bluuebunny/crossref_metadata_2025 huggingface dataset:
Motives And Behaviors of Medical Students (mis)using Prescription Stimulants
Authors: Fond G. , Berna F. , Domenech P.
Published: May 2016

Aims

To estimate the prevalence of psychostimulant use in French medical undergraduate and postgraduate students, associated consumption behaviors and motives.

Design

A population-based cross-sectional study using a self-administered online survey.

Participants

A total of 1718 French students and physicians (mean age 26.84 ± 7.19 years, 37.1% male).

Measurements

Self-reported lifetime use, motives, socio-demographic and academic features for other the counter (OTC), medically prescribed (MPP), and Illicit (IP) psychostimulant users.

Findings

Lifetime prevalence of psychostimulant use was 33% (29.7% for OTC, 6.7% for MPP and 5.2% for IP). OTC consumption mainly aimed at increasing wakefulness during competitive exams preparation and internship. OTC consumption was twice more frequent among users of other psychostimulants (MPP and/or IP). Most of OTC consumers began their consumption during exam preparation. Corticoids were the most frequently consumed MPP (4.5%) before methylphenidate and modafinil (1.5% and 0.8%, respectively). Unlike corticoids, methylphenidate and modafinil prescriptions are tightly regulated in France. Motives for MPP consumption were increased academic performance/concentration–memory and wakefulness. in that respect, restrictions on methylphenidate and modafinil prescriptions seem to be effective at limiting misuse. Corticoids were mostly consumed by interns seeking for wakefulness. Overall, 5.2% of the subjects consumed at least once IP, mostly cocaine and amphetamine derivatives. They sought euphoria and/or novelty.

Conclusions

Psychostimulant use is common among French undergraduate students, interns and postgraduate physicians. The type of drug used seems to depend mainly on product availability. increased rates of corticoids consumption for wakefulness purposes suggest another potential public health problem, as corticoids may have severe side effects.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Knowledge of Patients’ Voting Rights Amongst Mental Health Professionals Working in The London Borough of Westminster During The 2015 Uk General Election
Authors: MacLaren T. , Townell J. , Shanmugham S. , Argent V. , De Ridder L. , Venkataraman A. , Clarke M. , Khwaja M.
Published: May 2016

Introduction

Being able to participate in elections and to vote are important components of social inclusion; empowering people with mental illness to have a voice.

It is important that mental health professionals understand the voting rights of adults with mental illness in order to be able to provide appropriate advice and support.

Objectives

To explore knowledge of the voting rights of adults living with mental illness amongst mental health professionals working in both community and inpatient settings in Westminster, London.

Aims

To understand the level of knowledge amongst mental health professionals regarding the voting rights of patients with mental illness in order to identify unmet training needs.

Methods

A survey, in the form of a staff quiz was undertaken in all community and inpatient teams prior to the May 2015 general election. All multidisciplinary team members were included.

Results

in total, 211 surveys were completed. Ninety-eight percent of staff correctly identified that being a psychiatric inpatient does not change an individual's right to vote. Less than 50% of the staff members demonstrated correct understanding of the rights of patients detained under forensic sections, and the rights of the homeless to vote.

Conclusions

It is encouraging that knowledge of voting rights amongst staff appeared higher in our survey than in some published surveys. However, despite the development of a Trust Voting Rights Policy and Educational Film prior to the 2015 general election further staff education, particularly the rights of those detained under forensic sections or who are homeless, is required.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mapping vulnerability to bipolar disorders
Authors: Raposo M.R. , Piqueras M.D. , Martínez I. , Galdámez A.L. , Gil A. , Murcia J.B. , Belmar A. , Rodríguez A. , Manzur P. , Bello I. , Bravo S. , Ivanov V. , García C.J.
Published: May 2016

Introduction

Although early interventions in individuals with bipolar disorder may reduce the associated personal and economic burden, the neurobiologic markers of enhanced risk are unknown.

Objectives

The objective of this paper is to analyze the existence of neurobiological abnormalities in individuals with genetic risk for developing bipolar disorder (HR)

Material and methods

A literature search was performed in the available scientific literature on the subject study object, by searching MEDLINE.

Results

There were 37 studies included in this systematic review. The overall sample for the systematic review included 1258 controls and 996 HR individuals. No significant differences were detected between HR individuals and controls in the selected ROIs (regions of interest): striatum, amygdala, hippocampus, pituitary and frontal lobe. The HR group showed increased grey matter volume compared with patients with established bipolar disorder. The HR individuals showed increased neural response in the left superior frontal gyrus, medial frontal gyrus and left insula compared with controls. The overall results found no significant differences between individuals at high genetic risk and controls since the magnitude of the association as corresponds to an OR < 1.5 (low association)

