bluuebunny/crossref_metadata_2025 huggingface dataset:
Huntington disease, to have or not to have: That is the question – the importance of psychiatric symptoms
Authors: Carvalhão Gil L. , Lázaro M. , Queiroz L.
Published: June 2017

Introduction

Huntington's disease (HD) is an autosomal dominant inherited neurodegenerative disorder, beginning in adulthood. HD represents the majority of patients who present the triad of motor, cognitive and psychiatric symptoms. The last two may be early manifestations, but the clinical diagnosis is based on motor symptoms and a positive genetic test for CAG repeat extension. The remaining patients that are negative for the HD genetic mutation may have HD phenocopies.

Objectives

Illustrate the role of psychiatric assessment, discuss the psychiatric and behavioural manifestations, and management.

Aims

Illustrate the challenge of diagnosing HD in psychiatry.

Methods

A literature search was performed on PubMed database. The patient clinical record was reviewed.

Results

We report a case of a 49-year-old male with a family history of HD (mother, uncle, cousin). He was diagnosed with a psychotic disorder fifteen years ago, hospitalised twice and thereafter treated as an outpatient with fluphenazine long-acting injection. He was a symptomatic for ten years. During the last year, he started showing dysphoria, marked irritability, stammering, inappropriate behaviour, poorly structured paranoid delusions, mild cognitive impairment and lack of insight. This was correlated with the beginning of functional impairment, both professionally and socially. Further assessment was performed: neurological evaluation, head CT scan and the genetic test was negative. He is clinically stable under haloperidol long-acting injection.

Conclusions

HD is a rare condition which is frequently under diagnosed, especially in early stages, due to lack of recognition of psychiatric symptoms. HD-like disorders should be considered if the clinical picture is obvious, but HD gene test result is negative.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Protagonist-patient and servant-doctor: A medicine for the sick doctor-patient relationship
Authors: Ferraz I. , Guedes A.
Published: June 2017

The doctor-patient relationship (DPR) is very ill; it is in need of emergency assistance. Although there have been change in this relationship, no current model is satisfying. In 1972, Robert Veatch defined some models of DPR. Likewise, Pierloot, in 1983, and Balint, in 1975 and ultimately, Mead and Bower, 2000 with the model of Person-center-care (PCC) medicine.

Objective

Evaluate the different kinds of DPR described in the literature and propose an abduction-based model of the Servant DPR, in which patients are protagonists in their treatment.

Methods

Pubmed literature review of the last forty years with the keyword ‘physician-patient relations’.

Discussion

While nursing care advanced in its professional efficacy through Watson's human care and through the leader servant model, the DPR models demonstrated that the doctors are lost in their posture, even feeling as abused heroes. Models that include the patient in decision-making and that value the patient as a person (PCC) promise a revolution in the medical realm. Nevertheless, the PCC model is not enough to heal the DPR itself, because the role of the doctor must be changed to adapt to the relationship, otherwise, the PCC by itself can increase the burden upon the doctor. Doctors with a role of remunerated servant (not slave), like any other professional who delivers a service with excellence, focusing in the main actor, the patient, can heal the DPR.

Conclusion

The Servant DPR gives a positive counter transference, increasing the doctor's motivation and giving him back the sense of purpose in medicine, increasing the health system's effectiveness.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Work memory and inhibition in abused children
Authors: Martinez M.C. Jimenez
Published: June 2017

Introduction

It has been shown that children with a history of abuse tend to have a deficit in both their academic and cognitive abilities. Mesa-Gresa, P., & Moya-Albiol, L. (2011) [1]. This study aimed to identify the relationship between abuse (psychological, neglect, custody and abandonment) and the performance of executive functions of memory of verbal work and inhibition.

Method

The Executive Function battery (Gonzalez, M., & Ostrosky, F., 2012) [2] was applied to 38 preschoolers 4–5 year olds who have experience abuse and to 36 preschoolers who have not. Data was analysed using the test t for independent samples and the Chi-cuadrado from Pearson.

Results

Inhibition was affected in children with psychological abuse and negligence. It means that children presented difficulty in controlling their behaviour. Children victim of abandonment showed lower performance of executive functions of memory of verbal work. Such function allows them to carry on daily activities efficiently. Conversely, children without previous history of abuse showed higher performance in both tests especially in inhibition.

Conclusion

Findings suggest that child abuse in preschoolers can influence the performance in their executive functions without difference in gender.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Alexithymia and coping strategies among medical students
Authors: Messedi N. , Feki I. , Saguem B.N. , Masmoudi R. , Masmoudi J.
Published: June 2017

Introduction

University life is stressful for the student, which is characterized by disturbed emotional regulation or alexithymia. To face these stressful events he must use certain coping strategies.

Objectives

Studying the prevalence of alexithymia and exploring coping strategies among medical students, and establish the relationship between these parameters.

