bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive-behavioral therapy for bipolar disorder
Authors: Abreu T.
Published: May 2016

Introduction

Bipolar disorder is a chronic disease with a major impact on patient's functioning and quality of life, not only during episodes of mania/hypomania or depression, but also during euthymic periods. In recent years, it has been noticed that pharmacotherapy, albeit its great value, is not enough to prevent recurrences of the disease. Therefore, it has been a greater investment in psychosocial interventions as adjuvant treatment. The utmost studied of these interventions is Cognitive-Behavioral Therapy (CBT).

Objectives and aims

Gather information about the efficacy of CBT in bipolar disorder.

Methods

Literature review.

Results

Several studies have compared groups of bipolar patients submitted to CBT to controls submitted to treatment as usual. The methods and size of samples differ, but the results are in general concordant. Individual or group CBT has had positive results in reducing symptoms, increasing the euthymic periods, decreasing duration of episodes and improving global functioning and quality of life.

Conclusions

There are limitations on the application of CBT in bipolar patients, mainly the decrease of its effects over time; less efficiency in patients with more severe disease; major impact on depressive symptoms than manic; and lack of human resources trained to apply these techniques. Notwithstanding these limitations, the demonstrated gain in the use of CBT on bipolar disorder is evident; hence, investment in this area is undoubtedly important.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Influence of art therapy in complex treatment on the quality of remission in patients with recurrent depressive disorder
Authors: Korostiy V. , Hmain S.
Published: May 2016

Introduction

According to studies done in recent years regarding the treatment of patients with recurrent depressive disorder, a shift of interest from studies evaluating the effectiveness of therapy to the study of remission is seen. According to the literature, complete remission occurs in only 40–50% of patients, in other cases there is residual symptoms.

Aims

Evaluating the effectiveness of art therapy in treatment in patients with recurrent depressive disorder on the quality of remission.

Methods

The study involved 135 patients: 60 male and 75 female patients aged from 18 to 30 years old. The main group of patients apart the combined treatment also participated in group art therapy with the use of drawing techniques, while the control group – statutory standard therapy. We used clinical, psychopathological, psychodiagnostic and statistical methods.

Results

The results of the effectiveness of art therapy in complex treatment in patients with recurrent depressive disorder is detected primarily in reducing of the level of anxiety at the early stages of treatment, as well as in reducing of the severity of anhedonia and improving the quality of life in remission period.

Conclusion

These results support the use of art therapy in treatment in patients with recurrent depressive disorder during period of active treatment, and after achieving clinical remission contributes to achieving and maintaining high-quality and stable remission with full restoration of quality of life and social functioning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychotherapy of somatoform disorders
Authors: Kudinova O.
Published: May 2016

In Ukraine there is tendency to increased deseaseness and prevalence's of somatoform disorders.

The most significant role belongs to the patient's self-evaluation of the influence of the disease on their social status that is an essential past of the self-picture of the disease and the important point of therapeutic rehabilitation intervention.

On the basis of the examined 300 patients on somatoform disorders and 200 patients on psychosomatic diseases, we have elaborated a formal test that allows evaluating quantitatively the influents of the disease on various spheres of patients’ social status.

It was absolutely unexpectable the common for psychosomatic and somatoform disorders patients rise of significance of personal individual, every day life factors in cases of aggravation of the main disease course. We created the cognitive-behavioral psychotherapy system with suggestive and autosuggestive implementations.

Elucidation of peculiarity of personal perception of the disease served as basis of elaboration of purposeful system of psychotherapy, consulting, psychological support for patients with high-effectiveness 1.5–3 years catamnesis in 85% patients.

Our experience showed the necessity of the use the target-oriented integrativе models of psychotherapy, parted on stages. On the first stage-sedative-adapting the receptions of cognitive and suggestive psychotherapy are used. There is group therapy on second stage. On the third stage elements of the autogenic training mastered.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Introduction to systemic family therapy
Authors: Peñuelas Calvo I. , Sevilla Llewellyn-Jones J. , Cervesi C. , Sareen A. , Gonzalez Moreno A.
Published: May 2016

Introduction

In the past six decades, extensive research has been done on family therapy from different areas of knowledge such as psychology, psychiatry and social work. Leading to development of different intervention techniques and optimal clinical evaluation with families.

Aims

The systemic perspective focus on the study of the dimensions that contribute to the stability and consistency of the members of the family system. The family is an interrelated system, dependent on each other, where there is an influence of the group over the individual, which is why each of its members plays a pivotal role in family therapy. Throughout all these years of evolution of systemic family therapy, many different concepts and techniques have been used, including the ones currently used today.

Methods

Knowing the evolution of the different techniques allows us to understand the functioning of families, for example, their links and the elements that constitute it: their roles, the functions performed by each member in the family, communication, standards and power relations.

