bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effectiveness of the Inference Based Approach to Treating Obsessive-compulsive Disorder with Poor Insight; a Randomized Controlled Multicentre Trial
Authors: Visser H. , van Megen H. , van Balkom T.
Published: June 2017

Background

There is an urgent need for an effective psychological treatment for patients with obsessive compulsive disorder (OCD) with poor insight, since this disorder is associated with severe suffering and a low quality of life. The inference based approach (IBA), a new psychotherapy for OCD specifically targets insight in OCD. In a randomized controlled multicentre trial, the effectiveness of IBA was compared to the effectiveness of CBT for treating patients with OCD with poor insight. In this study, 24 sessions of IBA were tested versus 24 sessions of CBT. Ninety patients with a main diagnosis of OCD with poor insight according to the DSM-IV criteria participated in the study. The primary outcome was reduction of the obsessive-compulsive symptoms.

Results

In both conditions, a significant OCD symptom reduction was reached, but no condition effects were established. Post hoc, in a small subgroup of patients with the worst insight (n = 23), it was found that the patients treated with the IBA reached a significantly higher OCD symptom reduction than patients treated with CBT [estimated marginal mean = –7.77, t(219.45) = –2.4, P = 0.017]. Of patients treated with IBA, 41.9% were responder and 20.9% completely recovered. Of the patients treated with CBT, 42.6% were responder and 12.8% recovered.

Conclusion

Patients with OCD with poor insight improve significantly after psychological treatment. The results of this study suggest that both CBT and the IBA are effective treatments for OCD with poor insight. The IBA might be more promising than CBT for patients with more extreme poor insight.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clinical Outcomes of the First 2 Years of Implementation of the Integrated Care Pathway for Concurrent Major Depressive Disorder and Alcohol Use Disorder
Authors: Samokhvalov A.V. , Awan S. , Le Foll B. , Probst C. , Voore P. , Rehm J.
Published: June 2017

Background

Both major depressive disorder (MDD) and alcohol use disorder are highly prevalent, often comorbid and cause significant socioeconomic burden. At CAMH, we have developed and integrated care pathway (ICP) to treat these disorders and evaluated its effectiveness in comparison to treatment as usual (TAU)

Methods

Chart review; descriptive statistics, c2 and t-tests, linear mixed effects models, Kaplan–Meier and log-rank analyses.

Results

Overall, 81 patients were enrolled into ICP. Comparisons of treatment retention rates between ICP patients and matched historical controls (n = 81) showed significantly lower dropout rate in ICP cohort (18.5% vs. 69.1%, P < 0.001, Fig. 1). The ICP patients demonstrated significant reduction in depressive symptoms severity (QIDS: 14.6 vs. 10.0, P < 0.001; BDI 26.3 vs. 16.2, P < 0.001), reduction in the amount of alcohol consumed weekly from 44.6 standard drinks at baseline to 12.6 (P < 0.001) by the end of treatment, which was significantly better compared to controls (56.9 vs. 25.2, P < 0.001), P = 0.014 (Fig. 2).

Conclusions

The ICP is a feasible approach to treatment of concurrent AUD and MDD with significantly higher retention rates than TAU. Patients demonstrate improvements on several levels including depressive symptoms, and changes in alcohol drinking patterns.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Risk Factors for Suicide Attempt: A Retrospective Study
Authors: Castaldo L. , Mazzone L. , Serra G. , Vicari S.
Published: June 2017

Introduction

Suicide is a leading cause of death among adolescents.

Objectives

To investigate suicidal behaviors among Italian adolescents.

Aims

To assess the rates of suicidal ideation (SI) and suicide attempts (SA) and the associated risk factors in patients admitted to emergency department (ED) of the Bambino Gesù Children's Hospital.

Methods

Retrospective study based on data of patients admitted to the ED from 1 January 2011 to 30 May 2016 who required a neuropsychiatric (NPI) consultation. We analyzed:

– outcome of the NPI consultation (hospitalization or discharge);

– risk factors for SA and SI;

– methods employed for SA.

Results

The number of NPI consultations for SI and SA increased from 6.45% in 2011 to 13.3% in 2015. More than 90% of consultations recommended hospitalization in the psychiatric unit (137 patient [66% female]; mean age of 15.5 ± 1.6 years) with average length of stay of 13.64 ± 10.63 days. Risk factors for SI and SA were non-suicidal self-injury, family conflicts and previous suicide attempts. Subjects evaluated for a SA reported a significantly higher frequency of family history of mood disorder (χ2 = 5.94; P = 0.02) and a comorbid substance abuse (χ2 = 4.49; P = 0.03) when compared with SI group. The method most frequently used to attempt suicide was ingestion of medications (52.83%).

