bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing a Specialised Debrief Model for Simulation Training in Psychiatry
Authors: Attoe C. , Valdearenas L. , Cross S.
Published: June 2017

Introduction

High fidelity simulation training has a rich history in medical education. However, simulation as an education tool in psychiatry has been underused and neglected. More recently, clinical educators have begun to harness the potential of simulation in psychiatry, with increased usage at under- and postgraduate levels. An essential element of simulation training is the debrief that takes place with participants and observers following simulated scenarios. Current practices in simulation for psychiatry often rely on debrief models primarily designed for non-psychiatry training.

Aims and objectives

This project aimed to develop a specialised debrief model for simulation training in psychiatry.

Methods

The research team undertook a thorough literature search to identify existing approaches to simulation debriefing, and key theoretical constructs. Clinical educators from psychiatry and non-psychiatry disciplines were invited to attend focus groups to explore the use and key elements of structured and reflective debriefs in simulation. Focus groups were transcribed and analysed using thematic analyses.

Results

Literature searching identified various debrief models that have been used in psychiatry and non-psychiatry disciplines. Pertinent educational theory was highlighted, such as experiential learning and adult learning. Focus groups highlighted adaptations required to tailor a debrief model to simulation in psychiatry, such as the containing of emotions and use of didactic sessions.

Conclusions

Findings identified key differences between debriefing simulated scenarios in psychiatry compared to non-psychiatry. These findings have been used to develop a preliminary debrief model for simulation in psychiatry.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Impulsivity and Current Alcohol Use in Adolescents
Authors: Smaoui N. , Charfi N. , Turki M. , Maâlej-Bouali M. , Ben Thabet J. , Zouari N. , Zouari L. , Maâlej M.
Published: June 2017

Introduction

Many studies have focused on the strong link between impulsivity and addictive behaviors, such as alcohol use disorders.

Objective

Our study aimed to investigate the links between alcohol use and impulsivity in a sample of Tunisian pupils.

Methods

This was a cross-sectional study conducted in May and June 2016. It enrolled 317 pupils from four colleges and schools in Sfax (Tunisia). The participants were asked to answer a self-administered questionnaire, after their consent. Alcohol use disorders identification test (AUDIT) was used to evaluate alcohol dependence. The Barratt Impulsiveness Scale (BIS), in its 11th version, was used to assess impulsivity trait. Its three second-order factors were attentional impulsiveness, motor impulsiveness, and non-planning impulsiveness.

Results

The mean age was 16 years with a sex-ratio of 1.07. The school children reported having drunk alcohol at least once in 18.9% of cases and 41.66% of them still consume. According to AUDIT, 1.6% of alcohol users presented an alcohol misuse and 21.6% presented dependence. According to BIS, impulsivity prevalence (IP) in the whole sample was 27.8% while it was 40% among the alcoholic participants versus 24.9% in non-alcoholic participants. The average BIS score was more important in the alcoholic participants (69.25 versus 65.53; P = 0.011). Alcohol consumption was correlated to attentional impulsiveness (P = 0.01) and motor impulsiveness (P = 0.008). Alcohol dependence was correlated to motor impulsiveness (P = 0.018).

Conclusion

These results show the importance of clinically evaluating and intervening on impulsive personality traits to better prevent addictive behavior such as alcoholism among adolescents.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Incidences and risk factors of severe infections in young adults with schizophrenia: A nationwide register-based cohort study in Denmark
Authors: Pankiewicz-Dulacz M. , Stenager E. , Stenager E. , Chen M.
Published: June 2017

Introduction

Patients with schizophrenia deal with many risk factors that make them more susceptible to infections. However, knowledge about incidence and the nature of infections among people with schizophrenia is scarce.

Aims

To investigate the occurrence and risk factors for severe infections in schizophrenia patients.

Objectives

– to determine incidence rates of infections among young adults with schizophrenia;

– to define risk factors for infections.

Method

Population-based nationwide cohort study with selection of all individuals born in Denmark between 1975–1990 and follow-up period from 1995–2013 was conducted. Data from the Danish Psychiatric Central Register and the Danish National Hospital Registry were used. A Poisson regression was chosen to estimate incidence rate ratios of infections and to explore the associations of different risk factors like sex, age, substance abuse and medical co-morbidity with the rates of infections.

Preliminary results

922,564 individuals born between 1975–1990 were included in the study. Overall, 3520 women and 5479 men were identified with schizophrenia. In percentages, 36% with schizophrenia had infectious diseases compared to 25% of background population. Some of severe infections like HIV (0.23% vs 0.05%), sepsis (0.72% vs 0.27%), hepatitis (1.4% vs 0.22%) skin infections (12% vs 6.2%)and tuberculosis (0.12% vs 0.06%) were highly increased in persons with schizophrenia, whereas smaller differences were found regarding CNS infections (0.5% vs 0.4%) and gastrointestinal infections (8.7% vs 6.2%).