Conclusions

The descriptive diagnosis of family ties, help us implement intervention strategies that could improve clinical care and diagnostic approach.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
False memory syndrome: A review and emerging issues, following a clinical report
Authors: Santos G. , Costa V.
Published: May 2016

False Memory Syndrome (FMS) is caused by memories of a traumatic episode, most commonly childhood sexual abuse, which are objectively false, but in which the person strongly believes. These pseudomemories usually arise in the context of adult psychotherapy and are often quite vivid and emotionally charged. FMS is rare and sometimes could be confused with psychotic disorder and malingering. The infrequency with which it is encountered makes this syndrome a diagnostic challenge. Failure to diagnose can lead to significant morbidity.

We studied a 26-year-old female with no prior Psychiatric history who started to recall vivid memories of sexual abuse perpetrated by her father, following few sessions of clinical hypnosis. She presented a low mood, disorganized behaviour and aggressivity towards her father when she was admitted to our ward. After a normal CT brain scan and lab tests and a meticulous clinical history, the clinical diagnosis was made. She was successfully managed with supportive psychotherapy combined with mood stabilizer medications.

This case illustrates the unknown field between memory and confabulation and the value of a complete history. Physicians should be alert and keep an open mind about this iatrogenic disorder. Research is needed on the identification of memory mechanisms, specific situations and personality factors involved in this syndrome.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Factors associated with non-show to first therapeutic appointments in a mental health clinic in Northern Israel
Authors: Elyashar L. , Vadas L. , Reshef A. , Bloch B.
Published: May 2016

Introduction

Patient non-show to clinical appointments is a major component of nonadherence, specifically in mental health institutions, being twice that of non-show in other medical specialties, and is associated with a greater risk of morbidity and mortality.

Aims and objectives

Our study was conducted to assess the rate and factors associated with missed first appointments in an outpatient mental health clinic, in order to find correlates between the various factors and the probability of non-show among newly referred patients.

Methods

This was a retrospective study of 400 consecutive outpatients referred to a single regional mental health clinic in northern Israel during 9 months. Data was collected on sociodemographics, attendance rates, source of referral, the presence of chronic physical illnesses and time elapsed between referral to appointment. The findings were statistically analyzed to identify factors associated with patient non-show rate.

Results

Of the 400 patients included in the study, the non-show rate was 39.6%. Patients who missed appointments were significantly more likely to be younger, to belong to the Arab sector and to wait longer for their appointment. They were less likely to be physically ill. Gender, marital status and source of referral were not significantly associated with the non-show rate.

Conclusions

Given the problematic potential outcome of non-show to mental health clinics, it is important to identify high-risk factors associated with non-show and unique to the population in question, so that interventions can be targeted at them, thus improving treatment outcome and reducing risk to patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Establishing a physical health monitoring service for patients on depot antipsychotic medication
Authors: Gill M. , McCauley M.
Published: May 2016

Introduction

Patients with major mental illness are recognised to be at risk of premature death for a multitude of reasons. Those with schizophrenia and bipolar disorder are at highest risk.

Objectives

International best practice recommends monitoring of blood tests, physical parameters such as weight, BMI, waist circumference and blood pressure, and side effects of patients prescribed antipsychotic medication. A clinic was established to target these interventions.

Aims

This initiative aimed to improve the physical health monitoring of patients prescribed depot antipsychotic medication in a catchment area of approximately 36,000 in Ireland.

Methods

A twice-yearly, multidisciplinary monitoring clinic was established. A protocol was drawn up, following a literature review and inspection of current international guidelines, and a proforma assisted as an aide-mémoire. A self-report questionnaire, the Glasgow Antipsychotic Side Effect Scale, was used to enquire about side effects.

Results

Evaluation took place in descriptive form with audit used to examine outcomes. Full blood test monitoring improved from 9% of patients to 61% in one year, with 78% of patients having had at least one blood test recorded. Prior to the clinic's establishment, only one patient had had any physical parameters recorded, but this improved to 96% recorded after the clinics were run. Side effect documentation also improved.

Conclusions

The clinic was well-received and led to improved teamwork. Future recommendations include organising the clinic so as to include simultaneous blood testing. A similar project is being planned to target all patients attending who are prescribed antipsychotic medication.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
How much longer will a patient stay in acute unit if mechanical restraint is required?
Authors: Grifell M. , Galindo L. , Dinamarca F.N. , Chavarría V. , Pérez E. , Salgado P. , Pérez V.
Published: May 2016

Introduction

Mechanical restraint is a therapeutic procedure commonly applied in acute units in response to psychomotor agitation. Its frequency is between 21 and 59% of patients admitted. These patients represent a risk to both themselves and for health workers. In order to implement measures to prevent agitation and therefore mechanical restraint, it is important to quantify the effects and costs of those procedures. The aim of this study is to determine whether the application of mechanical restraint in psychiatry acute unit is related to a longer stay in hospital.