Conclusions

There was an increasing demand of NPI consultation of SA and SI in the last years. A family history of mood disorder and a history of substance abuse are risk factors able to differentiate between SI and SA.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Are Social Networks Useful to Challenge Stigma Attached to Mental Disorders? Findings from the Time to Change Social Marketing Campaign 2009–2014
Authors: Sampogna G. , Henderson C. , Thornicroft G. , Evans-Lacko S. , Bakolis I. , Robinson E. , Luciano M. , Del Vecchio V. , Fiorillo A.
Published: June 2017

Introduction

The new channels of communication as social media (e.g. Facebook and Twitter) and the social marketing campaign (i.e. campaign focused on enabling, encouraging and supporting behavioural changes among target audiences) can represent useful strategies to challenge stigma attached to mental disorders.

Objectives

To evaluate the efficacy of the social marketing campaign of the time to change (SMC-TTC) anti-stigma programme on the target population in England during 2009–2014.

Aims

To assess the impact of the SMC-TTC anti-stigma programme in terms of:

– use of the social media channels;

– levels of awareness of the SMC-TTC;

– changes in knowledge, attitude, and behaviour related to mental disorders.

Methods

Participants completed the mental health knowledge schedule (MAKS), the community attitudes toward mental illness (CAMI) and the reported and intended behaviour scale (RIBS), together with an ad-hoc schedule on socio-demographic characteristics.

Results

In total, 10526 people were interviewed, it was found a growing usage of the SMC-TTC media channels and of the level of awareness of the campaign (P < 0.001). Being aware of the SMC-TTC was found to be associated with higher score at MAKS (OR = .95, CI = .68 to 1.21; P < .001), at “tolerance and support” CAMI subscale (OR = .12, CI = .09 to .16; P < .001) and RIBS (OR = .71, CI = .51 to .92; P < .001), controlling for confounders.

Discussion

In the general population, SMC-TTC has been found to be effective in improving attitudes and behaviours towards people with mental disorders.

Conclusions

Considering these promising results obtained in England, social media can represent the possible way forward for challenging stigma. The future on-going evaluation of the SMC-TTC may further shed light on the essential role of social media in reducing of stigma and discrimination.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Social anxiety as a basic factor shaping anti-vital and suicidal behaviour among contemporary adolescents
Authors: Sagalakova O. , Truevtsev D.V. , Stoyanova I.Y. , Sagalakov A.M.
Published: June 2017

Introduction

In adolescence, social anxiety (SA) and anti-vital and suicidal behavior (AB and SB) constitute a single syndrome.

Aim

The aim is to define the role of SA and its components in shaping adolescent AB, with a subsequent risk of SB.

Materials and methods

A total of 981 adolescents participated in the survey. The authors’ proprietary Anti-vitality and Resilience Questionnaire and Social Anxiety and Social Phobia Questionnaire; statistic methods: ANOVA, Correlation analysis.

Results and discussion

Twenty-four percent from the sample have high SA levels, and 21.8% have clinical SA levels connected with high risk of AB and SB. Adolescents find themselves in unstable conditions of the psychological field reorganization (crisis), and they are in need of actualization of means to satisfy their social motives. It makes them vulnerable to mental disorganization under evaluation conditions, and the situation is aggravated with the absence of internalized mental regulation tools. AB, SB is higher, the higher the SA in adolescents is. SA as a subjective perception of insufficient means to influence the surroundings in order to satisfy social needs can play one of the key roles in the accumulation of negative affect in the system of mental activity, and lead ultimately to its failure.

Conclusion

Inability to satisfy their actual motives, lack of strategy for self-realization and dealing with failures, and inability to keep the targeted priority in evaluation situations lead to feeling loss of life purpose and negative evaluation of the future and shape AB, SB.

Disclosure of interest

The research was supported by Russian Science Foundation (Altai State University).
Korean medication algorithm for bipolar disorder (KMAP-BP): Changes in treatment strategies for bipolar depression over 12 years
Authors: Jon D.I. , Seo J.S. , Kim W. , Lee J.G. , Shin Y.C. , Min K.J. , Yoon B.H. , Bahk W.M.
Published: June 2017

Introduction

Many guidelines for bipolar disorders have been introduced based on evidences. In contrast, KMAP-BP was developed by an expert-consensus.

Objective

To summarize the medication strategies for bipolar depression over four published KMAP-BP (2002, 2006, 2010, and 2014).

Methods

The questionnaire using a nine-point scale had covered some clinical situations with many treatment options about the appropriateness of treatment.

Results

For mild-to-moderate depression, antidepressant (AD) + mood stabilizer (MS) in early editions and MS or lamotrigine monotherapy and AAP + (MS or lamotrigine) in later editions were preferred strategies. For severe nonpsychotic depression, MS + AD was the only first-line medication in early editions. In 2014, various medications [MS + AAP (atypical antipsychotic), AAP + lamotrigine, MS + AD] were preferred. Valproate and lithium has been rated as first-line MS in all editions. Lamotrigine were positively preferred later. Adjunctive AD was accepted as first-line strategy for severe depression in all editions. Preference of AAP also has been increased remarkably. Adjunctive AAP was not first-line treatment for mild-to-moderate depression in all editions, but was for nonpsychotic depression in 2010 and 2014 and for psychotic depression in all editions. Recommended AAPs have been changed over 12 years: olanzapine and risperidone in 2002 and quetiapine, aripiprazole, and olanzapine in 2014 were first-line AAP.

