bluuebunny/crossref_metadata_2025 huggingface dataset:
Changing the Obesogenic Environment to Improve Cardiometabolic Health in Residential Patients with a Severe Mental Illness: ELIPS, a Randomized Controlled Trial
Authors: Jörg F. , Looijmans A. , Stiekema A. , Van der Meer L. , Schoevers R. , Corpeleijn E.
Published: June 2017

Introduction

The life expectancy of severe mentally ill (SMI) patients is shortened up to 30 years, due to cardiometabolic diseases, partly caused by unhealthy lifestyles behaviors. In residential facilities, adopting a healthy lifestyle is hampered by the obesogenic environment; an obesity promoting environment.

Objective

To determine, the effectiveness of a 12 month lifestyle intervention addressing the obesogenic environment to improve cardiometabolic health of SMI residential patients.

Methods

The effectiveness of lifestyle interventions in psychiatry (ELIPS) trial is a multi-site, cluster randomized controlled pragmatic trial. Twenty-nine sheltered and long-term clinical care teams serving SMI patients in the Netherlands were randomized into intervention (n = 15) or control (n = 14) arm, including 736 patients (73% psychotic disorder, 63% male, 48 ± 13 years). The intervention aimed to improve the obesogenic environment using a small change approach with a focus on nutrition and physical activity. Primary outcome was waist circumference (WC) after three and twelve month's intervention. Secondary outcomes were BMI and metabolic syndrome.

Results

General linear mixed models adjusted for age, gender, housing facility and antipsychotic medication showed that WC significantly decreased with 1.51 cm (95%CI = −2.99;−0.04, Cohen's d = 0.07) in the intervention group compared to control group after three months and tended to remain lower with 1.28 cm (95%CI = −2.79; 0.23, Cohen's d = 0.06) after twelve months. Metabolic syndrome Z-score decreased after three months with 0.225 SD (95% CI = −0.4038;−0.096, Cohen's d = 0.20), mainly due to lower fasting glucose and WC. No significant effects were found on BMI.

Conclusion

A small change approach targeting the obesogenic environment of SMI residential patients reduces cardiometabolic risk.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Elevated C-reactive Protein Levels Associated with Aggressive Behavior in Moroccan Patients with Schizophrenia
Authors: Kachouchi A. , Said D.S. , Imane P.A. , Fatiha P.M. , Fatima P.A.
Published: June 2017

Background

Recent studies reported an association between aggression and inflammation. In this study, we examined the association between aggressive behavior and inflammatory markers (serum levels of CRP) in schizophrenia inpatients.

Methods

Adult schizophrenia inpatients (n = 145) were prospectively identified and categorized according to their C-reactive protein measurement at admission as either elevated (CRP > 1 mg/dL; n = 45) or normal (CRP < 1 mg/dL; n = 100). The following indicators of aggression were compared: PANSS excitement component (PANSS-EC), restraints and suicidal behavior during hospitalization.

Results

The results show that patients with elevated CRP levels are more aggressive during hospitalization as detected by statistically significant higher scores of aggressive behavior (PANSS-EC score), and by increased rates of physical restraint during hospitalization. No statistically significant differences in the other clinical features, including suicidal behavior.

Conclusion

Our results are consistent with previous findings linking schizophrenia to activation of the inflammatory response system.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Treatment Adherence in Psychosis: A 2 Years Follow-Up of First-Psychotic Episode Patients
Authors: Malta Vacas S. , Carvalho R. , Heitor M.J.
Published: June 2017

Introduction

Much research on psychosis has focused on early detection and the development of effective interventions. However, the effectiveness of any intervention depends on the willingness of the patient to engage with an intervention in a sustained manner. Disengagement from treatment by patients with serious mental illness is a major concern of mental health services.

Objectives

This study aims to examine the prevalence of disengagement in a longitudinal cohort of first episode psychosis (FEP) patients.

Methods

Retrospective naturalistic 2 years follow-up study of FEP patients aged 18 to 35 admitted into the department of psychiatry of the Beatriz Angelo's hospital from 2012 to 2014. Data on socio-demographics, clinical characteristics, appointments and medication adherence and readmissions were collected.

Results

Between 2012 and 2014 were admitted 56 patients with a FEP into the department of psychiatry of the Beatriz Angelo's hospital. The great majority of the patients (67.9%) disengaged from the treatment, both appointments and medication. Of those, 13.2% did not attend any appointment, 26.3% attended between one and three appointments and 60.5% attended at least 3 appointments before disengaged. About 23% were readmitted between the 2 years follow up period, 15.4% were readmitted more than once.

Conclusions

The evidence reviewed indicates that approximately 30% of individuals with FEP disengage from services. Continuity of care is of particular importance with FEP, given evidence suggesting that long-term care can improve symptoms and functioning and reduces relapse risk.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Strategies for Managing Psychosis with Small Amounts or no Medication: A Proof of Concept Paper
Authors: Mehl-Madrona L. , Mainguy B.
Published: June 2017

Introduction

Some patients with the diagnosis of a psychotic disorder wish to minimize or avoid medications.

