bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Pain: Results of a Behavioral Intervention
Authors: Palomo Monge M. , Calvo Mauri J.F. , Alcocer Lanza M.F.
Published: June 2017

Introduction

Chronic pain and its estimate in general population varies widely depending on the area and population studied. It is concluded that exerts effects on both physical and mental health, either in the patient or his family, in addition to its social cost to influence activities of daily living, employment and economic welfare of a significant proportion of the general population, constituting one of the main reasons for medical consultation.

Aim

Hypothesis: The painful perception is an operant behaviour. Subjects Six subjects (S): 5 females and 1 male, aged between 56 and 72 years Diagnosis ICD-10: R52.2 chronic pain of neuropathic origin. Material soundproof booth with audiometer Maico MA52.

Methods design

Experimental single case.

Independent variable: behaviour modification treatment by differential molding using auditory stimulation as discriminative stimulus. Dependent variable: pain perception scale of 0-100%. Analysiscomparisons using non-parametric test, significance at P < 0.05.

Results

Table 1.M (Media), SD (Standard deviation)

Conclusions

Six replications of behavioural experiment were performed. All show statistical significance. Generalization occurs in 83%. The hypothesis is confirmed and effectiveness of the treatment protocol was concluded; however the line of work should continue.

Table 1Start sessionEnd sessionMSDMSDS165.4226.746.4119.91S252.0823.6027.0821.36S390.5310.4963.9126.16S452.4917.8823.5315.00S571.0114.4415.389.93S635.7125.5910.4420,12Signs test (start/end)U Mann-Whitney (base line/daily life)ZP <ZP <S1−2.041.0412−3.537.0004S2−2.598.0094−3.031.0024S3−3.015.0026−0.014.9885S4−3.175.0015−3.315.0009S5−3.328.0009−2.951.0032S6−2.214.0269–4.609.0001

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Low Compliance to Pharmacological Treatment of Severe Chronic Illness: Passive Suicide Ideation in Borderline Personality Disorder?
Authors: Bonea M. , Miclutia I.
Published: June 2017

Introduction

The core features of Borderline Personality Disorder (BPD), such as deliberate self-harm, suicide attempts and demandingness in interpersonal relationships persist with age, even though impulsivity decreases. Impairing progressive disease combined with affective instability and chronic feelings of emptiness can lead to a desire for death.

Objectives

To present a case of BPD with severe chronic endocrine pathology and liver cirrhosis who refused to take his treatment as prescribed.

Methods

A case report is presented and discussed.

Results

We report the case of a 61-year-old man with BPD and liver cirrhosis, complex endocrine pathology (pituitary adenoma, diabetes insipidus and primary hypothyroidism), type 2 diabetes mellitus with insulin therapy, essential hypertension and alcohol use disorder. He had a history of 5 suicide attempts caused by marked feelings of rejection and emptiness and a pattern of unstable relationships and lack of commitment, thus his marriage lasted only 2 years. He idealized and was extremely familiar with his clinician and displayed marked affective instability (dysphoria, periods of anger and despair, affective ambivalence towards his parents and recurrent depressive symptoms). Because of his liver disease, the psychotropic medication was ceased by his physician. The patient refused to follow the rest of his treatment plan and diet as prescribed, resulting in the deterioration of his somatic status. The patient denied an active suicidal ideation, but did not explain his non-compliance.

Conclusion

The impairment from BPD and the risk of suicide persist even in older age affecting the outcome of co-morbid somatic conditions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Multidisciplinary Approach to Several Mental Disorders: Clinical Case
Authors: Castrillo P. , Guijarro R. , Cerviño M.
Published: June 2017

The research evidence supports multidisciplinary treatment covers the different needs that appear in people with mental health problems, especially with long-term mental health disorders. The aim is to emphasize the importance of integrated treatment. It means to share therapeutic targets among different professionals. We propose that not only the therapeutical relationship between patient and psychiatry is important, but also a collaborative approach among different professionals. This is a descriptive study of a case of personality disorder and an individualized treatment carried out by different professionals from a multidisciplinary point of view. Combined pharmacological treatment, group and individual psychotherapy, and other therapeutic spaces are discussed in the present study as an alternative to individual therapy sessions. She has recovered her social and labour activity 14 years later from her first contact with mental health. Coordination and communication among clinical professionals would help us to improve quality of treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psyche in Historical Context: Identity and Existence in Captain Ahab and King Lear
Authors: Egloff G.
Published: June 2017

Introduction

What ties Ahab, the notorious captain of the Pequod in Herman Melville's 1851 novel, Moby-Dick, to King Lear, the desperate old regent from William Shakespeare's eponymous play published in 1608, is not only their overabundant quest for meaning, or their obsession with pursuing their targets, but their idiosyncratic experiencing of themselves in their personal realities.