Conclusions

The preliminary data results suggest, that individuals with schizophrenia have higher prevalence of all types of severe infectious compared to the background population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Parental styles and quality of life in the families with adolescents suffering from inflammatory bowel diseases
Authors: Zmeskalova D. , Prasko J. , Ociskova M. , Karaskova E. , Mihal V. , Kamaradova D. , Latalova K.
Published: June 2017

Background

Inflammatory bowel diseases (IBD) in adolescents are chronic medical conditions with a substantial influence on the well-being of the family members.

Methods

Total of 27 adolescents suffered from IBD, and 39 healthy adolescents completed questionnaires ADOR (parenting styles assessed by teenagers), KidScreen-10 (quality of life), SAD (Scale of Anxiety in Children), and CDI (Children's Depression Inventory). Their parents completed the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), and Pediatrics Quality of Life Family Impact Module (PedsQL).

Results

The parental styles of mothers and fathers of IBD adolescents and the parents of healthy controls were without statistically significant differences except for the fathers’ positive parental style, which was significantly higher in the fathers of controls. There were no statistically significant differences between IBD children and the healthy controls in the quality of life assessed. However, the parents’ quality of life of ill children was statistically significantly lower than of the parents of the controls. The mothers of IBD adolescents were significantly more anxious and the fathers more depressed than the parents of the healthy controls, but there was no difference in the levels of anxiety or depression between IBD adolescents and the controls. Positive parental style of parents of IBD children positively correlated with the quality of life of adolescents. Positive parental style of the fathers correlated negatively with the state and trait children's anxiety and negatively correlated with severity of childhood depression.

Conclusions

The parents of the adolescents with IBD represent important group for psychosocial support.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Description of the prevalence of psychiatric disturbances in patients with refractory epilepsy
Authors: Ramos-Perdigues S. , Bailles E. , Mane A. , Pintor L.
Published: June 2017

Introduction

Psychiatric morbidity in epilepsy is high, with prevalence rates of up to 50%, being higher in treatment-refractory cases. This co-morbidity worsen the quality of life. Psychiatric comorbidities are hampered by atypical presentations or disorders, which do not appear in the DSM-IV or ICD.

Objectives

To describe the psychiatric morbidity in a group of patients with refractory-epilepsy.

Aims

To provide evidence of the high morbidity and show the prevalence of the different psychiatric disorders.

Methods

We cross-sectional assessed psychiatric disturbances in resistant-epileptic patients using SCID for DSM-IV and clinical interview for epileptic specific psychiatric conditions. We grouped psychiatric disturbances into six clusters:

– affective disorders;

– anxiety disorders;

– psychotic disorders;

– eating disorders;

– conduct disorder;

– substance use disorder.

We also considered epilepsy specific conditions as Interictal Psychotic Disorder (IPI) and Interictal Dysphoric Disorder (IDD) characterized by 3/8 symptoms: depressive mood, anergia, pain, insomnia, fear, anxiety, irritability, and euphoric mood.

Results

The sample consist on 153 patients, with a mean age of 37. In total, 42.5% were males. One or more axis I diagnoses was seen in 38% of the patients. The most common condition was IDD (27.1%), followed by affective disorders (22%), anxiety disorders (15.3%), psychotic disorders (4%) and drug use (2%). There were no patients with eating or conduct disorders or IPI.

Conclusions

Psychiatric morbidity is frequent in resistant-epilepsy. Despite 38% of patients suffered from at least one axis I diagnoses, IDD was the most prevalent condition and not included in SCID interview.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Intrinsic functional connectivity of cortico-basal ganglia-thalamo-cortical circuitry underlying psychomotor retardation in major depressive disorder
Authors: Yin Y. , Yuan Y. , Fan L. , Xie C. , Zhang Z.
Published: June 2017

Introduction

Psychomotor retardation (PMR) in depression is analogous to the hypokinesia in Parkinson's disease, which is associated with the unbalanced direct and indirect pathways of cortico-basal ganglia-thalamo-cortical (CBTC) circuitry. This study hypothesized PMR in major depressive disorder (MDD) should be associated with the hyperactivity of CBTC indirect pathways.

Objectives

To substantiate the hypothesis that the PMR symptom of MDD might attribute to the hyperactivity of the ortico-basal ganglia-thalamo-cortical indirect pathway which could inhibit psychomotor performance.

Methods

We investigated the intrinsic stiato-subthalamic nucleus (STN)-thalamic functional connectivity (FC), three pivotal hubs of the indirect pathway, in 30 MDD patients with PMR (PMR group) and well matched 30 patients without PMR (NPMR group) at baseline, and 11 patients of each group at follow-up who remitted after antidepressant treatment.

Results

The results showed increased STN-striatum FC of PMR group at baseline and no more discrepancy at follow-up, and significant correlation between PMR severity and thalamo-STN FC.