Methods

We report qualitative and quantitative data on a group of patients as a proof of concept study–that management with minimal or no medication is possible.

Patients

A series of 60 adult patients presented with psychosis and engaged with us in dialogical psychotherapy, medication, and lifestyle management over at least six months in an effort to minimize or eliminate medication. An additional 209 patients presented for treatment but did not continue for six months. An anonymous, matched comparison group of 60 patients of the same age, socio-economic status, diagnosis, and severity of illness was generated from the electronic health records at another large clinic where one of us also worked (LMM). We quantifed symptom level using the Brief Psychiatric Rating Scale, the Positive and Negative Syndrome Scale, two depression rating scales, the Clinical Global Inventory, and the Revised Behavior and Symptom Identification Scale. Narrative interviews of all 269 patients generated qualitative data.

Results

Thirty-nine patients managed well without medication; 16 managed well on low-dose medication. Four individuals required progressively higher levels of medication and one decompensated. The overall cost-benefit was favorable in creating fewer hospitalization, crises, and diminished suicidality.

Conclusions

The results suggest the need for individualized approaches that are client-centered and build upon the previous successes of the person, enroll family and friends in a community effort, and collaborate with those communities to apply those approaches desired by the people themselves.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Impact of Environmental Influence and Vulnerability to Stress in the Development of First Psychotic Episode
Authors: Rossini Gajsak L. , Celic Ruzic M. , Koricancic Makar A. , Rojnic Kuzman M.
Published: June 2017

Introduction

Some findings in patients with first psychotic episode (FEP) could be related to alterations of stress responses. Alterations of stress response are reflected in the alterations of the HPA axis.

Objective

To assess the difference in stress response in FEP patients and healthy controls as well as implications of environment to vulnerability to psychosis.

Aim

To assess endocrine and autonomic responses to acute psychosocial stress, their associations with onset of the first psychotic episode as well as the influence of the environmental factors.

Methods

We have assessed clinical status through clinical psychiatric interviews, standardized psychiatric scales and validated psychological scales, (LEQ, WHOQOL-BREF, PBI, Rosenberg) in 45 subjects with FEP and 50 age and gender matched controls. All participants were then exposed to the Trier Social Stress Test (TSTT).

Results

Our preliminary findings on a sample of 95 participants indicate a differences between patients and controls in salivatory cortisol measured in 5 time points during the TSST. Patients with FEP experience more levels of baseline cortisole, and less changes during the stress test then controls. Baseline stress levels indicated in the salivatory cortisole levels correlate with perceived self-esteem, psychological and social quality of life.

Conclusion

Our findings support the alterations of stress response, possibly indicating vulnerability to stress in persons with FEP.

Funding

This work was funded by the grant of the Croatian Science Foundation No UIP-2014-09-1245 Biomarkers in schizophrenia – integration of complementary methods in longitudinal follow up of first episode psychosis patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Adjunctive Memantine in Clozapine-Treated Refractory Schizophrenia: An Open-Label One-Year Extension Study
Authors: Schulte P. , Veerman S. , Deijen J.B. , De Haan L.
Published: June 2017

Introduction

In a recent placebo-controlled, double blind crossover trial (n = 52), we found significant beneficial effects on memory (d = 0.30) and negative symptoms (d = 0.29) after 12 weeks memantine augmentation in patients with clozapine-refractory schizophrenia.

Aims

In this open-label 1 year extension study, we report the long-term effects and tolerability of memantine add-on therapy to clozapine.

Methods

Completers of the first trial who experienced beneficial effects during 12 weeks of memantine treatment received memantine for one year. Primary endpoints were memory and executive function using the Cambridge neuropsychological test automated battery (CANTAB), the Positive and Negative Syndrome Scale (PANSS), and the Clinical Global Impression Severity Scale (CGI-S).

Results

Of 31 RCT completers who experienced beneficial effects from memantine, 24 received memantine for one year. The small improvement in memory found in the memantine condition in the placebo-controlled trial remained stable in the extension study. Executive function did not improve. After 26 weeks of memantine add-on therapy to clozapine, PANSS negative symptoms (r = 0.53), PANSS positive symptoms (r = 0.50), and PANSS total symptoms (r = 0.54) significantly improved. Even further significant improvement in all these measures was observed between 26 weeks and 52 weeks memantine, with effect sizes varying from 0.39 to 0.51. CGI-S showed a non-significant moderate improvement at 26 weeks (r = 0.36) and 52 weeks (r = 0.34). Memantine was well tolerated without serious adverse effects.

Conclusions

In the one-year extension phase, the favorable effect of adjunctive memantine on memory was sustained and we observed further improvement of positive, negative and overall symptoms of schizophrenia.