Conclusion

There is accumulating evidence for the existence of neurobiologic abnormalities in individuals at genetic risk for bipolar disorder at various scales of investigation. The etiopathogenesis of bipolar disorder will be better elucidated by future imaging studies investigating larger and more homogeneous samples and using longitudinal designs to dissect neurobiologic abnormalities that are underlying traits of the illness from those related to psychopathologic states, such as episodes of mood exacerbation or pharmacologic treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Epidemic of Conversion Disorder in Janaozen, The Northern Kazakhstan
Authors: Molchanova E.
Published: May 2016

Janaozen, a small city in the Northern Kazakhstan is an oil town, where 8% of all Kazakh oil has been extracted since 1950s. Due to the harsh climate and uncomfortable living conditions on the one hand, and relatively high salaries on the other, the city became a “Mecca” for ethnic Kazakhs (oralmans), who migrated from the other countries of the former USSR. The strict division between “ours” and “oralmans” created a variety of predispositions for the existence of a recurrent intro-city conflict, which served as a background for the tragic events of December 2011. The strike of oil workers ended in a bloody carnage with long-lasting consequences. The high level of traumatic stress, secondary gain of traumatization, and relative isolation of oralmans created plausible conditions for explosion of mass conversion disorder, which in social consciousness was associated with measles vaccination.

On 16th of February, 20 teenagers were hospitalized with seizures of unknown aetiology, 60 girls got sick during the next three days, and 195 were hospitalized during the next three weeks. More than 100 were receiving an outpatient treatment. Foggy diagnosis of “post-vaccine reaction” led to panic among citizens, and a small city hospital became overcrowded by relatives of patients. The diagnosis of conversion disorder had been supported according to the criteria of ICD-10.

The results of numerous focus groups, archival research and individual interviews showed up the precise connections between oil workers’ strike in 2011 and mass conversion disorder in 2015.

Disclosure of interest

The author has not supplied his declaration of competing interest.
The Satanist Cult of Ted Heath: Ethical Implications of Authority Compromise
Authors: Kurz R.
Published: May 2016

Introduction

Seven UK police forces are currently investigating the alleged involvement of the late Edward Heath (Prime Minister 1970–1974) in a child abuse ring with Operation Midland investigating specifically the alleged murder of three boys.

Objective

The presentation raises international awareness of the investigation, sheds light on the suspected ‘Satanist’ ideology behind the cult and explores the implications for professional practice.

Aims

The paper highlights the corrosive impact on society of powerful pedophile rings that are protected by compromised authority representatives and professionals.

Method

Detailed accounts circulate on the Internet that name dozens of individuals allegedly active in the cult including high-ranking politicians, psychiatrists, psychologist, police officers as well as journalists and academics. Some of the alleged crimes can be corroborated with news reports or successful court prosecutions while the vast majority appear to be ‘known crimes’ that are successfully covered up.

Results

The widespread organisational structures parallel the Marc Dutroux case in Belgium. It appears to be the case that compromised mental health professionals and authority representatives shield the cult. It becomes an ethical obligation for the silent majority to speak out against such criminality and demand from their government effective investigation and prosecution.

Conclusion

Whilst an enquiry into historical allegations of institutional abuse is currently underway in the UK several cases emerged recently where satanic cults seemingly continue to be protected by the vested interests. Mental health professionals must stand up for victims and resist ill-conceived authority attempts to persecute abuse survivors and their supporters.

Disclosure of interest

The author has not supplied his declaration of competing interest.
The Characteristics of Alcohol Pharmacokinetics of Korean Female
Authors: Nam B. , Kwon Y.J. , Lee K.H. , Jon D.I. , Shon I. , Seo J.S.
Published: May 2016

Introduction

The systematized and proper sized research of alcohol pharmacokinetics in Korean has not reported ever.

Objectives and aim

Aim of this study is to measure the β value and alcohol pharmacokinetic factors in Korean adult female and the relationship between the β value and some variables including age, smoking, total body water, drinking capacity, BMI, blood cholesterol, body fat and body fat ratio.

Methods

Ninety-one subjects were randomly divided into two groups. One group was provided as much as 0.35 mg/mL/kg of alcohol and the other as much as 0.70 mg/mL/kg, and blood alcohol concentration was measured 15, 30, 45, 60, 90, 120, 180, and 240 min after the women finished drinking.

Results

The subjects’ mean alcohol elimination rate (β) was −0.002379 mg/100 mL·h, and there was no statistically significant difference in elimination rate between the two groups. The mean time to reach maximum blood alcohol concentration was 45 minutes, alcohol absorption rate was 0.1123 ± 0.1799 g/L/min, and the area under the concentration curve was 109.15 ± 62.95. Among the factors that correlated with alcohol metabolism, alcohol absorption rate and follicle-stimulating hormone were statistically significant, but age, body mass index, and body fat percentage were not significantly correlated with alcohol metabolism.