Methods

It was a cross-sectional study of 97 students in Sfax university medicine (Tunisia). We used:

– a questionnaire containing demographic and clinical data;

– Toronto alexithymia Scale (TAS-20): a score ≥61 indicates alexithymia;

– WCC (Ways of Coping Checklist-r Folkman) with 3 factors: problem-focused, emotion-focused and social support coping.

Results

The average age of participants was 24.07 years (±2.71); the sex ratio (M/W) was 0.4. They were smoking in 36.1% and sedentary in 43.3% of case. They had a nibbling activity in 57.7%. The average score of TAS-20 was 50. 92 10.46 and alexithymia was found in 16.5% of students. Alexithymia was significantly correlated with smoking (P = 0.003) and physical inactivity (P = 0.025). Most students (72.2%) opted for problem-focused ways of coping with a highest score at WCC = 29.21. A significant correlation was found between alexithymia and coping strategy with emotion-focused (P = 0.02). The TAS score was significantly higher among students who resort to this ways of coping = 26.11. (P = 0.002).

Conclusion

This study explored the role of alexithymia in stress management ubiquitous in university life. A high level of alexithymia could be a detrimental factor in stress management. Psychological support aimed specifically alexithymic dimension is indispensable.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The relevance of Paraphrenia: Case report
Authors: Peixoto M. , Oliveira M.M. , Bragança M.
Published: June 2017

Introduction

Paraphrenia is a chronic psychotic disorder with a better-preserved affect and minimal disturbances of emotion and volition and a much less cognitive deterioration and personality changes.

Objectives/aims

To report a case with probable Paraphrenia and to highlight the importance of the differential diagnosis in a first psychotic episode.

Methods

Case report and systematic review of the literature.

Results

We report a case of a 41-year-old man without a past psychiatry history that was led to the psychiatry emergency department (PED), by officers, because of strange behaviour and aggressiveness towards his family. In the PED the patient said that his real father was his father-in-law and that his ex-wife was his sister. His mental exam revealed disinhibition, disorganized speech with slightly mood elation, persecutory, mystic and influential delusions with various delusional interpretations. After being admitted to the psychiatric ward, in compulsatory care, he began treatment and a medical work up was completed. According to the family the patient had begun this strange behaviour four years prior. During the hospitalization it became clear that the patient was experiencing imaginative-confabulatoric multi-thematic delusions, sometimes interviewer guided, without showing cognitive deterioration and retaining his personality.

Conclusions

The diagnosis of atypical psychosis or psychosis not otherwise specified is not satisfactory since it agglutinates different conditions together. Paraphrenia is a well-established concept and should be used in order to define a group of psychotic patients who exhibited characteristic symptoms of schizophrenia, minus personality impairment and slower cognitive decline.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Issues of self-regulation of children with mental retardation
Authors: Sedova E. , Goryacheva T.
Published: June 2017

Matured self-regulation system is considered to be one of the crucial factors for the success in life and that explains the interest to this issue from researchers, belonging to varied psychological disciplines.

According to the Nikolaeva's (1991) model, self-regulation system consists of three levels: the level of self-regulation of mental states, the level of activity self-regulation and the motivational level.

The research aim was to describe maturing of self-regulation of children with mental retardation comparing with their normally developing peers.

The sample consisted of 39 children with the slightest degree of mental retardation in the age from 7 to 10 years, attending public school, and of 59 their normally developing peers.

The research methods included the Luria's neuropsychological test battery, adapted by Semenovitch (2008) for the first level of self-regulation, analysis of school results for the second level and Guinsburg's and Louskanova's tests of learning motivation for the third one.

According to the test results all the subjects were referred as having high, medium and low degree of self-regulation. All the children with mental retardation had the low degree.

The research shown that for normally developing children the defects of the first self-regulation level were compensated by maturing of the third one. As for the children with mental retardation, they had more severe defects in the first level, and maturing of the third level also delayed, so there was no compensation of their problems. That fact should be considered when working out intervention program for those children.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Role of Identity Style and Locus of Control in Prediction of Self-efficacy Among Teachers
Authors: Ghahari S. , Moradi I. , Gheitarani B. , Safari R.
Published: June 2017

Object

Identity style and locus of control are of the most important strategic variables in determining the characteristics of people personality. So, this study was conducted to investigate the relationship between identity style, locus of control and self-efficacy among teachers of Khodabandeh city in Iran during the academic year 2014–2015.

Methods

Among all teachers in Khodabandeh city during 2014–2015 academic year (419 teachers), 120 were selected using systematic random sampling method. All of them completed identity Style Inventory (ISI), Levenson Multidimensional Scale of Locus of Control and General Self-Efficacy Scale (GSE-10). For data analysis correlation and regression analysis (stepwise) was used.

