bluuebunny/crossref_metadata_2025 huggingface dataset:
Difference Between Normal and Priority Consultations On Mental Health Centers
Authors: Manso Bazús C. , Valdes Valdazo J. , Garcia Fernandez E. , Velilla Diez L.T. , Min Kim J. , Martinez Martinez C. , Heredero Sanz M.Á.
Published: May 2016

Introduction

Currently, in mental health teams there is overload in the first consultations, therefore, patients cannot be treated properly.

Objective

This study tries to reflect the differences between preferential and ordinary consultations, as well as the differences in the delay in the support between them.

Methodology

This is a retrospective observational study where data are collected for 3 months of the first consultations that are taken to a mental health center.

Results

The study reflects that preferential or normal (ordinary) derivation has no influence when it comes to the patient going or not going to the consultation.

On the other hand, there are very significant differences statistically in the waiting time between patients with normal and preferential priority.

Conclusions

According to the results observed would be advisable to use appropriate criteria to decide the priority of a patient's cares.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Comparative Study Between Preferential Consultations And Most Common Diagnoses
Authors: Manso Bazús C. , Valdes Valdazo J. , Garcia Fernandez E. , Velilla Diez L.T. , Min Kim J. , Martinez Martinez C. , Heredero Sanz M.Á.
Published: May 2016

Introduction

To the specialized attention arrives as preferred patients with minor diagnosis.

Objective

We do a relation between the type (normal/preferential) derivation of the first consultations and their corresponding diagnosis.

Methodology

Retrospective observational study with data gathered during 3 months, which handle 2 variables: on the one hand, type of derivation and on the other, effected diagnosis.

Results

The most frequent diagnosis found are adaptative disorders and affective disorders, corresponding to 45.45% and 9.1%, respectively of preferred leads.

Conclusions

Almost half of preferential queries (consultations) could be treated in first instance by primary care physicians releasing mental health care burden.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Knowledge and Uptake of Voting Rights By Adults With Mental Illness Living in Supported Accommodation in Westminster (London) During the 2015 Uk General Election
Authors: Townell J. , MacLaren T. , Argent V. , de Ridder L. , Shanmugham S. , Venkataraman A. , Clarke M. , Khwaja M.
Published: May 2016

Introduction

Voting is an essential human right. Being able to vote and participate in elections is an important component of social inclusion; empowering people with mental illness to have a political voice and in turn reducing stigma. Previous research indicates that patients with mental illness are less likely to vote compared to the general population.

Objective

This study explores knowledge and uptake of the voting rights of adults living in mental health supported accommodation in Westminster (London) in the 2015 UK general election.

Aims

Understand patients’ awareness of their eligibility to register and cast their vote. Identify patients’ interest in engaging in the voting process and strategies to overcome potential obstacles.

Methods

A staff-assisted survey was undertaken in all mental health supported accommodation across Westminster prior to the general election in May 2015.

Results

A total of 142 surveys were returned. Nine out of 10 surveyed believed they were eligible to vote; over half wanted to exercise their right to vote & if registered, a third felt they required assistance to vote.

Conclusions

The majority of community patients were positively aware of the impending general election and their own eligibility to vote. Only half wanted to exercise their right to vote, which is lower than the general population. As a third of the patients requested assistance for voting, this shows us that there are potential barriers impacting on their ability to exercise their right to vote. Staffs have an important role in promoting patient's right to vote by providing assistance with both the registering and voting process.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Knowledge and Uptake of Voting Rights By Psychiatric Inpatients in Westminster, London During the 2015 Uk General Election
Authors: Townell J. , MacLaren T. , de Ridder L. , Shanmugham S. , Argent V. , Venkataraman A. , Clarke M. , Khwaja M.
Published: May 2016

Introduction

Being able to vote empowers people with mental illness to have a political voice and promotes social inclusion. Evidence shows that patients with mental illness are less likely to vote compared to the general population.

Objective

This study explores the knowledge and uptake of the voting rights of adult patients in a psychiatric hospital in the 2015 UK general election.

Aims

To understand patients’ eligibility and intentions to vote during the 2015 UK general election. To establish what assistance patients may require in order to vote.

Methods

A staff-assisted survey was undertaken in all mental health wards in the Gordon Hospital, Westminster prior to the general election in May 2015.

Results

A total of 51 surveys were returned. Seventy-five percent thought they were eligible to vote, and 47% had already registered. Of those that had not yet registered, 37% wanted staff support to do so. Fifty-seven percent of the respondents intended to vote and of those 9 out of 10 intended to vote in person. Twenty-six percent of those intending to vote identified needing assistance in this process.

Conclusions

The majority of inpatients were aware of their eligibility to vote. Over half of the respondents planned to vote, which is lower than the UK average. As 1 in 4 patients intending to vote requested support, this suggests potential barriers impacting on their ability to exercise their right.