Conclusions

These results suggest that the β values for healthy Korean females can differ from the cut-offs that are currently used in Korea, which suggests that the legal limit for driving under intoxication should be adjusted.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychiatric Symptoms Paraneoplastic and Legal Obligation to Combination Therapy
Authors: Piqueras Acevedo M.D. , Martínez Pérez I. , Raposo Hernández: M.R. , González Galdámez A.L. , Belmar Simó A. , Gil Sánchez A. , Piqueras M.E. , Garcia Briñol C. , Bello Pombo I. , Busaileh Salas A. , Navarro A. , Alsuhail Lopez Blanco C. , peñalver J.M.
Published: May 2016

Women 49-year-old with a history of left mastectomy for breast Ca. The patient is brought to the emergency by his family for disorderly conduct compatible with manic phase and psychotic symptoms by delirious speech mystical-religious content refusal of the patient to be evaluated by any medical decision and abandoned chemotherapy. Initial screening is performed from the emergency department of organic pathology (TAC without findings and normalcy in other PC). At the beginning of involuntary admission income that is corroborated by the commission judicial, a request of the family and given the history of abandonment IC Oncology treatment is performed as a result of which it is found that the onset of the psychiatric clinic communicates matches the decision to abandon treatment; after reassessment of the clinical status of the patient and recommendation by her oncologist to resume treatment with RT to court new authorization for further diagnosis and initiation of treatment after assessment by forensic and judge is granted a week tests requested. After screening of limbic encephalitis but positive AC. SD income it is maintained and combined treatment is performed. At discharge, the patient is stable DP vs. psychopathology with good controls over concomitant breast disease.

Results

The need for medical treatment in organic pathology is justified even against the will of the patient in the context of represen

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Serine Racemase in Inhibitory Neurons at Striatum and it Might be Involved in Schizophrenia's Pathophysiology with d1 and d2 Receptors
Authors: Takagi S. , Balu D. , Coyle J.
Published: May 2016

Introduction

There is substantial evidence that hypofunction of the N-methyl-d-aspartate receptor (NMDAR) is a core pathophysiological mechanism underlying schizophrenia. d-serine and serine racemase (SR) (NMDAR co-agonist and it's producer) are thought to be involved in schizophrenia's pathophysiology as NMDAR function moderators. Our laboratory showed that excitatory neuron specific SR knock out (SRKO) mice still have just 50% reduction of SR whereas full SRKO mice had no SR. Furthermore d-serine and SR are found in inhibitory neurons not only in excitatory neurons with immunohistochemistry methods. Because NMDAR has excitatory functions, the existence of d-serine and SR in inhibitory neurons and their functions are of interest.

Aims

To elucidate the existence and roles of d-serine and SR in inhibitory neurons.

Methods

Inhibitory neuron marker, GAD65, specific conditional SRKO (GAD65 SRKO) mice were made by Cre-lox recombination method. The GAD65 SRKO mice were analyzed by HPLC for d-serine concentration, western blotting for SR expression, immunohistochemistry for SR positive cell's character identification and behavioral testing.

Results

GAD65 SRKO had about 50% reduction of SR in striatum but no reduction in hippocampus and frontal cortex. d-serine of GAD65 SRKO mice was not different from WT mice. Immunohistochemistry works revealed SR is in medium spiny neuron of striatum and has colocalization with DARRP-32, D1 receptor, and D2 receptor.

Conclusions

SR is expressed in inhibitory neurons at least in striatum. It might be involved in schizophrenia's pathophysiology because it colocalizes with D1 and D2 receptors.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Late-life Depression and Dementia Risk
Authors: Cherbuin N. , Kim S. , Anstey K.J.
Published: May 2016

Introduction

A substantial body of evidence linking late-life depression and dementia is now available. However, precise estimates of the relative risk attributable to late-life depression assessed with specific screening instruments at specified thresholds have not been previously produced.

Objective

Summarise dementia risks associated with depression.

Aims

Conduct a systematic review of the literature to produce precise and specific risk estimates for all cause dementia, Alzheimer's disease (AD), and vascular dementia (VaD).

Methods

The PubMed, PsycInfo, and Cochrane databases were systematically searched. Studies assessing incident dementia using validated measures of clinical depression or depressive symptomatology from prospective population studies were selected. The most specific analyses were conducted using both continuous symptomatology ratings and categorical measures of clinical depression based on single instruments with defined cut-offs.

Results

The literature search yielded 121,301 articles, of which 36 were eligible. Included studies provided a combined sample size of 66,532 individuals including 6593 dementia, 2797 AD, and 585 VaD cases. Random-effects summary estimates showed that the risk associated with depression did not differ by type of dementia. The most widely used instrument was the CES-D. A clinical threshold of 20 produced similar estimates for all-cause dementia (HR 1.83, 95% CI 0.95–3.52) and for AD (HR 1.97, 95% CI 0.96–4.04). Estimates based on other thresholds and continuous measures produced consistent results.