Disclosure of interest

P.F.J.S. reports personal fees from H. Lundbeck A/S, outside the submitted work and he is a board member of the Dutch Clozapine Collaboration Group. L.d.H., has received investigator-led research grants or recompense for presenting his research from Eli Lilly, Bristol-Myers Squibb, Janssen-Cilag and AstraZeneca.
Psychological and Psychophysiological Mechanisms of Mental Stress Reaction in Patients with ‘Hypertension at Work’, as Compared with ‘Classical’ Version of Essential Hypertension
Authors: Pervichko E. , Zinchenko Y. , Ostroumova O.
Published: June 2017

Introduction

‘Hypertension at work’ today is found one of the most frequent forms of stress-induced hypertension.

Objectives

To inquire into the specifics of psychological and psychophysiological mechanisms of stress reaction in patients with ‘hypertension at work’, as compared with ‘classical’ essential hypertension (EH).

Materials and methods

The study developed simulation of emotional stress with the aspiration level (AL) modeling. The level of state anxiety (SA), BP values, urine catecholamine levels and levels of renin and angiotonin I in blood plasma were taken before and after the experiment. Eighty-five patients with ‘hypertension at work’ (mean age was 45.9 ± 2.8) and 85 patients with ‘classical’ EH (mean age was 47.4 ± 4.5 years) took part in the study.

Results

Rates of ‘hypertension at work’ patients, when compared with second group patients, revealed a significant increase (Р < 0.001) of systolic BP in response to stress loads (on average, for 16.1 ± 1.9 mmHg and 4.1 ± 0.7 mmHg, respectively). Initially ‘hypertension at work’ patients had significantly lower levels of catecholamines, than the second group, while the levels of renin and angiotensin I were comparable. During the experiment, the patients in the first group showed a significant decrease in all parameters. After the experiment, the patients with ‘HTN at work’ did not show increase of SA, but revealed more frequent inadequacy (69.4%) and instability (56.5%) on the AL. Patients with ‘classical’ EH more often demonstrate adequate AL and lower growth of BP after the experiment.

Conclusions

Patients with ‘hypertension at work’ are more prone to repress their emotions. They reveal physiological features of chronic stress and psychophysiological exhaustion, if compared with second group patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Educational Programme in Primary Care is the Basic Way of Decreasing Suicides
Authors: Kornetov N.
Published: June 2017

Introduction

The depressive disorder (DD) is a widespread disease described to be a severe burden and to have high suicide risk. Depression is not yet listed in the primary care (PC), Russian specific educational program.

Objectives

To create educational Recognition of Depressive disorders Program (REDEP) in order to decrease suicides in Tomsk City and Tomsk Area (TA).

Methods

Educational Program WPA/PTD on DD (Russian version) was used as a basis of REDEP, comparative analysis of mortality ratio of suicides (MRS) throughout the period of 2004–2015 among the population of the Russian Federation (RF), Siberian Federal Region (SFR) and TA, analysis of suicide decrease in Tomsk City. The Program is based on ideas of collaboration between the Primary Medical Care institutions and the Service of Mental Health Care. Depression and its consequences on people and the economy should be listed as a non-infectious illness.

Results

We conducted a comparative analysis of suicides in RF, SFR and TA; we also assessed the dynamics of suicides reduction in TA under the influence of educational program on DD. The most prominent MRS decline was in TA: from 38.3 to 12.8 (P < 0.03). During 2008–2015, MRS was being held below 10/100,000 in Tomsk City.

Conclusions

Suicide prevention is possible if persistent and continual education of doctors in PC is in place. Such specialists are needed to recognize and manage depression and co-morbid conditions. The Program can be extrapolated to other regions of the country with high MRS.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Quality Improvement Project: Mentoring, Career Advice and Placement Introduction Session for Year 5 Imperial College Medical Students. Should Induction go Beyond Facts and Numbers?
Authors: Agalioti O. , Nayrouz S.
Published: June 2017

Introduction

Feedback received from previous rotations of year 5 Imperial College medical students in West London Mental Health NHS Trust has consistently shown that medical students feel uncertain about what to expect in their psychiatric placements and are sceptical about psychiatry as a future career option. This prevents them from maximizing the educational benefit and potential in their training.

Aims and objectives

Tutorial aims to prepare medical students for their psychiatric placements and create the opportunity for informal discussion about psychiatry as future career option. The session aspires to motivate students to be more involved and active participants and invite them to think about their future career option at an early stage.

Methodology

A 1-hour tutorial has been added to medical students’ induction in two successive rotations (July–October 2016). Thirty-seven (37) medical students have attended the tutorial so far. Tutorial provides information about psychiatric placements, learning opportunities as well as structural and operational issues. Besides, it encourages discussions about psychiatry as a future career option, informing students about psychiatric sub-specialties, career pathways and NHS operational structure. Feedback questionnaire is handed over at the end.

