bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurocognitive mechanisms behind mindfulness
Authors: Perestrelo J. , Teixeira B.
Published: May 2016

Introduction

Clinical applications of mindfulness have become widespread since the introduction of the mindfulness-based stress reduction (MBSR), a treatment program originally developed for the management of chronic pain. Neuroimaging techniques have allowed uncovering the neural mechanisms behind Mindfulness techniques.

Objective

To review some of the psychological and neural mechanisms behind mindfulness practice in order to explore the unique factors that account for its positive impact on emotional regulation and health.

Aims

Psychological and neural mechanisms behind mindfulness practice are reviewed.

Methods

A literature review of the theme is surveyed. Several articles were searched on Medline with the keywords “mindfulness”, “meditation”, “neurobiology” and “neurocognitive”.

Results

Mindfulness may achieve effective outcomes in the treatment of anxiety, depression, and other psychopathologies through the contribution of emotional regulation. Cognitive reappraisal has been suggested as a core cognitive control skill whereby mindfulness practice may regulate emotions. It seems that a neural circuit comprising the prefrontal cortex (PFC), the anterior cingulate cortex (ACC), the amygdala (A), and the insula (I) are involved in the unique processes of mindful emotion regulation.

Conclusions

Recent models of mindfulness allow for more rigorous examination and operationalization of the method to guide research. Increasingly investigators are focusing on the impact that mindfulness has on emotional regulation, which accounts for the effects on mental health.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
New data of the theory of self-medication
Authors: Prieto Sánchez I. , Ramírez Domínguez M.D.L.C. , Garrido Torres N. , Fernández León S. , Reina Domínguez M. , Rodríguez Martínez A. , Biedma Martín A.S. , González Macías C.
Published: May 2016

Objective

The theory of self-medication in patients with severe mental illness has been exposed for years but to date has not been confirmed or ruled out. With this study, we intend to show the latest available evidence regarding this context.

Methods

An exhaustive literature research in Medline and the latest forth in APA 2015.

Results

More and more evidence refute the veracity of this theory deeply rooted among some professionals.

Conclusion

There are theoretical alternatives that relate more sustained manner the relationship between consumption and toxic psychosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Autistic spectrum disorder masked by mental retardation and impulse control disorder
Authors: Rodríguez Andrés L. , Ballesta Casanova T. , Hernández García M.S. , Noval Canga C. , Gallardo Borge L. , Espina Barrio J.A.
Published: May 2016

Clinical case report

A 48-year-old male, diagnosed with impulsive control disorder, sex addiction disorder and mental retardation was followed-up by different psychiatrists for the last 20 years. He consults because of presenting depressive symptoms and behavioural disturbances related to the death of his mother two years before. The patient reports to experimenting depressed mood, irritability, insomnia and trends to cry. He has lost motivation for his job and hobbies (he used to show interest in topics such as physics, philosophy, maths, and medicine). He has feelings of loneliness, which make him look for social interaction and support through continuous calls to telephone sex lines. This act has made him spend large amounts of cash, thus, making him be in deep debts. He does not feel integrate in society.

Mental status examination

Introvert, limited social skills, coherent language, echolalic, monotone, tangential speech, depressed mood, feelings of guilt and futility, dysphoria, partial anhedonia, ideas of hopelessness, structured death ideation, unconsciousness of his own acts, with trend to impulsiveness and compulsive behaviour and insomnia.

Complementary test

Wais test: no mental retardation found.

Diagnosis

Autistic spectrum disorder (F84.0); major depressive disorder (F32.1); bereavement (V62.82).

Discussion

The patient showed classic diagnostic criteria DSM 5 associated with autistic spectrum disorder (Asperger's disorder in DSM-IV); the permanent inability for social interactions and repetitive, restricted and stereotypic behavioural patterns.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Gestchwind syndrome and epileptic psychosis, beyond the schizophrenia frontier
Authors: Rodriguez V. , Gómez C. , Gomis C. , González L. , Tercelán E. , Pérez J. , García L. , Ainbarro M. , Ortigosa C.
Published: May 2016

During late 19th and early 20th century neuropsychiatrists began to identify common behavioral and cognitive disturbances in epilepsy, but it is not until 1973 that Norman Gestchwind described the basics of what we know as Gestchwind syndrome. This syndrome includes the triada of hyper-religiosity, hypergraphia and hypo/hypersexuality and it was mainly associated with temporal lobe epilepsy. Moreover, it is well known the association between epilepsy and psychotic symptoms, the so-called schizophrenia-like syndrome, which can lead us to a false diagnosis of schizophrenia. We report a 44-year-old man who was brought to the hospital with delusional ideation of prosecution and reference in his work environment with important behavioral disruption, as well as delusional ideation of religious content. He had a diagnosis of schizophrenia since he was 18-years-old and personal history of generalized tonic-clonic convulsions in his twenties. During the admission, he recovered ad integrum very rapidly with low doses of risperidone, but referred recurrence of déjà vu episodes. After reviewing his patobiography and past medical history, we identified the presence of hypergraphia, hypersexuality and a profound religious feeling, fulfilling the criteria for Gestchwind syndrome, in the context of which was later diagnosed as chronic epileptic psychosis. It is very important a careful approach to the patobiography and personal history. Also, we should include classic differential diagnosis such as Gestchwind syndrome, as they can lead us finally to the correct diagnosis, which in this case meant not only a different treatment but also a better prognosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The influence of social comparisons made on Facebook and sociotropy on bulimia nervosa symptoms: A revised examination of the dual pathway model
Authors: Krug I. , Kalathas F.
Published: May 2016

