission can be inhibited through the increase in serotonin and norepinephrine. Additionally, dystonia may originate from the prevailing of noradrenaline as a result of the failure of dopaminergic–noradrenergic balance.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Women coping strategies to infertility stress can impact IVF outcome
[EV1356]
Authors: Kitanovic B. , Tulic L.
Published: May 2016

Infertility is defined as a failure to achieve a pregnancy after a woman has
attempted to get pregnant for more than 12 months. The impact of psychosocial
factors on IVF outcome is a growing field of research. This is the first study
estimating the impact of psychosocial stress and women coping on IVF outcome in
Serbia. The aim of this pilot investigation was to assess the influence of
psychological factors on the outcome of in vitro fertilization in Serbian women.
Psychometric tests were administered at the first visit to 100 women undergoing
IVF treatment at Clinic of Gynecology and Obstetrics, Clinical centre of Serbia,
University of Belgrade, Serbia. We used questionnaire that covered key
demographic and obstetric information and Serbian version of COMPI test,
specially designed test measuring stress in infertility, as well as, Zung
Depression Self-Rating Scale and Beck Anxiety Inventory. Results of pregnant and
non-pregnant group were compared. In the cohort of Serbian women, it has been
remarked that they predominantly use active confronting coping style. We found
statistically significant differences ways of coping styles between pregnant and
non-pregnant group. Women from the pregnant group had significantly lower scores
of marital distress, and significantly higher use of meaningbased coping styles.
It is found that the use of active avoidance coping correlates negatively with
the level of depression and personal, marital and social distress. Clinicians
should be aware that infertility is a stressor itself and that coping strategies
can influence IVF outcome. Therefore, psychosocial assessment should be a part
of an IVF unit.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Examining the person X situation interactions of internalized traits, state body affect and upward comparison behaviour
Authors: Rogers A. , Lewis V. , Krug I. , Fuller-Tyszkiewicz M.
Published: May 2016

Objective

Although the influence of trait internalization and state body satisfaction on appearance comparisons has been well documented, their interactive influence on comparison behaviours is unknown. Therefore, the present study thus tested a person X situation model in which both mood state and trait internalization interacted to predict engagement in upward comparisons.

Method

One hundred and forty-eight women aged 18 to 40 completed baseline measures of trait internalization, and then completed via iPhone app an experience sampling phase in which they reported momentary experiences of mood and comparison behaviours at up to 6 random times daily for 7 days.

Results

Multilevel analyses revealed that although upward comparisons were more likely for individuals who internalized the thin ideal (t = 3.27, P < .001), this effect was minimized in instances when a participant was satisfied with her appearance (t = –1.90, P = .031). Further exploratory analyses showed that state body satisfaction was a stronger predictor than trait internalization of comparison behaviours (R2 = .14 vs. R2 = .11) when the time lag between state body satisfaction and comparison event was less than 2 hours, but this pattern reversed as the time lag between state level predictor and outcome increased beyond 2 hours (R2 = .09 vs. R2 = .12).

Conclusions

Present findings suggest that bolstering one's body satisfaction in the moment may be as clinically important as reducing a client's interest in the thin ideal for alleviating occurrence of unhealthy body comparisons.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychosis due to traumatic brain injury – controversies and diagnoses difficulties
Authors: Amorim A.
Published: May 2016

Introduction

A traumatic brain injury (TBI) can cause numerous psychiatric complications. Humor and anxious disorders, personality disorders and psychoses are some of those possible problems. The diagnosis of psychosis due to traumatic brain injury (PDTBI), although controversial, has been subject of crescent debate and the idea that a TBI could cause a psychosis is gaining credibility. Diagnosing a PDTBI can be difficult. DSM-5 criteria are rather vague and there are many potential confounding factors due to similarities with other etiological psychosis.

Objectives and aims

Alert clinicians to the diagnosis of PDTBI, clarify this clinical entity and define features that may allow them to do the differential diagnosis with other etiologic psychotic disorders.

Methods

The authors performed a research in PubMed using the keywords psychosis and traumatic brain injury and selected the adequate articles to meet the objectives proposed.

Results

Differential diagnosis of PDTBI should be done with schizophrenia, schizoaffective psychosis, delusional disorder, substance-induced psychosis, psychosis due to other medical condition and with posttraumatic stress disorder. Differentiating PDTBI and schizophrenia can be particularly difficult. Some features have been proposed in the literature as potentially differentiating, namely the presence of negative symptoms (more common in schizophrenia), findings in MRI/CT and EEG.

Conclusions

Establishing PDTBI diagnosis can be difficult. While awaiting new studies, clinicians should, in cases of TBI related psychosis, achieve a meticulous clinical history and mental exam, in order to ensure a correct diagnosis and, therefore, determine an appropriate intervention.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Cyclic vomiting syndrome
Authors: Cano Ruiz P. , Cañas Fraile S. , Gómez Peinado A. , Sánchez García M.D.
Published: May 2016

Introduction

Cyclic vomiting syndrome (SVC) is a functional gastrointestinal disorder characterized by paroxysmal episodes of vomiting, recurrent and cyclical presentation. Although this disorder was first described in children, recently it has increasingly been recognized in adults.

Objective

To know the pathogenesis of the syndrome and the optimum approach.

Method

Theoretical review and cyclic vomiting syndrome brief statement of a case. This is a man of 51 years for 7 months has repeated episodes of vomiting often than 1 episode for week, with vomiting every 10–15 minutes. The patient is admitted to the neurology department for endless instability and multidirectional nystagmus and right hemispheric deficiency symptoms, with acute renal failure prerenal rehydration and study. While entering data semiotic Wernicke disease are objectified. With replacement therapy meeting evolves favorably at the time of discharge from hospital asymptomatic.

Discussion

CVS, in conclusion, is a rare disease in adults whose diagnosis is one of exclusion. The adult presentation usually presents more durable, less frequent episodes. The pathogenesis remains unknown. The optimal treatment is to establish prophylactic migraine medications like amitriptyline. In the prodromal phase, it could be used ketocorolaco or sumatriptan and in the acute phase, ondansetron or lorazepam. Because of the morbidity associated with CVS, in particular the severity of symptoms, it is necessary to conduct more studies in adults.

Disclosure of interest

The authors have not supplied their declaration of competing interest.