Conclusion

There have been evident preference changes: increased for AAP and lamotrigine and decreased for AD. The high preferences for aripiprazole and lamotrigine in later editions were likely derived from favorable tolerability.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Obesity and quality of life in bipolar disorder
Authors: Jouini R. , Ben Ammar H. , Hamdi G. , Smari N. , Aissa A. , Khelifa E. , El Hechmi Z.
Published: June 2017

Introduction

Overweight and obesity, despite their comorbidities and mortality, could deteriorate the quality of life of people with bipolar disorder.

Objectives

The objective of this study is to evaluate the quality of life among patients with bipolar disorder and investigate a possible interaction between obesity and deterioration of the quality of life.

Aims

This study aims to highlight the importance of preventing overweight and obesity in people with bipolar disorder to obtain an adequate quality of life subsequently an acceptable control of the illness.

Methods

Fifty euthymic bipolar patients (Hamilton Depression Scale score ≤ 8, and Young Mania Rating Scale score ≤ 6) received the Medical Outcomes Study 36-Item Short-Form Health Survey in Arabic validated version in order to investigate the quality of life.

Results

We examined 50 euthymic bipolar patients (60% men, 40% women). The average age was 46, 5 years (23–70). Most patients (69%) were over weighted (BMI ≥ 25.0 kg/m2) (body mass index), of whom 40% were obese (BMI ≥ 30.0 kg/m2). Seventy-two percent of the investigated patients had an affected quality of life (score < 66.7). The mental items were deteriorated in 80% of the cases. An affected quality of life was correlated with obesity. The BMI was significantly and negatively correlated with the scores of dimensions D4 (mental health) and D8 (perceived health) (P < 0.01).

Conclusion

The investigation of quality of life in people with mental disorder enables to reveal the social handicap caused by these illnesses consequently emphasizes health care in mental affections.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clinical differences between unipolar and bipolar depression
Authors: Smaoui S. , Charfi N. , Maâlej Bouali M. , Zouari L. , Zouari N. , Ben Thabeut J. , Maâlej M.
Published: June 2017

Introduction

Epidemiological studies indicate that the majority of patients with bipolar disorder are diagnosed many years later. Unipolar depression represents the most frequent misdiagnosis.

Objectives

This study aimed to examine the symptom profiles of depressed patients in order to identify clinical specificities of bipolar depression.

Methods

A total of 31 depressed patients were recruited from psychiatry outpatient department of Hedi Chaker university hospital in Sfax (Tunisia), during October and November 2016. Unipolar and bipolar patients were compared on a broad range of parameters, including sociodemographic and clinical characteristics. Depressive symptoms were rated using the Montgomery Asberg Depression Rating Scale (MADRS) and Bipolar Depression Rating Scale (BDRS).

Results

The total sample comprised 31 patients with 16 men and 15 women. It involved 20 with unipolar depression and 11 with bipolar depression. Patients with bipolar depression had more family history of bipolar disorder (P = 0.037) and a triggering factor had been identified less often (P = 0.03). MADRS scores were similar in bipolar and unipolar patient (median score 28.22 versus 28.36; P = 0.964). BDRS scores were significantly higher in bipolar depressed patients (median score 33 versus 25; P = 0.01). The mixed subscale (item 16 to 20) scores were particularly higher (median 6 vs. 1.2; P ≤ 0.01) especially concerning irritability (P = 0.001). Increased motor drive (P = 0.004) and agitation (P = 0.008).

Conclusion

Our findings suggest that the presence of mixed symptoms is very important to recognize depressed patients as having a bipolar disorder. We also recommend routine use of the BDRS for patients presenting for treatment of depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Dog assisted therapy for teenagers with emotional and behavioural issues: A multicentre study
Authors: Calvo P. , Pairet S. , Vila M. , Losada J. , Bowen J. , Cirac R. , Bulbena A. , Holloway A. , Fatjó J.
Published: June 2017

Introduction

Further research is still needed to demonstrate the benefits of animal-assisted therapy (AAT) for specific participant profiles, such as children with behavioural disorders.

Objectives

We wanted to find out if AAT could be considered an efficient therapeutic strategy for the treatment of children with behavioural disorders.

Aims

We wanted to study the effects of a preestablished AAT program on the behaviour of children with emotional and behavioural issues in 6 different reception centres for children under government guardianship.