Results

Data were collected and analysed and findings are outlined in the diagram below (Fig. 1).

Conclusions and recommendation

The majority of medical students have feedback they found tutorial relevant and useful. Current tutorial formula will be revised based on feedback collated so far.

Findings are going to be shared with local Undergraduate Educational Committee and Imperial College medical school board.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Fig. 1

Imperial College medical students’ feedback.
Transparency and Due Process: A Systematic Approach to Educational Decision-making and Appeals
Authors: Peters A.
Published: June 2017

Introduction

Transparency and due process are inseparable principles that should underpin any educational and administrative decision made within an organization.

Objectives

It is considered best practice for organizations to place the processes and structures surrounding reviews of decisions made by their organization at arm's length to the committee or group that made the original decision. This ensures there is and that due process is followed.

Aims

An independent appeal process is an integral part of any fair system of assessment and decision making.

Methods

The Royal Australian and New Zealand College of psychiatrists has undertaken several reviews of its current processes to examine its practices as both substantive and procedural issues arise in decisions with regard to the provision of psychiatric training. The reconsideration and appeal policy was developed to set out a clear and fair process for applicants to request decisions of the RANZCP to be reconsidered and appealed. This ensures that an applicant has a fair and reasonable opportunity to challenge the original decision whilst receiving support from the RANZCP to minimize any stress that may be experienced during this process.

Results

The RANZCP has observed that the three phase process has enabled matters to be resolved at an earlier stage of the appeal cycle and do not require progression to a formal appeal.

Conclusion

This presentation will identify best practice methods in educational decision-making and conducting appeals.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Comparing Learning Outcomes for Mental Health Simulation Training Delivered to Entire Clinical Teams Versus Professionals Not Working Together Clinically
Authors: Valdearenas L. , Attoe C. , Cross S.
Published: June 2017

Introduction

Working effectively with colleagues using a multidisciplinary and interprofessional approach is vital in healthcare, particularly mental health, where the interface between physical and mental health is often missed due to involvement with different specialties. Collaborative clinical practice is essential to provide the best clinical care to people experiencing mental and physical health comorbidities. Simulation training encourages experiential learning for human factors (or non-technical) skills, such as teamwork and interprofessional collaboration. This study explored the differences in learning outcomes between team and non-team training for physical and mental health comorbidities.

Aims and objectives

This project aimed to establish differences in human factors learning, confidence and knowledge, following training for teams that work together versus interprofessional groups from various teams. The project hoped to continue improving mental health simulation training and promote and enhance human factor skills that are basic pillars of multi-disciplinary and interprofessional care.

Methods

The human factors skills for healthcare instrument (HFSHI), alongside confidence and knowledge measures were administered to all participants pre and post simulation training on interacting mental and physical health. A post-course evaluation survey with open questions was used to collect qualitative feedback on the impact of the training course.

Results

With data collection ongoing, preliminary results indicate differences between team and non-team simulation training, with particularly interesting qualitative findings.

Conclusions

Learning outcomes may differ for team versus non-team simulation training, evidencing the different value of these two training set-ups.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Music as a Helpful Instrument in the Treatment of Children with Asd in Their School Inclusion Program
Authors: Sindelar M.T. , Meini C.
Published: June 2017

Since birth infants are active and communicative partners engaged in protoconversations with caretakers. Motherese, the simplified language adults spontaneously use with infants, has a musical structure. We believe that for developmental and evolutionistic reasons music is a preferential tool to favor communication and to promote group identity. We carried on a musical experience with a group of autistic (ASD) children aged 5 to 7 years. Each child participated at their school with 10 typically developed classmates and their teachers. Our ASD children love music and enjoy playing and singing. With music, they overcome some communicative and social difficulties. Their bodily posture changed with music, facilitating joint attention and improvement of verbal language. When singing children learned linguistic skills, they ameliorated vowels’ pronunciation and understood how a question and an answer differ in melodic contour. Taking into account the unique sensory motor profile of each ASD child, we proposed rhythmic music with high proprioceptive input (for under-reactive children) and smooth and calming music for avoidant and easily overwhelming children in order to ameliorate intentionality and enlarge circles of communication. A combination of semistructured and spontaneous activity is the main components of our approach, which has both therapeutic and educational impacts. In the musical group, all the ASDs appeared to be more attentive, motivated, better performing and able to teach their acquired skills to their peers. Typical peers interact more with children with ASD with music. We consider this very helpful in the inclusion of ASD children in a school setting.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Influence of Peers Drinking and Parental Drinking and Attitudes on Adolescent Drinking
Authors: Smaoui N. , Charfi N. , Turki M. , Maâlej-Bouali M. , Zouari L. , Zouari N. , Ben Thabet J. , Maâlej M.
Published: June 2017

Introduction

It is widely recognized that parents and peers play a critical role in the adolescent's introduction to alcohol.

