bluuebunny/crossref_metadata_2025 huggingface dataset:
Belle De Jour: A Case of Hysteria
Authors: Noval Canga C. , Gómez Sánchez S. , Cepedello Pérez S. , Hernández Antón R. , Sevillano Benito I. , Rodriguez Andrés L. , Gallardo Borge L. , Medina Ojeda G. , De la Red Gallego H. , Portilla Fernánadez A.
Published: May 2016

Introduction

Histrionic Personality Disorder is one of the most common personality disorders diagnosed in Psychiatry. This disorder has been known to be present in more than 40% of patients. There is also a high tendency for those diagnosed with this disorder to be female.

Objectives

The case is to show all the difficulties caused by this pathology, differencial diagnosis with other personality disorders, groups of characteristics from different clusters and also, complications produced in daily routine.

Methods

The purpose is to study a clinical case of a 27-year-old woman, with a degree in journalism, who began with a depressive episode after a failed relationship. After being diagnosed of infertility, she debuted with dissociative episodes and somatization symptoms. After that, she suffered several depressive episodes. At the moment, all the clinical symptoms support the diagnosis of histrionic personality disorder.

Results

Histrionic Personality Disorder can be found in the cluster B group of personality disorders. They often present in an overly dramatic, erratic or emotional manner. They may fulfil their need for attention through speech and behaviour that draws one's focus of attention toward themselves, and also demanding and manipulative in interpersonal relationships. There are high comorbidity rates in those who suffer from HPD with other diagnoses.

Conclusions

Histrionic Personality Disorder appears to be one of the least threatening diagnosis among personality disorders as those affected are high functioning and do not seek relief for the disorder itself. There is also very little research on HPD which makes treatment options limitless.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Borderline Man
Authors: Santos T. , Conde E. , Almeida Leite R. , Santos V. , Alcafache J.
Published: May 2016

Introduction

As it has been for the last 30 years, male borderline personality are still misdiagnosed and herded into substance treatment, anger management and prison. Gender matters from the failure of clinicians to identify it in men to the failure of researchers to study how it affects men differently and the treatment implications of those dissimilarities.

Methods

The authors propose a retrospective study investigating all patients hospitalized with Borderline Personality Disorder diagnosis from 2000 to 2015 in Baixo Vouga Hospitalar Center.

Results

From an average of 500 patients admitted per year, in the considered period, the number of men with this psychiatric diagnosis was irrelevant.

Conclusions

Taking into account the results, it is important recognise some gender differences in borderline personality disorder with respect to specific types of self-harm behavior, such as self-cutting or levels of psychological distress at clinical presentation in order to prevent clinical disgnosis failure.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A longitudinal approach to the contribution of trauma and external shame on depressive symptoms in adolescence
Authors: Cunha M. , Almeida R. , Cherpe S. , Simões S. , Marques M.
Published: May 2016

Introduction

Trauma experiences during childhood and adolescence (Gibb, 2002; Ansel et al., 2011; Musliner et Singer, 2014; Hopwood et al., 2015), the experience of shame (Rubeis et al., 2008; Cunha et al., 2012; Rosso et al., 2014; Stuewig et al., 2015) and gender (English et al., 2004; Rosso et al., 2014) had been considered as predictors of depressive symptoms.

Objectives

To observe intra-indidual variability of trauma, external shame, gender (as predictors) and depressive symptoms (as dependent variable).

Aims

To test the predictive value of trauma, external shame and gender on depressive symptoms at 6 months, in adolescents.

Method

A sample of 325 adolescents (ages ranging from 12–18) completed the Child Depression Inventory, the Childhood Trauma Questionnaire and Other as Shamer, adolescents version. The results were analysed by the hierarchical multiple regression method (SPSS Inc., 22).

Results

The model – shame (b = 0.63; P < 0.001); affective abuse (b = 0.15, P = 0.001), gender (b = 0.12; P = 0.001), sexual abuse (b = 0.12, P = 0.002), and emotional neglect (b = 0.10; P = 0.013) – explained 63% of depressive symptoms variance.

Conclusions

The data indicate that the higher the level of shame and trauma, the higher the level of depressive symptoms at 6 months. The present study can add important information that sheds light to the role of mechanisms underlying the vulnerability to depressive symptoms and that might have impact in the existing therapeutic interventions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Social and family risk factors of self-injury in Polish population of psychiatrically hospitalized adolescents
Authors: Makowska I. , Kropiwinicki P. , Gmitrowicz A.
Published: May 2016

Introduction

During last 10 years, the number of non-suicidal self-injury patients (NSSI patients) in Department of Adolescent Psychiatry of Medical University in Łódź has doubled (from 20 to over 40%). According to DSM-5 criteria, NSSI are deliberate and superficial skin injuries. Such behaviours should be distinguished from suicidal behaviour disorder (SBD). However, the two display the high rate of co-occurrence.

Material and method

The study covered 1300 patients (12–19 years of age) hospitalized during last 6 years. The analysis included various variables, e.g. demographic, familial, problems related to school and to peer relations, and variables describing NSSI.