Aims

Captain Ahab is put in relation with King Lear, in order to show in what way issues of identity and of existence emerge in the course of their fictional lives. Lear is considered to have had deep influence on Melville the author in creating the character of Ahab. Since, in terms of present-day psychopathology, both fictional characters present with symptoms, their issues when put in historical context can untangle their personal realities.

Methods

Through a close reading of the characters’ behaviour and experiencing in historical context, issues of identity and of existence are elaborated on in order to advance to the psychodramatic substrate.

Results

Whereas at the beginning of the seventeenth century conflicts are newly transposed to characters’ minds instead of surroundings, the nineteenth century still sees Ahab's monomania on the outside. Identity and existence have increasingly been placed in individual psyche, though.

Conclusions

A paradigmatic change in personality concept at the turn of the modern epoch enables psychiatry and psychopathology to conceptualize the individual and to derive identity and existence from. Collective identity gives way to personal identity. With that, choice, interpretation, and failing are individualized.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Relations Between Minkowski and Levinas, a Look Beyond the Phenomenology in the Construction of the Psyche
Authors: Veliz Uribe J. , Ugalde M. , Catrifil P.
Published: June 2017

Introduction

Both Minkowski and Levinas introduced in France phenomenological thinking, psychopathology and metaphysics, respectively.

Objectives

It is in this context that interested raise the similarities and differences in relation to the study of time these authors in their link to the construction of the self (soi-même).

Aims

Both authors take up the relevance of temporality in the construction of the psychic, overtaking Husserl's phenomenology, the distinction between thinking and intuition discursive and theoretical thinking and sensitivity.

Methods

Comparative analysis of the problem of time and its relation to the psyche, Le temps vécu of Minkowski, Autrement qu’être of Levinas.

Results

You can set a break with Husserl's phenomenology, inspired by the philosophy of Bergson, based on the living back in the studio. At the same time, among the authors reviewed, there is an irreconcilable discrepancy in the notions of activity and passivity in relation to the construction of the self (soi-même).

Conclusions

Phenomenology applied to the psychic needs to return to its original inspiration to go beyond a methodological rigid reading, which ends up betraying its spirit, which leads her to forget the living world in its complexity.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
How to Deal with Growing Racism and Discrimination against Refugees and Asylum Seekers in Europe?
Authors: Küey L.
Published: June 2017

The growing number of refugees and asylum seekers pouring in Europe due to wars and armed conflicts constitute a great challenge for psychiatry and the mental health field. This challenge also includes the growing racism and discrimination against refugees and asylum seekers. Discrimination could be defined as the attitudes and behavior based on the group differences. Any group acknowledged and proclaimed as ‘the other’ by prevailing zeitgeist and dominant social powers, and further dehumanized may become the subject of discrimination. In a spectrum from dislike and micro-aggression to overt violence towards the other, it exists almost in all societies in varying degrees and forms; all forms involving some practices of exclusion and rejection. Hence, almost all the same specific human physical and psychosocial characteristics that constitute the bases for in-group identities and reference systems could also become the foundations of discrimination towards the humans identified as out-groups. Added to this, othering, rising from imagined and generalized differences and used to distinguish groups of people as separate from the norm reinforces and maintains discrimination.
Predictors of Post-traumatic Stress Disorder in Military Personnel Deployed to Peacekeeping Missions
Authors: Giorgi S. , Guguahsvili N. , Oniani T. , Kanaldarishvili G. , Lelashvili E.
Published: June 2017

Background

The following study shows that PTSD, depression and anxiety present actual and urgent problem in military field. These disorders appear to be highly co-morbid that results in much more complicated treatment process and outcome. Service members of Georgian armed forces participate in various international peacekeeping operations on the regular basis, though there are no researches conducted so far to provide evidence for mental health problem prevalence in Georgian deployed military personnel.

Method

Collection of the data took place during the period of 2014–2015 years after six months of service members returning from the international peacekeeping mission back to their homes. The sample for this research were represented by 2799 servicemen who actively engaged in ISAF peacekeeping missions. All of them were male, with average age: M = 29.3 (SD = 6.3). The data for the following research were collected using self-administered assessment measures, namely PCL-5 for PTSD screening and PHQ for depression and Anxiety and somatic complaints assessment.

Results

PTSD appeared to be significantly predicted by range/level of anxiety and depression symptom urgency, nevertheless after joint/combine integration of these variables in one regressional equation, just symptoms of depression remained as statistically reliable explanatory factor for the significant percentage of the somatic symptom range variation.