Conclusions

Our findings suggested the increased STN- striatum FC should be considered as a state biomarker to distinguish MDD patients with PMR from patients without PMR at acute period, and thalamo-STN FC could be identified as the predictor of the PMR severity for MDD patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Is an isolation room harmful to patients with schizophrenia?: A biochemical study of salivary amylase
Authors: Koreki A. , Kiyohara M. , Koizumi T. , Onaya M.
Published: June 2017

Introduction

Some patients with acute phase schizophrenia are too agitated to receive treatment in a normal hospital room. They must be isolated for the treatment. Although the stay in an isolation room seems harmful to patients, no study detailing the stress response to isolation with objective measures has been conducted.

Method

Nine patients with schizophrenia or schizoaffective disorder were recruited (mean age = 52 years, male = 3, schizophrenic = 7). At the time of evaluation, they were staying in an isolation room. To evaluate stress response to the environment, the level of salivary amylase was tested when the patients were either in the isolation room (T1) or out of the isolation room (T2). T2 was defined as one hour after the room's door was opened. The data were analyzed by the Wilcoxon rank-sum test.

Result

There is a significant difference between the median (range) levels of salivary amylase at T1 and T2 (19 [2–146] vs 44 [9–178], respectively, P = 0.021).

Discussion

The data demonstrate that the stress response at T2 was stronger than that at T1, which suggests that the isolation room environment is less stressful to the patient compared to being outside the room. An environment that has many potential stimuli, such as the presence of other patients and a television in the lobby, may be harmful to patients with acute phase schizophrenia. Therefore, although the isolation room is apparently harmful, it could, in fact, have a positive effect on patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effects of switching antipsychotics in 80 outpatients: A descriptive analysis from a mental health community
Authors: Medina Blanco R. , Martín Gutiérrez R. , Cuesta Nuñez M.J. , Sierra Biddle D. , Suárez Pinilla P.
Published: June 2017

Introduction

In the general practice, psychiatrists widely prescribe antipsychotics for several conditions as schizophrenia, bipolar disorder and behavioral disorders among others.

Aim and objectives

The aim of this study is to describe the clinical and sociodemographic features of typical patients receiving antipsychotics and their effects after switching to long-acting treatment.

Methods

A descriptive analysis of 80 outpatients collected from a mental health clinic in Santander (Spain) was performed. All patients were taking antipsychotics at baseline, both oral and intramuscular, and were switched to a different long-acting antipsychotic drug.

Results

At baseline, 24 patients were taking oral medication and 56 intramuscular. There were 37 females and 43 males. There were no gender differences in the final treatment, but Palmitate Paliperidone (71.3%) was the most prescribed drug, followed by intramuscular risperidone (16.3%) and long-acting aripiprazole (11.3%). We found gender differences regarding cannabis (P = 0.002), alcohol (P = 0.004) and tobacco (P = 0.043) consumption, being their use more common in males. In regard to diagnosis, schizophrenia was predominant in both gender groups, whereas delusional and behavioral disorders were more frequent in females. There were no significant differences in the reason of switching, but the inefficacy was more common in males and the side effects in females. At the switching, females were significantly older than males (P = 0.003). We found significant differences before and after switching regarding the number of admissions, emergency visits and length of stay.

Conclusions

Antipsychotic benefits are individual and unpredictable. When switching, some other different factors should be taking in account, not only regarding medication.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Development and investigating the effectiveness of an integrated school-based program for changing attitude toward substance abuse based on philosophy for children components and emotional intelligence
Authors: Rezaee H. , Shafiabady A. , Ghaedi Y. , Delavar A. , Esmaeili M. , Moghaddam L. Fattah
Published: June 2017

Background

Substance abuse in the youth is one of the major problems of any society. The research purpose was the development of a program for changing female adolescents’ attitude toward substance abuse and evaluating its effectiveness.

Methods

To develop the treatment, important variables influencing in shaping attitudes toward substance abuse were selected. Afterwards, structural equation modeling approach was conducted for examining the relationship among variables (emotional intelligence, critical thinking, caring thinking and reasoning) and identifying significant paths and variables. Based on these variables, a program developed for changing students’ attitudes. To evaluate effectiveness of programs a pretest-post test design with the control group was used. Random sampling was carried out for selecting 26 students attending senior high schools in district 2 of Tehran. Then, sample randomly assigned in experimental and control groups. Experimental group exposed to philosophy for children intervention in the form of community of inquiry. Control group didn’t receive the intervention. The data were collected from Nazari's questionnaire for attitude toward substance abuse.

Results

ANCOVA revealed that based on a composite score of attitude toward substance abuse (adjusting pretest effect), there is a significant difference between two groups at 0.99 significance level (partial = 0.329, P < 0.001, = 11.28).