Methods

Forty-five children (12 to 17 years old) with emotional and behavioural issues participated in a 14-session AAT program. Behavioural measures were those routinely scored as part of therapy; an observational report of 3 different problematic behaviours (such as impulsivity, lack of social skills or lack of personal recognition) was made twice a week for each child (with a score of frequency and intensity). A pre- and post-treatment “global behaviour score” was calculated for each child, as an average value of the 3 problematic behaviours measured during the month pre-treatment and the month post-treatment.

Results

The 45 participants attended, on average, 72.8% of AAT sessions. Independent behaviour scores differed between the pre- and post-intervention evaluations (n = 135 behaviours) (Wilcoxon test; P < 0.0001). Based on the global behaviour score for each child (n = 45), significant change was found between pre- and post-intervention evaluations (Wilcoxon test; P = 0.0011).

Conclusions

Our results suggest AAT could be a beneficial intervention for children with behavioural issues in terms of program adherence and behaviour improvement.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Sensory processing in children with and without attention deficit hyperactivity disorder: A comparative study using the Short Sensory Profile
Authors: Dalpatadu M. , Wijetunga S. , Kapugama K. , Kotalawala S. , Suraweera C.
Published: June 2017

Background

Attention deficit hyperactivity disorder (ADHD) is one of the sensory modulation disorders among others like autism, Asperger syndrome and Fragile X syndrome. Little is known about patients with ADHD and their sensory processing issues in Sri Lanka.

Aims

To investigate differences in sensory processing among children between (3–10) yrs with attention deficit hyperactivity disorder and those who are typically developing in Sri Lanka.

Methods

A descriptive cross sectional study of 75 children aged (3–10) yrs attending child guidance clinic at Lady Ridgeway Hospital (LRH) were compared with 75 age matched peers who were typically developing, using the Short Sensory Profile (SSP).

Results

Out of the sample population of 150, there was a significant difference in sensory processing total score (P-0.001) (df-29) of children with ADHD when compared to the typically developing group. The greatest differences were reported on the tactile (P-0.013), taste (P-0.000), under responsiveness (P-0.002), auditory filtering (P-0.002) & low energy (P-0.017). Out of the raw items commonest sensory processing problems were difficulty standing in line, distractability if there is a lot of noise around, being unable to work with background noise & difficulty paying attention due to auditory deficits.

Conclusions

Majority of children in this sample were reported to have difficulties with processing and responding to sensory input on the SSP. Further studies are needed to assess sensory issues in children with ADHD, to carry out effective interventions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The case of successful treatment of gender identity disorder of childhood
Authors: Pityk O. , Seliverstova V.
Published: June 2017

Gender identity disorder of childhood refers to a rather rare disorders, but according to the literature girls with the disorder in the future may become homosexual or transsexual. The necessary diagnostic criterion for gender identity disorder of childhood is the presence of a constant desire to belong (or the conviction of belonging) to the opposite sex, coupled with a strong denial of the behavior, characteristics and/or clothing specific to the registered sex. Usually the disorder is manifested in the preschool years, but for diagnosing it is necessary that it manifests before the onset of puberty. Both sexes may have a rejection of anatomical structures inherent in his own sex; however, such unusual display is rare.

Patient V. came to the appointment with psychiatrist with parents 3 years ago. During the interview reported that she starts to feel the boy at the age of 9 years. This announcement provoked outrage from parents. With the beginning of the critical days began to position herself in a male person. The patient met all diagnostic criteria for gender identity disorder of childhood. The patient underwent a course of systemic therapy combined with nootropics. Currently, patient name is the name of a female, the patient wears women's clothing, identifies herself as a woman. The patient continues to meet with a psychotherapist, is satisfied with the treatment, thoughts on sex change does not express. Thus, in the case of diagnosis of this disorder can become effective systemic therapy in combination with nootropics.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pediatric acute onset neuropsychiatric syndrome associated with Epstein–Barr infection in child with Noonan syndrome
Authors: Tisi G.P. , Marzolini M. , Biffi G.
Published: June 2017

Introduction

Pediatric acute onset neuropsychiatric syndrome is associated with various infections (i.e. Streptococcus, Mycoplasma pneumoniae).

Objectives

We describe a case of PANS associated with mononucleosis, in a patient with Noonan syndrome.

Aims

To report a case of EBV-related PANS.

Methods

A 13-year-old patient, diagnosed with Noonan syndrome, was referred to the pediatric unit of our hospital in August 2016 because of aggressive behavior and suicidal ideation. He had no personal or family history of psychiatric disorder. His parents and him denied substance abuse. His symptoms had begun abruptly one month prior to our evaluation, after watching an internet video, and consisted in intrusive thoughts and images associated with mental compulsions. Suicidal thoughts and verbal aggressiveness emerged because he felt overwhelmed by these symptoms.

Results

He was initially treated with sertraline 25 mg, and subsequently switched to aripiprazole because of increased anxiety. Throat cultures and anti-streptolysin titer (ASO) were negative, as well as Ig(M) and Ig(G) antibodies for M. pneumoniae. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also negative. Epstein–Barr virus Ig(M) and Ig(G) were positive. He continued therapy with aripiprazole 10 mg after hospital discharge with partial benefit.