Conclusion

Reliable dementia risk estimates associated with late-life depression can be produced and do not differ between dementia types. Such estimates should be used in evidence-based medicine practice to assess individual risk and to inform policy on interventions to decrease risk in the population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Questions About Dementia with Lewy Bodies, Personal Beliefs and Real Performance for Financial Capacity Tasks
Authors: Giannouli V. , Tsolaki M.
Published: May 2016

Introduction

Although cognitive impairment occurs early in the course of dementia with Lewy bodies, little is known about DLB and its impact on more complex civil capacities, such as financial capacity.

Method

Three patients (mild DLB, severe DLB and MCI in DLB) were examined. Their total scores and (sub)scores on a financial capacity test revealed below normal (more than 1.5–2 SDs below) performance in contrast to cognitive intact elders (see Table 1).

Results

This is in contrast with their personal beliefs of financial capacity, which reflect a tendency to overestimate their level of financial capacity as recorded on a Likert-scale questionnaire.

Conclusions

The findings prompt a need for further research for an emerging problem in forensic psychiatry, that takes the form of the question: do all DLB patients – even in the stage of MCI – have the capacity for financial transactions?

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Comorbidity and Polypharmacy in Elderly Living in Nursing Homes
Authors: Ferreira A.R. , Martins S. , Fernandes L.
Published: May 2016

Introduction

The ageing process is characterized by a high level of complexity, due to the co-occurrence of multiple chronic diseases (comorbidity) that often results in the concomitant use of multiple drug therapies (polypharmacy) for treatment and prophylaxis. Institutionalized elderly may be regarded as the paradigm of this complexity because of their multiple chronic diseases and decreased functional and cognitive functions.

Objective

To explore and characterize the prevalence of comorbidity and polypharmacy in a sample of institutionalized elderly.

Methods

A cross-sectional study was conducted with an elderly sample recruited from three Portuguese nursing homes. Clinical information was obtained through interview and by review of residents’ medical records. The Anatomical Therapeutic Chemical/ATC classification was used to indicate the main group of medicines used, and polypharmacy was categorized into minor (2–4 medicines) or major (≥ 5). Comorbidities were coded using the individual body systems of Cumulative Illness Rating Scale for Geriatrics/CIRS-G.

Results

The sample included 175 elderly with a mean age of 81 (sd = 10) years and institutionalized for an average of 7 (sd = 11) years. Residents presented a mean of 9 (sd = 4) co-morbid medical conditions, mostly psychiatric (80.8%), vascular (76.7%) and endocrine/metabolic (70.3%). Major polypharmacy was verified for 73.9% of residents. The mean number of medicines was 7 (sd = 3), most commonly for cardiovascular (86.0%) and nervous system (79.1%) and for blood and blood-forming organs (69.2%).

Conclusions

As in other studies in similar settings, polypharmacy was fairly common. These results convey an important message considering that polypharmacy has been associated with negative clinical outcomes that could otherwise be preventable by reducing the number of prescribed medicines.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A Case Report of a Capgras’ Syndrome in Elderly
Authors: Menguiano C. Moreno , Rodriguez M. Gutierrez , Sanchez F. Garcia , Herrero S. Bravo
Published: May 2016

Introduction

Capgras syndrome is the most frequent delusional misidentification syndrome (DMS) which was first described in 1923 by Capgras and Reboul-Lachaux as ‘L’illusion des sosies’. Consists of believe that close relatives have been replaced by nearly identical impostors. It can occur in the context of psychiatric disorders (schizophrenia, major depression) such organic, in which onset of delirium is usually later coinciding with neurological damage or neurodegenerative disease.

Case report

Woman 73-year-old diagnosed of schizophrenia since more than thirty years ago. Her family talk about general impairment of the patient in the last two years. She needed a couple of psychiatric hospitalizations because of her psychiatric disease, and probably onset of cognitive impairment. In this context, we objectified the presence of a Capgras syndrome.

Objectives

To review the literature available about Capgras syndrome in elderly and illustrate it with a clinical case.

Methods

Review of literature about Capgras syndrome in elderly by searching of articles in the PubMed database of the last five years to illustrate the exposure of a single case report.

Results

The etiology of this syndrome is not yet well understood. Advanced age is frequently found Capgras syndrome with or without the concomitant presence of an obvious cognitive impairment.

Conclusions

Since it is a complex process an etiological model that combines cognitive and perceptual deficits, organic impairment and psychodynamic factors should be proposed. And it is important to make a correct differential diagnosis that allows us to carry out the best possible treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Case-report and Review of Selective Serotonin Reuptake Inhibitors-induced Delirium in Older Adults
Authors: Petrykiv S. , de Jonge L. , Arts M.
Published: May 2016

Introduction

Selective serotonin reuptake inhibitors (SSRIs) are the most widely prescribed antidepressants with generally fewer side effects than most other types of antidepressants. However, in frail elderly, the use of SSRIs was anecdotally reported as a potential cause of a delirium.

Objectives

To present a case of citalopram-induced delirium in an older adult diagnosed with late-life depression.