Background

The dual pathway model (DPM) attempts to explain the processes that are etiological to the development of Bulimia Nervosa (BN) symptomology by examining both individual and sociocultural risk factors of BN. The DPM, however, is yet to incorporate the sociocultural factor Facebook, which is important given the widespread use of the social media website Facebook. In addition, research has suggested that the personality trait sociotropy may increase vulnerability to developing BN symptoms, however, there is limited evidence examining this factor in the DPM.

Objective

To test a revised DPM with the inclusions of social comparisons made on Facebook and sociotropy both (a) cross-sectionally and (b) longitudinally.

Method

Four hundred and seventy females participated at baseline (T1). Four weeks later, 274 females completed the follow-up assessment (T2), which assessed a subset of measures from the baseline assessment.

Results

An acceptable fit for both DM models was obtained through Structural Equation Modeling (SEM) using MPlus (See Figs. 1 and 2).

Conclusions

Prevention and early intervention efforts for both depression and BN should focus on addressing appropriate Facebook and social media use and these interventions should be tailored to individuals scoring high on sociotropy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychological factors influence the symptoms of Gastroesophageal Reflux Disease (GERD) and their effect on quality of life in Korean fire fighter
Authors: Lee S.Y. , Jon D.I. , Kyung-Joon M.
Published: May 2016

Objective

The aim of the study was to investigate the psychological factors influence the symptoms of gastroesophageal reflux disease (GERD) and their effect on quality of life in Korean Fire Fighters.

Methods

This study examined data collected from 1217 fire fighters. Depression and Anxiety were identified using the Patient health questionnaire-9(PHQ-9) and the 7-item Generalized Anxiety Disorder Scale. Occupational stress and Stress coping were identified using the KOSS-26 and the Ways of Coping Checklist-Revised. Self-esteem and quality of life were identified using the Rosenberg's Self-Esteem Scale and World Health Organization quality of life scale abbreviated version (WHOQOL-BREF). The scores for anxiety, depression and QoL of the two groups were analyzed. The correlation between psychological factors and QoL was also analyzed.

Results

Current psychological variables were associated with increased odds of concurrent GERD-related symptoms. Current depression, anxiety and stress were associated with increased odds of GERD-related symptoms. According to the WHOQOL-BREF, depression, anxiety, stress, stress coping and self-esteem were significantly correlated with quality of life in patients with GERD. Quality of life was obviously affected by psychological variables in patients with GERD.

Conclusions

These results indicate that psychological symptomatology, depression, anxiety, occupational stress and self-esteem are associated with GERD-related symptoms. Acknowledging this common comorbidity may facilitate recognition and treatment, and opens new questions as to the pathways and mechanisms of the association.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Evaluation of psychomotor/motor disturbances in elderly medical inpatients
Authors: McCarthy G. , Fitzpatrick O. , O’Neill D. , Meagher D. , Adamis D.
Published: May 2016

Introduction

Traditionally psychomotor subtypes have been investigated in patients with delirium in different settings and it has been found that those with hypoactive type is the largest proportion, often missed and with the worst outcomes.

Aims and objectives

We examined the psychomotor subtypes in an older age inpatients population, the effects that observed clinical variables have on psychomotor subtypes and their association with one year mortality.

Methods

Prospective study. Participants were assessed using the scales CAM, APACHE II, MoCA, Barthel Index and DRS-R98. Pre-existing dementia was diagnosed according to DSM-IV criteria. Psychomotor subtypes were evaluated using the two relevant items of DRS-R98. Mortality rates were investigated one year after admission day.

Results

The sample consisted of 200 participants [mean age 81.1 ± 6.5; 50% female; pre-existing cognitive impairment in 126 (63%)]. Thirty-four (17%) were identified with delirium (CAM+). Motor subtypes of the entire sample was: none: 119 (59.5%), hypo: 37 (18.5%), mixed: 15 (7.5%) and hyper: 29 (14.5%). Hypoactive and mixed subtype were significantly more frequent to delirious patients than to those without delirium, and none subtype more often to those without delirium. There was no difference in the hyperactive subtype between those with and without delirium. Hypoactive subtype was significant associated with delirium and lower scores in MoCA (cognition), while mixed was associated mainly with delirium. Predictors for one-year mortality were lower MoCA scores and severity of illness.