Finding

Data analysis showed a significant correlation between teachers’ identity style, locus of control and their self-efficacy (P < 0.05).

Conclusion

Due to the results, it can be concluded that identity style and locus of control can predict self-efficacy in teachers.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicidal Behaviour among Asylum Seekers in the Netherlands; Prevalence, Background and Prevention
Authors: Laban C.J.
Published: June 2017

Background

Problems of asylum seekers are multiple and complex. Having experienced pre migration adversities, they face multiple post-migration living problems in the host country. In clinical practice suicidal ideations and suicidal behavior often occurs.

Objectives/aims

To increase knowledge and give directions for preventive measures related to suicidal behavior among asylum seekers.

Method

Literature, related to the subject, is summarized.

Results

In this presentation the context of the reception of asylum seekers is explained. Data will be shown on suicides and suicidal attempts among asylum seekers, in comparison with the Dutch population and with international data. Moreover an overview of qualitative and quantitative research findings will be shown on the many risk factors asylum seekers experience: traumatic experiences, loss, mental health problems, poor living conditions, fear to be expelled, uncertain future and post migration living problems. Attention will be given to the situation of imprisoned undocumented migrants in The Netherlands. Hobfolls theory of the Conservation of Resources will be used to explain the increased risk for suicidal behavior and suicide among asylum seekers and undocumented migrants. Prevention strategies contain cooperation to decrease the risk factors, enhance the protective factors, early detection of signals, and good access to mental health care.

Conclusion

Asylum seekers encounter many risk factors for suicidal behavior and suicide. The impossibility to get control over their lives and the lack of resources of resilience needs to be recognized as important risk factors. There is a need for cooperation between all professionals and volunteers to change this situation.

Disclosure of interest

The author has not supplied his declaration of competing interest.
I Choose, Therefore I am. The Jaspers Concept of Choice and Implications on the Ability to Act
Authors: Riolo A. , Babici F. , Tassi F.
Published: June 2017

Introduction

According to Jaspers, with the term of choice you should not be understood the possibility to choose between objects but freedom as a choice for themselves. Because I choose, then I am; in fact, I feel my freedom in my mind. Choose what is best for the psychiatric patient in different contexts (relational, occupational, social, therapeutic) is the ability to act. The best practices provide that psychiatrists, nurses, social workers, rehabilitation professionals are committed to enhancing the capacity to choose but the legal protection measures are likely to be a contradiction.

Objective

We try to explore the theme of choice based on the capacity to act or failure to act from a phenomenological approach.

Method

Through some concrete cases, extrapolated from clinical practice, highlight the contradictions between enunciation of principles and procedures for responding to the problems of psychiatric patients who are not able to choose.

Conclusions

Protections of health and individual freedom are the weights of a balance poised, since there is uncertainty about the anthropological paradigm of the mentally ill.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Three Forms of Intuition in Eugène Minkowski
Authors: Veliz Uribe J. , Ugalde M. , Pastén C.
Published: June 2017

Introduction

Eugène Minkowski is one of the great authors of structural phenomenological psychiatry. However, it has stressed only its influence on the study of schizophrenia, however, the scope of its investigations is much coarser, while addresses issues that attempt to illuminate the way they are set life and humans.

Objectives

It is interesting to pose as the author emphasizes the importance of intuition, on more than one level, giving an epistemologically worthy rank in the constitution of the self (soi-même), in psychopathology and even in the ontology.

Aims

It is shown that in Minkowski research on intuition it appears as a study of a symptom called autism, as a psychopathological diagnostic method called empathy, and even as an ontological understanding that purpose of the study time.

Methods

Reconstruction of the uses of the notion of intuition in the work of Minkowski.

Results

Three ways clearly appear in different planes but complementary, pointing not only to a clinical trial, but take a glimpse metaphysical aspects.

Conclusions

The conclusions aimed are highlighting how Minkowski think intuition not only as a dignified way to understand the suffering, or establish a knowledge, but necessary for a clinic and even an approximation of what we are.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Repeated Programmed Hospitalizations (RPH) in the Care of French Military Suffering for War Post-traumatic Psychiatric Disorders: Interests and Limitations
Authors: Thomas G. , Le Pape E. , Py-Leroy E. , Mele E. , Tourinel G.
Published: June 2017

Introduction

The long-term management of psychiatric wounded patients with prolonged disorders requires a rethinking of our practice of care.

Objectives

The aim is to propose an integrative model of all valid therapies in the post-traumatic-stress disorder while taking care of comorbidities and ensuring patient support in the different administrative procedures that permit reconstruction. Repeated short-term hospitalizations can meet this objective by mobilizing resources, creating group dynamics, restoring a space of safety, allowing a rupture with the environment, preventing recurrence of crises, and by encouraging the histicization of trauma by the temporal sequences of intra/extra-hospitalisation repetition.