Conclusion

It would be wise to recommend mental health care specialists particularly to bear in mind the possibility of co-existing depression and anxiety symptoms in patients with PTSD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Status of Early Intervention Services in Greece
Authors: Bargiota S.I. , Garyfallos G. , Bozikas V.P.
Published: June 2017

Introduction

Schizophrenia and other psychotic disorders usually emerge during adolescence and early adulthood deteriorating the lives of young people. As a result, a lot of early intervention services have been developed worldwide.

Objective

This study aims to investigate the status of early intervention services in Greece related to similar programs around the world.

Methods

The literature was accessed in order to investigate the status of clinical early intervention services throughout the world. In terms of Greece, a naturalistic research was added to the literature one, since there are not enough published data available.

Results

Hundreds of early intervention programs exist in Australia, Europe, North America and Asia, designed to provide early and sustained care with less prescription not only soon after psychosis has been diagnosed but in a prodromal state as well, like the outreach and support in South London (OASIS) team. In Greece, four early intervention services have been established since 2007, without funding, and they still operate in a volunteer basis. Furthermore, the field about ultra-high risk subjects in Greece remains neglected.

Conclusions

The specialized services play an important role in the prevention and proper clinical management of the illness and its outcome with a positive impact on the economy. Greece needs to recognize the significance of this issue in order to enhance public health and welfare.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The therapeutic handling of a mental health promotion group: The therapist role in the Communitarian Mental Health Group
Authors: Craveiro Prado A.P. , Cardoso C.L.
Published: June 2017

Within the mental health promotion field, communitarian and group-based interventions are significant and viable approaches. One of the features of group studies is the therapeutic group handling, provided by the group therapist, which influences the therapeutic potential and development of the group. The communitarian Mental Health Group (CMHG) is an innovative intervention for promoting mental health, developed and researched for 18 years, in Brazil. The activity's goal is to promote the attitudes of attention and understanding over day-by-day experiences, as resources of mental health promotion. This research goal was to investigate and understand the therapeutic group handling provided by the CMHG's therapist and its connections to this specific group's characteristics. The corpus was built by the transcriptions of six groups. To each group session, all the therapist's interventions were analyzed in the context in which they happened. Later, those sessions were horizontally analyzed, as a mean to identify common aspects of the CMHG's therapeutic handling, which resulted in the elaboration of three main categories: framing–includes interventions which the therapist organizes the setting; providing keys–includes interventions which the therapist provides key concepts and encourages the participants to adopt certain attitudes, so that they can understand and interact with the assignment; Understanding the gesture–includes the interventions which the therapist stresses the gestures underlying the participant's communication. This research pointed that the therapeutic handling of CMHG is different from traditional models, and that it is related to its theoretical and methodological approach.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Discrimination and mental health among lesbian, gay and bisexual adults
Authors: Dos Santos M.A.
Published: June 2017

Introduction

Mental health care is indispensable, has an essential role in development, but mental health issues are a major public health concern worldwide. Sexual minorities, lesbian, gay and bisexual, suffer from prejudice and it determines health inequities, especially for their mental health.

Objective

To show the relation between discrimination and mental health issues in lesbian, gay and bisexual (LGB) people and to increase understanding of this serious neglected public health problem.

Methods

The search was conducted using Science Direct and Scopus, using the following keywords: “discrimination” and “mental health” and “lesbian” and “gay” and “bisexual”. Using the review of literature, documents in English (articles, official documents, editorial, reviews, clinical trials).

Discussion

Numerous studies have identified highest risk behavior, as illicit drug use, sexual risk-taking behaviors and mental health issues among LGB people. Some previous studies propose that health and risk disparities between heterosexual and LGB identifying or behaving people are due to minority stress–that is, that the stigma, discrimination, and violence experienced, leading to stress, thus predisposing illness, disease (worse mental and physical health outcomes) and potentially substance use, which may be used to relieve or escape stress.

Conclusion

Health professionals and healthcare organizations must cover these unmet mental health needs if they move to more integrated, coordinated models of care. Health educators should attend to the unique needs of each sexual orientation group when presenting sexual health information and health care providers should undergo diversity and sensitivity training to work more effectively with those groups.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Eosinophilia associated with clozapine – A case report
Authors: Abreu T. , Carvalho A. , Von Doellinger O.
Published: June 2017

Objectives

Clozapine is an atypical anti-psychotic used in the treatment of schizophrenia and other psychotic disorders. It is associated with several side effects, namely, hematologic disorders, the more common being agranulocytosis. Some cases of eosinophilia have been described. This work describes a case of transient eosinophilia caused by clozapine.

Methods

Description of a clinical case.