Conclusions

Psychomotor disturbances are not unique to delirium. Hypoactivity, this “silent epidemic” is also part of a deteriorated cognition.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Case report: Hallucinations as depressive equivalents
Authors: Garcia E. , Vicente I. , Martínez R.
Published: May 2016

We comment the case of a 12 years old girl who started with visual and auditive hallucinations. Hallucinations are not a common symptom between children. They may also be linked to many conditions, some of them with poor outcome as schizophrenia. Symptoms appeared in a short time, after a previous normal development. She talked about a man who followed her and that was always behind, she also had heard some insults of undeterminated voices. These symptoms were just of one-month duration and made her feel anxious and very afraid. After a normal organical study and a first proposal of medication they asked for our consultation. We found that the patient was alone at home every afternoon. Family, from other country, hadn’t any social support, and the father had had to travel away some days before the child began to suffer hallucinations. Suspecting an affective disorder as the basis of anxious symptoms, and hallucinations as a cultural presentation of them, we started with a social intervention mixed with support therapy. After some sessions the patient could talk about her loneliness and fears, disappearing the other symptoms. We will resume this case and literature about other cultural presentations that may difficult diagnosis or treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
“Makoki”: A view of electroconvulsive therapy in a Spanish comic of the early 80s
Authors: Pavez F. , Alcántara A. , Saura E. , Marset P.
Published: May 2016

Introduction

Analysis from cultural products has been previously reported in psychiatry field. This approach provides an understanding of the social imaginary about psychiatry and its work over a determined period of time.

Objectives

To describe the representations of ECT and insanity in an Spanish underground comic of the early 80s.

Methods

We performed an analysis of complete production (1979–1994) of “Makoki”, comic by Gallardo and Mediavilla, looking for the aspects related with our interest scope (Fig. 1).

Results

The comic analyzed is inscribed in the field of provocation and insolence. This is comprehensible in the historical context of Spanish transition, if we attend to almost forty years of cultural confinement as a result of a dictatorial regime. This cultural product could be seen as “politically incorrect” from the current perspective, given that reproduces some stigmatizing topics regarding mental illness, glorifying its alleged associations with violence and drug use, in addition to a negative view of ECT, represented as a sadistic instrument of punishment, control and subjugation (see Fig. 1).

Conclusions

The material analyzed reproduces the prevailing social stigma in its epoch about psychiatry and mental illness. The analysis of cultural products that reflect and built the speeches about the psychiatry and its action field, can be a useful strategy to understand the views of the general population in a given era.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
N–methyl–D–aspartate antagonists in depression–15 years after the first ketamine clinical study what has changed?
Authors: Ribeiro J. , Mota D. , Rosa L.
Published: May 2016

Introduction

In the last decades, multiple studies have suggested evidences of disturbances within the glutamate system in depressed patients. The first clinical study using ketamine in depression treatment was conduct fifteen years ago. Since then several studies tried to understand the mechanisms underlying the antidepressant effects of ketamine, as well as discover new drugs with better pharmacodynamic profiles.

Objectives/aims

Review the literature on the role of glutamate system in depression and novel approaches with glutamate N–methyl–D–aspartate receptor antagonists in depression.

Methods

Search and review of scientific literature on PubMed database with the keywords.

“major depressive disorder”, “depression”, “ketamine”, “glutamate”, “NMDA”, “neuroplasticity”.

Results

Abnormalities of the glutamate clearance at synaptic space and astrocytic dysfunction associated with glutamate metabolism have been associated with depressive symptomatology. In depressed patients, reduced levels of glutamate have been described by magnetic resonance spectroscopy in multiple cortical areas, amygdala and hippocampus, supportting the hypothesis of glutamate system involvement in the neurobiology of depression. Indeed, in the last 15 years, multiple clinical studies using ketamine provided some evidence that glutamate N–methyl–D–aspartate receptor antagonism could be an approach for refractory forms of depression. However, regardless all of the evidences, no drug targeting specifically the glutamate system has been approved for depression treatment.

Conclusions

The glutaminergic system plays a role in the pathophysiology of depression, why it's a possible therapeutic target. So, it's of utmost importance that future studies keep the focus in this area, looking for new drugs active in this system.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Disturbance of serum albumin conformation in patients with melancholic depression
Authors: Uzbekov M. , Syrejshchikova T. , Smolina N. , Brilliantova V. , Dobretsov G. , Krujkov V. , Emel’yanova I. , Krasnov V.
Published: May 2016

Introduction

The last years it is became clear that disturbances in molecular processes in pathological conditions can be connected with conformational changes in protein structure.

Aim

Investigation of blood albumin conformation in patients with melancholic depression.