Material and methods

We reviewed retrospectively the informatics record of all the mechanical restraints made and the total discharges of the three acute care units and dual disorders of our institution, between 2012 and 2015. For every discharge, the presence of at least one mechanical restraint was coded, resulting in two groups. The length of stay of the groups was then compared performing a t-test.

Results

The number of discharges analyzed was 4659 from which 838 had an episode of mechanical restraint associated. There are significant differences between the length of stay of admissions with and without episode of mechanical restraint. The episode of mechanical restraint during an admission is associated with 5 to 9 more days of stay in the unit (P < 0.001).

Conclusions

The performance of a mechanical restraint is associated with a statistically significant and clinically relevant higher length of stay. These results suggest that preventing agitation, and therefore mechanical restraint, would be possible to decrease length of stay, and therefore costs related to hospitalization.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
An evaluation of the EOLAS psychoeducation programme for service users: An innovative approach to collaboration between clinicians and ‘experts by experience’
Authors: Gibbons P. , Higgins A. , Hevey D. , Monahan M. , O’Connor C.
Published: May 2016

Introduction

Psychoeducation for service users has been shown in several recent meta-analyses to improve adherence with treatment, decrease rehospitalization rates and improve various measures of quality of life. The 8-week EOLAS Programme for service users with schizophrenia or bipolar disorder is unique in being designed, co-facilitated and evaluated collaboratively by both clinician and peer representatives. EOLAS forms part of the service plan of the national Health Service in Ireland.

Aims and objectives

To evaluate the impact of the EOLAS programme on participants’ perceived knowledge, confidence, advocacy, recovery attitudes and hope.

Methodology

Anonymised questionnaires were administered to participants before and after completion of the EOLAS Programme.

All survey participants were invited to attend for interview to examine qualitatively their experience of the programme. Interviews were recorded and subjected to thematic analysis.

Results

Forty-five subjects completed pre- and post-programme questionnaires (participation rate = 55%).

Significant improvements (P < 0.05) were identified across each of the 5 domains examined (i.e. perceived knowledge, confidence, advocacy, recovery attitudes, hope). Expressed satisfaction with the programme was high (95%).

At interview, participants (n = 12) particularly valued:

– the opportunity to ask questions of the psychiatrist e.g. about medication;

– improving self-care skills e.g. monitoring early warning signs of relapse;

– co-facilitation by a peer, which provided extra credibility and inspired hope;

– sharing experiences with peers.

Conclusions

The EOLAS programme succeeds in meeting the needs of the participants across the target domains. This success depends on the unique collaboration between clinicians and peer experts on which EOLAS is based.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Attitude toward medication as a predictor of therapeutic adherence. Importance of psychoeducation on treatment
Authors: González Soria C. , Fombellida Velasco C.I. , Fernández Martín L.C. , Sánchez Pernas L. , Al Chaal Marcos L. , Alonso León L. , De La Mata Hidalgo R. , Valriberas Herrero I.
Published: May 2016

Introduction

Between 25–50% of psychiatric patients are non-compliant with their pharmacological treatment. When differences between compliant and non-compliant patients were analyzed, differences were found in relation to their beliefs and feelings about medication. The Drug Attitude Inventory (DAI) was created to measure attitudes towards medication in adults. It predicted adherence in schizophrenia and depression studies.

Objective

Determine if psychotherapeutic and psychoeducational activities – during a partial hospitalization at the Psychiatric Day Hospital – can improve aspects related to feelings and thoughts about medication.

Method

We gathered retrospectively a sample of 151 patients hospitalized at the Psychiatric Day Hospital, from September 2013 to June 2015. Their thoughts and feelings about medication were measured with the DAI before and after the hospitalization. From the sample of 151 patients, 94 completed both tests, excluding who did not have the final DAI score. Differences between initial and final scores were statistically analyzed with the Wilcoxon test for paired samples.

Results

Of the 94 patients who completed the study, 52 showed an improvement in their DAI score, whereas the remaining 27 showed an equal or decreased final DAI compared to initial evaluation. The difference was statistically significant (P ≤ 0.05).

Conclusion

It seems that psychoeducational activities related to medication are important in order to reconsider or modify feelings and thoughts about treatment. Information on medication provided to psychiatric patients (to those who need psychopharmacological treatment), carried out in a group context, which facilitates an open and sincere communication, can be a useful strategy to improve compliance with treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Consumption of medicines for attention deficit hyperactivity disorder treatment per patient in children and adolescents in Slovenia from 2003 to 2012
Authors: Stuhec M. , Vedernjak U. , Igor L.
Published: May 2016

Background

According to the attention deficit hyperactivity disorder (ADHD) treatment guidelines, atomoxetine (ATX) is a second line treatment after stimulants and therefore a serious monitoring of ATX prescribing is necessary to avoid inappropriate prescribing.