Conclusions

It is recommended that the school based program should be used for developing and strengthen the students’ attitude based on exploring itself, rather than simply giving awareness about substance abuse. In this treatment, rather than highlighting accumulating knowledge, put emphasis on, thinking, decision-making, and management of emotions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Medical assistance in dying: The Canadian experience
Authors: Gaind K.
Published: June 2017

Canada is in the midst of implementing new and rapidly evolving policies on medical assistance in dying (MAID). Following the landmark Canadian Supreme Court Carter v. Canada ruling in February 2015, the former prohibition against physician-assisted death was deemed to violate the Canadian Charter of Rights and Freedoms. The Court provided until 2016 for development of national legislation and policies that allowed for physician-assisted dying in cases of “grievous and irremediable” illness and “intolerable suffering”. This session will review shifting public, societal and medical concepts regarding assisted dying and the Canadian experience to date, including evolving local and national policies that have been developed to allow medical assistance in dying in certain circumstances. We will also review work of the Canadian psychiatric association task force on medical assistance in dying (presented by the Task Force Chair), with a focus on challenges and issues relevant to mental health and mental illness.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Sexual dysfunctions and treatment compliance in individuals with psychotic disorder
Authors: Unsal G. , Karaca S. , Onan N. , Oz Y. Can , Aydın S. , Aydöner H. , Gulec H. , Ongun E. , Eren N.
Published: June 2017

Introduction

Sexual dysfunctions are more common in individuals with psychotic disorders and has a major impact on both quality of life and compliance.

Objectives

The purpose of this study is to investigate whether a relationship between sexual dysfunction and level of treatment compliance in individuals with psychotic disorders.

Methods

The sample group of the study consisted of 173 in-patients who agreed to participate were selected by random sampling method. The permission was obtained from the hospital's ethics committee. In this study, to assess the sexual functionality Golombok-Rust inventory of sexual satisfaction male and female form and to assess the treatment compliance; medical treatment compliance rate scale is used.

Results

When sexual problems and treatment compliance compared to gender, subscales of satisfaction (t = 4,423, P = 0.000), avoidance (t = 3.348, P = 0.001), touch (t = 2.165, P = 0.032) and overall total (t = 4.015, P = 0.000), although a statistically significant difference was found, there were no differences in treatment compliance. Aditionally, there is no relation between sexual problems and treatment compliance in men. It is also found that there is a weak negative statistical relation amongst treatment compliance and communication (r = −0.244, P = 0.027), avoidance (r = −0.270, P = 0.014), anorgasmia (r = −0.253, P = 0.022) and overall total (r = −0.249, P = 0.024) in women. According to these findings while sexual problems increase, treatment compliance decreases.

Conclusions

The level of compliance to the treatment and subscales of sexual problems; satisfaction, avoidance, and touch mean scores differ from each other. There was a weak negative correlation in between Women's compliance and sexual problems.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Molecular targets of the ethanol and original anticonvulsant in the treatment of alcohol dependence
Authors: Shushpanova T. , Novozheeva T. , Solonskii A. , Bokhan N. , Markova E.
Published: June 2017

Objective

Chronic exposure to alcohol causes neuroadaptive changes in the brain, which leads to the recurrence of the disease. Promising in this area is to find new safe and effective pharmacological agents acting on molecular targets of influence of alcohol in the CNS.

Methods

Experiments were performed on male rats Wistar and male mice (CBAxC57Bl/6)F1.U. Experimental animals were formed alcohol dependence, based on long-term use of alcohol solution. Animals in a state of alcohol dependence were injected original anticonvulsant meta-chloro-benzhydryl-urea. We evaluated parameters orienting-exploratory behavior and emotional reactivity of the animals in the test “open field”, the cellular and humoral immune response. Properties of benzodiazepine receptors of the brain examined radioreceptor method using selective ligands [3H]flunitrazepam and [3H]Ro5-4864.

Results

Chronic exposure to ethanol resulted in a significant change in the parameters of the experimental animal behavior and emotional reactivity in the test “open field”, observed suppression of immune response (∼40%), and increase in the number of receptors on 54.8–59.4% associated with reduced receptor affinity. Administration of meta-chloro-benzhydryl-urea led to the abandonment of the use of ethanol, recorded a correction of the above immunological and behavioral disorders due to alcohol intoxication. Properties of benzodiazepine receptors in the brain of experimental animals receiving the drug at a dose of 100 mg/kg for 14 days, indicators affinity and receptor density were close to the values in the control group.

Conclusions

Anticonvulsant has a modulating effect on the functional activity of the nervous and immune systems, reduces compulsive craving for alcohol.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Referrals and outcomes of assessment for compulsory admission under the mental health act 1983 in Norfolk, England
Authors: Beezhold J.N. , Fothergill D. , Jervis L. , Mosa G. , Pandey A. , Pandey S.
Published: June 2017

Introduction

A significant number of people are not detained in hospital following assessment under the Mental Health Act 1983 (MHA) for possible detention. However, since amendments in 2007, some studies show an increase in total patient detentions. There is currently a lack of published research describing both outcomes and their affecting variables.

Objectives

To determine rates, outcomes and affecting variables of MHA assessments in Norfolk, 2001–2011.

Methods

This observational study involved data collection from all 11,509 referrals for detention assessment under the MHA. Data was collected by Norfolk Social Services from 2001–2011 including age, gender and marital status.