Results

A 22-year-old female patient, with a treatment resistant psychotic disorder initiated clozapine in a slow titration to 300 mg. Ten days after initiating clozapine, the patient presented with eosinophilia (started with 6.6 × 108/L and peaked at 10.0 × 108/L). Two weeks later, the patient presented with a skin rash in the arms and legs. The case was discussed with internal medicine service and other causes of eosinophilia were excluded. Since the eosinophilia was mild, the rash was not severe and the patient did not present any other symptoms or signs, it was not considered necessary to stop clozapine. During the next three months, with close monitoring, the eosinophilia and the skin rash slowly resolved.

Conclusions

This is a case of a patient who presented mild eosinophilia and skin rash, associated to clozapine, with spontaneous resolution. We draw attention to the need of close monitorization and exclusion of other causes of eosiniphilia and rash. Furthermore, other hematologic disorders should be considered besides agranulocytosis, namely eosinophilia, when prescribing clozapine.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A Comparison of DSM-IV and international expert consensus diagnostic criteria for N.M.S
Authors: Gurrera R. , Mortillaro G. , Velamoor V. , Caroff S.
Published: June 2017

Introduction

Neuroleptic malignant syndrome (NMS) requires prompt recognition for effective management, but there are no established diagnostic criteria.

Objectives

To validate the recently published international expert consensus (IEC) diagnostic criteria for NMS, which assign priority points based on the relative importance of each criterion for diagnosing NMS.

Aims

Determine optimal diagnostic cutoff for priority point score.

Methods

Data were extracted from 221 archived telephone contact reports of clinician-initiated calls to a national telephone consultation service from 1997–2009; each case was given a total priority point score based on the IEC criteria. DSM-IV-TR research criteria, in original form and modified to accept less than ‘severe’ rigidity, served as the primary diagnostic reference standard. Consultants’ diagnoses served as an additional reference standard. The optimal priority point cutoff score was determined using receiver operating characteristic (ROC) curve analysis.

Results

Area under the ROC curve ranged from 0.715 (95% CI = 0.645–0.785, P < 0.001) for consultant diagnoses to 0.857 (95% CI = 0.808–0.907, P < 0.001) for modified DSM-IV-TR criteria. The latter was associated with 69.6% sensitivity and 90.7% specificity.

Conclusions

Agreement was best between IEC criteria with a cutoff score of 74 and modified DSM-IV-TR criteria (sensitivity 69.6%, specificity 90.7%); this cutoff score demonstrated the highest agreement in all comparisons. Consultant diagnoses showed much better agreement with modified, compared to original, DSM-IV-TR criteria, suggesting that the DSM-IV-TR criterion of “severe” rigidity may be more restrictive than what most knowledgeable clinicians use in practice.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Genital cenestopathy in psychotic depression responds to augmentation with aripiprazole and pregabaline: A case report
Authors: Čekerinac S. , Vuković V.
Published: June 2017

Introduction

Psychotic depression is a well-known entity, with recent data confirming the use of antidepressant and anti-psychotic co-treatment. Psychotic symptoms can be mood incongruent and present further difficulties for treatment.

Case summary

A 51-year-old female presented to our hospital, with symptoms of genital cramping, paresthesiae, feelings of unease in the vulva and depressive mood. In December 2014, the patient was diagnosed with genital polyps, which were successfully removed by curettage. The patient continued feeling various genital symptoms, which she associated with social and family stressors. After short initial outpatient treatment, the patient was admitted to our ward for complete assessment. Psychological assessment revealed psychotic elements, high anxiety and a passive aggressive personality. Abdominal ultrasound, lumbal spine radiography, physiatrist exam and computerized tomography of the brain showed no abnormalities. The patient was diagnosed with psychotic depression and referred to further outpatient treatment. Her drug regimen consisted of venlafaxine, risperidone, clonazepam and carbamazepine, which led to slight initial improvement. However, the patient still referred persistent symptoms as well as sedation as an adverse effect, so risperidone was switched to aripiprazole, and carbamazepine to pregabaline. The initiation of this treatment has led to complete withdrawal of symptoms and the patient has since maintained stable remission.

Conclusion

Aripiprazole is well suited to the female population because of its lack of hyperprolactinemia, and its combination with pregabaline may be an option for augmenting treatment in psychotic depression with cenestopathy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Depression and Parkinson's Disease: Biological Therapies
Authors: Mures B. , Lluis N.G. , Iñigo A.P. , German M.H. , Miriam T.G. , José R.Q. , Yolanda L.P.
Published: June 2017

Introduction.

Depression occurs in approximately 40% of patients with Parkinson's disease. Parkinson's disease is commonly associated with psychiatric morbidity, which includes depression, anxiety, and dopaminergic psychosis. These compound the patient's predicament. Fortunately, a variety of effective treatments are available.

Objective.

The purpose of this e-poster is to provide an update of the research regarding depression in Parkinson's disease.

Methods.