Multidisciplinary teams can provide valuable assistance to patients in the voting process in many ways, including information provision, organisation of leave and providing staff escort.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
DSM-5 Clinical/legal Challenges Regarding the USA's Death Penalty
Authors: French L.
Published: May 2016

Introduction

In May 2013, the American Psychiatric Association (APA) published the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in order to bring America's clinical professionals in concert with the World Health Organization's (WHO) international classifications, notably the ICD-10-CM. This effort was met with considerable resistance and changes were delayed until November 2015. Major social-cultural differences between the United States and its European and other North American partners (Canada and Mexico) poses challenges in critical forensic areas such as the clinical/legal assessment of death qualified offenders – a status unique to the USA.

Objective/aims

To articulate the clinical/legal differences between the previous DSM's (III; III-R; IV) and the DSM-5 and how the new language provides greater ambiguity in defining the mental status requirements for Mens Rea – competence to understand one's actions.

Methods

Present the major legal issues surrounding the US death penalty and brought before the US Supreme Court including: Furman v. Georgia (1972); Greg v. Georgia (1976); Jared v. Texas (1976); Proffit v. Florida (1976); Adkins v. Virginia (2002); Roper v. Simmons (2005); Miller v. Alabama (2012): … and legislative actions such as Rosa's Law (Public Law 111-256; 2010).

Results/conclusions

Advocacy groups pushed Rosa's Law to mental retardation with – intellectual and developmental disability. This change is reflected in the DSM-5 whereby mental retardation (MR) was once relegated to axis II, is now classified under intellectual disabilities (ID) given the impression that it is a transitory (correctable) and not a fix (organ disability) clinical condition.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Patricide, Matricide: A Comparative Study Among Tunisian Patients With Psychotic Disorders
Authors: Ghajati B. , Ghezaiel S. , Chebbi R. , Berrahal I. , Ridha R.
Published: May 2016

Parricide is defined as the homicide of a father or mother by a biological or adopted child. In adults, it is generally associated to a psychotic condition. Scientific research on the subject, have been mainly interested in matricide, patricide or double parricide. Studies comparing authors of patricide to those of matricide are rare.

Objectives

To compare socio-demographic and clinical profiles of patricide and matricide patients.

To compare modus operandi in matricide and patricide patients.

Methods

A retrospective, descriptive and comparative study was conducted, based on medical charts’ consult. Were included patients suffering from psychotic disorders (DSM-IV), hospitalized in the forensic psychiatry department of Razi hospital between 1995 and 2015, after not being held for insanity according to article 38 of Tunisian Criminal Code. Only patients who committed patricide or matricide were included.

Results

Our sample included 26 patients (13 patricides; 13 matricides). There was non-significant differences between two groups concerning: instructional level (P = 0.277), professional status (P = 0.387) and marital status (P = 0.790). Committers of patricide and matricide did not differ in terms of psychiatric diagnosis (P = 0.242) and substance abuse (P = 0.550). A significant difference was found between the two groups in terms of schizophrenia subtypes, patricide patients suffered from a disorganized schizophrenia whereas matricide patients suffered from paranoid subtype (P = 0.05). Patricide was more frequently associated to a conflictual relationship between son and father (P = 0.05). We did not record a significant difference in the crime weapon or its motivations.

Conclusion

Our results helps draw a profile for parricide patients in order to help identify the ones at risk.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Peculiarities of Mental Status and Criminal Behavior in Individuals Under Cannabinoid Consumption
Authors: Martinkiene V. , Survilaite A.
Published: May 2016

Introduction

Substance-related mechanism may be capable of promoting brain changes in high-risk individuals [1,2]. Cannabis use reported to be associated in long-term cognitive effects.

Aim

To evaluate mental status and criminal behavior in individuals under cannabinoid consumption in forensic psychiatric assessment.

Methods

A retrospective analysis was conducted of forensic psychiatry examination reports in psychoactive substance consumption cases (n = 170) in National Service of Forensic Psychiatry 2010–2014. Offenders, which were reported with cannabinoid consumption (n = 57) were assessed by socio-demographic characteristics, mental state, court order and outcome.

Results

Eighty-six percent offenders with cannabinoid consumption in observed period were men. The age of offenders prevailed from 18 to 35 years with basic education; 57.9% of offenders consuming cannabinoids were single (Fig. 1).

A total of 36.8% of all crimes in research group were committed against property, 31.6% – an unlawful possession of psychotropic substances, 22.8% – committed against human health, 8.8% – against public order (Fig. 2).

Conclusions

Impulse control deficiency and emotion disorders were prevalent among offenders under cannabinoid consumption; 17.5% were committed irresponsible, all of them due to comorbid psychiatric disorder. More likely to offend were men, aged 18–35 years, single, who had basic or lower education.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Relationships Of Clinical, Socio-demographic and Criminal Factors in a Sample of Forensic Psychiatric Patients
Authors: Sileikaite A. , Germanavičius A. , Česnienė I.
Published: May 2016

Introduction

The relationship between clinical factors and both psychosocial and criminal history characteristics among forensic psychiatric patients entering treatment in Lithuania has not been well explored.

