bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychiatric Assessment of Cases with Self-inflicted Poisoning in a Sample of Egyptian Children and Adolescents
Authors: El Rafei H. , Ghanem M. , Gamaluddin H. , Mohamed M.M. , Abdel Samiee’ A.M. , Shaker N.
Published: June 2017

Introduction

Suicide in children and adolescents is commonly underreported and studied. It is an interplay area of multiple static (sociodemographic), and modifiable (impulsivity, psychiatric morbidities, adverse life events (ALE), abuse, bullying) variables.

Objectives and aim

To assess and identify relative significance of dependent and independent risk factors in youngsters attempting self-inflicted poisoning.

Methods

Consecutive recruitment of patients aged 7–18, with normal IQ, admitted to poison control centre over 13 continuous months, with self-induced poisoning. All were assessed after guardians’ written informed consent for different risk factors identified for suicidal behavior using appropriate scales (PPS, SRRS-Y, FSSCS, BIS-11, J-TCI, Mini-Kid). Controls with no history of suicidal attempt were matched for age, sex and sociodemographics among their families.

Results

One hundred and twenty cases (16.7 years ± 1.6 SD, 91% females) and 100 controls (age 16.4 years ± 1.7 SD, 90.8% females) were assessed. In cases, 90.8% were of low/middle socioeconomic status, 73.5% had previous attempt, average within 10 months, 17.5% planned their attempt, 10.8% had a witnessed attempt. Stressor within 2 days was reported in 75.9%, severe in 40%. Impulsivity was more in its cognitive, planning and motor components (P = 0.001 in each) among attempters. Cases scored more on Novelty seeking, harm avoidance and reward dependence than controls who had more persistence, self-directedness and cooperativeness. Attempters had significantly more past medical and psychiatric history (P = 0.001, 0.05 respectively), 77.5% had a working psychiatric illness, 2% in controls.

Conclusion

Repeated suicidal attempts were the majority, with impulsivity as a predictive risk, especially if psychiatric morbidity or ALE in youths were encountered.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychiatric Co-morbidities in a French Cohort of Adults with High-functioning Autism (HFA)
Authors: Gaman A. , Godin O. , Scheid I. , Monnet D. , Murzi E. , Martinez Teruel A. , Amsellem F. , Laouamri H. , Souyris K. , Houneou J. , Infor T. , Delorme R. , Leboyer M.
Published: June 2017

Background and rationale

Psychiatric comorbidities are shown to be very prevalent in patients diagnosed with Autism Spectrum Disorder (ASD), up high to 53% for mood, 50% anxiety and 43% for ADHD disorders in an European cohort of adults with HFA. Using a new approach, our study proposes to explore aspects of comorbidities in the largest French cohort of HFA adults (C0733/InfoR) by implying qualitative and quantitative clinical tools.

Aims

To explore: (1) the prevalence rates of psychiatric comorbidities; (2) the interplay between comorbidities and the ASD symptoms.

Methods

Diagnosis was made according to DSM 5 criteria. Dimensional evaluation used Social Responsiveness Scale (SRS), Systemizing Quotient (SQ) and Empathy Quotient (EQ). We used T-test, Mann–Whitney test and linear regression models.

Results

We included 103 patients (mean age 29.3, sex ratio M/F: 3.4:1). Lifetime prevalence rates of 53.5% for depressive disorder 73.5% for anxiety disorders and 37.5% for ADHD were found. Subjects with psychotic co-morbid symptoms had a more severe social deficit (SRS score 66.2 vs 77.9 P < 0.05); patients with ADHD, lower cognition (mean IQ total 107.7 vs 99.0 P < 0.05). SQs (P < 0.05) were significantly higher in patients with co-morbid psychosis, dysthymia, suicide attempts, and depressive disorders and directly correlated with age (β = 0.35, P < 0.05). SQ and EQ were inversely correlated.

Discussion

The results reproduce the high prevalence of comorbidities in other studies and explore its association with social functioning and cognition. Identification of associated psychiatric conditions in subjects with HFA is therefore a crucial clinical issue potentially guiding the treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Group Experience and Dual pathology and Addictions in a Regional Hospital in Spain
Authors: García Jiménez M.G.
Published: June 2017

Introduction

Dual pathology is a term applied to those subjects suffering simultaneously from addiction and other mental disorder. Group psychotherapy can be used in people who have both diagnoses with good results in improvement of addiction and disease stabilization.

Objectives

The purpose of this study is to analyse to efficacy of a group of psychotherapy for patients with alcohol addiction and other mental disorder, and analyse the presence of personality disorder in this group and how it affects its evolution.

Methods

The study was conducted on a sample of 16 patients diagnosed with alcohol abuse or dependence with psychiatric co-morbidity who attended a therapy group for 6 months from January16 to June16. The study was conducted in ambulatory care (outpatient), being an open and heterogeneous group.