Material and methods

There were investigated 19 patients with melancholic depression (12 women and 7 men) and 25 health volunteers. Patient's state according to ICD-10 criteria was defined as a depressive episode in the frame of bipolar depressive disorder (type 2) (F32) and in the structure of recurrent depressive disorder (F33). Subnanosecond laser time resolved fluorescence spectroscopy (SLTRFS) (subnanosecond diapason) with K-35 fluorescent probe was used for the investigation of albumin conformation.

Results and discussion

There were revealed 3 binding sites in albumin molecule with fluorescent decay time of 1, 3 and 9 nanoseconds (A1, A3 and A9 sites, respectively) in healthy volunteers using SLTRFS approach. There were found significant differences between albumin binding sites of volunteers and patients with melancholic depression, respectively, А1–117 ± 7 и 142 ± 10; А3–358 ± 14 и 420 ± 26; А9–371 ± 16 и 433 ± 29.

Conclusion

These findings point out that melancholic depression is followed by conformational changes of albumin molecule that can affect its functional properties. We can hypothesized that albumin binding properties can serve as a biomarker of the efficacy of psychopharmacotherapy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Anhedonic brain while attending sexual and emotional pictures
Authors: Von Duering F.
Published: May 2016

Anhedonia is defined as the inability to gain pleasure from normally pleasurable experiences and reduced sexual desire. Rees et al. (2007) showed that limbic and paralimbic areas are responsible for sexual arousal and that anhedonia is associated with frontolimbic inhibition. In major depression, reduced ventral striatum and increased ventral prefrontal cortex areas was associated with anhedonia(Gorwood, 2009). Walter et al. (2009) indicated that there is a deviation in the neuronal activation pattern of the pregenual anterior cingulate cortex in anhedonic depression which is related to a glutamergic deficit. Glutamate was suggested to play a relevant role in reward system (Birgner et al., 2005). ACC is a key involved in affective state and glutamate mediates ACC activation to sexual attraction(Wu et al., 2009). Thus, a glutamatergic deficit might be related to reduced hedonic effect specific to major depression. Using an attention modulation of emotional and sexual pictures, we investigate the role of anhedonia on the ventral and dorsal systems in healthy volunteers and patients with major depression. They undergo an expectancy task in a 7 T scanner and passively view sexual and emotional photographs and are asked to expect either high salient pictures or high erotic pictures. Half of these pictures are announced by an expectancy cue, whereas the other half are preceded by a fixation cross. Snaith-Hamilton-Pleasure-Scale and Hamilton Depression Rating Scale are employed to assess anhedonia and depressive symptom severity. Brain metabolites in the dorsal and pgACC are measured using MRS. We will show how anhedonia modulates the neural response to sexual arousal.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Childhood trauma and cortisol awakening response in eating disorders: A dose-dependent trauma effect
Authors: Monaco F. , Monteleone A.M. , Pellegrino F. , De Riso F. , Patriciello G. , Cimino M. , Calvanese M. , Volpe U. , Monteleone P.
Published: May 2016

Introduction

A role for the hypothalamus-pituitary-adrenal (HPA) axis has been suggested in the pathophysiology of anorexia nervosa (AN) and bulimia nervosa (BN), and childhood trauma experiences have been detected frequently in patients with AN and BN. Since trauma exposure in the childhood may persistently affect HPA axis functioning, we explored HPA axis activity in AN and BN patients with and without childhood trauma history.

Objectives and aims

We aimed to examine possible associations between childhood traumatic experiences and HPA axis functioning, as assessed by the cortisol awakening response (CAR), in adult patients with AN or BN as compared to adult healthy controls.

Methods

Saliva samples were collected by 41 patients with symptomatic AN, 32 with symptomatic BN and 45 healthy controls at wakening and after 15, 30 and 60 min. They filled in the Childhood Trauma Questionnaire (CTQ), which assesses five specific types of childhood trauma.

Results

As compared to the control group, the no-maltreated AN patient group exhibited an enhanced CAR whereas the no-maltreated BN patient group showed a similar CAR. On the contrary, both AN and BN patients with a positive history of childhood maltreatment exhibited statistically significant blunted CAR as compared to no-maltreated patients. Moreover, in maltreated ED patients the CAR tended to decrease when the number of trauma types increased.

Discussion

Present findings confirm a dysregulation of the HPA axis activity in symptomatic patients with AN and BN and suggest a dose-dependent effect of childhood adverse experiences on the CAR of adult ED patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The European trainees’ perspective on psychiatric postgraduate education: An EFPT survey
Authors: Giurgiuca A. , Mogren T. , Tomori S. , Berze L. , Munjiza A. , Pinto da Costa M. ,   E.F.P.T. TEO-PC Research WG
Published: May 2016

Introduction

Despite efforts to unify psychiatric education among European member countries, there are still considerable variations between national training programmes. To ensure equivalence of training standards the current tendency of recommended guidelines and reports is steering psychiatric training towards becoming more competency focused.

Objectives

The research group of the European Federation of Psychiatric Trainees (EFPT) conducted a multi-national study on postgraduate psychiatry training. The aims are to assess the psychiatric trainees’ experiences and opinions on their national training and assessment methods in respect to the Union européenne des médecins spécialistes (UEMS) 2009 competencies framework.