Method

We propose, by means of a review of the literature, to discuss on a psychopathological level the interest and limits of this mode of care.

Results

This work reveals the specific therapeutic effects of repeated programmed hospitalizations, which constitute a new modality of institutional psychotherapy.

Conclusion

Rethinking the place of hospitalisation in the management of psychiatric illnesses can be useful to all psychiatrists who follow patients with chronic and co-morbid disease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Impact of Terrorist Attacks on the Profile of Consultants at the Outpatient Department of Razi Hospital
Authors: Trabelsi R. , Bouasker A. , Zalila H.
Published: June 2017

Introduction

A trauma is an uncommon experience of violence in which the physical and psychological integrity of an individual or group has been threatened. Intentional violence in general and terrorist attacks in particular are a perfect example of this. It turns out that during the year 2015 Tunisia was shaken by a series of terrorist attacks as sudden as violent. What impact would these actions have on the profile of consultants at the Razi hospital?

Methods

A retrospective and descriptive study of the consultants between January 1, 2015 and December 31, 2015, while determining the socio-demographic, clinical and therapeutic profile of the consultants for the first time at the outpatient clinic of the Razi psychiatric hospital, and indicating the different changes during the month following each attack; Bardo 18 March, Sousse 26 June and Mohamed V 24 November.

Results

Our study pointed to an increase in the number of consultants at the hospital (31%) and outpatient (128%) levels during the year 2015, without increasing the number of consultants New consultants. The new consultants are younger with a strengthening of the female predominance (56.8). In the months following the attacks from the same period of the previous year, we found that diagnoses of acute and post-traumatic stress disorders (151%) and (93%) increased in percentage.

Conclusion

The impact of terrorist attacks is harmful to people directly exposed but also to vulnerable people. It imposes the necessity of a preventive activity involving multidisciplinary interventions in order to develop the concept of resilience.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Medical Students Assessment from a Public University Considering the Relevant Aspects of Medical Practice
Authors: Alves Á.T.L.S. , Alves F.V. , Melo E.V. , Oliva-Costa E.F.D.
Published: June 2017

Introduction

In traditional medicine curriculum, internship is the moment in which students experience medical practice more intensively. Attitudes can be considered predictors of behaviors and actions. Evaluate them contributes to improve medical graduation.

Objective

Evaluate medical internship attitudes, considering medical practice and associated factors in a Brazilian public university.

Methods

Cross-sectional study with 69 students, using a structured questionnaire and an attitude scale. Descriptive statistic was carried out, classification of the attitude tendency, group analysis (‘clusters’) and F statistic.

Results

The average age was 25.1 and 56.5% were male. Students presented positive attitudes towards four from six aspects and negative attitudes toward death.

Conclusion

Results suggest the necessity of educational intervention, which follows the educational objectives.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The use of vitamin D3 sublingual tablets versus oral drops in the treatment of patients with COMT Val/Val genotype and major depressive disorder
Authors: Mech A.W.
Published: June 2017

Introduction

Vitamin D has been shown to be crucial in the regulation of dopamine and its relationship to major depressive disorder.

A five-year pre-interventional study of 25 hydroxy vitamin D levels in patients with major depressive disorder found values ranging from 17 to 32 ng/mL.

COMT Val/Val genotype has been associated with a 20–40% more rapid breakdown of dopamine in the prefrontal cortex as compared to individuals with a Val/Met genotype.

Methods

This retrospective study gathered data concerning outcome measurements in patients who displayed a baseline 25-OH level < 30 mg/mL and initially treated with sublingual tablet form of 10,000 IU vitamin D3. These data were compared to post interventional depression outcome scores for patients switched to oral vitamin D3 drops at a dose of 10,000 IUs.

Results

Scores on the MADRS 1–3 weeks following the vitamin D3 switch showed an improvement in mood with the lowering of scores on the MADRS.

Conclusions

Patients with a COMT genotype of Val/Val showed clinical improvement with a switch from oral D3 sublingual tablets to oral D3 drops. Further studies are needed to draw from conclusions. Pre- and post-25-OH vitamin D levels and other dopamine synthesis variables including serum ferritin would be useful as well as prospective double-blind placebo controlled trials. The future use of genotype-specific and supportive approaches deserves serious investigation.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Ultra-high risk psychosis. A case report
Authors: Santayana G. Pardo de , Landera R. , Juncal M. , Porta O. , Gómez M. , Núñez N. , Sánchez L.
Published: June 2017

Introduction

There is much debate on whether patients who are at high risk of developing a psychotic disorder in the near future (such as patients suffering of attenuated psychotic symptoms, brief limited intermittent psychotic symptoms or personality trait vulnerability) should be treated with antipsychotic drugs to prevent possible psychotic breaks from happening.