Conclusions

Epstein–Barr virus infection has been reported to precede various neuropsychological disorders, but to the best of our knowledge, rare cases of PANS following mononucleosis have been described in literature. In our case, psychopharmacological treatment for OCD symptoms was the only treatment performed and led to a partial remission of symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Face processing in autism spectrum disorder
Authors: Zaky E.
Published: June 2017

Background

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder that is characterized by impaired social and communicative abilities as well as restricted, repetitive, stereotyped pattern of behaviors, interests, and activities. Significant difficulties in social interactions in autistics are manifested by impairment in eye-to-eye contact, social reciprocity, and response to emotional cues.

Objective

Highlighting the neurological basis of normal face processing and its abnormalities in ASD with percussions on the management plan of autistic children.

Human face processing that was proved to be compromised in autistic individuals is pivotal for proper social interactions. Such simple spontaneous perceptual task in normal children is carried out by face processing areas of the brain; fusiform gyrus, superior temporal sulcus, and amygdala. Behavioral, electrophysiological, and neuroimaging studies showed evidences of dysfunction of such areas in autistics who often focus on face periphery and cannot interpret that it tells something about a person's state of mind. Very early targeted intervention can stimulate face processing areas of the brain during the early developmental phases of social brain circuitry which in turn will help autistics to pay attention to faces and learn to understand emotional expressions.

Conclusion

Eventually, prevention or at least significant amelioration of severity and symptomatology spectrum of autism might be possible.

Disclosure of interest

The author have not supplied his declaration of competing interest.
The profile of female crack users undergoing treatment on psychosocial care center for alcohol and others drugs in Brazil
Authors: Carvalho C.M. , Cardoso Vernaglia T.V. , Senju Suzuki N. , Correa Sória D. de Assis
Published: June 2017

Background

The prevalence of crack cocaine on Brazil reveal an increase since 2009 and represents a public health problem.

Aims

To describe and study the socio-demographic profile of female crack users undergoing treatment in psychosocial care center for alcohol and others drugs (CAPS AD).

Methods

This is a qualitative, ethnographic study of 9 female crack users that was conduct from February until September 2015 at CAPS AD in Brazil. This is study is part of a research entitled “The daily life of female crack users: public service access”.

Results

These women are young, have children that most of them are separated and have at least primary school. All of them have a long time using crack and different attempts of abstinence. They access different public health programs.

Conclusion

The results show the vulnerable profile of female crack users. These findings indicate the need specific public intervention in other to improve social and health conditions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Body dysmorphic disorder: Classification challenges and variants
Authors: De Uribe-Viloria N. , Alonso-Sanchez A. , Cepedello Perez S. , Gomez Garcia M. , De Lorenzo Calzon M. , Red Gallego H. De La , Alvarez Astorga A. , Medina Ojeda G. , Ladron De Cegama F. De Uribe
Published: June 2017

Introduction

The main feature of body dysmorphic disorder (BDD) is impairing preoccupation with a physical defect that appears slight to others. Previously, its delusional and nondelusional variants were sorted in two separate categories, but owing to new data suggesting that there are more similitudes than differences between them, DSM-5 now classifies both as levels of insight of the same disorder.

Objectives

To enunciate the similarities and differences between the two variants of BDD.

Aims

To better understand the features and comorbidity of BDD, so as to improve its management and treatment.

Methods

Taking DSM-5 and DSM-IV-TR as a reference, we have made a bibliographic search in MEDLINE (PubMed), reviewing articles no older than 5 years that fit into the following keywords: body dysmorphic disorder, delusions, comorbidity, DSM-IV, DSM-5.

Results

Both the delusional and nondelusional form presented many similarities in different validators, which include family and personal history, pathophysiology, core symptoms, comorbidity, course and response to pharmacotherapy.

Conclusions

The new classification of delusional and nondelusional forms of BDD as levels of insight of the same disorder, which places them closer to the obsessive-compulsive spectrum than to the psychotic one, not only improves treatment options, but also reinforces the theory that delusions are not exclusive of psychotic disorders, setting a precedent for the understanding and classification of other disorders with delusional/nondelusional symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mental Health Europe's “beyond the bio-medical paradigm task force” issues on ICD-10
Authors: Kinderman P. , Pini P. , Wooley S.
Published: June 2017

Introduction

Recent developments in psychiatric diagnosis risk downgrading psychological and social aspects of personal recovery and marginalise the individual needs and aspirations of people, considered in their local context. The publication of the fifth edition of the Diagnostic and Statistical Manual for Mental Health Disorders (DSM-5) by the American Psychiatric Association (APA) prompted MHE to establish the Beyond the Biomedical Paradigm Task Force (BBPtf) to investigate, debate and report on these issues.