Results

Main diagnosis was unspecified personality disorder and mood disorder (25%) followed by borderline personality disorder and mood disorder (18.75%), attention deficit disorder and hyperactivity (18.75%), mood disorder (12.5%), substance use disorder without other psychiatric co-morbidity (12.5%), narcissistic personality disorder (6.25%) and impulse control disorder (6.25%). Regarding progress in the stages of change, results were as follows: 31.5% of patients progressed to the stage of preparation for action, 25% alternating periods of abstinence from alcohol with brief relapse, 25% advanced to the stage of action, 18.5% managed to stay alcohol withdrawn.

Conclusions

In our sample, we can conclude that a therapeutic group including patients at different stages of change and diagnoses is positive. At the end, improvement in mood and anxiety was observed.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Online Clinic, a New Method of Delivering Psychotherapy
Authors: Omrani M. , Alavi N. , Rivera M. , Khalid-Khan S.
Published: June 2017

Introduction

Psychotherapy is one of the most widely investigated and practiced forms of treatment used in the treatment of different mental health problems. However, there are some barriers in delivering this treatment, including long waiting lists, therapist shortage and lack of access to therapists in remote areas. Therefore, using alternative methods to overcome these barriers seems necessary.

Method

The division of psychiatry at Queen's university provides different psychotherapy groups for individuals suffering from different kinds of mental health problem. We gave the participants the opportunity to choose online psychotherapy through an online clinic or the live group sessions. All the patients were assessed by different questionnaires for evaluation of the efficacy of the treatment. The online clinic was designed to facilitate the communication between patients and clinicians and the material was delivered in PowerPoint format through the online platform. All user activities were logged for security purposes.

Results

Statistical analysis showed that this method of delivering psychotherapy significantly reduced patients’ symptoms and also decreased the number of people on the waiting list and increased the amount of compliance in patient's taking part in psychotherapy and number of people who were able to receive psychotherapy.

Conclusion

Despite the proven short and long-term efficacy of psychotherapy, there are some barriers in delivering this treatment. It is an unequivocal public health needs to overcome these barriers through alternative methods of therapy. With Internet use ever rising, developing an online clinic could be a new way in delivering different kinds of psychotherapy.
Clinical Effects of the Suicide Attempt with Topiramate
Authors: Montero G. , Alberdi I. , Niell L. , Baena R.Á.
Published: June 2017

Objectives

We report the case of a 45-year-old male diagnosed with mixed personality disorder brought the hospital for strange behavior. He is being treated with fluoxetine, lorazepam and topiramate; and visited his psychiatrist 72 hours ago.

Results

He has an adequate level of consciousness and describes retrograde amnesia of the last 72 hours. We found blocks of thought and abnormal behaviors such as dressing and undressing or sorting his belongings repetitively. Urine was only positive for benzodiazepines. In arterial blood gas analysis it performed highlights compensated metabolic acidosis. After ruling out neurological diseases and administrating fluids i.v. the symptoms remitted, persisting only the amnesia, establishing the diagnosis of suicide attempt with topiramate.

Conclusions

The use out-of-guidelines of topiramate in personality and eating disorders is an increasingly common habit in daily clinical practice, as well as suicide attempts with this drug. In therapeutic doses, over 40% of patients taking topiramate, have asymptomatic metabolic acidosis, which in stressful situations may have clinical relevance. In case of acute poisoning, metabolic acidosis is more frequent and severe, manifesting itself by hyperventilation, hypertension and varying degrees of impaired consciousness and cognitive functions. There is also a paradoxical increase in the frequency of seizures. Treatment is supportive and there is no antidote, being lethal cases exceptional. Gastric lavage and administration of activated charcoal have limited use. The determination of plasma concentrations of topiramate is not available for most centers and is not useful in acute poisoning.
Social Determinants, Which Encourage the Criminal Desistance in Young People in Conflict With the Law
Authors: Orlando M.
Published: June 2017

Introduction

Previous studies about young people in conflict with the law (YPCL) have a tendency to focus on the risk factors that contribute to trigger antisocial criminal behavior. Instead, this study aims to research the social determinants that encourage the criminal desistance: understood as a gradual process taking place in the periods of absence of crime and desire to abandon the criminal activity.

Objectives

From a sample that is made up of 100 YPCL, the main objective is to deduce the social determinants, which encourage the criminal desistance in YPCL, it means young people who commit crimes.

Aims

To infer the social determinants (circumstances in which people are born, grow, live, including the health system) which foster the desistance in YPCL.

Methods

The results of a sample of 100 YPCL were assessed with three profiles as follows: I: DSM-IV personality disorders (PD T-Scores). II: swap personality syndromes (Q-Factor T-Scores). III. factor T-scores.

Results

This research shows the prevalence of the following social determinants associated with the desistance: (1) integrated families. (2) Educational and cultural opportunities (3) academic progress. (4) Healthy relationships that support and help. (5) Stable living arrangements (6) social conditions preserved the use of psychoactive substances and alcohol abuse.