Aims

The aims and objectives of this presentation are:

– to overview the clinical, socio-demographic and criminal factors in a Lithuanian sample of forensic psychiatric patients;

– to demonstrate which factors were significant to violent criminal behaviour;

– to address some main concerns and issues of risk assessment processes.

Methods

Data were collected from 325 forensic psychiatric patients’ files in one forensic psychiatric hospital in Lithuania. A sample consisted of 36 (11%) females and 289 (89%) males. The average age of patients was 41.7 years (SD = 14.0).

Results

Psychosis was the most common psychiatric diagnosis. The substance abuse problem was common in this population as well. The results of the logistic regression show that increase in patients’ substance abuse and their age was significantly associated with violent offending.

Conclusions

The study stressed an urgent need for further research of forensic patients in Lithuania.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychiatric Manifestations of Niemann-pick Type c Disease – Two Case Reports
Authors: Rebelo J. , Oliveira M. , Nunes P.
Published: May 2016

Introduction

Niemann-Pick type C disease (NPCD) is a rare metabolic illness, with autosomal recessive inheritance. NPCD has a heterogeneous presentation, with non-specific psychiatric symptoms, mostly affective and psychotic features and also cognitive deficits.

Objectives and methods

We present the case reports of two brothers with an adolescent-adult onset and discuss the evolution of their neuropsychiatric manifestations.

Results

The patients have now 35 and 31 years old and the youngest was the first to develop clinical manifestations of the disease. From 16 years old, he developed unspecified neurological impairment with gait imbalance. In the next years, the neurologic manifestations exacerbated, with dysarthria, ataxic gait, and his academic performance declined. With 24 years old, he presented acute psychosis, with unstructured delusion and auditory hallucinations. The acute psychotic symptomatology remitted with olanzapine but he revealed social withdrawal, apathy and progressive cognitive decline that persist until now. His brother, whose diagnosis was made in the course of the family genetic study, developed the first signs of the NPCD with 19 years old. He presented neuropsychiatric compromise, with impaired learning, social isolation and insomnia. They are receiving specific treatment with miglustat and symptomatic treatment for the psychiatric manifestations.

Conclusions

NPCD is a rare metabolic disease, with neuropsychiatric compromise. No general psychopathological profile has been associated to NPCD. Sometimes psychiatric symptoms dominate the initial clinical presentation, with neuro-visceral signs appearing later. An atypical psychiatric symptomatology should be extensively investigated in order to exclude organic causes, including metabolic diseases like NPCD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Depressive Symptoms in Older People in Greece and Cyprus
Authors: Argyropoulos K. , Panteli G. , Charalambous G. , Argyropoulou A. , Gourzis P. , Jelastopulu E.
Published: May 2016

Introduction

Depression is fast becoming a major public health problem with a very high prevalence rate in the 65 and over age group.

Objectives

The aim of the present study was to estimate the prevalence of depression in Greeks and Cypriots older adults.

Methods

A cross-sectional study was conducted among the 445 participants, 239 members of three day care centers for older people, in the municipality of Patras, West-Greece and 206 older adults (110 in the community, 65 in outpatient clinics, 31 in nursing homes) in Cyprus, aged > 60 years. A questionnaire was administered including socio-demographic characteristics. Depression was assessed using the Greek version of Geriatric Depression Scale (GDS-15).

Results

The overall prevalence of depression according to GDS-15 was 33% (28% moderate, 5% severe type). Depressive symptoms were more frequent in women (41,6% vs. 28,3%, P < 0,001), in not married (43,0% vs. 29,3%, P < 0,001), in elderly with chronic diseases (36,8% vs. 25,0%, P = 0,007), in older people dwellers of urban areas compared to rural (36,3% vs. 26,4%, P = 0,028) and in ages between 70 to 80 years old (38,7% vs. 31,6%, P = 0,038). Moreover, higher prevalence of depression was measured in Greeks compared to Cypriots (44,3% vs. 20,6%, P < 0,001). In a univariate analysis, the following variables were significantly associated with depression: female gender (P < 0,001), co-morbidity (P = 0,004), higher age group (P = 0,018), place of living (P = 0,022) and Greek nationality (P < 0,001).

Conclusions

High prevalence and several risk factors are strongly associated with depression, whereas Greeks are in higher danger of developing depressive symptoms in late life, than Cypriots.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Management of Late-life Insomnia
Authors: Bravo Herrero S. , Moreno Menguiano C. , Martín Aragón R. , Gutiérrez Rodríguez M. , Cruz Fourcade J.F. , Rodríguez Criado N. , Muñoz-Calero Franco P. , Sánchez Sánchez B.
Published: May 2016

Introduction

Insomnia is the most frequent sleep disorder in late life. Forty-two percent of elderly people in the United States often complain about difficulties to get or maintain sleep, or awakening too early. Insomnia is frequent in old people greatly due to frequency of concomitant medical illnesses and polypharmacy, rather than because of age.