Results and summary

The analyzed group consisted of 60,4% girls and 39,6% boys. Out of 43% of patients who performed NSSIs, 45% also confirmed BDS. The patients with diagnosed mental retardation and with schizophrenic psychoses performed significantly fewer NSSIs. The instrumental motive was the most frequently declared reason of self-injury (76%). The reactive (65%), and the illness-related motives (only 15%) were less frequent. In comparison to patients without self-injuries, the NSSI patients significantly more frequently (P < 0.05) experienced physical violence, unreciprocated love, played truant and repeated grades. Conflicts, delinquency, divorce, and lack of a sense of support were significantly more frequent in the family systems of NSSI patients. They more often experienced loss of their parent before age 15 and had close relatives suffering from mental disorders.

Conclusions

NSSI is a multi-dimensional issue that requires further research. Indicating potential risk factors allows for implementing efficient prophylactic, diagnostic and therapeutic actions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Dietary Pattern and Mental Health: Review of Literature
Authors: Tarelho A. , Duarte M. , Melim J. , Batista A. , Almeida S.
Published: May 2016

Introduction

If we are what we eat, are we eating ourselves into depression and anxiety? There has been an emerge evidence supporting a role for lifestyle factors in the development of these conditions.

Objective

To review evolving concepts and gain insight on the phenomenon of dietary pattern and mental health.

Methods

Bibliographic search in Pubmed for articles published between 2010 and 2015, using the keywords words mental health, diet and depression, from the 220 articles found, 68 were included.

Results

From the 68 selected articles, 19 were reviews, 3 randomized controlled trials and 2 meta-analysis. The scientific community agrees that substantial global changes in the food system have had a highly detrimental impact on dietary patterns. Thirty-three articles found a positive correlation between unhealthy dietary patterns and poorer mental health or better mental health with healthy eating habits, such as a potential protective role of mediterranean diet (or similar) with regard to the prevention of depressive disorders. A recent systematic review by Baskin et al (2015) revealed positive associations between poor quality and unhealthy diets and antenatal depressive and stress symptoms. Healthy diets were inversely associated with antenatal depressive and anxiety symptoms.

Conclusion

Although there is some evidence on the association between dietary quality and mental health, we can’t tell if it's a casual linkage or what are the biological pathways that mediate these relationships. Therefore, randomized control trials of diet are necessary to disentangle the effects of multiple health behaviors on mental health.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Attitude Toward Mental Health in the Republic of Georgia
Authors: Chkonia E. , Nino O. , Morgoshia S. , Nino G.
Published: May 2016

The stigma, discrimination and human rights violations that individuals and families affected by mental disorders suffer are intense and pervasive.

In order to study attitude toward mental health problems, more than 1000 population from the different region of Georgia have been interviewed within 3 months (May-July 2015) in their household.

The scope of questions used in the survey were based on the questionnaire proposed by the NHS Information Centre, Mental Health and Community.

The population of Georgia showed high levels of understanding and tolerance of mental disorders. Despite of this, the fear and exclusion toward people with mental illness were almost twice as more, compare to the countries, where community mental health services are developed. More than half of the interviewed reported that institutional care is quite sufficient for providing treatment and suggested that person with mental disorder should not have rights to a job. Social status, income and occupation did not play any role in terms of attitude.

Majority of the respondents thought that mentally ill patient is a person who is violent or who need isolation due to the disturbed or inadequate behavior.

The survey revealed that the attitude toward persons with mental disorders in the republic of Georgia less likely is based on evidence and objective information. The lack of knowledge and awareness of mental health issues increase stigma and discrimination regarding the people with mental health problems and prevent them from the integration into the society.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Resilience, Coping, Personality Traits, Self-Esteem and Quality of Life in Mood Disorders
Authors: Feggi A. , Gramaglia C. , Guerriero C. , Bert F. , Siliquini R. , Zeppegno P.
Published: May 2016

Introduction

Resilience is a dynamic, context- and time-specific process that refers to positive adaptation or ability to maintain or regain mental health despite experiencing adversity. Pathways to resilience include biological, psychological, social and dispositional attributes. In mood disorders, resilience may influence frequency of relapse, severity of episodes and response to treatment.

Aims

To evaluate resilience as well as personality features, coping abilities, self-esteem and quality of life in a sample of mood disorder patients.

Methods

We recruited mood disorder patients at the Psychiatry institute AOU Maggiore della Carità, Novara. Socio-demographic data were gathered and patients filled in the following self-administered scales: Resilience Scale for Adult (RSA), Brief Cope, Rosenberg Self-Esteem Scale (RSES), Paykel list of stressful events, Temperamental and Character Inventory (TCI), Quality of life (SF-36).