Conclusions

It is possible to identify the prevalence of social determinants which encourage the desistance in YPCL. Those allows them to transform their risk path in another that shows a positive development, associated with individual transformations that take them away from the criminal life and reintegrate into the community.
Postpartum Depression in a Public Hospital in Cyprus. Prevalence, Risk Factors
Authors: Argyropoulos K. , Andreou G. , Avramidis D. , Gourzis P. , Charalambous G. , Jelastopulu E.
Published: June 2017

Introduction

Postpartum depression (PPD) is a serious mental health condition. Untreated PPD places the mother and infant at risk and is associated with significant long-term effects on child development and behavior.

Objectives

Appropriate screening for and prompt recognition and treatment of depression after the birth of a child are essential for maternal and child well-being.

Aims

The purpose of the present study was to estimate the prevalence of PPD in the first 5 days after the birth of a neonate and to investigate associations with several risk factors.

Methods

A cross-sectional study was conducted among 150 mothers, in a public obstetric hospital in Nicosia, Cyprus. A questionnaire was administered including socio-demographic characteristics. The Greek version of the Edinburgh postnatal depression scale (EPDS), a 10–item questionnaire to identifying women who are at risk of PPD, was used to estimate depression among the participants.

Results

According to EPDS, 42% of the mothers screened positive for risk of developing PPD. Higher risk was observed in very young mothers (<20 years) (66.6% vs 15%), in women with history of psychological disorders (86.95% vs 33.85%), in single mothers (71.69% vs 22.8%), in women with serious problems during the pregnancy (74% vs 23.95%) and in mothers with not healthy neonate (75.7% vs 32.4%).

Conclusion

The study reveals a high prevalence of PPD and identifies various risk factors associated with developing PPD. The use of maternal depression screening programs such as the EPDS may help to recognize an elevated risk of postpartum depression and to ensure a healthier mother-child relationship.
Effects of Smartphone-based Memory Training for Older Adults with Subjective Memory Complaints
Authors: Shin M.S. , Oh S.J. , Seo S. , Lee J.H. , Song M.J.
Published: June 2017

Introduction

Brain health has garnered increasing attention as a requisite condition for healthy aging. The rapid growth in mobile health and increasing smartphone ownership among older adults has paved the way for smartphones to be utilized as effective tools for improving mental fitness.

Objectives

There are few studies that have explored the efficacy of smartphone-based cognitive training. The present study examined the memory-enhancing effects of smartphone-based memory training for older adults.

Aims

We explored whether newly developed application “Smartphone-based brain Anti-aging and memory Reinforcement Training (SMART)” improved memory performance in older adults with subjective memory complaints.

Methods

A total of 53 adults (mean age: 59.3 years) were randomised into either one of two smartphone-based intervention groups (SMART vs. Fit Brains®) or a wait-list group. Participants in the intervention groups underwent 15–20 minutes of training per day, five days per week for 8 weeks. We used objective cognitive measures to evaluate changes with respect to four domains: attention, memory, working memory (WM), and executive function (inhibition, fluency, etc.). In addition, we included self-report questionnaires to assess levels of subjective memory complaints.

Results

The performance on WM test increased significantly in the SMART group (t[17] = 6.27, P < 0.0001) but not in the control groups. Self-reports of memory contentment, however, increased in the Fit Brains® group only (t[18] = 2.12, P = 0.048).

Conclusions

Use of an 8-week smartphone-based memory training program may improve working memory function in older adults. However, objective improvement in performance does not necessarily lead to decreased subjective memory complaints.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cognition in schizophrenia: Selective impairment and factors that influence it
Authors: Petrova N. , Dorofeikova M.
Published: June 2017

Currently it is well known that schizophrenia is associated with cognitive impairment. Still there are many unresolved questions, such as whether cognitive deficit is total, what are the relationships of cognitive impairment with clinical features, demographic characteristics and different biomarkers, which could shed light on its pathogenesis. The aim of our study was to characterize cognitive impairment in schizophrenia and to find factors that may contribute to it. Sixty patients with paranoid schizophrenia were examined. BACS, Rey-Osterreith complex figure and correction task were used to assess cognitive functioning. Only 14.3% of patients had BACS score in the normal range. The vast majority of them showed impaired motor function, verbal and visual memory. Cognitive functioning did not worsen with time. Working memory impairment was influenced by genetic predisposition to schizophrenia and age of disease onset. Residual positive symptoms led to a decrease in the speed of skill development. Symptoms of anxiety and depression contributed to the impairment of accuracy. Hypomania was associated with impaired planning. Planning and problem-solving behavior did not correlate with other cognitive functions, which makes them isolated domains. Higher levels of NSE had been found in patients with more severe memory impairment. S100B level was associated with safer constructive abilities. In general, cognitive impairment in schizophrenia, although present in the majority of patients, varies a lot and appears selective and dependent on certain clinical features.