Aims

To review available literature on SSRI-induced delirium.

Methods

A case report is presented and discussed, followed by a literature review.

Results

Seven published cases of SSRI-induced delirium in older adults (> 60 years) were found while searching through Pubmed and Embase. Our case of a 75-year-old female is also included in this report. This patient was ambulatory treated with citalopram 20 mg per os against depressive symptoms and she developed a delirium four days after the initiation of the therapy. Blood tests were normal and CT scan showed no significant findings. No other medical evidence was found that could explain her delirium. Her symptoms finally resolved after discontinuation of citalopram.

Conclusion

The on- and off-treatment side-effect correlation by a segregate oral use of citalopram strongly suggests that SSRIs may have the potential to cause a delirium, especially in frail elderly. Further research on this topic is needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Spousal Caregiving for Parkinson's Disease: Life Changing Dynamics
Authors: Seibert P.
Published: May 2016

Although worldwide estimates of the prevalence of Parkinson's disease (PD) have been difficult to obtain, it is agreed that the frequency of cases is rising with the increase in human life expectancy. Spouses often assume the primary responsibility for individuals with PD and this considerable burden impacts all aspects of the caregivers’ (CG) and their families’ lives. Few have formal training in administering health care; yet they are required by necessity to undertake the CG role. We constructed two questionnaires specified for PD (84 items) and their CG (81items). Both were either mailed or emailed to 256 people from a PD association list. We also conducted in person interviews with 8 pairs of PD and CG. The questionnaires and interviews included a wide range of topics such as health history and change, physiological health, social engagement, support availability, stressors, emotional health, sleep, financial concerns, and overall QoL. Fifty-nine participants responded to the questionnaire (PD: 20 males, mean age 73.42; 11 females, mean age 77.73; (CG: 4 males, mean age 85.25; 24 females, mean age 69.13). We analyzed data specific to CG and also made comparisons between the CD and PD groups. Findings revealed increasingly significant physiological and psychiatric issues for both the PD and CG.PD reported greater satisfaction with support systems while CG expressed concern regarding the paucity of support for themselves. The presence of PD creates a multifaceted exponential increase in challenges to Qol for both PD and their CG with the latter receiving little support.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Interictal dysphoric disorder – the bridge between epilepsy and bipolar disorder
Authors: Sousa R. , Salta M. , Barata B. , Nogueira J. , Vieira J. , Ribeiro B. , Ribeiro R. , Mendes S. , Mendes R. , Gamito A.
Published: May 2016

Introduction

Psychiatric disorders are frequent among patients with epilepsy. The association between epilepsy and mood disorders is recognized since the classical antiquity. Recent studies demonstrated that the prevalence of bipolar symptoms in epilepsy patients is more significant than previously expected. In the first half of the twentieth century, Kraeplin and Bleuler were the first to describe a pleomorphic pattern of symptoms claimed to be typical of patients with epilepsy and recently Blumer coined the term interictal dysphoric disorder to identify this condition. Although for some authors, the existence of this condition as a diagnostic entity is still doubtful, for others, it represents a phenotypic copy of bipolar disorder.

Objectives

In this work, we start from the phenomenological similarities between the interictal dysphoric disorder and the bipolar disorder, to explore the neurobiological underpinnings that support a possible link between epilepsy and bipolar disorder.

Methods

Research of articles published in PubMed and other databases.

Results

Interictal dysphoric patients have features that resemble the more unstable forms of bipolar II disorder and benefit from the same therapy used in bipolar depression. Epilepsy and bipolar disorder share features like episodic course, the kindling phenomenon as possible pathogenic mechanisms and the response to antiepileptic drugs. The study of possible common biological processes like neurogenesis/neuroplasticity, inflammation, brain-derived-neurotrophic-factor, hypothalamus pituitary adrenal axis, provided promising but not consensual results.

Conclusions

Further efforts to understand the link between epilepsy and bipolar disorder could provide the insight needed to find common therapeutic targets and improve the treatment of both illnesses.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pathologic Aerophagia in Patients with Intellectual Disability: A Review of its Pathophysiology, Clinical Features and Management
Authors: Sajith S. , Wong W.
Published: May 2016

Background

Pathologic aerophagia is characterised by excessive swallowing of air resulting in significant abdominal distension or belching. This is a relatively rare condition in general population but has been reported in up to 8.8% of institutionalized patients with intellectual disability (ID). In severe cases, this can cause volvulus and ileus, and even intestinal perforation. Currently, there is limited information on this potentially life-threatening condition, particularly for people with ID.

Aim

To review the up to date literature on the pathophysiology, clinical features and management strategies of pathologic aerophagia in relation to people with ID.

Methods

A literature search of electronic database was performed using specific keywords. Review articles were selected using pre-defined criteria.