Aim

To review articles from the existing medical literature about treatment of patients in ultra-high risk of developing psychosis.

Methods

We describe the case of a 19-year-old male who was hospitalized after a suicide attempt in April 2015. He had been diagnosed of different psychiatric disorders such as mixed anxiety-depressive disorder, adjustment disorder and probable borderline personality disorder. During his stay at the hospital, we observed that he had schizoid personality traits. In the initial anamnesis, he denied ever having psychotic symptoms, but a few days later he admitted that the previous year he suffered throw a period of brief self-limiting psychotic symptoms.

Results

Prophylactic treatment was started with oral aripiprazole 15 mg/day, which was well tolerated by the patient. He has been free of psychotic symptoms for the last 17 months (from April 2015 to September 2016). No relevant side effects were detected.

Conclusions

Oral aripiprazole 15 mg/day can be a good therapeutic option in patients at ultra-high risk of developing a psychotic episode.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Communitarian Mental Health Group: Promoting mental health through daily experiences in Brazil
Authors: Craveiro Prado A.P. , Cardoso C.L. , Ishara S.
Published: June 2017

In Brazil, the mental health field has been the scenario of many transformations, among them, the recognition of community and group-based interventions as significant approaches concerning mental health promotion. These approaches regard the interpersonal relationships as a resource to individual's mental health care and the construction of a helping network. This study aimed to present and describe the Communitarian Mental Health Group (CMHG), an innovative intervention developed and studied in Brazil for 18 years. To accomplish that, a study of previous researches about this intervention was conducted, including the analysis of a book published in 2014. The activity goal is to promote mental health through the attitudes of paying attention, understanding and sharing everyday experiences, as resources for personal development and mental health care. It is an open and heterogeneous group, in which participants interact among them aiming mutual help. Each group session lasts 1 h 30, and each session is divided into three phases: sharing experiences with cultural elements considered meaningful to the goals of the group; sharing everyday experiences; sharing what was significant from that session, according to the participants. One of the premises is that taking care of our mental health belongs to the scope of the human being and it is not restricted to patients. Daily experiences are significant resources for mental health promotion and for the construction of a helping communitarian network among participants, bonded through the sharing of their quotidian. The CMHG represents a mental health promotion intervention able to complement other kinds of available treatments.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Oxidative stress, inflammation and mild cognitive impairment
Authors: Cherbuin N. , Anstey K.J. , Baune B.T.
Published: June 2017

Introduction

Oxidative stress (OS) and inflammation are processes known to be implicated in neurodegeneration. Moreover, risk factors for dementia (depression, obesity, sedentary lifestyle, diabetes, etc.) are associated with up-regulation of pro-inflammatory cytokines. OS has been found in animal models to contribute to cerebral amyloid angiopathy. However, investigations of the associations between OS, inflammation and MCI, typically in small clinical samples have produced mixed results.

Objectives

Clarify associations, between OS, inflammation and MCI in a large cohort of community-living individuals.

Methods

Cognitively healthy individuals (n = 211, 44% female, 75.2 years) and with MCI (n = 23, 44% female, 75.2 years) from a population sample were included. MCI diagnosis was established based on a detailed neuropsychological assessment. Inflammatory (IL1b, IL4, IL6, IL8, IL10, TNF-a) and OS (total anti-oxidants, NO, neopterin) markers were assessed in plasma samples. Associations between biomarkers, MMSE, and MCI status were tested with multiple linear and logistic regression analyses.

Results

Univariate analyses showed that log IL4 (estimate: −0.175, SE: 0.085, P = 0.041) and NO (estimate: 0.015, SE: 0.006, P = 0.017) were the only markers associated with MMSE scores. MCI status was predicted by log IL4 (estimate: 0.822, SE: 0.357, P = 0.021) and total anti-oxidants (estimate: −0.007, SE: 0.003, P = 0.014). Controlling for pro-inflammatory conditions (T2D, BMI, depression, hypertension) removed the associations with inflammation but not with OS.

Conclusions

These results indicate that increased systemic inflammation and increased OS were associated with lower MMSE scores and higher odds of having MCI. This confirms that systemic pro-inflammatory processes are associated with impaired cognition and should be specifically considered in treatment and risk-reduction interventions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Off-label prescriptions of quetiapine for sleep disturbances
Authors: Arts M. , Petrykiv S. , Fennema J. , De Jonge L.
Published: June 2017

Introduction

Quetiapine, a short-acting atypical anti-psychotic drug for the treatment of bipolar I disorder and schizophrenia, is increasingly used off-label for the treatment of sleep disturbances or insomnia. However, data supporting this off-label prescription of quetiapine are limited.

Objectives and aims

To report and discuss the effects of “off-label” use of quetiapine for the treatment of sleep disturbances.