Results

Following assessment, 6903 (60.0%) were admitted; of those, 1157 (16.8%) were voluntary and 5746 (83.2%) were detained; 4606 (40%) were not admitted. Admission rates for males (50.4%) and females (49.5%) were similar. Detention rates increased with age: 37.6% of < 18s; 47.1% of 18–64s and 61.4% of 65+. A greater proportion of married (57.5%) and widowed patients (58.2%) were detained, compared with patients who were single (48%). Accommodation status showed 52% of those living with other were detained versus 43.9% of those with no fixed abode.

Conclusions

The finding that a higher proportion of married than single people, and of those living with others versus living alone, were detained following assessment is unexpected but significant and needs further investigation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Comparison of self-stigma and quality of life in depressive disorder and schizophrenia – a cross-sectional study
Authors: Holubova M. , Prasko J. , Matousek S. , Latalova K. , Marackova M. , Vrbova K. , Grambal A. , Slepecky M. , Zatkova M.
Published: June 2017

Background

The views of one's self-stigma and quality of life in patients with schizophrenia and depressive disorders are significant subjective notions, both being proven to affect patient's functioning in life. The objective of this research was to find out the quality of life and self-stigma in connection with demographic factors and compare the two groups of patients in those variables.

Method

In a cross-sectional study, the outpatients with the schizophrenia spectrum disorders and depressive disorders completed the quality of life satisfaction and enjoyment questionnaire, the internalized stigma of mental illness scale and a demographic questionnaire during a routine psychiatric control. Furthermore, both patients and their psychiatrists evaluated the severity of the disorder by clinical global impression-severity scale.

Results

The quality of life of patients with depression or schizophrenia spectrum disorders did not significantly differ between the two groups. In both groups, unemployment was perceived to be a significant factor decreasing the quality of life. Self-stigma was detected to be higher in patients with schizophrenia as compared to the depressive patients. A strong correlation was found between the two scales, meaning that those with higher levels of self-stigmatization were less prone to see their life as fulfilling and joyful.

Conclusions

The present study shows that the degree of the internalized stigma can be an important aspect linked to the quality of life irrespective of the diagnostic category.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Prevalence and risk factors of postpartum depression
Authors: Cherif R. F , Feki I. , Sellami R. , Trigui D. , Baâti I. , Masmoudi J.
Published: June 2017

Introduction

Childbirth represents for women a time of vulnerability to postpartum mood disorders. These disorders range in severity from the early maternal blues to postpartum psychosis. Along this spectrum is postpartum depression (PPD) that may have many risk factors.

Objectives

The study aims to examine the prevalence of PPD and associated risk factors among a sample of Tunisian women receiving cares in the hospital of Sfax.

Methods

This is a descriptive cross-sectional study regarding 150 parturients examined during the first and the sixth week post-delivery. The EPDS (Edinburgh postnatal depression scale) was used to assess PPD.

Results

The total sample had a mean age of 29.61 years. During the sixth week study period, 126 of 150 were examined. Almost all of the women have a low school level (82.7%). Only 9.3% had a personal psychiatric history. Multiparity was found in 43.3% of cases. The current pregnancy was undesired in 15.3% of cases. Sympathetic signs of pregnancy were reported by 64.7% of women. The prevalence of PPD in the first week was 14.7% and 19.8% in the sixth week after delivery. The PPD was associated with the maternal age (> 35 years), the low school level, the existence of mood personal background, the parity, the difficulty to accept the pregnancy and sympathetic signs of pregnancy.

Conclusion

Postpartum depression is common on our sample. Identifying risk factors of PPD allows clinicians to detect subgroups of women with an increased vulnerability who might receive early psychiatric care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychiatric comorbidity in patients affected by fibromyalgia and/or autoimmune rheumatic diseases: Preliminary results of an observational study
Authors: Bellomo A. , Zendoli A. , La Marca A. , Cuozzo E. , La Montagna M. , Rinaldi A. , Melillo N. , Mele A. , Cantatore F.P.
Published: June 2017

Introduction

Fibromyalgia is characterized by skeletal muscle pain and axial stiffness, with elective multiple points of tenderness (tender points). According to scientific literature, the prevalence of depression, anxiety and a worse quality of life is higher in patients with fibromyalgia. Trauma (sexual abuse and physical aggression) has a key role in the pain perception.

Objectives

To describe the clinical characteristics of patients with fibromyalgia and/or autoimmune rheumatic diseases admitted to O.O.R.R. Foggia (Department of Rheumatology), to detect correlation between fibromyalgia and psychiatric disorders.

Aims

To underline psychiatric comorbidity in patients affected by fibromyalgia and/or autoimmune rheumatic diseases.

Methods

Diagnostic tests at Baseline (T0): Mini International Neuropsychiatric Interview and Structured Clinical Interview for DSM Disorder 2 to assess psychopathology, 12-Item Short Form survey for the quality of life, Diagnostic Criteria for Psychosomatic Research for disorders of somatic symptoms, Insight Scale for the awareness of the disease, Davidson Trauma scales to assess the presence of a post-traumatic stress disorder, Pittsburgh Sleep Quality Index about the quality of sleep. After 3 months (T1): further psychodiagnostic assessment for patients with positive mental status exam in drug treatment.