Objectives

The objective of our research was to revise the current state of knowledge about management of insomnia in people above 65 years of age.

Methodology

For that, a bibliographical search through PubMed.gov has been made. From the obtained results, the 14 which best suited for our goals were selected, 10 of them dealing with people above 65 years and the rest with people above 75 or 80 years of age.

Results

Based on the literature reviewed, the current options of management of late-life insomnia are based on behavioral or pharmacological therapy. The combination of behavioral therapies shows results and is currently considered as an option, especially given the possibility of medicine interaction and the secondary effects hypnotic and sedative medicines might produce. There is a paucity of long-term safety and efficacy data for the use of non-benzodiazepine sedative-hypnotics. There are no criteria for the use of antidepressant sedatives in elderly people without diagnosed depression, although they are still used in practice.

Conclusion

Possibility of using behavioral therapy as first option. In case of polymedicated or multi-pathological patients, pay special attention when starting a pharmacological treatment, choose the most suitable one and supervise it closely.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Differential Diagnosis Based on Age. Diagnostic Difficulties
Authors: Rodrígue Vargas S.
Published: May 2016

Introduction

Following a case presented in our inpatient unit as well as various interdepartmental from internal medicine and other emergencies, we decided to conduct a literature review on the different organic causes that can trigger the onset of psychotic symptoms in elderly.

Objectives

A correct differential diagnosis of psychiatric symptoms in elderly.

Aims

Literature review of the literature on the presentation of psychotic symptoms in the elderly.

Methods

Description of a clinical case and development of diagnostic hypotheses.

Results and conclusions

For several decades are experiencing a gradual aging of the population, which means that we are at the onset of clinical symptoms not described by classical authors. Furthermore, scientific advances make infectious causes (such as neurosyphilis was our first diagnostic hypothesis) are increasingly rare. The elderly usually has multiple comorbidities, which are receiving various treatments that must be ruled out possible adverse effects.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Weathering the Silver Tsunami: Dementia Community Services in Singapore
Authors: Ting C.H. , Lim W.P.
Published: May 2016

Introduction

The prevalence of dementia rises with the rapidly increasing elderly population in developed world. In Singapore, 10% of the elderly population is estimated to have dementia. Other than physical and psychological needs, social welfare should also be addressed with the support of specialised geriatric care sources to improve their quality of life.

Objective

To study a case of an elderly with dementia, who was identified and managed through a multi-agency approach and to describe different services involved for dementia care.

Aim

To highlight the various elderly care organizations available in Singapore to address healthcare and social needs in dementia.

Method

Through a case report of an elderly who presented to hospital for medical issues with dementia, the social needs were identified and multiple agencies were involved to provide holistic care in dementia.

Result

A 77-year-old gentleman was brought by a community social worker to hospital as he was found ill during home visit. During admission, the concern for poor self-care and cognition decline was raised by his family. Mini-mental state examination was 16/30. He was diagnosed with vascular dementia with clinical and MRI Brain finding. With active multidisciplinary intervention, his medical issues were addressed, and family and social needs were attended by several voluntary welfare organizations. Access to memory clinic service was also arranged for. This intervention also provided opportunity for his long-term care and welfare.

Conclusion

Multi-agency approach is crucial in dementia care to identify their unmet needs and plan for long-term care in Singapore.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Evaluation of DBT Manual Adapted for People with Intellectual and Developmental Disabilities (idd): First Results
Authors: Elstner S.
Published: May 2016

Introduction

In contrast to psychopharmacological treatment, the current evidence base in psychotherapy for people with IDD is limited. But psychotherapeutic approaches offer an alternative treatment modality in people with IDD.

Objectives

Orientated on the “Dialectic-Behaviour-Therapy” concept, we developed an adapted manual for people with IDD and impulsive behaviour.

Aims

This study presents the first results of an evaluation our adapted DBT manual.

Methods

Three closed groups with 11 patients in total were prospectively included in a six-week in-patient psychotherapeutic DBT-programme. There was no randomisation or control group. Typical borderline symptoms (BS) were recorded using the “Borderline Symptom List” (BSL) and a short screening version for personality disorders (PSS-K). Impulsivity and behaviour in general were observed with the scale for impulsiveness and emotional deregulation (IES) and the German Developmental Behavioural Checklist (VFE). Special tendencies to self-harm were assessed using the scale for self-harm behaviour (IEFAS). From these scales, the means were observed during the course of our hospital therapy program over 6 weeks.

Results

There were 19 patients in total in 3 different groups. Eight dropped out for a variety of reasons. The mean scores for the remaining 11 patients in the BSL and PSS-K reduced significantly. The scores for impulsivity and self-harm improved. Overall, there was no significant change in behaviour.