Describe a case report. A 56-year-old man, with previous diagnosis of Parkinson's disease. We used SSRIs, but they was not enough to successful treatment so we decided to use ECT.

Results.

Our patient failed to respond to medication or develop intolerable medication side effects. Electroconvulsive therapy (ECT) should be considered for this group of patients. Contrary to popular belief, ECT is a widely used and safe treatment for depression when medication fails. ECT has been shown to be effective and safe in PD for treating both depression and dopaminergic psychosis. Several studies also report varying periods of motor improvement following ECT in PD. A study is currently underway at UBC to examine this phenomenon in a controlled setting. ECT improves depression, may permit a reduction in antidepressant medications, and has intrinsic antiparkinsonian properties.

Conclusions.

ECT, has repeatedly been shown to have beneficial effects in PD, but has never gained acceptance as a clinical treatment option. We review the literature on the use of ECT in PD, pointing out that ECT has beneficial effects on both the core motor symptoms of PD as well as the commonly occurring psychiatric comorbidities.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Multiple Suicide-Attempts in Adolescence: Psychodynamic Understandings on the Process of Integration of Hallucinated Bodily Experiences
Authors: Giacomini G. , Solano P. , Amore M.
Published: June 2017

Introduction.

Suicidal adolescents have a severely damaged body/mind relationship where issues pertaining to adolescence and psychache are tightly intertwined causing dissociation, hallucinations and concreteness. In this conundrum, the suffering mind swings from being identified and split from the body favouring self-harm and bodily together with visual hallucinations.

Objectives.

Investigating and working through suicidal concreteness together with the role and meaning of hallucinations in adolescents with a story of multiple suicide attempts.

Aims.

Achieving a first integration and appropriation of the emotional experience with the establishment of the boundaries between mind/body, inside/outside giving up hallucinations.

Methods.

Prolonged intensive psychodynamic work focusing on self-representation, the working through of persecutory internal objects causing rage, hostility and attacks on the affective links with the environment allowed a gradual process of integration of the self with the decrease of suicidiality.

Results.

The working through and containment of persecutory internal objects led to the possibility to unconsciously give up hallucinations and integrate the emotional experience in the mind together with the development of first effective boundaries between inside/outside.

Conclusions.

An intense work of containment and working through of persecution and rage in the early stages of the psychotherapeutic treatment of adolescent multiple attempters can significantly favour the relinquishment of hallucinatory mechanisms and self-harm as a way to cope with intolerable anguish and psychache. This favours the process of in dwelling of the psyche in the soma as described by Winnicott.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Once and Again: Intergenerational Transmission of Parenting
Authors: Cost K. Tombeau , Unternaehrer E. , Jonas W. , Gaudreau H. , Bouvette-Tourcot A.A. , Steiner M. , Lydon J. , Szatmari P. , Meaney M. , Fleming A.
Published: June 2017

Introduction

Animal and human studies suggest that individual differences in maternal parenting behaviour are transmitted from one generation to the next.

Objective

This study aimed to examine potential psychosocial mechanisms underlying an intergenerational transmission of conceptualization of parenting, including affect, cognition, and parental support.

Methods

In a subsample of 201 first-time mothers participating in the Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) project, we assessed maternal childhood rearing experiences, using the Parental Bonding Instrument and the Childhood Trauma Questionnaire. At 6 months postpartum, mothers completed questionnaires on parenting stress, symptoms of depression, internalization of maternal care regulation and current relationship with mother and father.

Results

We found significant direct associations of maltreatment and rearing by the grandmother with parenting stress at 6 months. These associations were mediated through distinct psychosocial pathways: the association of maltreatment on higher parenting stress was fully mediated through more maternal symptoms of depression (z = 2.297; P = 022). The association between sub-optimal rearing provided by the mother and higher parenting stress was mediated through lower internalization of maternal care regulation (z = -2.155; P = 031) and to a lesser degree through more symptoms of depression (z = -1.842; P = 065). Finally, higher quality rearing by the grandfather was indirectly related to lower parenting stress through positive current relationship with the father (z = -2.617; P = 009).

Conclusions

There are distinct pathways by which early experiences manifest in parenting stress. By understanding the structure of dysregulated parenting, clinicians will have practical information to specifically target maternal motivation, social supports, and depressed mood to disrupt maladaptive parenting cognitions and practices.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Bion's Group Psychotherapy for Dramatic Personality Disorders: An Empirical Study in a Public Mental Health
Authors: Pacetti M. , Liotta M. , Ambrosini F. , Sant’Angelo R.P.
Published: June 2017

Educational objectives

Psychotherapy is the most preferable intervention for personality disorder patients and group psychotherapy offers the possibility to increase the self-perception through resonance and mirroring processes. When a group is disorganized and emotionally tensioned generates regressive movements, which make it a basic assumption group.