Methods

An English-language literature search was conducted using Pubmed, EMBASE and Cochrane library (December 1980–December 2015) using the search terms quetiapine, insomnia, sleep disorders, sleep disturbances, and sleeplessness.

Results

During the last decade, there is an enormous increase in prescribing quetiapine. This anti-psychotic drug is among the best selling drugs worldwide. For the approved indications, the usual therapeutic dose range is 400–800 mg/day. However, off-label use of quetiapine was most evident for the 25 mg/day to 100 mg/day. In some countries, off-label uses are promoted to non-psychiatrists for the treatment of insomnia, dementia, agitation, and aggression. Inappropriate anti-psychotic use may lead to serious health problems, including metabolic effects, increased sudden cardiac death, and age-related side effects with increased risk for orthostatic hypotension, fractures, pneumonia, cognitive impairment, and stroke.

Conclusion

There is growing concern regarding the potential harm from off-label prescription of anti-psychotics, particularly quetiapine. There is little evidence supporting the enormous off-label uses of quetiapine. In addition, prescribing quetiapine for indications that are not evidence based has ethical, financial, and safety implications, especially in the older population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Isolated rhabdomyolysis caused by olanzapine: About a clinical case
Authors: Laajili Y. , Ellini S. , Rebhi H. , Haloui N. , Cheour M.
Published: June 2017

Introduction

Atypical anti-psychotics are increasingly prescribed, given their tolerance. Among these anti-psychotic olanzapine, known for its adverse metabolic effects. By against an adverse event type rhabdomyolysis with olanzapine appears uncommon (<1%) and few clinical cases have been reported in the literature.

Aim

The aim of our study is to illustrate with a clinical case the occurrence of an isolated rhabdomyolysis with olanzapine.

Materiel and method

Starting from the study of the case of a patient with rhabdomyolysis with olanzapine we studied the literature data. Clinical vignette: it is about a patient aged 25 followed for bipolar disorder type I. He responded to the association olanzapine and valproic acid then to valproic acid only. His last hospitalization for manic relapse dating to September 9, 2015 occurred in a context of treatment discontinuation. Upon admission the patient underwent an oral treatment based olanzapine and valproic acid. A dosage of creatine phosphokinase (CPK) done systematically, on September 11 showed high levels of (CPK) to 973 (U/L) without clinical signs of neuroleptic malignant syndrome. The electrocardiogram and biological tests results were normal. Other etiologies can lead to elevated (CPK) were eliminated. The persistent elevation of CPK motivated the arrest of olanzapine. The evolution was marked by a return to normal CPK rates after 15 days. The olanzapine was replaced by haloperidol and vaproic acid maintained. The pharmacovigilance investigation conclude to the accountability of olanzapine in this rhabdomyolysis.

Conclusion

Second generation, anti-psychotics are known for their better tolerance compared to conventional antipsychotics. However, they are not devoid of side effects.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Hyponatremia associated with selective serotonin-reuptake inhibitors
Authors: Petrykiv S. , De Jonge L. , Arts M.
Published: June 2017

Introduction

Psychotropic agents have been implicated in the cause of hyponatremia, including the majority of selective serotonin reuptake inhibitors (SSRIs). The reported incidence of hyponatremia caused by SSRIs varies widely up to 40%. Important risk factors are older age and concomitant use of diuretics. Though there are numerous retrospective studies available, an update of current knowledge SSRI induced hyponatremia is warranted.

Objectives and aims

To review the incidence, risk factors, mechanism, times of onset and resolution, and treatment of hyponatremia associated with selective serotonin-reuptake inhibitors (SSRIs).

Methods

An English language literature search was conducted using Pubmed, EMBASE and Cochrane library (December 1980–December 2015) using the search terms selective serotonin-reuptake inhibitor, hyponatremia, syndrome of inappropriate secretion of antidiuretic hormone, citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline.

Results

Numerous case reports, observational studies, and case-controlled studies, as well as one prospective clinical trial, have reported hyponatremia associated with SSRI use, with an incidence of 15%. Risk factors for the development of hyponatremia with SSRIs include older age, female gender, and concomitant use of diuretics, low body weight, and lower baseline serum sodium concentration. Predisposing factors, such as volume status, diuretic use, or concomitant use of other agents known to cause SIADH, may predispose to the development of hyponatremia. In published reports, hyponatremia developed within the first few weeks of treatment and resolved within 2 weeks after therapy was discontinued.

Conclusion

Practitioners should be on the alert for this potentially life-threatening adverse event, especially in older adults.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Aripiprazole once monthly outpatient experience
Authors: Sánchez Páez P. , Gómez Cano J.L. , Sánchez Flores L. , González Lucas R. , Artieda Urrutia P.
Published: June 2017

Introduction

Aripiprazole once monthly (AOM) is one of the most recently introduced antipsychotics with a different mechanism of action, which seems to bring clinical and tolerability implications [1].