Objectives

The aim of the study was to examine the relationship of parental and peers drinking to adolescent drinking behavior.

Methods

A cross-sectional study was carried out in four colleges and schools in Sfax in Tunisia, in May and June 2016. The sample consisted of 317 pupils, and was determined through a simple randomized sampling. These adolescents were asked to answer a self-administered questionnaire, after their consent. Alcohol use disorders identification test (AUDIT) was used to evaluate alcohol dependence.

Results

The mean age was 16 years, with a sex-ratio of 1.07. The participants reported having drunk alcohol at least once in 18.9% of cases and 41.66% of them still consume. According to AUDIT, 1.6% of alcohol users presented an alcohol misuse and 21.6% presented dependence. They reported that parents’ attitude toward their alcohol use was favorable in 27.11% of cases. Among dependent adolescents, the prevalence of fathers’ alcohol consumption was 20% while that of friends was 70%. Adolescent drinking was significantly correlated to fathers, mothers and peers drinking (P < 0.001, P = 0.004, P < 0.001 respectively), mothers and peers smoking (P = 0.05, P < 0.001 respectively), fathers and peer's cannabis use (P < 0.001, P < 0.001 respectively).

Conclusion

Findings suggest that negative family and peers influence increased risk of alcohol consumption in adolescents. Understanding the influences on parents’ beliefs about their children's drinking and the functions of social networks in preventing alcohol consumption may be necessary to address adolescent risky drinking.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Polypharmacy among elderly populations
Authors: Leal I. , Ordás P. , Vicente R. , Avila C.
Published: June 2017

Introduction

Potentially inappropriate prescribing, is highly prevalent among older patients hospitalized with major psychiatric illness. Inappropriate use of psychotropic medications in elderly patients has become a focus of concern.

Objectives

To determine the prevalence of potentially inappropriate prescribing including potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs), according to STOPP-START, Beers and PRISCUS criteria applied by CheckTheMeds®.

Aims

To identify potentially IP, PPo and the prevalence of contraindications, interactions and precautions in older patients hospitalized with major psychiatric illness.

Methods

Retrospective cross-sectional study with patients over 65 discharged from the Psychiatric acute unit of the university hospital of La Princesa (Madrid) between January 2013 and October 2015 was conducted. The CheckTheMeds® program was used to identify IP.

Results

A total of 104 elders–74 females and 30 males–were included, with a mean age of 76 years (range: 65–91). An average of 5.73 (range: 1–16) was prescribed drugs at discharge. The Ip results STOPP 81.73% (n = 85), START 43.26% (n = 45), Beers 94.23% (n = 98) y PRISCUS 40.38% (n = 42). Contraindications were described in the 21.15% of the patients, precautions in 83.65% and interactions in 83.65%. Psychotropic drugs were the most often inappropriate prescribed medicaments.

Conclusion

Prescribing omissions are twice as prevalent as IP in the elderly. Currently, inappropriate prescription of psychotropic agents is very common for the elderly. Application of such screening tools to prescribing decisions may reduce unnecessary medication, related adverse events, healthcare utilization and cost and nonpharmacological interventions, should be thoroughly explored.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clinico-pathological profile evaluation in patients affected by chronic inflammatory bowel diseases
Authors: Travagliati F. , Borrelli E. , Martinelli S. , Dattoli L. , Ferrarese D. , Gaetani E. , Scaldaferri F. , Gasbarrini A. , Janiri L. , Camardese G.
Published: June 2017

Introduction

Inflammatory bowel diseases (IBDs) have high social impact. Aetiology is still unknown, however multifactorial genesis is surely implicated. We tried to correlate IBDs and psychological distress through evaluated psychometrical instruments and subsequently to relate subjective influences with gastroenteric clinical manifestation, defining new critical elements on which IBD are based.

Methods

In our study, we included 57 participants, selected according to their diagnosis, between those attending our gastrointestinal ambulatory: 26 had Chron's disease, while 31 had ulcerative colitis. 78 people without gastroenteric or psychiatric disorder were also included in the study as control group. Psychometric questionnaires were administered to evaluate anxiety and depressive symptoms, quality of live, self-efficacy and resilience (Fig. 1).

Results

Levels of anxiety and depression were higher in patients with IBDs than in the control group. STAI-Y highlighted higher state anxiety and trait anxiety levels in first group. HADS showed higher scores in ill patients, as well as CD-RISC showed a more impaired resilience. EQ-VAS, PGWBI and GSE revealed significant differences in health status, psychological wellness and self-efficacy between the two groups.