Conclusion

This study presents the results of a trial of a DBT manual for people with IDD and BS. In general the BS declined, the impulsivity improved. The study is limited by the small numbers in the patient sample and the absence of a control group.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Think Fast, Treat Faster – A Case of a Treatable Rapidly Progressive Dementia
Authors: Santo V. Espirito , Figueiredo A.R. , Almendra R. , Almeida A. , Guimaraes P. , Velon A.G.
Published: May 2016

Introduction

Rapidly progressive dementias (RPD) are conditions that develop over days, weeks or months, which could be treatable if diagnosed in the acute phase.

Clinical case

A 62-year-old man with personal history of type 2 diabetes, started complaining of fronto-temporal headache, nausea and sub-febrile temperature. He went to his family doctor who prescribed ciprofloxacin 500 mg bid. Later on, he had difficulty to sleep and referred complex visual hallucinations. His family noted involuntary movements of the left upper limb and that he became more clumsy needing help for daily life activities. He went to our hospital one week later. He was apyretic and hemodynamically stable. On neurological examination, he had executive and visuospecial dysfunction, left limbs bradykinesia and ipsilateral limb ataxia. Involuntary movements of his left upper limb resembled alien limb phenomena. Complete blood count, complete metabolic panel, iron, folic acid, vitamin B12, anti-neuronal antibodies were normal. HIV, hepatitis B and C serologies were negative. Cerebrospinal fluid study showed 4 cells (100% mononuclear), normal glucose and protein levels, negative bacteriological exam but positive Herpes Simplex-1 Virus (HSV) DNA. Brain CT and MRI showed signs of ischemic microangiopathic leukoencephalopathy. He started treatment with acyclovir 30 mg/kg/d IV and quetiapine 100 mg id. His symptoms improved but he remained with a mild mnesic cognitive deficit and bradykinesia that stayed stable 3 years later.

Conclusion

This case exemplifies atypical HSV-1 encephalitis, one cause of RPD, that an early recognition is essential to reduce its associated morbidity.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effectiveness of Cognitive Behavioral Therapy in the Treatment of a Phobic Disorder in a Patient with Down Syndrome and Early Alzheimer's Disease
Authors: Mallet J. , Guillard V. , Huillard O. , Dubertret C. , Limosin F.
Published: May 2016

Introduction

Down syndrome was clinically described the first time in France by Esquirol (1838) followed by Down (England, 1866), to the identification of a chromosomal abnormality in 1959 (trisomy 21), which is the most common abnormality in neurodevelopmental disorders. Life expectancy increased from 9 years in 1929 to 55 currently. This is a common cause of mental retardation, and few tools are suitable for the care of these patients, including patients with Alzheimer's disease (prevalence of 55% between 50 and 59) or depression (prevalence 30%). No study evaluates the effectiveness of cognitive and behavioral therapy (CBT) in patients with Down syndrome but it is known to be effective in Alzheimer's patients. Some cases have been reported on the efficacy of CBT on phobias in patients with intellectual disability.

Objectives and aims

To evaluate the efficacy of CBT in the treatment of a specific phobia in a patient with Down syndrome and early Alzheimer's disease.

Method

Literature review and clinical case of a 51-year-old patient, hospitalized under constraints for behavioral disorders (agitation, body treatments refusals).

Results

By adapting CBT techniques to the problem of intellectual disability, treatment against the phobia was effective with clinical improvement, which allowed a return home.

Conclusion

The tools provided by CBT are suitable for the treatment of anxiety disorders in patients with intellectual disability, especially in patients with Down syndrome. Psychiatric disorders are under-diagnosed in these patients and under-treated. CBT is an aid to the treatment. It may allow the dismantling of symptoms and reduce behavioral problems.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Implementation Of Health Of The Nation Outcome Scale (HoNOS) In Outpatient Clinic, Sligo Mental Health Services: Feasibility And Agreement With Global Assessment Of Functioning Scale
Authors: Mulligan O. , Helmi L. , Adamis D. , O’Mahony E. , McCarthy G. , MacDonald A.
Published: May 2016

Introduction

Outcome measurements in mental health services is beneficial in allowing healthcare providers in determining the effectiveness of their treatment plan. Health of the Nation Outcome Scale (HoNOS) and Global Assessment of Functioning (GAF) are two well-established instruments to measure patients’ outcome.

Aims and objectives

To measure the correlation of these two scales, and the feasibility of HoNOS.

Methods

Prospective longitudinal study of psychiatric outpatients attending a clinic in Sligo. Patients were assessed using HoNOS and GAF by trained doctors during the consultation. Feedback from doctors using HoNOS during the research was taken as a measure for feasibility.