Methods

This study surveyed 745 psychiatric trainees from 10 EFPT member countries using a questionnaire designed specifically for assessing this issue.

Results

In this sample, the majority are aware of having a competency based training programme but 86.5% are poorly acquainted with the UEMS competencies framework. All key competencies were rated as being important but not all as being relevant in the assessment process. One's level of preparedness and the degree of education one's receives during their training differs from one competency to another. Trainees who aren’t satisfied with their national training would be in favour of taking an end of training Pan-European exam which differs from the one's that are satisfied and wouldn’t be interested in undergoing this assessment method.

Conclusions

This sample isn’t fully acquainted with the competency-based concept for postgraduate training. The ones satisfied with their postgraduate psychiatric education seem to be less inclined to take an end of training Pan European exam.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Indicators in psychiatric assessments; an evidence-based practice
Authors: Rumalean Y. , Parfitt C.
Published: May 2016

There are subtle signs and symptoms that can function as strong, significant and evidence-based indicators to improve upon diagnosis of mental illness as a primary clinical issue. With the well-being of patients at stake and services experiencing mounting pressure on their time and resources, the accuracy of such a diagnosis is critical. The data used in this study was obtained from the Hampshire Police of individuals arrested under Section 136 of the Mental Health Act 1983 (Amended 2007). Documented observations by the arresting officers were transferred onto a list of signs and symptoms, adapted for clinicians and non-clinicians. Answers to all 23 indicator questions were assigned a binary coding and became the input data. A logistic regression model (LRM), sensitivity and specificity analysis, analysis of maximum likelihood estimates, and confusion matrix, were applied. Three significant evidence-based indicators for primary mental illness diagnosis: “fixed stare/looking (possibly) confused” (perplexed), “calm/seemingly calm”, and “poor attention and concentration, not able to follow instructions easily” (distracted). There was suggestion that when all three identified indicators are absent within the same assessment period, primary mental illness should not be diagnosed. A correlation was observed between the presence of one, two, or all three indicators and the increased chance of patients suffering from moderate-to-severe primary mental illness. The indicators would very likely be particularly helpful in cases where signs and symptoms of primary mental illness are less obvious and made more complex by actual underlying problems of drugs/alcohol, difficult personality traits, and/or criminal behaviour.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Detection and management of agitation in psychiatry: A Delphi expert consensus study
Authors: Garriga M. , Pacchiarotti I. , Hidalgo D. , Bernardo M. , Vieta E.
Published: May 2016

Introduction

The assessment and management of psychomotor agitation may result in the use of coercive or sedative treatments. In the absence of conclusive evidence, the consensus of experts can guide clinical decisions.

Objectives

To seek consensus recommendations on the assessment and management of psychomotor agitation.

Methods

An international expert task force in this field developed consensus using the Delphi method. Twenty-seven experts were invited to participate and 91% of them agreed. Initial survey items were gathered from the content of literature search (systematic review). This included open-ended questions inviting participants to add suggestions by e-mail correspondence. After this initial first round, the Delphi study was conducted online using Google Forms. Survey items were rated on a 5-point scale. Items rated by at least 80% of experts as essential or important were included. Items rated as essential or important by 65–79% of experts were included in the next survey for re-rating. Items with consensus below to 65% were rejected and excluded.

Results

The initial survey included 52 items. The second web-based survey included 33 items. The briefer third survey consisted of 6 items that needed rerating. Twenty-two of the initial 33 items were endorsed and formed the clinical recommendations on the assessment and management of the psychomotor agitation. The endorsed items were categorized into 5 domains forming the clinical recommendations.

Conclusions

The panel expert generated 22 recommendations on the assessment and management of agitation. The Delphi method is a suitable formal iterative process for reaching consensus on relevant and controversial issues.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Recognizing high-risk behavioural patterns in emergency psychiatry: From surveillance to technical assistance, insights into an innovative project* from the point of view of potential users
Authors: Voigtlaender B.S. , Schölzel D. , Schönherr A. , Schloßhauer J. , Barth T.
Published: May 2016

Introduction

After legal restrictions regarding coerced medication in Saxony, we monitored significant increases in aggressive behaviour and regarding the use of physical restraints at our closed psychiatric ward. Alternative measures for managing dangerous behaviour were discussed.

Objectives

There are limitations regarding the use of treatment interventions in emergency psychiatry, e.g. the use of constant observation is limited in its efficiency generally and video surveillance is prohibited by law in high-risk areas (e.g. bathroom).

Aims

To find appropriate solutions for patient safety improvement in emergency psychiatry including high-risk areas, prospects of the field of “technical assistance” entered the limelight of interest.