Objectives

Mental Health Europe (MHE) – along with others both within and outside mainstream psychiatry – has noted with concern the increasing dominance of a biological approach to mental health problems. We see a risk of diagnoses being misused when they become part of a complex managerial health system responding mainly to the economic and issues of safety or social control. This kind of misuse could breach the principles of the UN CRPD. MHE welcomes the role of the WHO in coordinating internationally appropriate classification systems. However, we want to ensure that systems based on biomedical, economic and managerial issues are balanced with systems based on knowledge of personal experiences, life stories and direct relationships, which have proven outcomes and which respect human rights and dignity.

Aims

This workshop will explore the complex philosophical issues associated with psychiatric diagnosis and, in particular, the ICD-10 revision process.

Disclosure of interest

I am President of the British Psychological Society and a member of both Mental Health Europe's “Beyond the Bio-Medical Paradigm Task Force” and the Council for Evidence Based Psychiatry. I am currently in receipt of funding from the National Institute for Health Research (NIHR) and the Economic and Social Research Council (ESRC), and I have previously received funding from a variety of sources.

The others authors have not supplied their declaration of competing interest.
Behavioral disorders in emergencies. Differential diagnosis and treatment
Authors: González S.M. Bañón , Portilla N. Ogando , Jiménez M.G. García , García R. Álvarez , Sánchez F. García
Published: June 2017

Introduction

The clinical case has been submitted because it presents a number of difficulties in diagnosis. After seven psychiatric hospitalizations, it does not present a definitive diagnosis, poor prognosis and multiple relapses.

Objectives

Both analyze clinical, psychopathological and epidemiological characteristics of behavioral disorders in relation to a clinical case and review causes, incidence, prevalence, diagnostic, therapeutic tools and the importance of an appropriate differential diagnosis to reach a correct therapeutic approach.

Methods

Review of the impact literature for the last five years concerning behavioral disorders: prevalence, incidence, pathogenesis and its relationship with psychiatric disorders encoded in DSM-V.

Results

It is evident that the patient has behavioral disorders and psychotic symptoms in the context of cocaine intoxication. Although sometimes the dose of cocaine has been very small and probably not justifies in all cases a toxic psychosis, it is true that withdrawal periods have been short; therefore difficult to assess. Also mania-like symptoms have been discussed because the patient has an increased activity, dysphoric mood, anxiety and decreased need for sleep.

Conclusions

Response to treatment and hyperactivity, impulsivity and inattention characteristics make us consider the diagnosis of adult Attention Deficit Hyperactivity Disorder (ADHD). ADHD in adults and adolescents have significant comorbidity with substance abuse, particularly cocaine, amphetamines and psychostimulants, also alcohol, tobacco and cannabis, and with other psychiatric disorders: oppositional defiant, personality (especially cluster B: antisocial, etc), anxiety (generalized anxiety, phobias, panic..), affective or eating disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cancer, depression symptoms and quality of life: The role of creativity
Authors: Delpech L. , Sordes F. , Sudres J.L.
Published: June 2017

The diagnosis of cancer is associated with the occurrence of psychopathological symptoms, which cause even more difficulties to patients. Scientific research demonstrates that creativity could help increase the general population's quality of life and regulate their negative emotions, but only a few studies are available on the link between creativity and the regulation of patients’ respective experience. This study aims at (1) measuring the impact of creativity on the patient's level of depression and quality of life and (2) evaluating the psychopathological profile of the creative person. Thirty-five subjects undergoing chemotherapy treatment (age: 61 + 11) took part in this study. The experimental protocol is composed of creativity, depression and QoL tests. The results show that creativity is negatively correlated with depression level and positively with QoL (r = −45; P = <.05 and r=.54; P = <.01 respectively). The linear regressions show that creativity is a variable, which predicts a high QoL (F = 13.83; P=.001). Also, 29.5% of the QoL variability is explained by creativity. A cluster analysis sorted out three different groups: very creative persons (VCP); mildly creative persons (MCP); slightly creative persons (SCP). VCPs have a significantly lower level of depression and have a better QoL compared to SCPs. MCPs have a level of depression between the other groups and a similar level of QoL than VCPs. These results suggest that creativity could have a noticeable influence on how patients experience their cancer. Further studies on this phenomenon will be necessary for creativity to be taken into account for psychological follow-up in oncology.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Prevalence of ADHD and co-morbid conditions among university students
Authors: Gormez A. , Kocer E. , Kurtulmus A. , Kirpinar I.
Published: June 2017

Background

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent difficulties with attention, increased impulsivity and hyperactivity. Comorbidity is often reported in adults with ADHD with a range of 60–100% of patients having at least one co-morbid condition.

Objective

The purpose of this study is to determine the prevalence of ADHD among university students and to investigate some co-occurring symptoms and disorders.

Aims

We aimed to raise awareness of adult ADHD and underscore its co-morbidity.