Results

Total of 441 HoNOS and 237 GAF completed on 280 patients (53.2% female, mean age 46.23; SD = 14.89). The correlation between HoNOS and GAF was (r = –0.696, P < 0.001). In reassessment, we found significant reduction in HoNOS score when comparing the first assessment with the second (t = 4.590, df = 110, P < 0.01) and the third (t = 2.876, df = 37, P < 0.01). Using a linear mixed-effects model, it was found that patients with diagnosis of schizophrenia, mood affective disorder, neurotic disorder, personality disorder and younger in age are more likely to improve during the follow-up compared to those with organic mental disorders, alcohol related problems and older age.

Conclusions

HoNOS is a feasible scale and can be potentially used as an outcome measurement in the mental health services. Can help in deciding better management plan for patient and improvement of the service. HoNOs can also be used for comparison of outcomes between services in national and international level.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A Retrospective Study of the Impact of Antipsychotic Medication on Readmission in Patients Followed by a Domiciliary Care Unit
Authors: Oliveira J. , Sobreira G. , Coelho I. Capeto , Gomes F. , Nobre A.
Published: May 2016

Introduction

Domiciliary care services’ patients have severe psychiatric disorders, challenging social contexts and physical comorbidities. These influence outcome but are difficult to modify. Conversely, antipsychotic medication is changeable and has been shown to be related to number of readmissions and length of stay.

Objectives

To assess whether injectable or oral and first or second generation antipsychotics (FGAP and SGAP) are associated with readmission and contact with mental health services.

Aims

To improve the quality of care in our domiciliary care unit (PreTrarCa) and its efficacy.

Methods

Active patients in PreTrarCa in 2015 with schizophrenia, schizoaffective, delusional or bipolar disorders were included (n = 64). Information regarding medication and average number of hospitalizations, appointments and missed appointments per year was retrospectively collected.

Results

Patients were mostly male (37), with mean age of 54, and mean follow-up of 41.20 months; 23 were prescribed injectable antipsychotics alone, 21 oral antipsychotics alone and 20 both; 36 were on injectable FGAP and 7 on SGAP. Oral medication was significantly related with missed appointments per year, but not with number of actual appointments. No other significant relation was found; although patients on SGAP had more hospitalizations (0.9 vs. 0.3 per year) and longer length of stay (21.9 vs. 6.3 days) these differences were not statistically significant.

Conclusion

Type of antipsychotic was not associated with readmission rates or contact with mental health services. Confounding variables and clinical outcome measures were not included and the effect of medication changes during follow up was not addressed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Seven Years Of Occupational Psychiatry In A Portuguese Universitary Hospital
Authors: Sousa L. , Antunes A. , Bastos L.
Published: May 2016

Introduction

Occupational psychiatry is the field of psychiatry that focuses on work, its importance in the lives of individuals and work organizations. It gained visibility in the 2000 decade, after the creation of the Academy of Occupational and Organizational Psychiatry. Following that trend, occupational psychiatry outpatient started in 2008 at Hospital de Santa Maria.

Objective

To describe the structure and functioning of that project; to characterize the population that has been referred to this subspecialty, as well as the main motives for referral; and to highlight some paradigmatic cases that deserve special attention.

Aims

Call attention to the importance of occupational psychiatry at the individual and institutional level.

Methods

All the patients ever referred to the occupational psychiatry consultation were considered for the analysis. Clinical information was obtained through medical records and interviews with the patients. Bibliographic research was conducted through the PubMed in the Medline library.

Results

In our hospital, the prototype patient referred to occupational psychiatry is a middle-aged woman working as a medical assistant. The most frequent motives for referral were related to difficulties in accomplishing job duties and definite psychiatric diagnosis corresponded more often to the common mental disorders (anxiety, depression and adjustment disorders). At the institutional level, the initiative was received with great enthusiasm.

Conclusions

As Freud stated “To Love and work are the cornerstone of our humanness”, in line with that we consider that occupational psychiatry should be taken as a priority in what concerns to mental health policies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Stigma and Poor Mental Health Literacy As Barriers to Service Use Among Unemployed People With Mental Illness – A Qualitative Study
Authors: Staiger T. , Waldmann T. , Krumm S. , Rüsch N.
Published: May 2016

Introduction/objectives

Mental health problems were shown by different studies to be both: results of and risk factors for unemployment. However, unemployed people with mental health problems often have difficulties in finding and using mental health services and therefore do not benefit from therapies. Because unemployed individuals outside the healthcare system are a hard-to-reach group, barriers to but also facilities for mental health services are poorly understood.

Aims

The aim of the study is to identify barriers and facilitators of help seeking and service use, based on experiences of unemployed people with mental health strains.

Methods

We conducted 15 qualitative semi-structured interviews with unemployed individuals, facing self-reported mental health problems or mental illness. Topics included individual experiences with help-seeking and mental health service use, with a focus on barriers and facilitators. Interviews were audiotaped and transcribed verbatim. Transcripts were analyzed using qualitative content analysis and major themes were identified.