Methods

In 2014, a cooperation of Chemnitz University of Technology, Intenta GmbH, Eckstein Design and the affiliated partner Klinikum Chemnitz started a project*, which focuses on the development of a technical assistance system for recognizing high-risk behavioural patterns (e.g. suicide attempt) in risk areas in emergency psychiatry. The system is based on a smart-sensor technology and waives a recording and storing of sound and vision.

Results

In the 1st half of the project technical development and the design of the system were the focus of attention. Special requirements regarding use cases, user acceptance, data protection and ethical concerns were processed by our psychiatric department. Testing and further development of the system in clinical settings are planned.

Conclusions

The development of the system must be seen as a big challenge in many regards. Further research is indispensable.

*Sponsored by the Central Innovation Program Mittelstand of the Federal Ministry for Economic Affairs and Energy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Health related quality of life in adults with ADHD symptoms: A population survey using 15D and AAQoL
Authors: Alaheino L. , Leppämäki S. , Partonen T. , Sainio M.
Published: May 2016

Introduction

Health related quality of life (HRQoL) can be measured and compared, to give us an understanding of the impact different diseases have on health. The diagnostic tests for attention-deficit/hyperactive disorder (ADHD) in adulthood fail to catch the diversity of ways the condition affects one's life. Disease-specific quality-of-life scales try to reach beyond the typical symptoms of the condition, to find those specific difficulties a person subjectively grades as challenging.

Objectives

To assess the levels of general and disease-specific HRQoL in adults with ADHD-like symptoms.

Aims

To understand the impact ADHD-like symptoms have on adults’ HRQoL.

Methods

A random, nationwide sample of 3000 Finnish speaking citizens (aged 18-44 years) was drawn from the national population register. A subsample of 171 people, 57 screener (Adult ADHD Self-Report Scale [ASRS]) positive cases and two age- and sex-matched controls for each case, participated in a telephone interview. General HRQoL was measured with 15D, and disease-specific HRQoL with Adult ADHD Quality-of-Life (AAQoL) scale.

Results

The 15D score was 0.866 for the screener positives, 0.943 for the controls, and 0.945 for the Finnish population reference. The difference between the screener positives and controls was significant (P < 0.001). The AAQoL sum score was worse for the screener positives than controls (61.9 vs. 82.1, P < 0.001), and all the subscales were affected accordingly.

Conclusions

Adults with ADHD-like symptoms have a lower quality of life, as measured both on the general and on the condition-specific quality of life scales.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Characterizing rare mis-sense variations of CACNA1I identified in a Swedish schizophrenia cohort
Authors: Pan J. , Allen A. , huang L. , Daez D.
Published: May 2016

CACNA1I (hCaV3.3) encodes the α1 pore-forming subunit of human voltage-gated T-type calcium channels. CaV3.3 is expressed in a limited subset of neurons including GABAergic neurons of the thalamic reticular nucleus (TRN) where they support oscillatory activity essential for sleep spindle generation. CACNA1I is implicated in schizophrenia risk by emerging genetics including genome-wide association studies (PGC, 2014), and exome sequencing of trio samples (Gulsuner et al., 2013). In order to understand the impact of disease-associated sequence variation on the function of CaV3.3, we set out to analyze a complete set of rare mis-sense coding variations in CACNA1I in a Swedish cohort, including 15 variations identified in patients, 20 identified in control subjects, and 23 in both. We established a heterologous expression system of isogenic cell lines, each carrying single-copy inducible cDNA variants of hCaV3.3, and evaluated their functional impact on channel function by electrophysiology, calcium imaging, and biochemistry. We found at least five coding variations impaired overall channel protein abundance, as well as whole cell current density. In addition, we identified hCaV3.3 variants with altered voltage-dependence of channel activation and inactivation. Overall, we found that reduced calcium influx through hCaV3.3 is associated with the group of variants identified in patients, compared to those in both patients and controls. Our findings suggest that patient-specific rare variations of CACNA1I may influence channel-dependent functions, including rebound bursting in TRN neurons, with potential implications for schizophrenia pathophysiology.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Screening for metabolic syndrome in older patients with severe mental illness: Two-years observational study
Authors: Franza F. , Aquino K. , Calabrese L. , Cervone A. , Fiorentino N. , De Guglielmo S. , Iandoli M. , Soddu A. , Solomita B. , Fasano V.
Published: May 2016

Introduction

Patients with serious psychiatric illness (SMI) have a reduced quality of life and life expectancy than the general population. Metabolic syndrome (MS) is a clinical aspect determining who should be considered to reduce the risk of serious and chronic organic factors, even more significant in the elderly.

Objectives

To evaluate metabolic screening of elderly patients with severe mental illness (SMI).

Aims

To evaluate the importance of routine screening of metabolic parameters in elderly guests of residential facilities with or without SMI; metabolic screening at baseline and after two of hospitalization.

Methods

Elderly inpatients (44 Tot) with Severe Mental Illness (SMI: bipolar disorder: 34%; schizophrenia: 46%; other: 20%) vs elderly inpatients (78 Tot). Data collected at baseline: psychiatric diagnosis; any previous diagnosis of hypertension, diabetes, dyslipidemia; ECG. At baseline and for two years were administered following scale: BPRS; PANSS; Qli; MMSE, ADL.