Conclusions

IBDs seem related to psychological diseases. Affected patients have higher anxiety and depression levels than general population as well as lower self-efficacy and resilience. Those elements being strictly linked to physical discomfort contributes to develop a loop in which patients get caught. Creating a model of integrated cooperation between gastroenterologist and psychiatrist during treatment of patients with IBDs seems fundamental to grant at once all the professional figures each patient needs for better care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Augmentation in profound, SRI-refractory OCD: Is aripiprazole superior to other to other dopamine blockers?
Authors: Pampaloni I. , Tyagi H. , Drummond L.
Published: June 2017

Introduction

OCD is a common disorder, affecting 1% of the population and usually responds to treatment with serotonin reuptake inhibitors (SRIs) or exposure and response prevention (ERP) and to augmentation with antipsychotics. However, some patients fail to respond. The national inpatient unit for obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD) (i) is the only 24-hour staffed inpatient facility for OCD in the UK and treats patients with profound, treatment-refractory OCD. There is evidence of efficacy of aripiprazole in augmenting SRI sin severe OCD (ii).

Objectives

To compare the efficacy of aripiprazole versus other antipsychotics as SRI augmentation.

Methods

One hundred and nine patients admitted to the unit between March 2006 and September 2011 and discharged on an antipsychotic and an SRI were included. The Yale-Brown obsessive compulsive scale (YBOCS) was administered at admission and at discharge. Data were analysed using SPSS version 23 using analysis of variance (ANOVA). Two groups were compared: those receiving SRI + aripiprazole versus those receiving SRI + another antipsychotic.

Results

sixty-two patients received SRI with aripiprazole and 47 SRIs with another antipsychotic. Overall, patients showed improvement, with an average YBOCS reduction of 11.7 (33% reduction). Patients taking aripiprazole improved by an average of 13 (36% reduction, P < 0.05).

Conclusions

Patients of the national unit with severe, treatment refractory OCD treated with aripiprazole augmentation showed a greater improvement than those on other antipsychotics. Further research into aripiprazole in OCD is warranted.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Antidepressant therapy is followed by normalization 0f serum albumin conformation in patients with melancholic depression
Authors: Syrejshchikova T. , Smolina N. , Uzbekov M. , Dobretsov G. , Krjukov V. , Brilliantova V. , Krasnov V.
Published: June 2017

Objectives

Discovery of biomarkers for evaluation of efficacy of psychopharmacotherapy is important task.

Aim

To study parameters characteristic for albumin binding sited in melancholic depression (MD) using fluorescent laser spectroscopy in range of 30–50 picoseconds.

Methods

22 patients with MD (dep) (F33.1 and 2) were investigated in dynamics of antidepressant therapy (venlafaxine: 75–150 mg/daily) for 30 days. Control group (con) consists of 54 volunteers. Decay of fluorescence amplitude (A) of fluorescent probe K-35 from serum albumin was measured using laser. Earlier, we revealed 3 binding sites in albumin with amplitudes A1, A2 and A3 with decay time of 1, 3 and 9 nanoseconds, respectively.

Results

There was revealed significant decrease of amplitude A1dep, normalized on mean value of A1 for controls (A1dep/A1con), for patients with MD after treatment with venlafaxine. In this case, A1depvalues decreased and were equal to A1 values of controls (P < 0.01): A1dep/A1con before treatment–1.23 and after 30 days of therapy–0.97 relative units; for controls this value was–1.00 relative units. The same type of normalization was observed for amplitudes A2 and A3 of melancholic patients. There were revealed significant changes of A3/A1 ratio that points out on conformational changes of serum albumin molecule in dynamics of venlafaxine therapy.

Conclusion

We have registered unidirectional changes in albumin molecule in patients with MD. Investigated parameters can serve as potential biomarkers for evaluation of efficacy of psychopharmacotherapy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Genetic counselling in patients with bipolar disorder–ethical challenges
Authors: Vasile D. , Vasiliu O.
Published: June 2017

Background

Genetic counselling in psychiatric patients is almost always a challenge on multiple levels of communication, because the mental health specialist is situated between the need to validate the freedom of procreation, and the duty to inform patients about the risk of transmitting their disease to off-springs. Bipolar disorder (BPD) is reputed to be one of the most heritable psychiatric disorder, a factor that complicate even more the ethical situation.

Objectives

To assess how psychiatrists and psychologists conducted genetic counseling for patients with BPD and the challenges that mental health professionals consider important when they need to make this type of counseling.

Methods

Standardized interviewing of 15 psychiatrists and psychologists who experienced during their clinical practice aspects of genetic counseling in patients with BPD.

Results

The most commonly reported problems related to the genetic counseling in bipolar patients were: lack of reliable data on family history (53.3%), amplification of patient stigmatization (46.6%), controversies in the literature on the assessment of the disease risk (40%), difficulties in maintaining a nondirective attitude (33.3%), lack of genetic counseling follow-up (33.3%), disproportionate interest from the partner without mental disorder, when compared to patients, in terms of aspects of genetic counseling (26.6%), alteration of the therapeutic relationship and patients interest in treatment (26.6%).