Results

Patients fear adverse reactions of psychiatric medication. They report to be treated as “different” by their social environment and health professionals, which leads to a lack of self-esteem and inhibits them in their help seeking efforts. Social support and desire for change on the other hand can be strong motivational factors in searching for help.

Conclusion

Perception of GPs towards mental health issues of their patients, and especially unemployed patients, has to be raised. Stigmatization of mental illnesses and help seeking should be reduced in practical context.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Improving Ghana's Mental Health Care Through Task Shifting – Psychiatrists and Health Policy Directors Views
Authors: Agyapong V. , McAuliffe E. , Farren C.
Published: May 2016

Background

Currently, Ghana has only twelfth psychiatrists in active service providing for the mental health needs of a population of nearly 25 million people. Ghana has therefore adopted a system of task-shifting to address the critical shortage of psychiatrists.

Aim

To examine the perception of psychiatrists and health policy directors about the government's policy to expand metal health care delivery in Ghana through a system of task-shifting from psychiatrists to community mental health workers (CMHWs).

Methods

A self-administered semi-structured questionnaire was developed and administered to 11 psychiatrists and 29 health policy directors.

Results

Only one psychiatrist and 3 (10.3%) health policy directors reported they were not aware of task-shifting within Ghana's mental health delivery system. Ten (91.1%) psychiatrists and 23 (79.3%) health policy directors were aware of a policy of the Government of Ghana to improve on the human resource base within mental health through a system task-shifting. Overall, 5 (45.5%) of the psychiatrists and 9 (31%) health policy directors perceived there are some resistance to the implementation of a policy of task shifting including resistance from traditional and spiritual healers, some psychiatrists, some community psychiatric nurses and psychologists. The majority of psychiatrists and health policy directors were of the view that CMHWs should be allowed to assess, diagnose and treat most of the common mental disorders.

Conclusion

Psychiatrists and health policy directors in Ghana support Governments policy to expand on mental health care delivery through a system of task-shifting despite their knowledge of resistance from certain professionals.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Transcultural Approach in Early Psychosis Interventions
Authors: Guerrero Jiménez M. , Rodrigo Manzano J.A. , Carrillo de Albornoz Calahorro C.M. , Girela Serrano B.M.
Published: May 2016

Introduction

The Early Psychosis Intervention Programme (EPIP) in South Granada serves a population with a first psychotic episode. In 2014, 16 patients entered the program, 6 of whom were North Africans.

Aims

It is justified by clinical and health care needs to adapt and contextualize care plans and interventions to the specific necessities of this population: considering its suffering meaning and interpretation.

Methods

A descriptive study of the data obtained in this population with the Scale of Positive and Negative Syndrome of Schizophrenia (PANSS) arises.

Results

In the positive scale, the 6 subjects score in the low range (between 6–25th percentile).

On the negative 2 score in the low range and 4 in the middle (between 26–74th percentile).

In the compound scale in 3 cases, the predominance of negative symptoms is in the low range scale, the rest is in the middle range.

Finally, in general psychopathology scale, 2 subjects scored in the low range, the same who scored in the same range in the negative scale. Two subjects scored in the midrange and 2 in the high.

Conclusions

According to data, positive symptoms do not stand out among this group of patients. As for negative symptoms, if the range is low, so is the measure of general psychopathology. If the range is average, general psychopathology is medium-high. Also, when the range is average in negative symptoms, means the compound profile reflects predominance of negative syndrome. This reveals the importance of emphasizing a negative symptoms approach and its relationship with general psychopathology.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychiatry Trainees in Turkey Considers Leaving the Country
Authors: Kilic O. , Sonmez E. , Guloksuz S. , Pinto da Costa M.
Published: May 2016

Introduction

The brain drain of mental health professionals is an important issue especially for developing countries with inadequate recruitment rates. The European Federation of Psychiatric Trainees (EFPT) investigated the extent of migration among trainees across Europe by Brain Drain research project. Results from a non-EU country, with the lowest number of mental health professionals per 100 000 population across OECD countries might provide important clues.

Objective

To identify attitudes towards and behaviors towards international migration among psychiatry trainees from Turkey.

Method

An online survey was conducted among psychiatry trainees from Turkey in 2013, as part of the EFPT Brain Drain Research Project.

Results

Of 107 trainees surveyed, 74% considered living abroad. However, the rate of having even short mobility experience was just 13%, and these were mainly educational visits. More than half of those who visited a foreign country reported to have a satisfactory experience, which might explain the positive influence of these visits on attitudes towards migration. Responders perceived academic conditions as the most important aspect of training that needs to be improved, in line with the fact that inadequate training programs were important reasons for migrating.