Results

Apart from a few small controlled trials on pharmacotherapy, most of the studies were case series or uncontrolled studies. The understanding on pathophysiology is incomplete but is thought to involve a reflex-induced movement of upper oesophageal sphincter and may be associated with anxiety or stress. A comprehensive history and physical examination as well as an abdominal radiograph may be helpful in diagnosis. The mainstay of treatment is reassurance and behaviour therapy. Medications that are helpful include antacids, anti-reflux drugs and benzodiazepines. Surgical treatment is recommended for patients who do not respond to conservative treatment.

Conclusions

Pathologic aerophagia is not uncommon in people with ID and can present with severe challenges in the assessment and management. Further studies are necessary to provide evidence-based treatment guidelines for the management of this condition particularly in patients with ID.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychosocial Factors Associated with Frequent Rehospitalization of Patients with Mental Health Disorders
Authors: Amirejibi T. , Zavradashvili N.
Published: May 2016

International research, which focuses on frequent users of the psychiatric services and on the psychosocial factors that are associated with frequent rehospitalization, emphasize that the problem of revolving door patient still stands and is severe. Research concerning the above mentioned issue has not been conducted in Georgia, therefore, this study aimed to explore the revolving door patients and psychosocial factors that contribute to their relapse and frequent readmission to acute psychiatric unit. Study was conducted at psychiatric department of Ghudushauri National Medical Center. Qualitative and quantitative analysis based on medical files of 34 adult patients with psychotic disorders, rehospitalized in acute psychiatric unit 60 days after their last discharge in 2012–2014 years, was conducted. Results of the study are in line with international research findings concerning the psychosocial factors that contribute to frequent rehospitalization of patients with psychotic disorders, such as: unemployment (97%), lack of support system (76,5%), non-compliance with treatment (91.2%), emotional reactivity to stressful life events, etc. However, according to the study, family atmosphere turned out to be the central problem which influences the index of conflict and expressed aggression in the family, has impact on the size of patient's support system, on substance abuse, on patient's relapse and on their emergency rehospitalization. According to the results of the study, family atmosphere is one of the most active and multifaceted factors that contribute to patient's relapse and frequent rehospitalization in Georgia. Therefore, implementing and developing interventions discussed in the research paper that will target this factor is essential.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mental Pain Expression in Psychopathology and its Assessment as a Therapeutic Outcome Measurement
Authors: Becker G. , Steiner E. , Nitzan U. , Grossman-Giron A.
Published: May 2016

Introduction

Every theory that explains psychopathology refers to different aspects of mental pain whether it regards annihilation anxiety, fragmentation of the self or feelings of intolerable anguish. The concept of mental pain has proved to be an important symptom in mood disorders in general and suicide in particular (Orbach et al., 2004; Levi et al., 2010; Levinger et al., 2015). Combining the understanding that mental pain is as a part of all forms of psychopathology with the growing interest in assessing therapeutic processes via outcome measures has led to the assumption that the tolerance and severity of mental pain could become powerful outcome measurement. The aim of this study is to assess the Mental Pain Scale (OMMP) and Tolerance to Mental Pain Scale (TMPS) as outcome measurement and to learn about their capabilities to distinguish between different psychopathologies.

Objective

The first objective would be to examine patterns of mental pain subscales in different psychopathologies. The second objective is to assess the OMMP and TMPS as outcome measurements.

Method

Two hundred and thirty outpatients were administered a clinical questionnaire battery composed of eight questionnaires. The patients were to fill these questionnaires every 3 months for one year or until the end of their therapy.

Results

We will present preliminary findings regarding the expressions of mental pain in different kinds of psychopathology and results of 3 months follow-up.

Conclusion

Tolerance and severity of mental pain are a vital to the assessment of psychopathology and should be used as outcome measurement of therapeutic process.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The metacognitive functioning in bipolar patients and in bipolar alcoholics patients
Authors: Vecchiotti R. , Meschini L. , Borsella I. , Pianella U. , Orsolini L. , Panichi M. , Valchera A.
Published: May 2016

Introduction

Metacognition is described as the set of human abilities that allows us to recognize and think about own and other people's mental states. We use these skills in order to overcome psychological and interpersonal issues and to cope emotional, cognitive and behavioral suffering. Studies that focusing on metacognition in bipolar disorder (BD) are still limited and data are controversial. Our purpose is investigating the difference between BD patients and BD patients with alcohol addiction (BD + A), in terms of metacognitive functions. In addition, we want to assess among BD + A whether the increase in metacognitive functions mediates the relationship between symptoms at T0 and T1.

Methods

Forty patients were recruited for this study. A set of tests was performed on each patient to formulate a metacognitive and clinical evaluation. A single measurement was performed on 20 BD patients. Two measurements (T0–T1) were carried out on the 20 BD + A patients, after an integrated treatment.

Results

Data shown significant differences between these two groups. As regards the treatment of BD + A patients, differences were found between T0 and T1. Among the BD + A patients, reduction in the Beck Cognitive Insight Scale (BCIS-SC, P 0. 042) scores between T0 and T1, leads to the prediction of symptom improvement.