Conclusions

Genetic counseling is a challenge for mental health professionals, who must cope with the lack of reliable data on the pathogenesis of BPD, negative reactions from the patients’ partners, patient disinterest or hostility and possible negative effects on the therapeutic relationship.

Disclosure of interest

The presenting author was speaker for Astra Zeneca, Bristol Myers Squibb, CSC Pharmaceuticals, Eli Lilly, Janssen Cilag, Lundbeck, Organon, Pfizer, Servier, Sanofi Aventis and participated in clinical research funded by Janssen Cilag, Astra Zeneca, Eli Lilly, Sanofi Aventis, Schering Plough, Organon, Bioline Rx, Forenap, Wyeth, Otsuka Pharmaceuticals, Dainippon Sumitomo, Servier.
Akathisia: Prevalence and risk factors in patients with psychosis and bipolar disorder
Authors: Jouini L. , Ouali U. , Ouanes S. , Rania Z. , Jomli R. , Zgueb Y. , Nacef F.
Published: June 2017

Introduction

Akathisia is probably the most common and one of the most distressing of the movement disorders associated with antipsychotic drugs. Little is known about its prevalence and its risk factors in real-world psychotic and bipolar patients to date.

Objectives

The main objective of this study was to determine the prevalence of akathisia and to determine the risk factors and the treatments associated with it in a sample of Tunisian patients with schizophrenia, schizoaffective or bipolar disorder.

Methods

Seventy-four patients with schizophrenia, schizoaffective or bipolar disorder were included and assessed with a validated scale: the Barnes Akathisia scale (BAS). Ongoing psychotropic treatments were recorded.

Results

The global prevalence of akathisia (as defined by a score ≥ 2 on the global akathisia subscale of the BAS) was 20.5%. Akathisia was significantly more common in patients with schizophrenia or schizoaffective disorder than in patients with Bipolar disorder (27.5% vs 9.4%; P = 0.049). However, the prevalence of akathisia did not differ according to sex, age, the illness duration, the presence of a comorbid anxiety disorder, the number of antipsychotics used, the type of the used antipsychotic (first vs second-generation), the antipsychotic chlorpromazine-equivalent total dosage, the use of benzodiazepines or anticholinergics, or the reported drug compliance.

Conclusions

Akathisia seems to be more common in some psychiatric disorders than in others such as schizophrenia or schizoaffective disorder. Longitudinal studies would be required to draw any firm conclusions concerning the factors involved in the emergence of akathisia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
National child developmental and mental health disorders screening policy in Thailand
Authors: Benjaponpitak A.
Published: June 2017

Background

Developmental disorders and mental health problems result in less optimal outcomes in children. Although awareness among the public had been improving, there was paucity of early identification frameworks, care pathways as well as the process of monitoring and evaluation in Thailand.

Objective

To develop appropriate National child mental health policy in Thailand.

Aim

To promote developmental and mental health outcomes of children.

Method

Current child development and mental health research as well as policy development were reviewed. The framework of development together with major mental health disorders screening and intervention among children has been studied and established as a major policy in Thailand since 2014. The National developmental screening has been implemented in children aged 9, 18, 30 and 42 months. District level hospitals have been coached to facilitate Health promotion schools to screen and provide early intervention for grade 1 students with mental health problems. Annual data has been collected and analyzed to reflect the milestones of child development and mental health prevention-promotion policy in Thailand.

Result

The coverage of National developmental screening ranges from 70–80% of children. About 20% of preschoolers are at risk of language delay while nearly 20% of grade 1 children are at risk of emotional, behavioral and learning problems. Parental awareness is the major challenge for those with limited financial resources.

Conclusion

Investments in early childhood development are needed. The pathways to develop the appropriate intervention requires further collaboration among stakeholders.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Differences in symptom expression between Vietnamese and German patients utilizing a psychiatric outpatient service using the PHQ
Authors: Dreher A. , Hahn E. , Ta T.M.T. , Nguyen M.H. , Diefenbacher A. , Burian R. , Dettling M.
Published: June 2017

Objective

Despite a large body of work on somatic symptom presentation among people of Asian descent, research has shown heterogeneous results. Examining symptom presentation in clinically and ethnically well-characterized populations constitutes a first step towards better understanding differing patterns symptom of presentation. This is the first larger study aiming to compare Vietnamese and German psychiatric outpatients regarding symptom presentation.

Methods

110 Vietnamese and 109 German patients seeking psychiatric treatment at two outpatient clinic services in Berlin were asked to complete the patient health questionnaire (PHQ). Comparisons of Vietnamese and German patients were conducted using independent t-tests. The somatic symptom module (PHQ-15), the depression module (PHQ-9) and the original PHQ-modules examining anxiety and psychosocial stress levels were compared for both groups using multivariate analysis. Categorical variables were evaluated using Chi2 analysis. Crohnbach's alpha was calculated separately for both groups and all PHQ modules.