Results

Affectivity disorders, feelings of anger, irritability, hostility, impaired stress response, increased vulnerability to traumatic events are very frequent in patients affected by fibromyalgia.

Conclusions

The preliminary results of this study show that patients with fibromyalgia have diagnoses of major depression, anxiety disorders, post-traumatic stress disorder and personality disorders (cluster B). Multidisciplinary interventions are needed integrating the rheumatologic therapy with the psychiatric one, based on the detected diagnosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Treatment attitude and hospitalization: Comparison of oral therapy and long-acting injectable (LAI) antipsychotics in patients with schizophrenia
Authors: Montemagno L. , Ludovico M. , Distefano A. , Marta Valentina M. , Mariacatena B. , Maria C. , Antonio M. , Antonino P.
Published: June 2017

Background

Adherence to prescribed antipsychotic drugs is a crucial factor in predicting medium- to long-term clinical outcome in schizophrenia. A helpful approach to promote adherence in schizophrenia is the use of long-acting injectable (LAI) antipsychotics.

Object

To evaluate:

– the global functioning and the hospitalization rate occurred in the year before and in the year following the switch from a low-efficacy oral antipsychotic to either a LAI once-monthly therapy (palmitate paliperidone or olanzapine pamoate) or the corresponding oral compound (paliperidone\risperidone or olanzapine) in schizophrenic patients;

– the treatment attitude and the insight in patients treated with second-generation antipsychotic (SGA)-LAIs and with the corresponding oral compounds.

Method

Sixty adult schizophrenic outpatients: thirty were switched to LAIs and thirty to the corresponding oral antipsychotic. We used the following scales: Drug Attitude Inventory (DAI), Schedule for the Assessment of Insight (SAI), Life Skill Profile (LSP).

Results

Number of hospitalizations per year decreased in both groups (LAIs: from 1.3 ± 0.5 to 0.3 ± 0.5; oral: from 1.3 ± 0.5 to 0.6 ± 0.5). We found a direct association between the “hospitalization event” and the oral drug compared to the corresponding LAI formulation (P = 0.049; OR: 3.05; 95% IC: 1.01–9.26). Patient receiving LAIs achieved a more significant improvement at the LSP score compared to the oral group (P < 0.001 vs. P = 0.0034) and higher DAI (5.9 ± 4.3 vs. −1.1 ± 4.3) and SAI (8.7 ± 2.9 vs. 5.6 ± 2.1).

Conclusions

Our data suggest that SGA-LAIs, improving the adherence to the treatment, may sensitively reduce costs in mental health services.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Transcranial direct current stimulation: Adverse effects and the efficacy of a commonly utilised sham protocol
Authors: Kortteenniemi A. , Ali-Sisto T. , Wikgren J. , Lehto S.
Published: June 2017

Introduction

Transcranial direct current stimulation (tDCS) is a promising neuromodulation method that has, for example, been used to treat depression. Nevertheless, the adverse effects of tDCS and the validity of the current standard tDCS sham protocols have received limited attention.

Objectives

To evaluate the extent and types of tDCS adverse effects and to assess the reliability of sham stimulation as a control procedure for tDCS in a double-blind setting.

Aims

To compare adverse effects between tDCS and sham stimulation groups, and to determine how well the participants and the experimenter are able to distinguish tDCS from sham stimulation.

Methods

A sample of healthy volunteers received a 20-minute session of either tDCS (n = 41; 2 mA) or sham stimulation (n = 41; ramp up 15 s, ramp down 15 s; no current in between). The anode was placed over F3 and cathode over F4. Both the participants and the experimenter reported immediate adverse effects and the perceived likelihood for the participant to receive tDCS. Analyses were conducted using the Mann–Whitney U-test.

Results

The tDCS group reported more erythema compared with the sham group (P = 0.016, Cohen's D = 0.444). No other significant differences in adverse effects were observed. In the tDCS group, both the participants (P = 0.034, Cohen's D = 0.612) and the experimenter (P = 0.006, Cohen's D = 0.674) reported a higher perceived likelihood of the participant receiving tDCS than in the sham group.

Conclusions

tDCS has only modest adverse effects. Nevertheless, the current standard sham protocol appears insufficient.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A grounded theory of service providers’ perceptions of a recovery-oriented transformation of a mental health service
Authors: Eikmeier G. , Junghans T. , Kruse T. , Lacroix A.
Published: June 2017

Recovery-oriented mental health service programs are often rather based on ideological or political considerations than on empirical evidence.

At Klinikum Bremerhaven Reinkenheide, we have included peer support workers in our teams in order to improve the quality of our treatment program and the recovery attitudes of the staff members.

To control and evaluate this process an independent investigator conducted 13 (T1: February 2012), respectively 15 (T2: September 2013) interviews with different stakeholders of the change process. The interviews were transcribed and analysed for the categories level of information, confidence, participation and profession/working conditions/team structure.