Conclusions

Our results confirm the existence of a specific profile of metacognitive functioning in these patients. Our results reveal that the metacognitive functions appear to be predictors of the improvement in the remission of symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Assessing Strategies to Improve Antipsychotic Adherence: The Portuguese Version of the Difficulty Implementing Adherence Strategies
Authors: Cardoso A. , Aguiar P. , Byrne M. , Xavier M.
Published: May 2016

Introduction

Non-adherence is a problem throughout medicine and there are many strategies that are used to improve antipsychotic adherence. A review of the literature identified 33 commonly cited strategies for enhancing consumer adherence. Three core themes were identified: Information/Education; Behavioural strategies; and Cognitive/Motivational strategies.

Aims/objectives

To develop the Portuguese version of the DIAS.

Methods

The DIAS was translated and adapted for Portuguese language. The translation was done by the first author (AC). The accuracy of this translation was discussed in a two focus group of experts, providing opinion on face and content validity. The participants were asked to rate how often they had difficulties using each of the 33 strategies with consumers who were non-adherent. A four point Likert scale was used (1 = never; 4 = always) such that higher scores indicated more frequent difficulty using the strategy.

Results

A convenience sample of 65 mental health professionals working in a variety of settings is being collected. The average score in DIAS was 85.0 (SD14.6). The value of internal reliability coefficient α was 0.93. The intraclass correlation coefficient of total MABQ score was 0.45. The t-test showed that there were no statistically significant differences between the mean values of the measurement scale at two different times (84.5 vs.90.5; P = 0.04).

Conclusion

Interventions to improve antipsychotic adherence would benefit from further research. However, it is important always to bear in mind that none of these strategies can be a substitute a positive therapeutic alliance. The Portuguese version of DIAS will provide professionals with a new tool to evaluate the frequency how strategies are implemented and the impact of each strategy in treatment adherence.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mobility in Psychiatry: A Personal Experience in Swiss Addictology
Authors: Feteanu C.
Published: May 2016

Introduction

Switzerland is a very attractive country for workforce brain drain in the field of psychiatry, with work, academic and financial conditions identified as pull factors; resulting in long-term migration and high level of satisfaction [1].

Objectives

To enlight the phenomenon by reporting a personal experience of migration from France to Switzerland for work reasons as a psychiatrist.

Aims

To describe the main characteristics of the Swiss Mental Health Care in the Canton of Vaud focused on ambulatory cares in addictology.

Methods

Self-report description from the Centre Saint-Martin for drug addictions of the Community Psychiatry Department in Vaudois Teaching Hospital (CHUV) of Lausanne.

Results

The Centre Saint-Martin is an ambulatory center providing cares, support, treatment and harm reduction for adult drug addictions within a multidisciplinary team. The striking point of this model is the intense support made towards the community (general practionners, somatic and psychiatric cares) in order to maintain and develop addiction cares in the general health system. The case management model, still rare in France, is being implemented in the center resources management. Detailed descriptions are proposed.

Lack of psychiatrists in the French speaking Canton of Vaud makes it very attractive for European specialists. Work and academic facilities, including psychotherapy training are accessible to foreign psychiatrists.

Conclusions

Work migration is a unique way to experience different practices in psychiatry within Europe. Living and working conditions in Switzerland make it a country particularly attractive.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
An Innovative Day Centre in Athens With Expertise in Children Neglect and Abuse. A Unique Therapeutic Intervention Through the Fog of Economic Crisis
Authors: Kanellopoulos A. , Marini E. , Antoniou X. , Nikolaidis G.
Published: May 2016

The Day Centre “THE HOUSE OF THE CHILD” is a unique in Greece community unit providing customized clinical mental health services for therapeutic treatment and psychosocial rehabilitation of children and adolescents victims of abuse, neglect or domestic violence, as well as children or adolescents involved in cases of bullying. The Day Centre was founded by the non-profit voluntary organisation “THE SMILE OF THE CHILD”. The Day Centre's services are addressed to children and adolescents up to age of 18 who live either in residential care or in the community having a documented history of exposure to violence of any kind. Services are free of charge and are expanded to the following areas:

– early intervention-evaluation-counselling;

– diagnosis and treatment of the full range of child psychiatry disorders and issues of clinical attention;

– diagnosis and treatment of specific learning deficits and provision of speech therapy, οccupational therapy and special education support when needed;

– counselling for parents and carers of victimized children and adolescents;

– registering and statistical analysis of psychosocial rehabilitation needs arising from the child abuse incidents.

More general activities for raising awareness and sensitivization of the wider community in order to prevent all forms of child abuse and victimization.