Objectives

In most countries in Central Europe, except Germany, there is no data on drug consumption for ADHD medicines (expressed in defined daily dose (DDD)/ADHD patient/year).

Aim

The main purposes of this study were: calculate and present the pattern and evolution of national consumption in Slovenia expressed in the percentage of DDD/patient/year consumption for the period 2003–2012.

Methods

The national consumption and population data for this period were obtained from Slovenian databases. A DDD/ADHD patient/year was calculated. Only immediate-release methylphenidate (IR-MPH), methylphenidate-osmotic release oral delivery system (OROS-MPH) and ATX have been available and included in this study.

Results

Less than 50% of patients with ADHD are treated with medications in Slovenia. A total consumption rose rapidly from 41.3 in 2003 to 148.5 DDD/ADHD patient/year in 2012. The total consumption for ATX and MPH is almost equal (140.9 for ATX and 150.3 for MPH in 2012). This result is lower as it has been seen in Germany (208 DDD/ADHD patient/year in 2008 for MPH).

Conclusions

In the last decade in Slovenia, the total consumption is increasing rapidly, which indicates a positive trend. This pattern (low total consumption) has not been seen in Germany. After the new drugs have been available on the Slovenian market, the total consumption rose rapidly.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Crisis in the psychiatric patient: A structured illness-management-oriented group intervention
Authors: Fucci G. , Ratti N. , Gattamorta R. , Godoli R. , Randi S. , Riccipetitoni M.P.
Published: May 2016

Introduction

Crisis prevention and management of the psychiatric patient have obtained a central role in the policies of Mental Health Services. In this context, Mental Health Centre of Ravenna has launched a “Crisis Center”, a rehabilitation group project applied to three types of users: users in an early stage of crisis, users in a post-critical stage and users at high risk of crisis. Intervention was based on the Illness Management and Recovery practice, an evidence-based program which consists in social skills training activities, emotions management, symptom management, coping skills training, psycho-education and, more generally, supporting users in their personal recovery process.

Objective

Objectives of this project is to prevent crisis and hospitalization and to provide an alternative to institutionalization for mental health users.

Aims

The aims of this study was to analyze and show effects and results of the project, in its first three years of life.

Methods

Through the database “Infoclin”, we analyzed data of 94 users who took part in the project between January 2012 and December 2014.

Results

Analysis showed, primarily, that out of 94 users, 64 (68%) have not needed hospitalization in the following two years after intervention. Furthermore, out of 39 users with a history of one or more hospitalizations at time of entry, 22 (56.4%) have not needed hospitalization in the next two years.

Conclusions

Despite the low number of users analyzed, it is believed that this study should be considered a further evidence of the positive effects of the IMR practice within mental health services.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The post-traumatic growth: The wisdom of the mind, its clinical and neuropsychoanalytic vicissitudes
Authors: Rozentsvit I.
Published: May 2016

The purpose of this symposium is to bring awareness about and to promote knowledge of the phenomenon of posttraumatic growth (PTG) and its neurobiological mechanisms. The other purpose is to explore neuro-psycho-education as an important tool in understanding trauma and in promoting PTG.

The idea of PTG was pioneered by Calhoun and Tedeschi (1999), who addressed positive psychological change (as they compared it with the “mind's wisdom”), which occurs in some individuals after trauma. PTG happens in the context of and despite of processing traumatic pain and loss. This phenomenon includes five main factors: relating to others with greater compassion; finding new possibilities, personal strength, spiritual change, and a deeper appreciation of life.

Both neuropsychoanalysis and neuro-psycho-education offer us the knowledge of neurobiology and its mechanisms of “action” (such as neuroplasticity, neurointegration, mind-body integration, connectomes, ‘triune brain’, ‘bottom up processing’ and ‘top-down regulation’, etc.) and help modern mental health practitioners to understand their clients from “inside out”: to read the cues of their underlying (and not verbalized) patterns of being; to access their undisclosed, untold, emotional-relational history; to understand how this history shapes the present; to appreciate one's unique personal growth, even in the aftermath of trauma, and to understand mindfulness and mentalization as two powerful healing processes which play significant role in PTG.