Results

We collected data from 61 patients. Statistical analysis was performed by calculating the Pearson Correlation Coefficient between the RSA and the other tests. We observed a positive correlation between RSA and coping “Emotion” and coping “Problem”. A negative correlation was found between RSA and coping “Avoidance”. Resilience was also positively related to self-esteem and physical, mental and general health. As far as personality traits are concerned, resilience was positively correlated with Reward dependence, persistence, self transcendence, self directedness and cooperativeness.

Conclusions

Since higher resilience levels are related with better physical and mental health, constructive coping and self-esteem, strategies aimed at enhancing resilience could improve treatment and quality of life in patients with mood disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Factors affecting burden of main caregivers in children with epilepsy
Authors: Kim M.D. , Yoon B.H. , Jon D.I. , Lee K. , Kwon Y.J. , Bahk W.M.
Published: May 2016

Objective

The purpose of the study was to evaluate burden of main caregivers in children with epilepsy and to identify factors associated with caregiver burden.

Method

Main caregivers of pediatric patients with epilepsy were enrolled four general hospitals in several cities of Korea. One hundred and twenty-fou caregivers of patients were included in this cross-sectional study. Sociodemograhic/clinical characteristics of patients and sociodemographic characteristics of caregivers were collected. The caregivers were assessed using the Korean version Zarit burden Interview (ZBI), Center for Epidemiological Studies of Depression Scale (CES-D) and social support/conflict scale. Multiple linear regression methods were used to evaluate factors contributing to burden of caregivers.

Results

Of the 124 participants, 98(81.7%) were the mothers. The mean score on the ZBI and CES-D were 23.66 (± 19.15) and 13.87 (± 12.95) points, respectively. Factors affecting of caregiver burden were the number of antiepileptic drugs (AEDs), which patients are taking, and CES-D score by multiple linear regression analysis.

Conclusions

Higher number of AEDs prescribed and depression of caregivers are main factors contributing to burden of caregivers in children with epilepsy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Perceived Problem Solving Skill of Iranian Nursing Students: A Cross-Sectional Study
Authors: Moshirabadi Z. , Haghani H. , Borimnejad L.
Published: May 2016

Background

The ability to solve problems and make decisions creatively has become paramount to new nursing graduates, as these skills assist them with recognizing and evaluating situations that require prompt attention. The purpose of this study was to determine and compare nursing student's perceived levels of own problem solving skills in various years of their 4-year program.

Methods

This is a cross-sectional study. Three hundred and twenty-two undergraduate nursing students in BSc nursing program participated in this study. The study setting was nursing School of Iran university of medical sciences. The Problem solving inventory (PSI) was used to data gathering. The scale was divided into three subscales including: problem-solving confidence (PSC), approaching avoidance style (AAS), and personal control (SC). Students involved in the study signed the study Informed consent.

Results

Findings showed that the mean score of total problem solving skill was 89.52 ± 21.58. The mean score of the 4th year students in PSI was less than other year students (84.18 ± 27.47 vs 89.13 ± 18.71, 91.57 ± 21.87, and 91.52 ± 20.8). This study finding revealed that 4th year students in 3 factors of problem solving (PSC, AAS, PC) considered themselves more successful than others. Meanwhile, when the results are compared according, no significant differences occurred among the student in different years (F: 1.46, P ≤ 0.22).

Conclusion

Educating should help students to reach the desired levels of problem solving skills by allowing them to acquire and practice these abilities in the field. Nursing students with advanced problem solving skills will be essential for this changing society.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Stigma: Dimensions and Correlates In A Multi-Ethnic Population
Authors: Subramaniam M. , Abdin E. , Picco L. , Pang S. , Shafie S. , Vaingankar J. , Kwok K.W. , Verma K. , Chong S.A.
Published: May 2016

Introduction

Mental health stigma is a multidimensional concept that encompasses many different themes and definitions. Public stigma is defined as the degree to which the general public holds negative views and discriminates against a specific group.

Objective

To understand the context and correlates of stigma in multi-ethnic Singapore.

Aims

The current study aimed to (i) explore the factor structure of the Depression Stigma Scale and the Social Distance Scale using an exploratory structural equation modelling approach and (ii) examine the correlates of the identified dimensions of stigma in the general population of Singapore.

Methods

Data for the current study came from a larger nation-wide cross-sectional study of mental health literacy conducted in Singapore. All respondents were administered the Personal and Perceived scales of the Depression Stigma Scale and the Social Distance scale to measure personal stigma and social distance respectively.

Results

The findings from the factor analysis revealed that personal stigma formed two distinct dimensions comprising “Weak-not-Sick” and “Dangerous/Unpredictable” components while social distance stigma items loaded strongly into a single factor. Those of Malay and Indian ethnicity, lower education, lower income status and those who were administered the depression and alcohol abuse vignette were significantly associated with higher weak-not-sick scores. Those of Indian ethnicity, 6 years of education and below, lower income status and those who were administered the alcohol abuse vignette were significantly associated with higher dangerous/unpredictable scores.