Purpose

To highlight the change of a group of patients after the inclusion of a new patient named Margherita.

Methods

The patients were included within the group run by two psychotherapists after a cluster B personality disorder's clinical diagnosis (except for antisocial personality disorder), confirmed by SCID II and by a set of individual interviews aimed to prepare the patient to the inclusion within the group.

Results

Margherita, from the first sessions, showed the tendency to coercively polarize the attention on herself through themes of discouragement and helplessness, posing a threat for the members’ identity and resulting in a disorganization of the work group, which became a basic assumption group.

Conclusions

The temporary disorganization of the group with the consequent regression to a worse functioning condition has subsequently allowed to revitalize the group and to avoid its dissolution. After the temporary regression, indeed, the work group was restored and started again to function even based on the new patient's problems.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Neuropsychological Approach to the Consciousness in L.S. Vygotsky – A.N. Leontiev – A.R. Luria school
Authors: Kovyazina M. , Fomina K. , Varako N. , Dobrushina O. , Zinchenko Y. , Martynov S.
Published: June 2017

Introduction

Existing polysemy in definitions of human consciousness creates the major difficulty in its understanding. With the development of intensive care modern methods, the number of patients survived after coma and dwelling in disorders consciousness conditions rises.

Aims

Among, the most important practical questions of neuropsychology is estimation of the patient's consciousness current condition. The solvation of these problems requires precise denotation of consciousness neuropsychological criteria.

Methods

All of definitions of consciousness in Russian psychological school, have the binarity as a common feature: in one hand, in view of the world, yourself, and another hand–extraction and differentiation of yourself from the ambient world (self-consciousness).

Results

Neuropsychological model of consciousness (in particular, self-consciousness) includes all higher psychological functions (HPF). However, condition of none of them cannot be sufficient criterion of consciousness estimation. In Russian psychology it is suggested to study the consciousness through its own characteristic, among which one can designate reflexivity, which includes cognitions and personal meanings.

Conclusions

It is possible to determine the quality of consciousness at a specific instant of time, through the system of human relations, as activity is motivated the knowledge is acquired, the affective side of the activity is determined, the self-consciousness is formed exactly through the personal meaning. Personal meaning can act as that quantity of consciousness (self-consciousness) analyses where the external reality and human attitude to this reality are differentiated. One can judge about a degree of contact between a human and a real world by indirect difference between them.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
PA Guidance Paper on Tobacco Dependence and Smoking Cessation
Authors: Möller H.J.
Published: June 2017

Tobacco dependence is the most common substance use disorder in adults with mental illness. The prevalence rates for tobacco dependence are two to four times higher in these patients than in the general population. Smoking has a strong, negative influence on the life expectancy and quality of life of mental health patients, and remains the leading preventable cause of death in this group. Despite these statistics, in some countries smokers with mental illness are disadvantaged in receiving intervention and support for their tobacco dependence, which is often overlooked or even tolerated. This statement from the European Psychiatric Association (EPA) systematically reviews the current evidence on tobacco dependence and withdrawal in patients with mental illness and their treatment. It provides seven recommendations for the core components of diagnostics and treatment in this patient group. These recommendations concern: (1) the recording process, (2) the timing of the intervention, (3) counselling specificities, (4) proposed treatments, (5) frequency of contact after stopping, (6) follow-up visits and (7) relapse prevention. They aim to help clinicians improve the care, health and well being of patients suffering from mental illness.

Disclosure of interest

In the last three years, HJM received honoraria for lectures or for advisory activities by the following pharmaceutical companies: Lilly, Lundbeck, Servier, Schwabe and Bayer.

He was president or in the Executive Board of the following organisations: CINP, ECNP, WFSBP, EPA and chairman of the WPA-section on Pharmacopsychiatry.
Morphophenotypical patterns in patients with negative symptoms in schizophrenia
Authors: Kornetova E. , Semke A.V. , Kornetov A.N. , Dmitrieva E.G. , Dubrovskaya V.V. , Bokhan N.A.
Published: June 2017

Introduction

Positive-negative dichotomy in course of schizophrenia leads to search for factors which could influence the formation of basic symptoms. The study of patients’ body types and morphological peculiarities according clinical feature of schizophrenia could find some influence factors. Body type and regional morphologic dysplasias (RMD) are basically morphophenotypical patterns available for routine examination in usual clinical psychiatric practice.

Aims

To reveal associations between body type, morphologic dysplasias and course of schizophrenia.