The Day Centre's personnel comprises from a psychiatrist–scientific coordinator, three child psychiatrists, three clinical psychologists, a special educator, a speech therapist, a social worker, an occupational therapist and two administrators. This interdisciplinary therapeutic team undertakes a comprehensive diagnostic evaluation and therapeutic intervention scheme to address the complex disorders and wider psychosocial needs of children – victims.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychiatrist's Mental Health: A Look at Burnout in a Psychiatry Department in Portugal
Authors: Neves S. , Vieira F. , Madeira N. , Santos J. , Garrido P. , Craveiro A. , Veiga F. , Saraiva C.B.
Published: May 2016

Introduction

Mental ill health is common among doctors. Fast, efficient diagnosis and treatment are needed as mentally ill doctors pose a safety risk to themselves and to patients, yet they are often reluctant to seek help. Focusing on psychiatry, it is known that psychiatrists as a professional group are prone to stress burnout and suicide. Thus, it seems relevant and current to address on the burnout in this professional group.

Objectives/aim

To analyze the burnout levels and the existence of psychopathology in a Portugal psychiatry department.

Methods

Anonymous self-completion questionnaire, prepared by the Suicide Prevention Consultation (also using MBI-Maslach Burnout Inventory and QIS-Suicide Ideation Questionnaire) and distributed by e-mail and online submitted for all psychiatrists in the department.

Results

Forty-two percent of psychiatrists responded, mostly women. Although the percentages of responses related to fatigue/amount of work are significant, there were not high levels of emotional exhaustion and depersonalisation, but before satisfactory levels of personal fulfilment.

Conclusions

High levels of “burnout” are associated with high scores of emotional exhaustion and depersonalisation, but also with low scores of personal fulfilment. Despite the preliminary results of this study, it is important to remember important prevention strategies. Further studies directed to psychiatry trainees seem important, as this represents an important risk group, where an early intervention can make a difference.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Medical Comorbidity Related Risk Factors For Hospital-Based Mortality In Psychiatric Disorders of Icd-10 Classes F1–F4: A Comparative Overview of Five Studies In General Hospital Admissions
Authors: Schoepf D. , Heun R.
Published: May 2016

Introduction

Up to 60% of the non-suicide related premature mortality of individuals with major psychiatric disorders is said to be mainly due to medical diseases.

Objectives and aims

Based on five representative studies in general hospital admissions over 12.5-year observation, we will represent a comparative overview of medical comorbidity related risk factors for general hospital-based mortality in prevalent psychiatric disorders of ICD-10 major classes F1–F4.

Methods

In the original studies, medical comorbidities that increased the risk for hospital-based mortality were identified using multivariate forward logistic regression analysis. In secondary analysis, independent risk factors for general hospital-based mortality were compared between studies using the OR and the 95% CI.

Results

A total of fifteen medical comorbidities represented independent risk factors for general hospital-based mortality in more than one psychiatric disorder of ICD-10 major classes F1–F4. Infectious lung diseases and chronic obstructive pulmonary disease were mortality risk factors in all diagnostic classes. Type 2 diabetes mellitus represented a risk factor for general hospital-based mortality in individuals with schizophrenia (SCH), bipolar disorder (BD), and major depressive disorder (MDD). Atrial fibrillation was a mortality risk factor in individuals with MDD, anxiety disorder (ANX), and alcohol dependence (AD). In addition, nineteen medical comorbidities represented independent mortality risk factors in only one of the diagnostic classes, i.e. two in individuals with SCH, three in individuals with MDD, three in ANX, and eleven in AD.

Conclusions

In general hospitals, the pattern of medical comorbidities that explain the outcome of in-hospital deaths differs considerably between psychiatric disorders of ICD-10 major classes F1–F4.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mental Health Staff: to Promote Resilience, to Reduce The Risk of Burnout
Authors: Semenova N. , Palin A. , Gurovich I.
Published: May 2016

Introduction

Stress and burnout are clearly problems for mental health workers. In this paper, we present data from research study on moderators of burnout in mental health staff.

Objectives/aims

The purpose of this study was to explore the phenomenon of resilience as experienced by Russian mental health clinicians working in a highly demanding, specialized and stressful environment (e.g., staff shortages, health service shortages, not being notified of changes before they occurred).

Methods

The study used a range of self report questionnaires. Measures included a demographic checklist, the Hardiness Survey (Maddi 1984), and the GCOS – The General Causality Orientation Scale (Deci & Ryan 1985). The participants for this study were drawn from Medico-rehabilitation Unit, Psychiatric hospital, – the disciplines of psychiatry, clinical psychology and nursing. In all, 10 ward based mental health professionals were surveyed.

Results

This paper outlines the results of these measures. This in turn allows us to develop intervention strategy to ensure an effective provision, which depends on satisfied professionals, who have a sense of ownership over what they do and an ability to shape the direction of their endeavours.

Conclusions

The study's findings have the potential to inform organizations in mental health to promote resilience in clinicians, to deliver stress management interventions for staff with the potential to reduce the risk of burnout and hence staff attrition, staff retention and mental health.

Disclosure of interest

The authors have not supplied their declaration of competing interest.