The study was supported by RSCF 14-50-00069 grant.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Impact of Cannabis in the Early Stages of Schizophrenia: A 3-Year Longitudinal Study on Cannabis Influence on Relapse Rates
Authors: Gomez Revuelta M. , Juncal Ruiz M. , Porta Olivares O. , Gajardo Galan V. , Santayana Jenaro G. Pardo de , Sanchez Blanco L. , Abejas Diez D. , Landera Rodriguez R. , Garcia Ayala L. , Nuñez Morales N.I. , Fernandez Rodriguez M.
Published: June 2017

Introduction

The first five years after the onset of a first episode of psychosis (FEP) are crucial for long term outcome. In this period, the risk of relapse is particularly high. Consequences of relapse include an increased risk of neurotoxicity, chronicity, hospitalization, decreased response to treatment, increased economic burden and functional impairment.

Objectives

To discern the influence of cannabis on relapse as it may contribute to adopt specific measures in patients during early stages of the illness.

Material and methods

PAFIP is an early intervention program for patients with a FEP. Between January 2005 and January 2011, 163 patients were recruited for this study. They were followed-up during 3 years at intervals of three months. The sample was divided into three groups: (1) those non-cannabis users neither before the FEP nor during follow-up (nn), (2) consumers before the FEP and during follow-up (ss) and (3) consumers before the FEP that gave up consumption during follow-up (sn).

Results

No statistically significant differences between the three groups were observed but a trend (P = 0.057) towards a more enduring survival in Group 3 (sn). (Kaplan–Meier curve and detailed Log Rank Test results will be included in the final poster).

Conclusions

Cannabis has a detrimental effect on schizophrenia. The interruption of its use could contribute to improve the outcome of the disease, as the results of our study suggest.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Concordance and Discrepancy Between Subjective and Objective Cognitive Assessment in Bipolar Disorder: What is Influencing this Discrepancy?
Authors: Lima F. , Cardoso T. , Bonnin C. , Martinez-Aran A. , Vieta E. , Rosa A.
Published: June 2017

Introduction

Evidence has shown that some patients with bipolar disorder have a relatively accurate sense of their cognitive abilities, whereas others may overreported or underreported cognitive difficulties, which causes a discrepancy in this measures.

Objectives

To investigate concordance and discrepancy between subjective and objective cognitive measures, as well as to identify factors that could influence this discrepancy.

Methods

Patients who met DSM IV-TR criteria for bipolar disorder in partial or full remission (HDRS-17 score ≤ 12; YMRS score ≤ 7) were recruited from outpatient clinic at Barcelona and Porto Alegre. Objective cognitive assessment was performed by the Letter-Number Sequencing (LNS-WAIS III). Cognitive Complaints in Bipolar Disorder Rating Scale (COBRA) was used as a subjective cognitive measure.

Results

Were included 179 patients. We found a concordance between COBRA and LNS in 62 cases, and discrepancy in 117 cases (Fig. 1). The incongruent group (COBRA–and LNS + ) have less years of study (8.10 ± 4.01) than the incongruent group (COBRA+ and LNS–) (13.44 ± 4.05, P = 0.001), and than congruent group (COBRA–and NLS–) (13.75 ± 4.04, P = 0.003). Finally, the congruent group (COBRA+ and LNS + ) was the group with higher functioning impairment.

Conclusions

A few number of false-negative cases were detected, suggesting that COBRA can be used as a screening instrument. A special attention should be provided for subjects with a few years of study, because possibly these subjects presents more difficulty in express its cognitive difficulties.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Could Soluble Intercellular Adhesion Molecule-1 be Associated with State Affective Symptomatology in Healthy Adults?
Authors: Pantovic M. , Dunjic Kostic B. , Petronijevic N. , Velimirovic M. , Nikolic T. , Jurisic V. , Lackovic M. , Totic S. , Jovanovic A. , Damjanovic A. , Ivkovic M.
Published: June 2017

Introduction

Immune parameters are frequently associated with mood disorders and affective temperaments. In our study, we investigate the role of soluble intercellular adhesion molecule-1 (sICAM-1) in affective temperaments and mood symptoms in healthy adults.

Methods

Healthy adults were screened for psychiatric disorders using the non-patient version of the Structured Clinical Interview for DSM-IV-I and II. Affective temperaments were evaluated with Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A). State mood symptoms were assessed using the Young Mania Rating Scale (YMRS) and Montgomery-Åsberg Depression Rating Scale (MADRS). Serum sICAM-1 levels were measured using enzyme-linked immunosorbent assay.

Results

We identified no association between sICAM-1 levels and affective temperament scores. We identified correlation between sICAM-1 levels and manic symptoms measured by YMRS. Furthermore, sICAM-1 was a significant predictor of manic symptoms in a linear regression model with age, gender, BMI and smoking habits as confounding variables.