Methods

Anthropometric, somatoscopy examination of patients with schizophrenia with gradually progressive negative disorders: emotional, volition, thought disturbances, increasing autism and social isolation, stable anhedonia with motivation defect were conducted. The accounted morbidity of 168 patients from the whole group of individuals with schizophrenia was about 10% (128 [76%] males, 40 [23.8%] females). Clinical presentations of schizophrenia met the criteria of ICD-10. Anthropometric investigation was conducted with the help of Martin's anthropometer and major thickness compasses for recognition of body type. RMD was registered descriptively.

Results

It was shown that in patients with negative course of schizophrenia asthenic body type prevailed (60%) with the accumulation of RMD (94,4%) in comparison with healthy individuals (26.2%, P< 0.001). Among patients with positive symptoms of schizophrenia picnic body type prevailed (P < 0.001).

Conclusions

Asthenic body type, accumulation of multiple RMD is associated with the domination of negative symptoms and continuous course of schizophrenia. Results of the study indicate the need for a deeper study of this issue on constitutional approach.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neural modulations in processing of natural information in patients with schizophrenia and their unaffected siblings
Authors: Lerner Y. , Bleich-Cohen M. , Madah W. , Solnik S. , Yogev-Seligmann G. , Kremer I. , Hendler T.
Published: June 2017

Recent studies in healthy populations have shown a hierarchical network of brain areas to process information over time. Specifically, we revealed that the capacity to accumulate information changes gradually from the early sensory areas toward high-order perceptual and cognitive areas. Previous research in schizophrenia pointed to impairment in comprehension of information. Yet, the neural mechanisms underlying the breakdown of information processing are poorly known. Better understanding of the neural circuits involved in information processing may assist in early identification of predisposition to the disease. Using fMRI, we examined different levels of information comprehension elicited by naturally presented stimuli. Healthy participants, patients with first episode schizophrenia and their undiagnosed siblings listened to a real-life narrated story and scrambled versions of it. To estimate the level of synchronization in response time courses, we calculated inter-subject correlation (inter-SC) across the entire stimuli within each group. The time-scale gradients found in healthy and siblings groups were consistent with our previous findings. Within the schizophrenia group, the reliability patterns obtained for the shortest and intermediate temporal scales were similar to patterns observed in healthy groups. However, the analysis of responses to story condition (long temporal scale) revealed robust and widespread disruption of the inter-SC. In comparison to healthy groups, the response time courses to the story were highly variable within the schizophrenia group, although some significant inter-SCs in the TPJ and precuneus were found. The hierarchical temporal deficit is a fundamental trait that may be a better target for the study of the etiology and pathophysiology of the disease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Efficacy of memantine in schizophrenic patients: A systematic review
Authors: Montemitro C. , Spano M.C. , Lorusso M. , Baroni G. , Di Iorio G. , diGiannantonio M.
Published: June 2017

Introduction

Several evidences support the hypothesis that glutamatergic dysfunction may be implicated in the pathogenesis of schizophrenia and in the last few year great interest has been focused on the role of the N-methyl-D-aspartate receptor (NMDAR). Memantine is a noncompetitive NMDARs antagonist, binds the same site of NMDARs of Mg2+, endogenous blocker of NMDARs, with moderate affinity, rapid unblocking kinetics and strong functional voltage-dependency. Memantine does not affect the physiological activation of NMDARs whereas it blocks the sustained activation under pathological conditions. Preclinical studies have demonstrated that memantine at high concentrations targets many receptors, including serotonin, nicotinic acetylcholine, sigma-1 and serotonin and dopamine receptors.

Objectives

Increasing interest in memantine add-on therapy in schizophrenic patients with negative and cognitive symptoms may suggest that memantine could be a new promising treatment in schizophrenia.

Aims

The aim of this update was to evaluate clinical data about the memantine effectiveness in schizophrenic patients.

Methods

We searched on PubMed to identify original studies about the use of memantine in treatment of schizophrenic patients. The search conducted on June 16th, 2016 yielded 135 records. Neuf papers met our inclusion criteria.

Results

Negative symptoms improved in the large majority of patients treated, however there is not a clear evidence on cognitive and positive symptoms (Table 1)

Conclusions

Memantine therapy in schizophrenic patients has given unclear results. It seems that memantine improves mainly negative symptoms, while cognitive and positive symptoms did not improve significantly. Further trials with a more numerous sample are required obtain an objective result.

Table 1

Observation during Memantime administration.

↓: reduction in severity of symptoms; -: no relevant modifications; +: onset of new symptoms

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Insight and apathy in patients with paranoid schizophrenia: Rehabilitation approaches
Authors: Papsuev O. , Movina L. , Minyaycheva M. , Gurovich I.
Published: June 2017

Introduction

For many decades, clinicians were very well aware of lack of insight in patients with paranoid form of schizophrenia. This group of patients is not only less compliant with pharmacotherapy, but also is hard to manage in the rehabilitation setting. This dictates the necessity to develop special approaches to this group of patients, based on clinical data.