Conclusion

There is a need for well-planned and culturally relevant anti-stigma campaigns in this population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effectiveness of A School-Based Universal Prevention Program for Enhancing Self-Confiden Considering The Extended Effects Associated With Achievement of The Direct Purposes of The Program
Authors: Yamasaki K. , Murakami Y. , Yokoshima T. , Uchida K.
Published: May 2016

Introduction

We have developed a group of school-based universal prevention programs for children's health and adjustment. The programs are characterized by new theories such as the somatic-marker hypothesis and enjoyable methods that utilize animated stories and games. This study adopted one of the programs for the development of self-confidence.

Objective

The aim was to examine the effectiveness of the program. In addition to the direct purposes of the program, children's adjustments at school and homeroom class were evaluated as extended effects.

Methods

Participants were third grade children in six public elementary schools in Japan. The final sample included 442 children (219 boys and 223 girls). The program was implemented weekly in one regular 45-minute class over 8 weeks. Participants completed a battery of three questionnaires three times, 1 month before the start of the program (T1), 1 week before the start of the program (T2), and during 1 week after the last class of the program (T3).

Results

Results showed that all of the main endpoints of the program significantly improved in the intervention condition (i.e., changes from T2 to T3), compared to the control condition (i.e., changes from T1 to T2). Moreover, children's adjustment at school and homeroom class increased in the intervention condition, compared to the control condition. However, implicit affect was unchanged.

Conclusion

This study suggests that the program is effective for enhancing self-confidence, along with adjustments at school and in class. Future research that examines the sustainability of the effectiveness of the program is planned.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Auditory Hallucinations In A Deaf Patient? – A Clinical Report
Authors: Aleixo M.A. , Moreira C.A. , Sobreira G. , Oliveira J. , Carvalhão Gil L.
Published: May 2016

Introduction

According to some studies, deaf psychiatric inpatients have prevalence rates of psychotic disorders ranging from 20 to 54%. There are descriptions of the paradoxical finding that prelingually deaf patients with psychosis may hear voices.

Objectives

To present a case report and conduct a database review in order to understand if deaf patients with psychosis can have auditory hallucinations.

Aims

The authors’ aim is to describe a case, highlight the clinical and scientific relevance of auditory hallucinations in deaf patients and the difficulties and limitations of this process.

Methods

A Pubmed database search using as keywords “auditory hallucinations”, “deaf” and “deafness” and retrieved papers were selected according to their relevance.

Results

The authors report a case of a 47-year-old female patient apparently suffering from congenital deafness. The patient had no previous psychiatric history until 4 months prior to her admission at our institution, when she started having psychotic symptoms. The patient was admitted into a Neurology ward but because no neurological sign was found psychiatric liaison consultation was requested. Four months later, she had the same symptoms, describing a voice that said to “shut up” and was admitted to a psychiatric hospital. After medication, the symptoms relapsed and now she is followed in an outpatient setting.

The presence and nature of auditory hallucinations in deaf patients is not fully elucidated and there are methodological problems in the investigation of this subject.

Conclusions

Current evidence is still inconclusive and the fact that prelingually deaf patient hear voices needs further research.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Ice Bucket At First…and then? – Psychopathology in Amyotrophic Lateral Sclerosis Patients and their Caregivers, a Review
Authors: Figueiredo A.R. , Espírito Santo V. , Almendra R. , Costa A.
Published: May 2016

Introduction

Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disorder that affects motor neurons in the cerebral cortex, brainstem and spinal cord. The progressive loss of motor function creates profound changes on patient's lives and their caregivers.

Objective

Assessment of eventual existence of psychopathology in ALS patients and their caregivers.

Methods

Literature review using the terms: ALS, Amyotrophic Lateral Sclerosis, psychopathology, psychiatric disorder; depression; anxiety, caregivers.

Results

Moderate depressive or anxious symptoms are often observed. The results are not consistent, some studies showing that major depression is less common that in general population, others that is mildly increased. Some studies show that depressive symptoms are related to poorer QoL and with faster disease progression, others suggests no correlations. Coping strategies, cognitive appraisal and social support are important factors to psychological adaptation to ALS. After the diagnosis, high levels of anxiety can be observed. Psychopathological features are observed at this time, and generally depression does not increase as death approaches. Beyond loss of physical functions, it seems that patients’ neurobehavioral symptoms, such as aggressiveness, disinhibition and impulsivity, cognitive impairment, and also lack of social support have a negative effect on caregivers’ mental health. Concordance between patient and caregiver distress was found.

Conclusions

It is important to assess potential psychological distress in ALS patients and their caregivers, given that cope with disease can affect its course. Caregivers’ needs should be addressed, to benefit their well-being and consequently patients’ QoL. There are few studies about psychopharmacotherapy and/or psychotherapy in these patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Late Onset Schizophrenia. A Case Report
Authors: Hernández Sánchez J.M. , Cancino Botello M.C. , Molina Lopez M.F. , Muñoz Carril M. , Arnés González S. , Monzó J.A.
Published: May 2016

Introduction

The presence of elderly people is more and more common in developed countries. Unlike other medical conditions, late onset psychosis includes organic and mental precipitants in its differential diagnosis.