The main result of T1 was that nursing staff fostered the projected transformation while physicians and psychologists focused on risk management and worried about losing their role. As implication of the T1 results, we offer a continuous in-house-training to improve interprofessional teamwork and social psychiatric expertise. At T2 all interviewed participants judged the involvement of the peer support workers positively. Many oft the interviewees expressed though that from their point of view their participation had decreased and/or, the reorganisation was already terminated. As implication of T2, we now try to improve our internal communication and cooperation and strengthen the involvement of all stakeholder groups.

Besides the employment of peer support workers, it is essential in a recovery-oriented transformation of mental health services:

– to train staff members continuously and;

– to involve all stakeholder groups continuously in the change management.

A third survey is projected for 2017 to implement further requirements for a successful change process.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Impact of communication on family satisfaction and anxiety in critical care
Authors: Sundararajan K.
Published: June 2017

Objective

The objectives of this study were to explore the impact of a communication course for doctors on family satisfaction and anxiety in an Australasian ICU and to elucidate the determinants of family satisfaction and anxiety.

Design

Prospective observational study. Pre- and post-study design.

Participants

One hundred and three consecutive family members of patients staying in the ICU for more than 48 hours were identified. Eighty-six subjects were evaluated and analysed.

Methods

Ten-point Likert scale (FS-ICU Questionnaire) used to measure satisfaction. Hospital Anxiety and Depression Scale was used to measure anxiety. Study performed over a 12-week period (9 weeks pre- and 3 weeks post-course) in a 34-bed intensive care unit before and after a communication course for junior medical officers.

Results

Fifty-six subjects were approached for the purpose of this study. Forty-three family members were included, 40 of patients who survived, and 3 whose relative died in ICU. Overall family satisfaction was high (mean scores 9.44 ± 0.91). Post-course, 47 subjects were approached for the purpose of this study and 43 family members consented to participate. Overall family satisfaction was high (mean scores 9.84 ± 0.97). There was a statistically significant difference in the frequency of doctors’ communication before and after the course (P < 0.01) and anxiety levels (P = 0.0001)

Conclusion

The majority of families are happy with their care in the ICU. A communication course aimed at junior medical officers was effective in improving satisfaction and reducing anxiety among family members.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Lack of insight as a third variable between subjective appraisal of cognitive impairment and psychotic symptoms
Authors: Rossi R. , Santarelli V. , Marucci C. , Gianfelice D. , Pacitti F.
Published: June 2017

Background

The relationship between subjective appraisal of cognitive deficits and symptom severity in schizophrenia is unclear. Insight reportedly impacts on both factors. Our aim is to further asses the relationship between the subjective perception of cognitive deficits, symptom severity and lack of Insight as a mediator variable.

Methods

A total of 109 subject diagnosed with schizophrenia. Positive and Negative Syndrome Scale (PANSS) was modelled as dependent variable; Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) was modeled as independent variable and “Lack of Insight” (LoI) PANSS Item was tested as a mediator variable. Mediation was assessed using the Sobel Mediation Test.

Results

LoI acts as a suppressor variable (i.e. it enhances the relation between the independent and dependent variable) between SSTICS and negative symptoms, while showing a mediator effect between SSTICS and depressive symptoms.

Discussion

LoI has a central role in mediating the relationship between subjective appraisal of cognitive deficits on the one hand and positive and depressed symptoms on the other. Its suppressor role between SSTICS and depression is consistent with several reports of an enhanced risk of depression in patients fully aware of their disability. Its mediator role between STICSS and positive symptoms supports the centrality of LoI as a metacognitive function whose failure may worsen psychotic symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Can neuropsychological testing facilitate differential diagnosis between at-risk mental state for psychosis and adult attention deficit hyperactivity disorder?
Authors: Studerus E.
Published: June 2017

Introduction

Patients with an at-risk mental state (ARMS) for psychosis and patients with attention deficit hyperactivity disorder (ADHD) have many overlapping symptoms and hence can be difficult to differentiate clinically.

Objectives

The aim of this study was to investigate whether the differential diagnosis between ARMS and ADHD could be improved by neuropsychological testing.

Methods

A total of 157 ARMS and 122 adult ADHD patients were recruited via the Basel Früherkennung von Psychosen (FePsy) study and the ADHD Special Consultations Unit of the University of Basel Psychiatric Hospital, respectively. Verbal learning and memory was tested with the California Verbal Learning Test (CVLT), sustained attention with the Continuous performance test (CPT) and problem solving abilities with the Tower of Hanoi task. Group differences in neuropsychological performance were analyzed using generalized linear models, which included age and gender as covariates.

Results

Adult ADHD patients recalled significantly fewer words in the CVLT (both after short and long delay) and had significantly more false alarms and omissions and longer reaction times in the CPT than ARMS patients.