Method

Fifty patients with schizophrenia spectrum disorder were randomly recruited to be assessed by PANSS scale and Apathy Evaluation Scale (AES), which was introduced both by trained clinicians (C) and as a self-assessment measure (S). Demographic data was collected along with clinical description on prevailing symptoms during acute phase.

Results

While AES-C scores were very well correlated with PANSS motivation subscale, AES-S scores showed prominent discrepancies both with PANSS items and AES-C version. Lower scores on AES-S were also associated with paranoid schizophrenia and prevailing delusional symptoms in acute phase. As well AES-C/AES-S ratio also correlated with paranoid form and delusional symptoms in manifest psychoses.

Discussion

Patients with paranoid schizophrenia not only lack insight into positive symptoms, but tend to underestimate their negative symptoms such as motivation and apathy. Clinically, this can be described by overestimated strengths, overstated expectations, exaggerated hopes, mistakenly overrated beliefs. But when faced with reality, these patients are unable to adjust themselves and frequently are negativistic to offered help and therapies.

Conclusion

We assume that paranoid patients should be treated not with straightforward strategies, such as psychoeducation, but with less stigmatizing methods that work on metacognitive and motivational levels.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The association between first-episode psychosis and abnormal glycaemic control: Systematic review and meta-analysis of clinical studies
Authors: Perry B. , McIntosh G. , Weich S. , Singh S. , Rees K.
Published: June 2017

Background

Schizophrenia, which is linked to a range of physical health conditions, might share intrinsic inflammatory disease pathways with type-two diabetes mellitus (T2DM). Psychotropic medication has presented a major confounder in examining this association. First-episode psychosis (FEP) patients present an interesting cohort to study this potential association, being generally younger with less comorbidity, and with limited exposure to antipsychotic medication.

Aims

To assess whether FEP, which could be described as ‘developing schizophrenia’, is associated with prediabetes, or ‘developing diabetes’, to determine whether intrinsic disease links could cause the conditions to develop in unison.

Methods

Using PRISMA criteria, we searched Embase, Medline, PsychInfo, Web of Science, and Google Scholar to 6th January 2016. We assessed case-control studies with biochemical assessment of prediabetic states in FEP patients alongside matched controls.

Results

Twelve studies were included, involving 1137 participants. Several measurements examined prediabetes, including fasting plasma glucose, impaired glucose tolerance, and insulin resistance. Pooled analysis found FEP to be related to impaired glucose tolerance (mean difference 1.31 [0.37, 2.25]), insulin resistance (mean difference 0.30 [0.18, 0.42]), and the number of patients with impaired glucose tolerance (odds ratio 5.44 [2.63–11.27]).

Conclusion

Our findings suggest a potential link between prediabetic markers, in particular impaired glucose tolerance and insulin resistance, and FEP. However, we cannot establish causality, and the studies contributing to this review were at some risk of bias. Nevertheless, the findings might help to explain the increased prevalence of T2DM in patients with schizophrenia and could have implications for the management of schizophrenia patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Can the ‘mediation’ approach help to understand the role of lack of insight in the relationship between symptoms and functioning in schizophrenia?
Authors: Rossi R. , Santarelli V. , Marucci C. , Pizziconi G. , Pacitti F.
Published: June 2017

Introduction

The relationship between Lack of insight (LoI) and other symptoms in schizophrenia is complex. LoI could be associated with severity of symptoms at one side and global functioning at the other. For this nature LoI is a candidate ‘mediator’ for the relationship between psychotic symptoms and global functioning.

Objectives

The aim of this study is to explore the possible role of LoI as a mediator between psychotic symptoms and global functioning in a sample of people with schizophrenia.

Methods

Seventy-three patients with a diagnosis of schizophrenia were included. The five-factor model of the PANSS by Wall work was used to assess psychopathology and G12 item as an estimate of LoI. Global assessment of functioning (GAF) was used to measure global disability. Pearson's r correlations and linear regressions for Sobel test for mediation were performed. PANSS factors were modeled as predictors of global functioning and LoI as the mediator.

Results

Correlations revealed the prerequisite relationships between LoI, positive, negative and disorganized PANSS factors and global functioning. Mediation analyses show that LoI partially mediates the relationship between positive and disorganized factor scores and global functioning. No mediation for negative factor score was observed.

Conclusions

Lack of insight mediates the relationships between positive and disorganized factors and global functioning. The partial mediation we report suggests that LoI on the one hand is an independent contributor to global function, but further shows an indirect effect of PANSS positive and disorganized factors to GAF total score.

Disclosure of interest

The authors have not supplied their declaration of competing interest.