Conclusion

Overall, psychiatry trainees in Turkey tend to remain in their country of origin, which may protect healthcare system against the detriment of workforce loss. The relatively low rate of migration may also reflect the legislative barriers (e.g. being o non-EU country) impeding migrating. Our findings also suggest that the unmet educational needs of trainees require immediate attention.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Nose – a Case Report of Body Dysmorphic Disorder and a Literature Review
Authors: Agostinho C. , Henriques S. , Coelho I.
Published: May 2016

Introduction

Body Dysmophic Disorder (BDD) is relatively common disorder. Patients with delusional beliefs seem to show greater morbidity (more suicidal attempts and drug abuse or dependence) and less likelihood of receiving treatment.

Objectives and aims

In this study, we intended to report a case of BDD followed in psychiatric consultation from 2 years ago, and to make a review of the literature, namely presentation, treatment and prognosis of BDD.

Methods

We conducted a description of a BDD case and a research using “Body Dysmorphic Disorder” keywords on Pubmed.

Results

J.F., 45 years old, unemployed, living with his father, referred to the Psychiatric consultation by his GP. The disorder started in the adolescence with an excessive preoccupation with hair loss and nose length, but in early adulthood these concerns became more important. Around 30 years old he was followed in Psychiatry but abandoned. Years later he underwent nose plastic surgery. He tried underwent other nose surgeries, but was refused. He was advised to look for psychiatric care. From the initial observation I highlight the appearance (thin, with a wig, adhesive tape connecting the tip of the nose to the forehead pulling up the nose), delusional ideas regarding the appearance of the nose, overvalued hypochondriac ideas, and no insight for the disease. The patient was reluctant in taking psychotropic drugs. He was referred to day hospital, which he attended with great irregularity.

Conclusions

BDD is a disorder with poor prognosis, especially when delusional variant is present, probably in relation to the lack of insight.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mindfulness Skills Deficits in Pathological Skin Picking Behaviours
Authors: Pozza A. , Dèttore D.
Published: May 2016

Introduction

Pathological Skin Picking (SP) is a psychiatric condition with a 2–5%-prevalence in the community and consists of repetitive picking behaviours associated to marked distress, which can cause significant skin damage. Research has evidenced a Focused SP subtype, typically occurring in response to negative emotions, an Automatic subtype, occurring without awareness during activities not related to the picking behavior, and a Mixed one. Mindfulness skills have been studied as a protective factor involved in the treatment of several psychiatric disorders. Studying Mindfulness deficits in SP might help to identify interventions tailored for specific subtypes of SP behaviours.

Objectives

The current study examined the relationship between Mindfulness skills and pathological SP behaviours.

Aims

The study aimed to investigate whether Mindfulness skills deficits uniquely predicted SP subtypes behaviours after controlling for general distress in a community sample.

Methods

Ninety-seven community individuals (mean age = 39.71, SD = 16.37, 59% females) completed measures of SP, Mindfulness skills and general distress (anxiety and depression).

Results

Lower Mindfulness skills of Describing Internal Experiences (B = −0.12, P < 0.05) and higher anxiety (B = 0.08, P < 0.05) predicted more severe Automatic SP. Lower Mindfulness skills of Non-judging Inner Experiences (B = −0.12, P < 0.05), higher anxiety (B = −0.12, P < 0.05) and higher depression (B = −0.12, P < 0.05) predicted more severe Mixed SP. Focused SP was not associated to Mindfulness skills and general distress.

Conclusions

Mindfulness skills deficits could be associated to Automatic and Mixed but not Focused SP. Future studies should investigate whether Mindfulness programs are effective for individuals reporting Automatic or Mixed SP behaviours.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Influence Of Family Dynamics In The Development And Recovery Of Patients With Cancer Diagnosis. Report Of Two Cases
Authors: Leon-quismondo L. , Dieguez-porres M.F.
Published: May 2016

Introduction

Nowadays, it is well known that a cancer diagnosis has an important impact on the patient and his family. Given a stressful life event, such as cancer, the family is in crisis, so it is crucial how they facing the process. Two families with different adaptation process at the time of diagnosis are presented and the differences are analyzed.

Cases

Family 1: Woman, diagnosis of breast cancer. She lives with her husband and she has two children. Troubled family relationships before the diagnosis. Following the cancer diagnosis, family conflicts increase, both with their children and with her husband. The family is not able to adapt to the new situation and the patient perception is that her family do not care what is happening to her.

Family 2: Woman, diagnosis of breast cancer. She lives with her boyfriend, she has no children. She has a good relationship with her family before the diagnosis, without unresolved conflicts in the past. Since cancer diagnosis the whole family has turned to the patient, being more available for her needs, physically and emotionally. She is feeling supported by them and this is making the adaptation process and family adjustment easier, feeling the patient stronger to cope with illness.

Conclusions

In families with unresolved crisis before the disease, the psychological stress increases after diagnosis. The family finds it difficult to react and adapt to the changes caused by the disease and the relationships between its members deteriorate. Conversely, if the family dynamic is good, it is a positive factor in the recovery.

Disclosure of interest

The authors have not supplied their declaration of competing interest.