Results

Vietnamese patients endorsed significantly higher levels of somatic symptoms overall and on individual somatic items, such as pain-related disturbancies. Yet, German and Vietnamese patients did not differ in terms of depression severity. Vietnamese patients with fewer German language skills showed a significantly higher tendency for somatization. While German patients showed higher total scores on the anxiety- and stress-modules of the PHQ, this difference was not statistically significant. Vietnamese and German patients showed comparable Crohnbach's alpha for all subscales.

Conclusion

As data was collected from both groups upon the first visit to an outpatient clinic, the symptoms reported could be reflective of culture related symptom awareness when feeling discomfort in the context of mental illness.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Time spent in retirement, health and well-being
Authors: Lucas A.R. , Daniel F. , Guadalupe S. , Massano-Cardoso I. , Vicente H.
Published: June 2017

Introduction

From a life-span developmental perspective, retirement can be considered a life event that entails a complex psychological challenge, including leaving one's professional life and organizing/enjoying the newly available free time. The literature about retirement identifies different stages and patterns of transition/adaption associated with time spent in retirement.

Objectives

To analyze the association between time spent in retirement and subjective measures of mental health, depressive symptomatology, loneliness and satisfaction with life.

Methods

Quantitative cross-sectional study with 641 participants (M = 74,86). The instruments included: sociodemographic questionnaire; mental health inventory (MHI-5); geriatric depression scale (GDS); UCLA loneliness scale; satisfaction with life scale (SWLS).

Results

Statistically significant differences in all the health and well-being variables addressed were found between subgroups of time spent in retirement (MHI-5: P = 0.001; GDS: P < 0.001; UCLA: P = 0.038; SWLS: P = 0.022). Mental health and satisfaction with life increases in the first year after retirement, but during the second year, they decrease to the levels found in pre-retirement. Loneliness and depressive symptomatology follow an inverted pattern. With the passing of years, loneliness and depression tend to increase; mental health and satisfaction with life tend to decrease.

Conclusions

The results provide support to the hypotheses of honeymoon and disenchantment phases in the recently retired and to the existence of different patterns of transition/adaptation associated with time spent in retirement. They also highlight the relevance of devising intervention strategies that enable individuals to maintain the satisfaction levels with life and mental health achieved during the first phase of retirement.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
MINDing the gap: Service users’ perspectives of the differences in mental health care between statutory and non-statutory organisations
Authors: McAndrew S. , Warne T. , Beaumont E. , Hickey A.
Published: June 2017

Introduction

In the UK, almost 50% of illness diagnosed among working age adults is mental distress, depression and chronic anxiety being the two most prevalent illnesses. However, only 24% of those diagnosed receive appropriate interventions within the National Health Service (NHS). In light of this, third sector organisations, such as MIND, are left to fill the gap in providing therapeutic care. This paper reports on an evaluative study of what Mind offers as opposed to statutory services from a service user perspective.

Aim

An exploration of the differences in mental health care between statutory and non-statutory organisations.

Objectives

To identify how service users experienced MIND's counselling service. To establish the benefits and disadvantages of mental health care within statutory and non-statutory services. To identify the impact of mental health care from non-statutory services.

Method

This qualitative research project, adopted a case study approach. Using one to one narrative interviews, data from 12 participants, five males and seven females were collected. Following transcription, each narrative was analysed individually, with thematic analysis being used across all 12 interviews.

Results

Six themes were identified; mindful of the gap; easing like sunday morning; magic moments; love is in the air; lighting up a future and changing the status quo.

Conclusion

Mind plays a significant role in enabling those with psychological problems to move towards building a better future. Findings suggest statutory services can learn important lessons from non-statutory organisations not least how best to provide cohesive, collaborative and compassionate mental health care for those in distress.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Acculturation strategies and severity of depression among Vietnamese migrants
Authors: Nguyen M.H. , Hahn E. , Burian R. , Dettling M. , Diefenbacher A. , Ta T.M.T.
Published: June 2017

Aims

Migration with its long-term changes and the resulting task to adjust to the new environment has been associated with an increased risk for mental health problems. This study aims to gain further insight on the relationship between the fours acculturations strategies (integration, assimilation, separation, marginalization) and severity of depression.

Methods

A total of n = 79 first generation Vietnamese outpatients from a psychiatric outpatient clinic for Vietnamese migrants in Germany were investigated regarding self-reported depressive symptoms (patient health questionnaire-9) and acculturation (Stephenson multigroup acculturation scale; SMAS).

Results

Patients with an integration acculturation strategy reported lower severity of depression compared to marginalized patients, who reported the highest severity of depression.

Conclusion

The results implicate that the integration of both the mainstream society and the ethnic society might serve as a resource, whereas the rejection of both societies might increase the risk of depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.