Objectives

We describe the patient profile that may benefit from AOM treatment.

Methods

This is a single-centre, retrospective, one year follow-up study of 13 cases of ambulatory AOM use. We analyze clinical and functional evolution, and the tolerability profile of patients in a real clinical practice basis.

Results

Mean age was 53.69; 53.8% were males and 46.2% females. The most frequent diagnosis was Schizophrenia and other chronic psychosis (69.3%). Only 7.7% had co-morbidity with substance use disorder (cocaine); 61.6% were on previous treatment with other injectable anti-psychotics; 84,6% of the sample received AOM as monotherapy. Reasons for switching to AOM are shown on Fig. 1. Events during switching are shown on Fig. 2. Outcomes with AOM long-term treatment were positive in 84.61% of cases and are shown on Fig. 3.

Conclusions

Switching to AOM could be considered as a good strategy to improve tolerability, functionality and ultimately adherence to treatment in patients in middle age of life with a chronic psychotic disorder [2].

Fig. 1

Reasons for switching.

Fig. 2

Events during switching.

Fig. 3

Outcomes with AOM.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Treating bipolar disorder in pregnancy
Authors: Solana C. , Nascimento S. , Mendes M. , Duarte M.
Published: June 2017

Introduction

Bipolar disorder is a chronic psychiatric illnesses characterized by alternating episodes of mania/hypomania and major depression, or with mixed features. Acute exacerbations and maintenance treatment with appropriate pharmacotherapy are mandatory. Long-term treatment with mood-stabilizing medications is typically required. The incidence of bipolar disorders in women during the primary reproductive years is very high, and the episodes of mania or depression are thought to occur in an estimated 25%–30% of women with bipolar disorder during pregnancy.

Objectives

Provide a clinically focused review of the available information on the effectiveness and safety of the different pharmacotherapies in the treatment of bipolar disorder during pregnancy.

Methods

A bibliographic review is made of the pregnancy in bipolar disorder, based on the data published in PubMed.

Results

Clinical decision making about the use of mood stabilizers and atypical anti-psychotics by pregnant women can be conceptualized as balancing the competing risks imposed by withholding or stopping pharmacotherapeutic treatment against that of continuing or initiating pharmacotherapy during pregnancy. Some of the most effective pharmacotherapies have been associated with the occurrence of congenital malformations or other adverse neonatal effects in offspring. There is few information about the safety profile and clinical effectiveness of atypical anti-psychotic drugs when used to treat bipolar disorder during pregnancy.

Conclusions

Treating women with bipolar disorders during pregnancy is a challenge. There are no uniformly effective or risk-free treatment options. Fully informed decision-making requires the review of the risks of both untreated maternal bipolar disorder and risks associated with potentials interventions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychiatrists’ opinions on long-acting anti-psychotics drugs: Perceived differences and identification of the ideal patient for each of these medications
Authors: Verdino V. , Fagiolini A.
Published: June 2017

Introduction

Long-acting anti-psychotic drugs (LAI) are increasingly used in clinical practice, owing to their ability to improve adherence.

Objectives and aims

To understand the variables that inform treatment choice, within the LAI anti-psychotics, in the daily clinical practice.

Methods

Fifteen attending psychiatrists from the university clinic of Siena and the community mental health service USL 7 Siena and Val d’Elsa were asked to answer a questionnaire comprising 4 questions, and asking for their clinical experience regarding olanzapine, risperidone, haloperidol, zuchlopentixol, paliperidone and aripiprazole LAISs.

In particular, they were asked to indicate:

– which LAI has been their mostly used;

– what have been the most relevant side effects;

– an efficacy score ranging from 0 to 5;

– who the ideal patient for each of these medications could be.

The answers were statistically assessed and the final results described as a percentage of the total.

Results

The results are shown by the Tables 1 and 2.

Conclusions

LAI are still heterogeneously used in the daily clinical practice: their actual use depends on the individual experience with a specific drug as well as on their costs and the availability of resources within the medical service. The most used LAI resulted to be risperidone, although haloperidol LAI is still considered to be the most effective one. Those psychiatrists interviewed had an overall good opinion about the most recent LAI such as paliperidone and aripiprazole. This is due to their good tolerability, which allows them to be administered more safely to the youngest, in order to preserve their good functioning.