Method

486 undergraduate students at Bezmialem Vakif university in Istanbul filled in the Adult ADHD Self-Report Scale (ASRS), Beck Anxiety Scale (Beck-A), Beck Depression Scale (Beck-D) and a purpose-designed structured socio-demographic form.

Results

Our results revealed that 6% of participants reported significant ADHD symptoms using 1.5 standard deviation above mean on the ASRS. 67% of students with significant ADHD symptoms had a psychiatric history other than ADHD. History of depression, anxiety and sleep problems were significantly higher in this group (P < 0.05). They scored higher on Beck-A and Beck-D (P < 0.05). Students with significant ADHD symptoms reported more night eating, binge eating behaviours and more headache (P < 0.05). There was no statistically significant difference in the history of epilepsy, asthma, allergy and diabetes. Family history of psychiatric disorder particularly ADHD, depression and eating disorder were higher in the ADHD group (P < 0.05).

Conclusion

Our results demonstrate that ADHD is prevalent among university students with high co-morbidity. Hence people with ADHD need comprehensive and lifelong assessment and management of their symptoms and needs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
VTE and physical health assessment upon admission to acute functional and organic psychiatric in-patient wards: An audit
Authors: Mistry N. , Sikka G.
Published: June 2017

Introduction

Venous thromboembolism (VTE) is a condition that causes a blood clot to form within the venous blood system. If this blood clot forms in the peripheral venous system it can cause symptoms such as calf pain and swelling. If this clot becomes dislodged, it may travel through the vessels into the pulmonary artery which can have much more severe consequences.

Objectives

There has been a great deal of effort in recent years to increase the percentage of in-patients receiving a VTE assessment; and for those patients to receive appropriate VTE prophylaxis. VTE is a significant cause of inpatient deaths. This audit aims to compare current working practice to local standards and identify learning points.

Methods

VTE and physical health assessment data was collected by checking electronic admission summaries from three acute psychiatric in-patient wards on a random date in 2016. The local pathway for the management of physical health and wellbeing states that the VTE assessment and Physical Health Assessment should be completed within 6 hours of admission. NICE guidelines also state that all patients should be assessed on admission, with a standard of 100%.

Results

60% of patients had a VTE assessment and 54% of patients had a physical health assessment done within 6 hours of admission.

Conclusions

This audit shows that the necessary standards are not met. Importance of these assessments has been communicated during induction programmes for all staff.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The EFPT-PSUD survey
Authors: Rojnic Palavra I. , Orsolini L. , Potocan M. , Diego Q. , Martens M. , Levola J. , Grichy L. , Gondek T.M. , Dias M. Casanova , Pinto da Costa M. , Tomori S. , Mullerova S. , Sonmez E. , Borovcanin M. , Banjac V. , Marinova P. , Pakutkaitė I.K. , Kuiters J. , Popescu A.L. , Biskup E. , Naughton S. , San Roman Uria A.
Published: June 2017

Introduction

Although psychoactive substance use disorders (PSUD) belong to the domain of mental health, their management varies greatly among European countries. Furthermore, both the role of psychiatrists and trainees in the treatment of PSUD is not the same for each European country.

Aims

Among the context of the European Federation of Psychiatric Trainees (EFPT), the PSUD Working Group has developed a survey that has been spread out between the 15th of august 2015 and 15th of October 2016, at the aim of gathering information about the training in PSUD in Europe, both from Child and Adolescent, and General Adult Psychiatric (CAP and GAP) trainees.

Objectives

The survey investigated, at European level, the organisation of the PSUD training, trainees satisfaction, attitudes towards people who use psychoactive substances, management of pharmacologic and involvement in common clinical situations.

Methods

A 70-items questionnaire regarding the aforementioned objectives was developed, and shared trough an online data-collecting system among European CAP and GAP trainees, with 40 trainees per country filling the survey in at least 25 countries. One national coordinator per country facilitated the delivering of the survey.

Results

A total of 1250 surveys were filled from more than 25 European countries.

Conclusions

Data from the survey will be promptly analysed.

The survey will be the first to explore European psychiatric trainees attitudes and practices about PSUD. Findings from this independent survey may serve in understanding the needs of trainees in the field of substance misuse psychiatry.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Connection between body mass index (BMI) and expression of symptoms in individuals with mental disorders
Authors: Pisk S. Vuk , Anamarija B. , Nikolina T.V. , Igor F.
Published: June 2017

Introduction

Research shows that the prevalence of obesity is greater in individuals with mental disorders than in general population. According to literature, obesity is correlated with intensity of symptoms and suicidality.

Objectives

The aim of this study was to determine whether there is a correlation between BMI and severity of symptoms, as well as suicidality and gender. The aim was also to determine whether there is a difference in the severity of symptoms and suicidality among individuals with different diagnoses.