Conclusions

Adult ADHD patients show larger deficits than ARMS patients in the domains of verbal memory and sustained attention, but not in problem solving abilities. This in line with current meta-analyses, which found that impairments in the domains of attention and verbal memory are of medium effect size in adult ADHD patients and of small effect size in ARMS patients. Our results suggest that measures of these domains can be exploited to improve the differential diagnosis between adult ADHD and ARMS patients.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Memory and medial temporal lobe structures in patients with schizophrenia and their siblings
Authors: Vorackova V. , Mohr P. , Knytl P. , Fajnerova I. , Dorazilova A. , Kratochvilova Z. , Skoch A. , Rodriguez M.
Published: June 2017

Episodic retrieval is characterized by the subjective experience of remembering. Semantic memory, on the other hand, is a more structured record of facts, meanings, concepts and knowledge about the external world that we have acquired. The medial temporal lobe (MTL), especially the hippocampus and parahippocampal cortex, plays a central role in both types of memory process. Published studies suggested that individuals with schizophrenia have deficits in episodic and semantic memory, as well as structural abnormalities of the medial temporal lobe. However, it is not clear whether reported correlations reflect the impact of the disease state or that of underlying genetic influences contributing to the risk. To understand better etiology and effects of psychosis on the global brain structure and cognitive processing, relatives of individuals with schizophrenia can be studied. The aim of our study was to examine the association between abnormalities of the MTL, psychopathology, and memory impairment in schizophrenia. Study sample (n = 60) consisted of first episode schizophrenia patients, their non-psychotic siblings and matching control subjects. We used high-resolution magnetic resonance imaging and probabilistic algorithms for image analysis. Episodic and semantic memory was measured with neuropsychological tests. Our results showed differences in memory performance between the groups. Neuropsychological data were correlated with MRI findings. The results may provide insight into etiology of schizophrenia and its effects on cognition and help to identify neuroanatomical and cognitive endophenotypes of psychotic disorders.

Supported by the grant projects MH CR AZV 15-28998A, MEYS NPU4NUDZ: LO1611; Czech Science Foundation, grant No. 16-13093S; Institutional Support 00023001IKEM.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Fenethylline (Captagon) abuse: Case report and literature review
Authors: Preve M. , Casigliani S. , Godio M. , Suardi N.E. , Traber R. , Colombo R.A.
Published: June 2017

Introduction

Novel psychoactive drugs (NPS) has rapidly increase in the last years in the drug market as a recreational use. Fenethylline is a theophylline, an amphetamine-like drug, having stimulant effects similar to those of other amphetamine-type derivatives. Fenethylline was used as medicament for hyperactivity disorders in children, narcolepsy and depression, but it has also been used as a drug of abuse under the common name of ‘captagon’. The purpose of this report is to review the clinical evidence for the potential of abuse of fenethylline. We propose a case report and literature review.

Method

We conducted a systematic review of the literature with the principal database (PubMed, Enbase, PsychInfo) and we present a case report.

Results

The effects of fenethylline is characterized by euphoria, derealization, autopsychic and somatopsychic depersonalization, hallucination, agitation and decrease of pain perception.

Discussion and conclusion

The primary drug market for fenethyline (as captagon) has traditionally been countries located on the Arabian Peninsula but also North Africa since 2013. To our knowledge, there is no report on the recreational use of fenethylline in literature. The clinical features of fenethylline intoxication were also similar to effects from other amphetamine-like drugs. In our case report, dissociative symptoms are the core of fenethylline intoxication. Further research is warranted to replicate our clinical and qualitative observations and, in general, quantitative studies in large samples followed-up over time are needed. Methodological limitations, clinical implications and suggestions for future research directions are considered [1,2].

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Efficiency of Cocarnit preparation in clinical course of alcohol dependence at withdrawal syndrome stage
Authors: Sosin I. , Goncharova O. , Chuev Y.
Published: June 2017

Introduction

Recently scientific attention of Ukrainian narcology was focused on the group of new complex pharmacological preparations with polymodal pathogenic effect option (Cocarnit, World Medicine, Great Britain).

Aims and objectives

To ground feasibility of Cocarnit application in complex treatment of alcohol withdrawal syndrome (AWS).

Method

Eleven patients with alcohol addiction were examined. An integrated research of relieving and adjuvant effects of pharmacological preparation Cocarnit in complex with traditional detoxication therapy in clinical course of alcohol dependence at AWS stage was carried out. One to 2 ampoules of Cocarnit were injected intramuscularly once per 24 hrs, № 6.

Methods

Clinical-psychopathological, clinical-laboratory, consulting of specialists, methods of psychological investigation (CIWA; САН; SF-36) at day 1, 7 and 14 of treatment.

Results

AWS quantification score on admission was 41. Further therapeutic regress of all AWS components was registered. At day 1 the patient's condition started improving, clinical score was 32; at day 3 – 17; day 5 – the score was 13, insignificant tremor remained. At day 7 of treatment, practically complete relieving effect of the therapy was ascertained. With САН method at day 7 of the treatment, an increase of figures in all scales was registered: state of health 2.7, activity 2.4, mood 2.5. SF-36 method: at day 1 – the score was 24, day 7 – 32, day 14 – 49.

Conclusions

Thus, the developed by us method of integrated treatment with inclusion of Cocarnit for withdrawal state in alcohol addicts allows to stop acute signs of pathology within 3–5 days.

Disclosure of interest

The authors have not supplied their declaration of competing interest.