Objectives

To present a case of late onset schizophrenia.

Methods

Medline search and review of the clinical history and the related literature.

Results

We present the case of a 71-year-old woman with organic medical history of rectum adenocarcinoma in 2008 that underwent radiotherapy, chemotherapy and surgical resection with successful results. According to the psychiatric history, this patient has needed two admissions to the psychiatry ward, the first of them in 2012, (when the delusional symptoms started), due to deregulated behaviour in relation to persecutory delusions and auditory pseudo-hallucinations. In 2012, she was diagnosed with late onset schizophrenia. Blood tests (hemograme, biochemistry) and brain image were normal. Despite treatment with oral amisulpride and oral paliperidone and due to low compliance, delusional symptoms have remained. We started treatment with long-acting injectable papliperidone 75 mg/28 days having reached clinical stability.

Conclusions

Late onset psychosis is due to a wide range of clinical conditions. In this case, our patient had no organic precipitants. The evolution and presentation of delusional symptoms in this patient made us think of late onset schizophrenia as main diagnosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cycloid Psychosis: A Case Report
Authors: Martinez-Ales G. , Louzao I. , Irimia A. , Bravo M.F. , Marin J.
Published: May 2016

Introduction

Episodes of time-limited acute psychosis, with full recovery in between, are categorized as acute polymorphic psychotic or brief psychotic disorders. Leonhard described the three forms of cycloid psychosis (CP). Perry considers it a separate entity.

Case report

We report the case of a 54-year-old male, with a 9-year history of brief psychotic disorders. He was admitted to an inpatient unit after a 4-day episode of persecutory delusion, leading to high emotional repercussions and isolation at home. Euthymia was present. Previous admissions, 9 and 5 years before, presented similar clinical pictures. Treatment with low dose paliperidone during 6-month periods had led to the complete resolution of the episodes (restitutio ad integrum: no psychotic manifestations and the ability to run his business). In this episode, 8 days after the reintroduction of 12 mg of paliperidone per day, cessation of the symptoms took place. Careful reconstruction of the clinical history showed no stressors or drug consumption. And immediately previous 5-day phase of insomnia, hyperactivity and expenditure was described by the patient's wife.

Discussion

Three inpatient admissions, a careful clinical history and a thorough review of the evidence regarding Perris criteria led to a diagnosis of CP.

Conclusion

CP, a classical nosological approach, is helpful in a clinical setting, as it might imply different prognosis and treatment. Recognition of CP, not included as an entity by the major diagnostic systems, requires a high index of suspicion.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
ADHD-associated risk-taking: The role of benefit and risk perceptions
Authors: Pollak Y. , Aloni H. , Shoham R.
Published: May 2016

Attention deficit and hyperactivity disorder (ADHD) is associated with increased engagement in risk-taking behaviors. The present study aimed to further our knowledge regarding the extent and the reasons for the association between ADHD symptoms and risk-taking, using a theory-driven behavioral economy theory. The Domain Specific Risk-Taking scale was used, on which 244 adults rated the likelihood of engagement in a range of risky behaviors, across five real life domains, as well as the magnitude of perceived benefit and risk they ascribed to these behaviors. Level of ADHD symptoms was positively correlated with engagement in risky behaviors and benefit perception, but not with risk perception. Mediation analysis confirmed that benefit perception, but not risk perception, mediated the association between ADHD symptoms and engagement in risk-taking behaviors (Fig. 1). These findings emphasize the role of benefit perception in facilitating risk-taking by people with ADHD symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Time-course of treatment-emergent adverse events in a long-term safety study of lisdexamfetamine dimesylate in children and adolescents with ADHD
Authors: Otero I. Hernández , Banaschewski T. , Nagy P. , Soutullo C.A. , Zuddas A. , Caballero B. , Geibel B. , Yan B. , Coghill D.R.
Published: May 2016

Introduction

The long-term safety and efficacy of lisdexamfetamine dimesylate (LDX) in children and adolescents with attention deficit/hyperactivity disorder (ADHD) was evaluated in a European 2-year, open-label study (SPD489-404).

Objective

To evaluate the time-course of treatment-emergent adverse events (TEAEs) in SPD489-404.

Methods

Participants aged 6–17 years received open-label LDX (30, 50 or 70 mg/day) for 104 weeks (4 weeks dose-optimization; 100 weeks dose-maintenance).

Results

All enrolled participants (n = 314) were included in the safety population and 191 (60.8%) completed the study. TEAEs occurred in 282 (89.8%) participants; most were mild or moderate. TEAEs considered by the investigators as related to LDX were reported by 232 (73.9%) participants with the following reported for ≥ 10% of participants: decreased appetite (49.4%), weight decreased (18.2%), insomnia (13.1%). TEAEs leading to discontinuation and serious TEAEs occurred in 39 (12.4%) and 28 (8.9%) participants, respectively. The median (range) time to first onset and duration, respectively, of TEAEs identified by the sponsor as being of special interest were: insomnia (insomnia, initial insomnia, middle insomnia, terminal insomnia), 17.0 (1–729) and 42.8 (1–739) days; weight decreased, 29.0 (1–677) and 225.0 (26–724) days; decreased appetite, 13.5 (1–653) and 169.0 (1–749) days; headache, 22.0 (1–718) and 2.0 (1–729) days. Reports of insomnia, weight decreased, decreased appetite and headache were highest in the first 4–12 weeks.