Conclusions

Our findings suggest that sICAM-1 could be a relevant immune factor for severity of state affective symptoms and could contribute to better understanding of complexity of affective disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Negative Psychotic Symptoms in 22q11.2 Deletion and Their Association with Neuropsychological Profile
Authors: Pontillo M. , Lin A. , Armando M. , Menghini D. , Alvares G. , Vicari S.
Published: June 2017

22q11.2 deletion syndrome (22q11.2 DS) is associated with a markedly elevated risk for schizophrenia spectrum disorders. The role of negative symptoms in the pathogenesis of schizophrenia in this population and their link to role, social and cognitive functioning is still unclear. Aims of this study were investigate the association between negative symptoms, social and role functioning and neurocognitive performance in the sample of individuals with 22q11.2DS and compare them to healthy controls. The study was conducted on a sample of 60 individuals with 22q11.2DS (mean age = 14.8; SD = 4.8) and 56 healthy control (HC) participants (mean age = 13.8; SD = 5.4). Individuals with 22q11DS and high level of negative symptoms showed significantly higher level of impairment in several neurocognitive domain (i.e. visuospatial abilities, verbal response inhibition) compared with individuals with 22q11DS and low level of negative symptoms and healthy controls. They showed also lower global functioning, specifically role functioning and not social functioning. Negative symptoms are frequent in 22q11.2DS and are associated with specific cognitive deficit and low role functioning. These results suggest that negative symptoms should be considered an important target in the assessment of risk of conversion to full-blown psychosis and in planning of psychological interventions for this population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Childhood Trauma and Cortisol Response to the Trier Social Stress Test in Symptomatic Patients with Eating Disorders
Authors: Marciello F. , Buonomenna V.-M. , Caivano V. , Cascino G. , D’Agostino G. , Nunziata D. , Monteleone P.
Published: June 2017

Introduction

Childhood trauma exposure is associated with the risk of eating disorders (EDs) in adulthood. The biological basis of this link may involve a persistent dysregulation of the endogenous stress response system, in particular the hypothalamic-pituitary-adrenal (HPA) axis, as a consequence of early life maltreatment.

Objective

Adult patients with EDs and history of childhood trauma may have a dysregulation of the HPA axis that could be different from EDs patients without childhood trauma exposure.

Aims

In order to assess the effects of childhood trauma experiences on HPA-axis activity in EDs, we compared the salivary cortisol response to the Trier Social Stress Test (TSST) of adult patients with EDs according to their history of childhood trauma.

Method

Twenty-seven EDs patients and 13 healthy women participated in the study. Salivary cortisol responses during exposure to the TSST was measured. Participants also completed the childhood trauma questionnaire (CTQ) and eating-related psychopathological rating scales.

Results

According to CTQ, 15 individuals with EDs reported childhood maltreatment whereas 12 EDs patients and all the healthy women did not experience childhood maltreatment. Compared with the control group, non-maltreated EDs patient group exhibited a slightly enhanced cortisol response to TSST, whereas the group of non-maltreated EDs patients showed a normal cortisol response. Moreover, EDs patients with childhood maltreatment exhibited statistically significant blunting of cortisol compared to non-maltreated ones.

Conclusions

The present findings support the evidence that, in patients with EDs, there is a dysregulation of HPA-axis activity and that childhood trauma exposure may contribute to this dysregulation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Blood levels of patients with profound refractory OCD who are on supra-normal dosages of sertraline
Authors: Drummond L. , Robert V.
Published: June 2017

Introduction

Patients with OCD usually require higher dosages of serotonin reuptake inhibiting (SRI) drugs than is used for the treatment of depression. This observation resulted in treatment-refractory patients being occasional prescribed selective SRI drugs above the normal upper limit of prescribing. Previous studies have shown that these high doses are well tolerated.

Objectives

We decided to investigate the blood levels of patients on dosages of sertraline that were above the normal therapeutic range.

Method

Successive patients treated by the National Inpatient Service for OCD/BDD who were treatment refractory and prescribed > 200 mg sertraline per day were included. All had previously received 2+ trials of different SRIs for > 3months each as well as been offered augmentation with dopamine blockers and at 2+ trials of exposure and response-prevention. All patients scored in the profoundly ill range of the Yale Brown Obsessive Compulsive Scale.

Sertraline was titrated in 50 mg increases every 2–4 weeks up to a maximum of 400 mg. Blood samples were taken after their morning dose. This was after the patients had stabilised for at least 2 weeks on the higher doses.

Results

Seventeen patients were included in the study and received sertraline dosages ranging from 225 mg to 400 mg per day. Blood levels were within therapeutic range or below for all patients. Following treatment within the service, these patients generally showed an improvement of an average of improvement of 43% on the YBOCS.