Both neuropsychoanalysis and neuro-psycho-education also help clinicians to be in touch with and to regulate our own emotions and somatic responses to a “difficult client”, while maintaining “benevolent curiosity” and empathic stance.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Sexuality and affectivity: Two themes in a psychosocial intervention for psychotics inpatients
Authors: Vaccaro A. , Zoppellaro C. , Fusco V.
Published: May 2016

The aim of this project is about valuing these themes, not only in order to increase physiological genres knowledge or the responsible use of contraceptives, but is mainly about growing sexual psychosocial features awareness. Treating these themes in a psychoeducational intervention means: minimize sexually-transmitted diseases, prevent psychotic patients from quitting psychopharmacological treatment and favour the birth and the development of intimate relationships that may help patients leaving an unhelpful isolation condition.

Increase the awareness of different sexual and affection aspects: physiological, anatomic and reproductive, relational and communicative, emotional, social and cultural, playful and pleasant ones.

The 18 meetings interventions were done using a psychoeducational model; an active leading group manner (role plays and simulations) was used in order to ease the exchange of views between patients and the group leader.

We did a first round of meetings with ten patients who participated actively; we also submitted to them a questionnaire – before and after the intervention – in which we collected knowledge and opinions about different themes (contraceptives, risk awareness, affective relationships etc.).

From a qualitative analysis of the results we saw a knowledge-improvement about the dealt themes, and also, in some cases, we identified a modification in some problematic behaviours. The sample it's still too small for statistical analysis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Does clinical change always means the same? Comparison of different perspectives
Authors: Egger S. , Weniger G. , Prinz S. , Vetter S. , Müller M.
Published: May 2016

Introduction

In psychiatric practice, the assessment of change from pre- to post-treatment is a key approach for monitoring treatment effects and for the prediction of treatment outcomes. The Health of the Nation Outcome Scales (HoNOS) as a clinician-rated measure and the Brief Symptom Inventory (BSI) as a self-report measure are tools (that are) often incorporated in outcome monitoring. Their usefulness, however, has been questioned by two important issues: their psychometric properties and their lack of concordance.

Aims and objectives

The aim of the study is to evaluate the responsiveness of HoNOS and BSI as well as their interactions to predict clinical meaningful change according to the Global Clinical Impression (CGI) as quasi-gold standard for treatment outcome.

Methods

A consecutive sample of patients admitted to a Swiss psychiatric hospital for either alcohol use disorders, schizophrenic psychoses, mood disorders, anxiety and somatoform disorders, or personality disorders was assessed with Brief Symptom Inventory (BSI) at admission and discharge. The HoNOS and the CGI were rated by the responsible clinicians at admission and discharge. Ordinal logistic regressions will be conducted using the CGI categories as ordered categorical outcome. HoNOS and BSI scores as well as their interaction terms will be used as independent variables.

Results and conclusion

Complete data of admission and discharge is available from approximately 600 cases. Graphical presentations will illustrate the resulting associations.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Validation of BGaze method supporting ADHD diagnosis
Authors: Esposito F. Lorena , Varela P. , Alkan E. Ozan , Morata I. , de la Osa N. , Ezpeleta L. , Crespillo J. Cañete , Super H.
Published: May 2016

Introduction

Eye movement recordings can provide information about higher-level processing of visual information. Recent evidence shows a novel role for eye vergence in orienting attention (Solé Puig et al., 2013). Based on such eye tracking data, the BGaze method (Braingaze; Spain) detects visual attention. The outcomes of the BGaze method have been applied to classify ADHD patients from healthy controls.

Aim

In this study, we validated the BGaze method.

Objective

We therefore recorded eye movements in children while performing a visual detection task.

Methods

We evaluated the BGaze method using 4 types of supervised machine learning algorithms. In total, 138 different trained models were tested. Nineteen ADHD diagnosed patients (children 7–14 years of age) and 19 healthy age matched controls were used to build the 138 models. We performed 30 times repeated random sub-sampling validation. In each repeated random split, training set consisted of 80% of the data and test set of the remaining 20%. Finally, all the 138 models were tested with a validation set consisting of 232 children, including 22 ADHD patients.

Results

Across all the 138 models, BGaze method showed an average accuracy of 90.84% (minimum 86.21%; maximum, 95.26%) and an average AUC of 0.95 (minimum 0.90; maximum, 0.97). Best models gave accuracies of 92%, AUCs of 0.96 and FN and FP rates of 4.3% and 7.5%, respectively. Mean scores during the training-testing phase averaged 99.63%.

Conclusion

The BGaze method is robust, accurate, and can provide an objective tool supporting the clinical diagnosis of ADHD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neurological symptoms in schizophrenia: A case report
Authors: Benavente López S. , Salgado Borrego N. , de la Hera Cabero M.I. , Oñoro Carrascal I. , Flores L. , Jiménez Rico R.
Published: May 2016

Introduction

Patients with epilepsy and schizophrenia could present atypical clinical presentations with neurological symptoms that are not frequently presented in schizophrenia.