Conclusions

TEAEs associated with long-term LDX treatment were characteristic of stimulant medications, with the greatest incidence observed during the first 4–12 weeks.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Antipsychotic polypharmacy at the clinic of psychiatry, clinical centre of Serbia
Authors: Divac N. , Damjanovic A. , Stojanovic R. , Savic Vujovic K. , Letunica B. , Prostran M.
Published: May 2016

Introduction

Antipsychotic polypharmacy is not supported by current guidelines. However, it is often present in practice. A common reason for this is to gain a greater, faster therapeutic response and reduce the doses of individual drugs, thus reducing the adverse effects.

Aims and Objectives

The aim of this study is to analyze the prevalence of antipsychotic polypharmacy at the Clinic of Psychiatry, Clinical Centre of Serbia and to compare it with the data from 10 years ago when similar research was conducted.

Material and methods

This is a cross-sectional study conducted in 2015. The data were obtained from the patients’ charts and compared with the results of a more extensive study conducted at the same hospital during 2002–2005 period. Statistics was performed using standard statistical methods.

Results

Of the total number of patients (n = 44), 81.8% (n = 36) were on antipsychotic monotherapy, while in the previous study, which included 198 patients, monotherapy was noted in just 32.3% hospitalizations (n = 64) (Chi = 34.5; P < 0.001). Among patients treated with polypharmacy, the majority was prescribed the combination of a first- and second-generation antipsychotic (n = 7, 87.5%), while just one patient was treated with two first-generation antispychotics (n = 1, 12.5%). In the 2002–2005 period, the combination of two first-generation antipsychotics was dominant (58.9%, n = 79).

Conclusion

This study indicates that in Serbian psychiatry there is a strong tendency towards reduction of antipsychotic polypharmacy. However, this is a single-centre study with a relatively small number of participants and more extensive research on the national level is warranted to confirm this trend.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Lithium-induced acute intermittent dystonia in a patient with schizoaffective disorder
Authors: Engel A. , Bilbruck T. , Hossain S. , Leahy R.
Published: May 2016

While lithium is well known for its neurotoxicity, there are very few publications about lithium-induced acute dystonic reaction. We are presenting a clinical case of lithium-induced acute intermittent dystonic reaction in a patient with schizoaffective disorder (SAD). The patient is a 69-year-old African-American male with a long history of SAD, who was treated for many years with ziprasidone and divalproex and was admitted with SAD exacerbation. Due to increased QTC interval, we switched patient to lurasidone. After 2 weeks, due to increased ammonia level, divalproex was switched to lithium (600 mg loading dose and then 450 mg twice/day). Three days later, patient developed a series of intermittent episodes of acute dystonia, manifested as mutism, dysarthria, upper and lower extremity muscle rigidity, dysphagia, and tremor (Table 1). Dystonic reactions responded to benztropine. Eventually, lithium was discontinued and patient did well on a combination of carbamazepine and olanzapine. In this case, we would like to emphasize not only the intermittent but also the atypical presentation of acute dystonic reactions with involvement of large muscle groups, the resemblance to NMS, and a “spectrum” of dystonic reactions rather than one clear-cut presentation. We can only speculate the role lurasidone played in this presentation but reoccurrence of dysarthria on day 54 after lithium was restarted points to its major role.

Table not available.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
From Child and Adolescent to Adult Mental Health Services: The Intrepid Journey
Authors: Nascimento M. , Santos C.C. , Bastos Martins G.
Published: May 2016

Background

The move from Child and Adolescent Mental Health Services (CAMHS) to adults’ services (AMHS) is likely to coincide with other transitions in the adolescents’ life. Barriers affecting this transition have been referred in most countries, but there is a lack of studies on this matter.

Aims

To evaluate the transitional process from CAMHS to AMHS in Portugal, focusing on four criteria: continuity of care, parallel care, a transition planning meeting and information transference. The continuity/discontinuity of the diagnosis and therapeutic plan made at CAMHS has also evaluated.

Methods

Identification from a sample of adolescents transferred from Clínica da Juventude (adolescents’ clinic) to 3 major AMHS, collecting information regarding the quality of the transition between these services.

Results

Fifty-nine adolescents were discharged in 2014, average of 16.5 years old, after being followed in our clinic for an average of 7.44 months. Ten continued being followed in adult psychiatric services (17.5%), with different disorders: 4 depressive, 2 personality, 1 anxiety, 1 bipolar, 1 addiction to psychoactive substances, and 1 oppositional defiant disorder. Even in those cases the transition was far from optimal, with 4 of those presenting the need to use adult emergency facilities.