Conclusions

A subgroup of patients with profound refractory OCD seem to either malabsorb or rapidly metabolise sertraline resulting in lower than therapeutic blood levels.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A validation study of the Mood and Feelings Questionnaire, Danish version
Authors: Frøkjær J. Eg , Bilenberg N. , Wesselhoeft R.
Published: June 2017

Introduction

The Mood and Feelings Questionnaire (MFQ) was developed to measure depressive symptoms in children and adolescents. It includes a child self-report part and a parent report on child part. The MFQ has been validated and proven clinical useful in several countries.

Objectives

To validate the MFQ in a population of Danish children and adolescents.

Aims

There is a need of a standardized questionnaire for Danish children and adolescents tapping into affective symptoms. Before routine use the MFQ must have been validated in Denmark. This study examines the validity of MFQ in Danish children and adolescents.

Methods

The study included two samples of probands aged 8–18 years. A population-based sample of school children and their parents, and a clinical sample including two subsamples:

– patients referred for Child and Adolescent Mental Health Services with depressive symptoms;

– in-patients at the paediatric department of a University Hospital.

All included probands and their parents filled out the MFQ and the clinical samples in addition answered the depression section of the Beck Youth Inventories, and were interviewed using the depression part of “K-SADS-PL”.

Results

Preliminary results from both samples will be presented at the EPA 2017 in Florence.

Conclusions

Depending on the results of this study, the MFQ might be used as a screening instrument and as a clinical tool to monitor depressive symptoms in Danish children and adolescents.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Social and family characteristics of children with stuttering in Tunisia
Authors: Baccouche K. , Walha A. , Hadjkacem I. , Kammoun W. , Hariz I. , Ayadi H. , Moalla Y. , Ghribi F.
Published: June 2017

Introduction

Stuttering constitutes for children a psychological and social disability, in which the environmental context plays an important role in the installation, stabilization and aggravation or attenuation.

Objective

Our study aims to describe the socio-familial characteristics of children with stuttering.

Patients and methods

This is a descriptive and analytical-retrospective study carried out on 80 children with stuttering and had been followed-up in the child psychiatry department of UMC Hédi Chaker Sfax (Tunisia) for more than 3 years (January 2012 to 31 December 2013).

Results

In our study, the prevalence of stuttering in child psychiatry consultation department of Sfax is 4%. Most of the patients were either the youngest (36.25% of cases) or seniors (35% of cases).

Personal history of speech disorder had been reported in 8 children (10% of cases). Family history of speech disorder was reported in 33.75% of cases. These disorders had been kind of stuttering in 60.66% of cases, speech delay in 18.52% of cases and sound speech disorder in 7.41% of cases.

The parent–child relationship is marked by a parental rigidity in 18.6% of cases. The existence of triggering factor was noted in 37.5% of cases: traumatic situation (30% of cases), the birth of a younger sibling (22% case).

Conclusion

The emergence and evolution of stuttering depend on predisposing, precipitating and chronicisants factors. Identifying these factors and adopting a favorable parental attitude contribute to the fight against stuttering in children and, at least, avoid aggravation and chronicity of this disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Behavioral problems in Silver–Russell syndrome – Case report
Authors: Karher K. , Banda I.
Published: June 2017

Objectives

The aim of this study is to present two cases of Silver–Russel Syndrome patients with behavioural problems. The male is diagnosed with ADHD, and the female shows antisocial behaviour.

Background

Russell–Silver syndrome (RSS) is a rare disorder characterized by intrauterine growth retardation and postnatal growth deficiency along with a handful of common physical characteristics and a range of other symptoms.

Methods

Clinical observation, tests (EEG, psychological tests – IQ scale, JEPQ, Projective techniques) and interviews with the patients and their parents and foster parents.

Results

S.H. (20 years) – is opponent, aggressive, refuses every kind of cooperation with delayed mental development.

V.M. (10 years) – premature baby (born in the sixth month) in a 40 years old mother (second pregnancy); blind on right eye and very low vision on the left eye; lost both of his parents at the age of 1.6 in a car accident; had several operations and is always under some treatments. V.M. had low school performance. The foster parent noticed that he has an attention deficit. Besides, he is very aggressive verbally and physically, has low frustration tolerance, borderline intelligence.

Conclusion

According to several studies that claims that patients with Silver–Russel syndrome have behavioural problems and among them, the most common are attention deficit problems; our study improves that hypothesis. Both of our patients have attention deficit problems.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Is bipolar over diagnosed in adolescents?
Authors: Paulino S. , Santos N. , Almeida A.C. , Gonçalves J.
Published: June 2017

Introduction

Since the mid-1990s, the diagnosis of bipolar disorder has increased significantly: two-fold among adults, four-fold among adolescents and 40-fold among children. Mood instability is a hallmark symptom of many psychiatric disorders but does not imply necessarily a diagnosis of bipolar disorder. Misdiagnosis is not just an academic issue: mood stabilizers have significant adverse effects and expose patients to side effects that range from mild to potentially life-threatening.

Objectives

Discuss the potential overestimation of bipolar diagnosis in the adolescent population through a statistical analysis of a sample from the adolescence's consultation of Centro Hospitalar Lisboa Norte.