Methods

Participants in this study were 37 men and 73 women with diagnosis of psychosis, personality disorder, bipolar affective disorder, unipolar depression and anxiety disorder treated in Psychiatric hospital “Sveti Ivan”, Zagreb, Croatia. Sociodemographic data were collected and BMI was calculated. All participants fulfilled the DASS 21 (Depression, Anxiety and Stress Scale by Fernando Gomez) and Suicide Severity Rating Scale (Columbia–Suicide Severity Rating Scale (Center for Suicide Risk Assessment).

Results

There is no significant correlation between BMI and severity of symptoms, as well as between BMI and suicidality. But there are significant differences in the severity of stress (P = 0.005) and suicidality (P = 0.004) in individuals with different diagnoses.

Conclusions

The results identify that a significant part of individuals with mental disorders are either obese or overweight, but there were no significant differences in relation to suicide and intensity of symptoms depending on the BMI.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Irreversible silent
Authors: Azvee Z.
Published: June 2017

Objectives

Lithium is a well-known substance used in treatment of mood disorders. It has a narrow therapeutic index with recognised adverse effects on renal and thyroid function. Clinical guidelines published by the national institute for health and clinical excellence in the United Kingdom (NICE) recommend renal and thyroid function checks before lithium is prescribed, as well as ongoing monitoring of renal function, thyroid function and serum lithium levels. Lithium-induced drug toxicity is frequently seen in clinical practice. While the ongoing monitoring serves to monitor reversible side effects of Lithium provided its discontinued, rarely patients develop a persistent neurological side effect known as a syndrome of irreversible lithium-effectuated neurotoxicity (SILENT).

Method

This is a case report on a patient where the patient developed SILENT syndrome after being treated with Lithium, long term for bipolar disorder.

Results

This case supports the biological mechanism of SILENT syndrome. It also caused a huge implication in the patient's care.

Conclusions

As clinicians, we are well aware of following treatment guidelines for Lithium. This case report was written to raise awareness regarding a “SILENT” albeit significantly debilitating syndrome of Lithium use.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Neurosyphilis presenting with affective psychosis and Parkinsonism: A case report
Authors: Butt H.S. , Hopkins C.W.P.
Published: June 2017

Introduction

A 38-year-old gentleman was admitted to an inpatient psychiatric unit with a first episode of fluctuating affective psychosis. He initially presented as manic although subsequently evolved a severe depressive episode, with prominent bizarre, affect-incongruent delusions throughout this period. Upon admission, anisocoria was evident, although this was attributed to a past head injury. Over the course of his admission he developed emergent Parkinsonism, initially ascribed to prescription of aripiprazole. Given his anisocoria and worsening Parkinsonism, further investigation was undertaken. While his MRI brain scan was unremarkable, his serum and CSF specimens tested positive for Treponema pallidum serology, and he was diagnosed with neurosyphilis. He was treated with a single dose of intramuscular penicillin, but experienced marked deterioration of neurological symptoms (paraparesis and truncal ataxia) and was transferred to the general hospital for an extended 14 day course of intravenous penicillin. Following this extended course of antibiotic therapy, resolution of neurological symptoms was seen, but no sustained improvement in residual psychotic symptoms has been seen.

Conclusions

This case demonstrates the potential neuropsychiatric consequences of neurosyphilis, and serves as a reminder of its potential to imitate other psychiatric presentations. This gentleman, and many like him, continue to experience severe and enduring psychopathology despite penicillin treatment when cases are detected late. Given the potential consequences of this, we would advocate assertive screening for syphilis in patients admitted to psychiatric units.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Experimental intervention program in psychosomatic pathology
Authors: Coutinho A. , Silva D. , Carvalho I. , Silva R. Ribeiro , Ribeiro L.
Published: June 2017

Introduction

The work of Bion, developing the psychoanalytic theories of Freud and Klein on the origins of anxiety in childhood, includes the hypothesis of a protomental system as a matrix in the human organism in which physical and mental are at first undifferentiated. He defends that the continuing experience by the infant of parental containment of its anxieties, through a process of projection and introjection, develops its capacity for thinking about frustration rather than evading it. This conception was extended to psychosomatic illness, by the hypothesis that, without this experience, frustration may lead to basic assumption mentality and psychosomatic illness rather than emotions and thought.

Objectives

This work aims to describe an experimental technique of group psychotherapy, inspired in Bion's principles combined with relaxation techniques, in the context of psychosomatic diseases.

Aims

The authors pretend to identify improvement in clinical symptomatology, quality of life, identification and expression of emotions, in the group submitted to this method, compared to controls.

Methods

It was performed a weekly group psychotherapeutic session and a weekly relaxation session (using Jacobson's method), along two months. The patients were randomly selected and submitted to psychological evaluation with scales and questionnaires, in the beginning and at the end of the study.

Results

At the time of submission of this work, the results of the intervention were in analysis.

Conclusions

This paper describes an experimental method of psychotherapeutic intervention in the field of psychosomatic disease, using a transdisciplinary perspective.

Disclosure of interest

The authors have not supplied their declaration of competing interest.