Conclusions

Several barriers between CAMHS and AMHS might account for the ongoing problem with the transition between services. In addition, considering that the onset of severe and recurring mental disorders begins generally before the age of 25, this raises the discussion around the present distinction between child and adolescent mental health services and adult services at 18 years old.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Paliperidone palmitate versus other antipsychotics
Authors: Hervías Higueras P. , Maroto Martín L. , Raffo Moncloa S. , Leonor del Pozo M.
Published: May 2016

The aim of the study was to describe the psychopharmacological treatments received by inpatients diagnosed with spectrum disorders schizophrenia and other psychotic disorders in Dr. Rodriguez Lafora Hospital. It is an observational, descriptive and retrospective study. We collected information about patients aged 18 to 64 who were hospitalized during the month of January of 2015 in the acute psychiatric hospitalization by Selene software. We reviewed treatments and number of psychiatric re-hospitalization six months later and we analyzed the results by SPSS software. From a sample of 51 inpatients, 15 of them were diagnosed with disorders of the spectrum of schizophrenia and other psychotic disorders. Of the patients, 13.3% was treated with haloperidol, 26.7% with olanzapine, 26.7% with risperidone although it was modified by paliperidone in mental health center, 6.7% with quetiapine, 6.7% with amisulpride, 13.3% with oral paliperidone and 13.3% patients with intramuscular paliperidone. Of these, 40% are readmitted to hospital. Patients were readmitted due to ineffectiveness and adverse effects of haloperidol, olanzapine, risperidone. 73.3% of inpatients were treated with monotherapy. Of the patients, 26.7% were treated with polytherapy, who received olanzapine, risperidone and amisulpride. It would be important to use psychoactive substances that allow monotherapy to reduce adverse effects and psychiatric re-hospitalization.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
About existence of overmedication in patients with depressive symptoms and the appearance of un-induced movement disorder
Authors: Manzur Rojas P. , Carrillo Cordoba M.A. , Sanchez Bahillo A. , Raposo Hernandez M.R. , Botias Cegarra P. , Ibernon Caballero M.I.
Published: May 2016

Overmedication and the combined use of various antidepressants while increasingly seen in daily clinical practice. The drug-induced Parkinsonism, often presented as tremor, rigidity, bradykinesia and impaired postural reflexes. The syndrome is caused by multiple drug drugs can be classified into high risk, intermediate and low. This case is a 75-year-old woman diagnosed with recurrent depressive disorder, which after several adjustments in medication for depressive symptoms with poor response to treatment. It is referred by her family doctor to the neurologist at the onset of tremors in limbs, dyskinesia orolinguales, rigidity and bradykinesia. After studies to rule out organic neurology disease, is derived psychiatry for changing inducing drugs parkinsonism. The last scheduled treatment was: Mirtazapine 15 mg/day, quetiapine 25 mg/day, Clonazepam 2 mg/day, paroxetine 40 mg/day, Sulpiride 50–150 mg daily. After confirming parkinsonism signs, psychiatry proceeds to changing pharmacology, with slow decline until suspension of antipsychotics, paroxetine by venlafexina change, and also change of antihypertensive (captopril). After review at 2 months it is seen signs of improvement parkinsonism, appreciating the mental patient improvement with decreased physical discomfort and keeping the improvement in the last review (4 month) with venlafaxine 150 mg/day, Lorazepam 1 mg casual. The prevalence of drug-induced Parkinson's can go from 15 to 32% of the population. Risk factors identified are: advanced age, family predisposition, doses and drug power inductor, female gender and the presence of brain atrophy. The main objective should be to prevent the onset of Parkinson drug, to monitor patients that may be at higher risk of developing it.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Tolerability of desvenlafaxine in clinical practice: An observational phase-IV study
Authors: Navarro B. , Perez I. , Perez L. , Erkoreka L. , Arroita A.
Published: May 2016

Introduction

Desvenlafaxine is a SNRI which presents low affinity for muscarinic, H1 and α1 in vitro receptors and a marginal hepatic metabolism. Different studies have shown effectiveness and a favorable tolerability profile, but only a few of them have been realized independently.

Objectives and aims

To study the incidence and characteristics of short-term desvenlafaxine side effects (SE) in daily clinical practice.

Methods

A total of 123 patients with recently introduced desvenlafaxine treatment are recruited from Barakaldo and Uribe-Kosta Mental Health Centers, and UKU scale is administered to measure SE. Descriptive data are calculated using SPSS v.22.

Results

SE are observed in 30.09%. Among these, 5.69% experimented improvement or disappearance of SE with dose reduction, whereas 16.26% had to stop DVF treatment. The most frequent SE was nausea/vomiting (7.3%), followed by dry mouth (4.9%), blurred vision (4.9%), tachycardia (4.1%), sexual SE (4.1%) and tension/inner unrest (4.1%). Among the patients with anxiety disorders, 27.78% present SE versus 30.47% of patients with other diagnoses.