Table 1

Table 2

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clozapine treatment of adolescent refractory emergent emotionally unstable personality disorder: Challenges in diagnostics and therapeutics
Authors: Whitaker S. , Mathe M.
Published: June 2017

Despite recent advances precision diagnostic criteria on how best to diagnose and treat EUPD remains debated. Therapeutic indication and appropriate use of anti-psychotics including clozapine in this patient group remains unclear. It is debated about personality disorder being diagnosed in children and adolescents, overall it is much more acceptable for adolescents to be given a diagnosis of ‘emerging’ personality disorder if they exhibit clinical features of such. Clozapine has been used (as an off-license treatment) in adults diagnosed with personality disorder improving psychopathology and quality of life. These patients have been tried on numerous other treatments. In a secure unit for adolescent girls who meet the criteria for a diagnosis of emergent personality disorder who posed serious risks to themselves and others three were given a trial of clozapine The off license use of clozapine was tried in all three patients showed a reduction in incidents, reduced need for polypharmacy and improvement in their qualities of life. One cannot account for these changes being the result of clozapine alone; however, these cases add to the growing body of evidence of the benefits of clozapine in patients with emergent personality disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Modified Electroconvulsive Therapy in Pseudocholinesterase Deficiency: A Case Report
Authors: Yildizhan E. , Tomruk N.B. , Dereli M. , Özdemir A. , Yıldırım H. , Canbek Ö.
Published: June 2017

Introduction.

Pseudocholinesterase (PCHE) deficiency is an inherited condition, in which recovery from anesthetic agents like succinylcholine and mivacurium is slow and complicated with prolonged paralysis of respiratory muscles in susceptible patients. Succinylcholine is used very frequently as a muscle relaxant during the procedure.

Objectives.

In Bakirkoy research and training hospital for psychiatric and neurological diseases, 24.310 patients were hospitalized for acute conditions and 3490 of these patients were treated with electroconvulsive therapy (ECT) in 3 years. We present a very rare case that we encountered in our practice; a severe PCHE deficiency case that could have complicated the modified ECT procedure unless necessary precautions were taken.

Aims.

Detection of PCHE levels of all patients eligible for ECT is part of our pre-ECT assessments procedure, and the case presented here shows the benefits of this method.

Methods.

The patient is a 29-year-old woman, with a 15 year history of schizophrenia. She was hospitalized for homicidal risk and refusal of treatment. Inadequate clinical response with pharmacological interventions and continuous aggressive excitations directed us to consider ECT.

Results.

After the detection of PCHE deficiency (PCHE level: 126 U/L), we performed the modified ECT with propophol and rocuronium instead of succinylcholine as usual. Sugammadex 100 mg was used for fastening the recovery. Response to treatment, which is recorded with positive and negative syndrome scale, was good and we completed 9 ECT sessions without complication.

Conclusions.

Screening for PCHE levels in the pre-ECT assessments is efficacious in order to decrease the complications of the ECT procedure.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pollyanna Syndrome in Psychotherapy-or Pseudotherapy. Counseling, Consoling or Counterfeiting?
Authors: Latecki B.
Published: June 2017

Pollyanna syndrome, the name being taken from a book of the same title, means “an excessively or blindly optimistic person.” The occurrence and danger of such attitudes in psychotherapy is discussed. Such attitudes may occur both in patients and their therapists. Either of them may say “things will not be so bad...” attempting to console not him/himself but the other party. The main aim of psychotherapy is to facilitate taking responsibility and decisions. But there are also other aims, identical to those attributed to philosophy in ancient times, namely, “to treat the soul” or, clinically speaking, to provide consolation. This is usually achieved by attributing meaning and purpose to suffering and set-backs. In the paper, I discuss how the therapist could avoid the trap of being and coercing the patient to be “optimistic, positive, and strong” when the situation does not necessarily warrant such an attitude. Philosophy may be of help here. One may apply theodicy, that is, the philosophical attempt to explain and justify the evil existing in God's world. Another possibility is Ericksonian approach of utilization, paradoxical intervention, using metaphors and hypnotic techniques in order to let the patient come up with his own, intimate resources facilitating recovery. Logotherapy, which is an existential approach is recommended, either as such or as a part of REBT. In short, the difference between an ineffective and an effective approach is the difference between being optimistic and being realistic.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Borderline Personality Disorder – Dilemmas and Therapeutic Challenges
Authors: Tasic G. , Anakiev S.
Published: June 2017

Treatment of borderline personality disorder has some specifics relative to other disorders, which are deriving from nature and structure of those people. Treatment is very slow, often with interruptions, and it presents a special challenge for contratransferal feelings but at the same time offers a possibility of continuous learning, for the patient and the therapist. Main characteristics of this personality disorder are the diffusion of identity, primitive defence mechanisms concentrated around the cleft and relatively preserved ability to rest reality. As classical psychoanalysis and psychoanalytical psychotherapy did not give results in therapy of this disorder, Otto Kernberg took its basic techniques but used them adjusted for borderline personality disorder, developing so called transfer focused psychotherapy. This paper will present the main principles of this modification, applied in practice.

Disclosure of interest

The authors have not supplied their declaration of competing interest.