Methods

Analysis of 106 patients taking into account the initial diagnosis and the diagnostic stability over 6 months. Non-systematic review of the literature.

Results

From this sample, 39.2% of the adolescents have a diagnose of unipolar affective disorder, 0.02% of bipolar disorder and 0.1% of disruptive mood disorder. These diagnoses did not change over the follow-up period.

Conclusion

It is important to try to understand the reasons of this potential discrepancy (influence of pharmaceutical company marketing, of parents’ desire, of doctors’ fear) to reduce controversy and confusion and to adjust treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Access and participation: What factors influence the provision and utilisation of health care services by children with learning disabilities?
Authors: Rebowska A.
Published: June 2017

Aims

The aim of this literature review is to explore the range of factors that influence the degree of access to health care services by children and young people with learning disabilities.

Background

Children with learning disabilities are at increased risk of a wide range of health conditions comparing with their peers. However, recent reports by UK government as well as independent charities working with children and young people with learning disabilities demonstrated that they are at risk of poor health outcomes as a result of barriers preventing them from accessing most appropriate services.

Methods

Comprehensive searches were conducted in six databases. Articles were also obtained through review of references, a search of the grey literature, and contacting experts in the field. The inclusion criteria were for studies evaluating access to healthcare services, identification and communication of health needs, organisational aspects impacting on access and utilisation, staff attitudes where they impacted on access, barriers, discrimination in patients with intellectual disabilities age 0–18. The literature search identified a sample of 36 papers. The marked heterogeneity of studies excluded conducting a meta-analysis.

Results

Barriers to access included problems with identification of healthcare needs by carers and healthcare professionals, communication difficulties, the inadequacy of facilities, geographical and physical barriers, organisational factors such as inflexible appointment times, attitudes and poor knowledge base of healthcare staff.

Conclusion

The factors identified can serve as a guide for managers and clinicians aiming to improve access to their healthcare services for children and young people with intellectual disabilities.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Developing and implementing digital-assisted parent training intervention for disruptive behavior in primary health care
Authors: Sourander A. , Ristkari T.
Published: June 2017

Background

According to many epidemiological studies early prevention of mental health problems is essential in childhood. The objectives are:

– to determine whether a digital-assisted intervention using whole-population screening that targets the most symptomatic 4-year-old children is effective at 12 months after the start of treatment;

– to describe the Finnish Strongest Families intervention model in primary health care.

Methods

The target population was children with high level of DBD symptoms screened from the population of 4-year olds attending annual child health clinic check-ups. The RCT study was conducted in southwest-Finland between 2011 and 2013. In the control group, participants (n = 232) were given access to a parent training website and a telephone call from a coach. Participants (n = 232) in the intervention group received internet and telephone delivered the Finnish Strongest Families program.

Results

During the 12-months follow-up results of the intervention showed the behavioural problems of the four-year-old children reduced significantly in the families who participated in the 11-week program compared to the control group. So far, this evidence-based intervention has been implemented in 13 municipalities in Finland and the nationwide implementing process is in progress.

Conclusions

Training parents online and over the telephone significantly decreases preschool children's disruptive behavior. Therefore, it is important to provide low threshold, digitally delivered, family oriented promotion, prevention and early intervention programs in the primary care. More studies are needed to evaluate the long-term effects and cost-effectiveness of digital interventions in preventive mental health care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Delirium: “The out of the track” of physicians
Authors: Mangas M. , Santos G. Alcobia , Martins Y. , Pires A. Matos
Published: June 2017

Introduction

Delirium is an acute clinical syndrome with diverse and multi-factorial etiologies. It has high prevalence in hospitalized patients and it is associated with serious adverse outcomes, increasing morbidity and mortality. Delirium requires a differential diagnosis with a wide range of mental disorders.

Aim

To evaluate cases referred to liaison psychiatry in Hospital José Joaquim Fernandes, in regard to the frequency, cause and misdiagnoses of delirium.

Methods

A retrospective analysis of liaison psychiatric referral from January to August 2016.

Results

The overall referral consisted of a total of 111 cases. Delirium was the second most frequent referral (21.6%), after depression. Half of patients had an advanced age (71–90 years). A total of 44.8% of patients with delirium were misdiagnosed and the referral causes were “depression”, “dementia”, “aggressive behavior”, “agitation” and “schizophrenic psychosis”. The majority of patients were referred by internal medicine. The most frequent underlying conditions were: postoperative (27.6%), respiratory diseases (24.1%) and sepsis (17.2%).