Case Report

We report the case of a 41-year-old male who was diagnosed of schizophrenia and was admitted into a long-stay psychiatric unit. He started at 33 years old with a depressive disorder. After prescribing venlafaxine, symptoms did not remit and the patient started to present apathy, anhedony, impoverished speech, social isolation and blunted affect. Then, the patient started to present behavioral disturbances consisted in regressive behavior, aggressive behavior, inappropriate language, echolalia, sexual disinhibition, impulsivity, worsening of executive functions and soliloquies. A neurological study was made with CT scan and electroencephalography, and no evidences of neurological abnormalities were found. After that, clozapine was prescribed, with an improvement of some symptoms like apathy, anhedony and aggressive behavior, but persisting the impulsivity, regressive behavior, inappropriate language, sexual disinhibition and echolalia.

Discussion

Patients with schizophrenia and epilepsy could not respond appropriately to antipsychotic drugs. In this patient, the psychiatric symptoms more frequently seen in schizophrenia responded well to clozapine, but neurological symptoms did not improve with the standard treatment, causing a severe disability to the patient that was the main reason for his prolonged admission.

Conclusions

It is recommended to make a detailed neurological exploration in all psychiatric patients, in order to explore atypical symptoms and comorbidities that could reveal new diagnosis and therapeutic objectives.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Hypergraphia: Illustrating clinical pictures
Authors: Carvalhão Gil L. , Ponte A. , Gama Marques J.
Published: May 2016

Introduction

Hypergraphia is an extensive writing tendency sometimes coupled with hyperreliogiosity and atypical sexuality, completing a syndrome described by Waxman and Geschwind in 1975 during interictal phases of patients with temporal lobe epilepsy. Nevertheless, it may arise from any temporolimbic lesion, usually in the right hemisphere, in contrast to the schizophreniform psychosis more often seen in left-sided lesions.

Objective

A review on the lateralizing significance of temporolimbic lesions, highlighting the (un)specificity of hypergraphia, after a case report concerning a patient with both hypergraphia and schizophreniform psychosis.

Methods

Analyse patient's clinical records and PubMed review, using hypergraphia, epilepsy and psychosis as keywords.

Results

We report a 74-year-old male admitted due to aggressiveness. The patient had a traumatic brain injury in his 20s with secondary left temporal epilepsy. He lived in a psychiatric asylum, for almost 40 years, with the diagnosis of schizophrenia, showing fluctuant atypical sexual behavior. After being transinstitutionalized to community nursing-home he developed meningoencephalitis, leading to medication change and behavior relapse. He showed viscosity, circumstantiality, soliloquy, euthymic mood and normal cognition. He wrote profusely, e.g. lists of various categories and letters to eminent clerics and politics. His diary was scanned for illustrative purpose.

Conclusions

Hypergraphia is an uncommon but easy to find symptom that deserves the full attention of the clinician, especially in the differential diagnosis between schizophreniform psychosis and temporal epilepsy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
An innovative child psychiatry training program using a family-based model for at-risk military families
Authors: Szeftel R. , Pataki C.
Published: May 2016

Introduction

Few child psychiatrists are well trained in family-based interventions for military families who experience significant trauma, intergenerational posttraumatic stress disorder, substance abuse, depression and high rates of suicide (Ramsawh et al., 2014). The innovative VA/UCLA/LACDMH Child and Adolescent Psychiatry Training program, sponsored jointly by the VA Greater Los Angeles Healthcare System (VA) and the Los Angeles County Department of Mental Health (LAC DMH), will address unmet needs of at-risk military families using a family-focused model also applicable to other families exposed to trauma.

Objectives

To present the curriculum of the VA/UCLA/LACDMH training program and details of the collaboration between the LA VA and LAC DMH.

Aims

To highlight how innovative child psychiatry training programs can be developed through creative institutional collaborations.

Methods

The VA/UCLA/LACDMH program family-based model and FOCUS (Lester et al., 2011) intervention were structured to meet regulatory standards of child psychiatry training programs.

Results

A specialized family-based child training program was created to meet the needs of at-risk military families while providing rigorous child and adolescent psychiatry training. Components Early Intervention Family Clinic for At-Risk Children provides family psychoeducation, and identifies children and adolescents at risk.

Focus

An evidence-based early intervention for at-risk military families to enhance resilience and mitigate stress through improved coping, increased problem solving, and effective communication.

Conclusions

A successful collaboration between the LA VA and LAC DMH can lead to an innovative family-based child psychiatry training program.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Battery of scales for comprehensive assessment of social cognition, neurocognition and motivation in patients with schizophrenia
Authors: Minyaycheva M. , Kiselnikova K. , Papsuev O.
Published: May 2016

Introduction

There has been a special interest in roles of neurocognition, social cognition and motivation impairments in patients with schizophrenia and possible approaches to remediating these deficits. Clinical practice lacks a comprehensive tool to measure those deficits.