Results

After two years metabolic screening has recorded at least one of the new interactions between the five factors of MS (ATP III) in 50% of patients with: one (34%); two (21%); three (11%); four (3%) new altered parameters. In MS inpatients, 53% of new metabolic alterations were recorded in 53% (MS inpatients) vs 23% without MS after two years.

Conclusions

Our results showed a higher frequency of MS in patients with SMI than comparison subjects. Haloperidol was the antipsychotic medication that caused minor impact on the development of metabolic disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A description of clinical profile of over 65-years-old patients in acute psychiatric hospitalization unit at Hospital Universitario Central De Asturias (Oviedo, Spain)
Authors: Abad-Acebedo I. , Gonzalez-Blanco L. , Torio-Ojea E. , Bestene-Medina S. , Rodriguez-Revuelta J.
Published: May 2016

Introduction

Older patients with psychiatric conditions often have other disorders that include different levels of cognitive impairment, modifying the presentation of psychiatric symptoms and requiring treatment adaptations [1].

Objective

To describe clinical profile of hospitalized patients > 65 years, and its relationship with the presence of cognitive impairment and the length of hospital stay.

Methods

Descriptive and comparative study. Sample: 71 inpatients > 65 years (mean ± SD Age: 72.42 ± 5.96), admitted to “Hospital Universitario Central de Asturias”(Spain) from August 2014 to June 2015. Age, length of hospitalization, diagnosis, cognitive impairment and treatment data were collected (Table 1).

Results

Days of hospital stay (mean ± SD) = 15.89 ± 11.53. No variable showed significant relation except number of antipsychotics taken (r = 0.307, P = 0.009). Cognitive impairment was significantly more frequent in men than women (45.5/15.8%; χ2 = 7.46; P = 0.006). No other variable showed significant differences.

Conclusions

A high percentage of psychiatric inpatients > 65 years present a cognitive impairment (29.6%) which was more frequent in males (45.5%). The length of hospital stay seems to be similar than in the rest of patients and not being affected by any of studied variables. More studies should be carried on to compare those results with similar variables in younger population and to analyze if there are differences between subgroups (65–75 vs > 75) [1].

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Burden of informal carers in northwest Ireland: A pilot study of factors that influence burden
Authors: McCarthy G. , Gresswell I. , Adamis D.
Published: May 2016

Introduction

Research has shown that approximately 67% of carers experience extreme mental tiredness, a decrease in their quality of life and a deterioration in their physical health since taking on a care-giving role.

Aims and objectives

This study aims to identify factors that influence carer burden and in doing so, identify the sub-populations of carers who are most susceptible to burden.

Methods

In northwest Ireland, 53 informal carers referred to the Carers Association, Sligo were contacted and met for a face-to-face interview. Measurements used included demographic data, the Neuropsychiatric Inventory, Zarit Burden Interview, Social Network Index and Brown's Locus of Control Scale.

Results

Of the 53 carers, 43 were females and 10 males (age range: 32–81 years, mean age of 64.5 years). Of the corresponding 53 patients, 21 were females and 32 males (age range: 17–92 years, mean age of 72.1 years). Multiple linear regression analysis showed that sex of carer, marital status and the patient's behavioural problems were statistically significant independent factors, which influenced carer burden (p < 0.01). Female sex and greater patient behavioural problems increased susceptibility to burden and being married increased resilience towards burden.

Conclusions

The ability to predict which carers are more susceptible to burden allows physicians to more quickly identify “higher risk” carers, facilitating routine check-ups by physicians and carer support services. Further research should explore why female and unmarried carers are more susceptible to burden and whether it is possible to tailor support services to their individual needs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Religiosity and its influence on mental health of late age persons
Authors: Pishchikova L.
Published: May 2016

Christian anthropology considers personality as a unity of spiritual, emotional and corporal manifestation. Spirituality is defined as highest level of development and self-control of mature personality, ignoring which leads to moral dissonance and spiritual conflict. For the believing person, it is indisputable that belief, church sacraments and practices are capable to facilitate not only corporal, but also spiritual diseases. Clinical and expert analysis of 235 late age patients (> 60 years), who underwent forensic psychiatric examination in criminal and civil cases, helped to identify the influence of religiosity on mental health of late age persons. At late age, appeal to spirituality defines further evolutionary development of the person and favorable forms of aging. It is noted that elderly believers have no expressed cognitive and emotional frustration. When developing mental disorders, they resort to church sacraments and prayers. Thus, a patient with visual hallucinosis noted that during a prayer “visions calmed down, left or started listening”. A patient with acoustical hallucinosis (“blasphemous” voices) considered them as manifestation of “dark powers”, fought them by appeal to the icon of the Mother of God. A patient with menacing acoustical hallucinations read Psalmbook, dawned on them a cross sign with “consecrated hand” (venerated to Sacred relics) and “locked” them in room corner. Ignoring spirituality, which is observed in psychiatry, is connected with incompatibility of representations based on science and belief; low level of religiousness among psychiatrists; underestimation of religion role in life of patients; lack of special knowledge of this area.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Depression and mild cognitive impairment – Comorbidity and/or continuum?
Authors: Sobreira G. , Aleixo M.A. , Moreia C. , Oliveira J.
Published: May 2016

Introduction

Depression and mild cognitive impairment are common among the elderly. Half the patients with late-life depression also present some degree of cognitive decline, making the distinction between these conditions difficult.