Conclusions

The characteristics of SE with DVF in daily clinical practice are comparable to those found in previous studies, and the overall profile is more benign than other AD. Aspects such as gender and sexual function must be considered. In patients with anxious symptoms DVF is also effective and ES are presented similarly, opening a new line of research and treatment of conditions with these characteristics.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Heavy cannabis use impairs verbal memory of first psychotic episode patients
Authors: Nuñez C. , Ochoa S. , Huerta-Ramos E. , Baños I. , Barajas A. , Dolz M. , Sanchez B. , Del Cacho N. , Genipe G. , Usall J.
Published: May 2016

Introduction

Cannabis consumption is known to be increased in both schizophrenic and first psychotic episode patients. Contrary to what has been reported in studies with healthy people, all published studies so far have reported no impairments or even beneficial effects on neurocognition associated with cannabis consumption in schizophrenia and first psychotic episode patients. However, these studies did not address the effects of very high cannabis consumption.

Objective

Our aim in this study was to assess the effects on neurocognition of regular and heavy cannabis consumption in first psychotic episode patients.

Methods

A total of 74 patients were included in the study and assigned to 3 different groups according to their mean cannabis consumption during the last year (non-users, regular users, and heavy users). Participants were administered verbal memory, attention, processing speed, working memory, vocabulary, arithmetic and spatial orientation tasks.

Results

Our results showed the heavy cannabis group of first psychotic episode patients to be significantly impaired in all the verbal memory measures with respect to the non-users group. There were no significant differences between regular users and non-users. Moreover, regular cannabis consumption was associated with an improvement in some attention and processing speed measures.

Conclusions

Our data showed heavy cannabis consumption to impair verbal memory in first psychotic episode patients and suggest a dose-related effect of cannabis consumption, since regular consumption did not impair verbal memory and may be beneficial for other tasks.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Reduction in medication expenditure: Review of strategies at a children's psychiatric facility
Authors: Reddy B. , Azeem M.W. , Smiles J. , Carrabetta L.
Published: May 2016

Prescription drug costs rise about 15% annually. Solnit Center has been exploring ways to reduce overall expenditure on medications while promoting best practice of care. Lack of facility-based pharmacy has posed specific challenges in ordering medications, optimal usage and minimizing wastage of drugs. Each of these areas were examined and reviewed at Pharmacy and Therapeutics Committee of the facility. This information was shared with the ordering physicians and standard prescribing practices were established. This project was aimed at tracking medication costs over a 11-year period while monitoring supplies and destruction of unused medications.

Aims

1. Reduce overall medication expenditure while maintaining standard of care. 2. Develop a program to return unused medications for refund.

Methods

1. Monthly review of pharmacy cost by facility, patient and medication. 2. Development and legislative approval of a program to return drugs. 3. Collaborate with contracted pharmacy to explore ways to cut costs. 4. Train nurses and physicians to understand optimal ordering practice. 5. Demonstrate medications wasted with associated financial impact to the facility.

Results

The expenditure to the facility over 11 years has gradually decreased despite increase in medication costs. In 2004, the facility spent $ 712,904 and in 2014, the expenditure was $ 584,022.

Conclusions

Awareness about costs and optimal ordering practices led to significant savings to the facility.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A review of transcranial magnetic stimulation for treating negative symptoms of schizophrenia
Authors: Oliveira J. , Sobreira G. , Moreira C.A. , Aleixo M.A. , Brissos S.
Published: May 2016

Introduction

The finding of prefrontal dysfunction in schizophrenia patients with negative symptoms (NS) has raised interest in using transcranial magnetic stimulation (TMS), which can modulate prefrontal function and dopamine release, as potential treatment for NS.

Objective

To briefly review current literature concerning the use of TMS as treatment for NS.

Aims

To assess whether current evidence supports the use of TMS for NS.

Methods

Narrative review of articles found through a PubMed database search using the keywords “transcranial magnetic stimulation”, “schizophrenia”, and “negative symptoms” between 1998 and 2015.

Results

Up to date, reviews of randomized sham-controlled studies found positive effects of TMS in NS. However, they exposed several methodological difficulties. More recent studies, reviewed in this poster, tried to overcome these, using results from multiple centers, larger samples and blinding. Various TMS techniques were studied, differing in frequency, motor threshold (MT), stimulus location, and treatment duration. Overall, TMS continues to show promising results in reducing NS; particularly rTMS 10 Hz, for at least 15 sessions on the left dorsolateral prefrontal cortex (DLPFC) at a 110% MT.

Conclusions

TMS may be a useful treatment for NS for patients not responding to pharmacological treatment alone. Studies remain difficult to compare due to different measures of outcome (PANSS and SANS being the most commonly used) and techniques. Furthermore, possible modulators of response include duration of illness, cognitive symptoms amelioration, medication and their dose, and different NS may respond differently to TMS. More studies are needed to better understand the utility of TMS in NS.

Disclosure of interest

The authors have not supplied their declaration of competing interest.