Objective

To build a comprehensive assessment battery to measure neurocognitive, social cognitive and motivational deficits in order to form targets for remediation programs and assess their efficiency.

Aims

Translation and adaptation for Russian speaking subjects (if needed) of identified assessments upon authors’ agreement.

Methods

By consensus decision of 5 professionals in the field of clinical psychiatry, psychology and neuroscience a number of assessments were selected with the following criteria: 1. Relevance to domain assessed, 2. Appropriateness for Russian social context, 3. Reference rates in scientific papers, 4. Time consumed by each assessment.

Results

Six measures reflecting main domains (neurocognition, Theory of Mind, attributional style, social perception, emotion processing, motivation) were selected: 1. BACS (Brief Assessment of Cognition in Schizophrenia) (R.S. Keefe et al., 2008), 2. Hinting Task (R. Corcoran 1995), 3. AIHQ (Ambiguous Intentions Hostility Questionnaire) (D.R. Combs et al., 2007), 4. RAD–15 (Relationships Across Domains) (M. Sergi et al., 2004), 5. Ekman–60 (P. Ekman et al., 1976), 6. AES (Apathy Evaluation Scale) (R.S. Marin et al., 1991).

Conclusions

The battery built encompasses all targeted domains of neurocognition, social cognition and motivation. Time consumed by the battery estimates 130 ± 15 minutes, which is appropriate for clinical practice in a rehabilitation centre. Future research will focus on patients profiling and shaping of rehabilitation programs accordingly.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Aripiprazole once-monthly efficacy in patients with schizophrenia. Review
Authors: Molina López M.F. , Cancino Botello M.C. , Peña Serrano A. , Canseco Navarro M.D.L.A.
Published: May 2016

Introduction

long acting injectable formulations of antipsychotics are a valuable option for patients with schizophrenia, offering continuous medication delivery and stable dosage levels. Aripiprazole once-monthly is the first dopamine partial agonist available in long acting formulation approved in Europe for Schizophrenia with excellent results so far.

Aims

to conduct a current review of articles related to the use and efficacy of Aripiprazole once monthly in patients with Schizophrenia.

Methods

systematic review of the literature in English using the following keywords: “aripiprazole once-monthly”, “aripiprazole long acting formulation”, “schizophrenia”. PubMed database.

Results

Aripiprazole once-monthly (AOM) formulation efficacy has been proven in many studies. The importance of maintaining an oral overlap during 14 days is highlighted in all studies that have been reviewed in order to reach therapeutic level; therefore, it can be used in patients with acute decompensations. Recent studies comparing AOM versus Paliperidone Palmitate once monthly (PP) have shown that patients with AOM had greater clinical improvement and, even though both drugs were well tolerated, when Quality of Life Style Scale was analyzed an important improvement in empathy, sense of purpose, emotional interaction and curiosity in the AOM group was observed.

Conclusions

long acting injectable antipsychotics increase long-term adherence treatment and reduce risk of relapse. Because of its unique mechanism of action, Aripiprazole once-monthly improves positive and negative symptoms, giving the patient an opportunity to have a better quality of life.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Correlation between childhood trauma and cognitive impairment in patients with schizophrenia
Authors: Mrizak J. , Trabelsi R. , Arous A. , Aissa A. , Ben Ammar H. , El Hechmi Z.
Published: May 2016

Introduction

Abusive childhood experiences are claimed to be more prevalent in people with schizophrenia (SCZ) than in the general population. The exposure to childhood trauma can have adverse effects on cognitive function.

Objectives

To investigate whether there is a relationship between childhood trauma (CT) and cognitive functioning in patients with SCZ.

Methods

Fifty-eight outpatients with stable SCZ were recruited. The participants completed the Childhood Trauma Questionnaire retrospectively assessing five types of childhood trauma (emotional, physical and sexual abuse, and emotional and physical neglect). They also completed a neurocognitive battery comprising the following tests: the Hopkins Verbal Learning Test–Revised (HVLT-R), the Letter Digit Substitution Test (LDST), the Stroop Test (ST), the “Double Barrage” of Zazzo (DBZ), the Modified Card Sorting Test (MCST), the Verbal Fluency (VF), the Trail Making Test-Part A (TMT-A) and the Digit Span (DS).

Results

The patients with a history of physical abuse (P = 0.03) or emotional neglect (P = 0.07) performed worse at the delayed recall of the HVLT-R. A history of emotional neglect was also correlated to a significantly worse performance in theTMT-A (P < 0.0001), while physical abuse was correlated to worse DS (P = 0.015). High emotional abuse scores were significantly correlated to poorer efficiency in DBZ (P = 0.025).