Objectives

To conduct a database review in order to understand the relationship between these entities, and treatment approaches.

Aims

To create and implement clinical guidelines at our institution, to evaluate and treat elderly patients presenting with depression and mild cognitive impairment.

Methods

A PubMed database search using as keywords “late life depression”, “depression”; “cognitive impairment”; “mild cognitive impairment” and “dementia” between the year 2008 and 2015.

Results

Late-life depression and cognitive impairment are frequent among the elderly (10–20%). Depression is also common in the early stages of dementia decreasing as the cognitive decline progresses. The causal relationship between these entities is not well understood and some authors advocate a multifactorial model (genetic risk factors; neuroendocrine changes; vascular risk factors) and the cognitive impairment of said changes is dependent on the individual's cognitive reserve. Regarding treatment of depression in patients with cognitive impairment, most authors advocate a stepped approach with watchful waiting and then, if symptoms persist, the introduction of pharmacotherapy and psychosocial intervention.

Conclusions

The relationship between cognitive impairment and depression is still not clear and probably multifactorial. The diagnosis of depressive symptoms in patients with severe cognitive impairment can be difficult and most forms of pharmacological treatment in this population are not beneficial, making it important to carefully evaluate the benefits of introducing new medication.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Anosognosia in dementia – Relevance for clinical-practice in a memory clinic
Authors: Verhülsdonk S. , Höft B. , Supprian T. , Lange-Asschenfeldt C.
Published: May 2016

Introduction

Anosognosia is a common symptom in patients with dementia, although data on prevalence vary widely. It is associated with decreased compliance to medical diagnosis and treatment. The rejection of assistance challenges professionals as well as caring relatives.

Objectives

Anosognosia increases with progression of disease but is also found in early stages. The underlying mechanisms are not completely understood; past studies described an association with executive dysfunction.

Aims

Our study aims to identify the frequency of anosognosia in our memory clinic.

Methods

We evaluated disease awareness using the Clinical Insight Rating Scale in 124 patients presenting with diagnosis of Alzheimer's disease in our memory clinic. We correlated the degree of awareness with standardized cognitive, affective, and functional parameters.

Results

One hundred and fourteen patients (90.9%) showed decreased awareness, in 51.7% of our sample awareness was seriously impaired or even entirely lacking. In accordance with the literature, anosognosia correlated significantly with the result of the Mini-Mental-Staus-Examination as indicator of global cognitive functioning (r = −0.291, P < 0.05) and with the need for assistance in everyday-life (r = .364, P < 0.05). We found no correlation with depressive symptoms or age.

Conclusion

The phenomenon of anosognosia is frequent in the setting of a memory clinic and has special impact on clinical practice as it is well correlated with executive functioning and global cognition and, thus, is a relevant factor for the initiation of medical care for patients with dementia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Family burden and quality of life of mothers of children and adolescents with mental retardation or borderline mental capacity
Authors: Utas Akhan L.
Published: May 2016

Introduction

Studies have found that the cognitive function levels of intellectually challenged children add a burden to the family and affect quality of life.

Objectives

The purpose of this study was to determine the family burden felt by mothers of children, ages 6–16, whose mental capacity evaluation indicates an IQ of 35–79 to explore the mother's quality of life and discover the factors that yield an impact in this context.

Aims

The main objective of this study therefore was to ascertain the family burden and quality of life experienced by the parents of children with mentally retarded or borderline mental capacity.

Methods

The WISC-R test was used in the research to determine the intellectual capacity of children, 6–16 years of age. The sample comprised 131 children and adolescents between the ages 6–16 with IQs in the interval of 35–79 and their mothers. The parents accompanying their children were assessed using the Family Burden Assessment Scale, the World Health Organization Quality of Life instrument and a sociodemographic questionnaire that was filled out during face-to-face interviews.

Results

The quality of life of the mothers was found to be average. At the same time, as the IQ level of the children went up, the less the mothers felt they were under a family burden. It was seen that the mothers experienced the most difficulty in the domains of “perception of inadequacy” and “emotional burden.”

Conclusion

Mothers with intellectually disabled children need psychosocial support. Providing all members of the family with counseling services to help them cope with the issues and responsibilities involved in the care of disabled children may make a significant difference in quality of life.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.