Discussion/conclusion

Delirium is one of the most frequent diagnoses in liaison psychiatry. This study supports the statement that delirium is often not recognized and that is misdiagnosed as a primary psychiatric illness, mainly, dementia or mood disorder. Although delirium is classified in ICD-10 as a psychiatric diagnosis and clinically manifests with a wide range of neuropsychiatric abnormalities, it is secondary to a medical/surgical disorder that requires urgent approach by the respective specialty.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Alternating intravenous racemic ketamine and electroconvulsive therapy in treatment resistant depression: A case report
Authors: Bartova L. , Weidenauer A. , Dold M. , Naderi-Heiden A. , Kasper S. , Willeit M. , Praschak-Rieder N.
Published: June 2017

Introduction

Treatment resistant depression (TRD) affecting approximately 10–30% of all depressed patients often remains misdiagnosed and undertreated, leading to a higher risk of relapse and suicide. Electroconvulsive therapy (ECT) and sub-anesthetic ketamine have repeatedly shown to be effective in the TRD population. Administering ketamine as an anesthetic component to augment antidepressant efficacy of ECT has been proven inconclusive, while a combination of alternating ECT and ketamine has not been investigated yet.

Case report

We present a severely depressed and chronically suicidal female inpatient who failed multiple antidepressant treatment attempts, requiring frequent psychiatric admissions. Since available conventional as well as non-conventional antidepressant treatment strategies were nearly exhausted, we employed a combination of ECT (bilateral stimulation up to 150%) 2–3 times/week, while intravenous racemic ketamine (up to 75 mg per infusion) was administered on ECT free days 2–3 times/week. Consequently, robust anti-suicidal and antidepressant effects could be observed already during the first treatment week. The temporarily occurring subjective forgetfulness disappeared after the last ECT. Summarizing, we employed 9 ECT treatments and 7 ketamine infusions leading to a stable psychopathological state even after discharge from psychiatric inpatient care. In order to prevent relapse a maintenance-therapy comprising ECT once monthly and 2 ketamine infusions (up to 100 mg per infusion) administered on the day before and after ECT was established.

Conclusions

In our patient alternating ECT and intravenous racemic ketamine were proven safe and long-term effective after numerous failed antidepressant trials including ECT and ketamine alone. We may hence encourage clinicians to widen their therapeutic armamentarium in severe TRD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Does committed action act as a buffer against the impact of shame on depression?
Authors: Ferreira C. , Marta-Simões J. , Trindade I.A. , Mendes A.L.
Published: June 2017

Committed action is defined as the ability to take action guided by personal life values, i.e., to be persistent in valued behaviours even when such pursuit implicates facing setbacks and experiencing discomfort. This is a key process for acceptance and commitment therapy, and is linked to several positive mental health outcomes. Although current literature has stressed the pervasive impact of shame on psychopathology, especially on depression, data concerning the role of committed action on the impact of shame on depression is considered insufficient. Considering these premises, the current study intended to explore the moderator role of committed action in the relationship between external shame and depressive symptomatology, in an adult sample of 178 participants of both sexes. Path analysis’ results showed that shame holds a positive effect on depression (β = 1.19, P < .001), and that committed action serves as a moderator of the effect of shame on depression (β = –.63, P < .010). The tested model accounted for 45% of the variance of depression symptoms. A graphical representation allowed to observe that committed action presents a buffer effect for the harmful impact of shame on symptoms of depression. That is, at any level of shame experienced, those individuals who revealed higher levels of committed action showed less depression symptoms. This study has corroborated the powerful effect of external shame on depression symptoms, which was found to be buffered by committed action. The present findings thus highlight the pertinence of identifying personal life values and motivating committed action, particularly in prevention and intervention programs for depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Association between self-stigma and coping strategies in depressive disorder–a cross-sectional study
Authors: Holubova M. , Prasko J.
Published: June 2017

Background

Self-stigma is a maladaptive psychosocial phenomenon that may disturb many areas of patient's life. In connection with maladaptive coping strategies should make mental health recovery more difficult. Specific coping strategies may be connected with the self-stigma and also with the severity of the disorder. The objective of the study was to explore the relationship between coping strategies, the severity of the disorder and self-stigma in outpatients with depressive disorder.

Method

Eighty-one outpatients, who met ICD-10 criteria for depressive disorders, were enrolled in the cross-sectional study. Data on sociodemographic and clinical variables were recorded. All probands completed standardized measurements: The Stress Coping Style Questionnaire (SVF-78), the Internalized Stigma of Mental Illness Scale (ISMI), and the Clinical Global Impression (CGI).

Results

The patients with depression overuse negative coping strategies, especially escape tendency and resignation. Using of positive coping is in average level. Coping strategies are significantly associated with the self-stigma. Negative coping (especially resignation and self-accusation) increase the self-stigma, using of positive coping (primarily underestimation, reaction control, and positive self-instruction) have a positive impact to decreased self-stigma. The level of self-stigma correlated positively with total symptom severity score.

Conclusions

The present study revealed the important association between coping strategies and self-stigma in outpatients with depressive disorders. Decreasing the use of negative strategies, and strengthening the use of positive coping may have a positive impact to self-stigma reduction.

Disclosure of interest

The authors have not supplied their declaration of competing interest.