Conclusions

The results need replication, but underline the necessity of investigating biological and psychosocial mechanisms underlying these subjects’ cognitive impairment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Implications of immunity and inflammation in schizophrenia and related psychotic disorders
Authors: Perestrelo J. , Mota D. , Coutinho A. , Santos M. , Lapa G.
Published: May 2016

Introduction

Intricate interactions between the immune system and the brain might have important etiological and therapeutic implications for neuropsychiatric brain disorders. A probable association between schizophrenia and the immune system was postulated over a century ago, and is supported by epidemiological and genetic studies pointing to links with infection and inflammation.

Objective

To describe some important areas of research regarding immune response in schizophrenia and related psychotic disorders and discuss potential mechanisms and therapeutic implications of these findings.

Aims

Associations between immune response, inflammation and schizophrenia and related psychotic disorders are reviewed.

Methods

A literature review of the theme is surveyed. Several articles were search on MEDLINE with the keywords: schizophrenia, psychosis, inflammation, immunity, infection.

Results

Schizophrenia is a multifactorial disease. It is associated with multiple genetic loci that confer risk, in addition to developmental and postnatal risk factors. Antipsychotic-naive first-episode psychosis and acute psychotic relapse seems to be associated with increased serum concentrations of interleukin 6 and other proinflammatory cytokines, which are normalized after remission of symptoms with antipsychotic treatment.

Conclusions

Inflammation and immune dysfunction might contribute to cognitive, negative, and positive symptoms in schizophrenia. Identification of specific inflammatory pathways for neuropsychiatric symptoms would provide novel targets for therapeutic intervention.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Rehospitalization rate of first episode and chronic schizophrenia patients one year after discharge
Authors: Softic R. , Becirovic E. , Mirkovic Hajdukov M.
Published: May 2016

Introduction

Relapse rate among patients with schizophrenia can determinate outcome of illness. Up to 40% of patients with first psychosis responds well to treatment. Despite this fact relapse rate is still high, in particular if treatment is discontinuated. Frequent use of first generation antipsychotics (FGA) in underdeveloped countries can be one of possible reasons for treatment discontinuation and consequent relapse.

Aims

To analyse rehospitalisation rate in patients with first and multiple episodes of schizophrenia, and compare it with medication choice.

Methods

Retrospective analysis of medical records of patients with schizophrenia hospitalised in Psychiatry Clinic of University Clinical Center Tuzla in period from year 2011 to 2013.

Results

During the two-year period, 37 patients with first episode of schizophrenia were hospitalised. Second generation antipsychotics (SGA) were used in 40.5%, and first generation in 13.5%, long acting injectibles - first generation (LAI) were used in 8.1%, and combination of FGA's and SGA's in 5.4% of cases. In the same period, 121 patients with multiple episodes of schizophrenia were hospitalised. SGA were used in 21.4%, FGA in 33%, LAI's in 47.1%, and combination FGA's and SGA's in 35.5% of cases. Relapse rate in the first year after discharge was 16.2% in group with first psychotic episode, and 33% in the group with multiple episodes of schizophrenia.

Conclusion

High relapse rate in group with multiple episodes can be explained with nonadherence regarding the side effects of too frequent use of FGA's.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Challenges faced by gender-variant people in receiving appropriate care and ways to improve their care and lives – A UK study
Authors: Clementi N. , Dobrzynska E.
Published: May 2016

Introduction

It is only in the last decade that trans people have been accorded rights and give protection in law from discrimination. A survey of 10,000 people undertaken by the Equality and Human Right Commission showed that 1% of the population was gender-variant to some extent. Gender-variant people continue to suffer restricted opportunities, discrimination and harassment at work despite the existence of anti-discrimination and equalities legislation. It is estimated that up to 40% of people with gender dysphoria may not be receiving appropriate help.

Objective

Review of UK policies, guidelines, legislation and research on challenges faced by gender-variant people and ways to improve their care and lives.

Aims

To improve gender-variant people access to care and ways to fight inequalities.

Methods

MEDLINE, PsycINFO databases were searched for articles published between 2005–2015 containing the keywords “gender dysphoria”, “gender-variant people” and “transgender people”. Relevant policies, guidelines and legislations were also reviewed.

Results

Transgender people still face major health inequalities and discrimination. National statistics show that 80% have experienced harassment, 62% suffered discrimination at work or home and 54% reported being denied access to NHS care due to lack of cultural competency from staff. Guidelines, research, policies and equality legislation have begun to be implemented to protect transgender people from discrimination and accord rights.

Conclusions

Many areas need attention and improvement including not only healthcare but also employment, education, housing and media perception. Promotion of equality in the general population with the aim of achieving cultural change and improvement of cultural competency of health professionals is needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.