bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantifying the inflation factors of observation error variance for COMS and MTSAT Atmospheric Motion Vectors considering spatial observation error correlation
Authors: Lee Sihye , Song Hyo‐Jong
Published: June 2017

In this study, the spatial error correlations in the Atmospheric Motion Vectors (AMVs) derived from the geostationary satellite imagery over East Asia are investigated. Good characterization of systematic errors in observations is essential in order to extract the maximum amount of information from the observations during the assimilation process. The spatial structure of AMV error correlations was identified based on datasets of AMVs collocated with sonde observations for July 2015. Results of AMVs from water vapour (WV; 6.7 µm) and infrared (IR; 10.8 µm) channels of the Korean geostationary Communication, Ocean and Meteorological Satellite (COMS) and the Multifunction Transport Satellite‐2 (MTSAT) are presented. For both channels, the length scales of the spatial error correlations in the MTSAT AMVs are longer than those of the COMS AMVs. For MTSAT (COMS) AMVs, a longer (shorter) length‐scale yields more (less) inflated observation error variance, and a larger (smaller) inflation factor for the diagonal form of the observation error covariance matrix is required to obtain the best quality of analysis.
Awareness and mitigation measures on highly pathogenic avian influenza in pastoral poultry flocks of North‐central Nigeria: any challenging gap?
Authors: Alhaji Nma B. , Yatswako Suleiman
Published: June 2017

Village poultry closely interact with wild birds and other livestock in extensively managed poultry flocks, a practice common in pastoral communities of Nigeria. This practice provides sustained dissemination of avian viruses, such as highly pathogenic avian influenza (HPAI) H5N1 virus. The objectives of this study were to assess their knowledge/awareness, risks identification and biosecurity measures on HPAI H5N1 in pastoral poultry flocks. A questionnaire‐based cross‐sectional survey was conducted in systematically selected pastoral households of North‐central Nigeria between May 2015 and June 2016. A total of 422 pastoralists participated in the study. Mean age of the respondents was 54.7 ± 11.4 SD years and 36.0% of them were in age group 50–59 years. The majority (81.3%) of respondents were of the Fulani tribe. Also, 64.9% of the respondents had no formal education and only 6.9% had tertiary education. About 30.8% of the nomadic and 81.0% of sedentary pastoralists significantly mentioned avian influenza to be a zoonotic disease. Very few nomadic (10.9%) and sedentary (26.1%) pastoralists significantly reported restriction of birds’ movement to nearby water bodies as biosecurity measure. Only 7.6% of the nomadic and 16.1% of sedentary pastoralists practiced keeping of birds according to species. Sedentary pastoralists were more likely to have significant knowledge about HPAI H5N1 than the nomadic (OR: 1.76; 94% CI: 1.19–2.61). Female pastoralists were more likely to practice significant biosecurity measures against HPAI H5N1 than the males (OR: 1.99; 95% CI: 1.28–3.09). The majority of pastoralists neither possessed adequate knowledge about avian influenza nor applied adequate biosecurity measures against it, which are the most challenging gaps. Education of pastoralists on HPAI virus infection, specifically on information about clinical signs of avian influenza in birds, transmission dynamics among different species of birds, flyways of migrating wild birds and adequate mitigation measures are recommended.
Connecting Gaucher and Parkinson Disease: Considerations for Clinical and Research Genetic Counseling Settings
Authors: Cook Lola , Schulze Jeanine
Published: June 2017

There are multiple autosomal recessive disorders in which carriers may be at risk for other diseases. This observation calls into question the previous understanding that carriers of autosomal recessive disorders escape clinical consequences. We also know that childhood genetic conditions may have adult disease counterparts (Zimran et al., The Israel Medical Association Journal: IMAJ, 16(11), 723–724, 2014). Individuals who have Gaucher disease and carriers of the disorder are at increased risk for a seemingly unrelated and complex neurological condition, Parkinson disease. Parkinson disease is, in part, caused by the same mutations in the GBA gene that lead to Gaucher disease, and the two conditions are thought to have shared pathophysiology. Briefly reviewed are how these two diseases historically became linked, where their paths cross, potential problems and considerations in disclosure of the link, and current guidelines and research in this area. Genetic counseling experience with a large Parkinson disease cohort is used as a starting point to question the state of clinical and nonclinical practice in disclosing this unusual connection We conclude that more research and discussion are needed to inform practice regarding the crossroads of Gaucher and Parkinson disease.
Social Media and E-mental Health
Authors: Krausz M.
Published: June 2017

Mental health services worldwide are only able to serve a minority of patients. Expert advice is in most cases not accessible even in developed countries with a functioning mental health care system. Threshold to care are high and the time between first critical developments and symptoms and first professional interventions is long, sometimes several years.

The evolving communication tools through social media and web-based services may provide new and exciting opportunities to change that. Especially young people have a different approach to interact, learn and access services through the Internet. The momentum there is as crucial as it is in education. Our mental health care system in all its components will most likely very different than today. E mental health will be an integrated component contributing to more capacity, higher quality of care and better accessibility.

What is the key in developing new tools and what can today's clinicians and researchers do to be an active partner in this process? What are the major concerns and how should we address them also as professional organization? This may be an opportunity of a lifetime for a paradigm shift. Its success relates to good integration and implementation of these exciting tools to create a new continuum of tools addressing a continuum of needs.

Disclosure of interest

The author has not supplied his declaration of competing interest.
VTA-insula Connectivity and Avolition in Subjects with Schizophrenia
Authors: Mucci A. , Giordano G.M. , Stanziano M. , Papa M. , Galderisi S.
Published: June 2017

Introduction

Avolition represents an important domain of negative symptoms in schizophrenia with a strong impact on functional outcome. Primary and persistent avolition is refractory to available pharmacological and psychological treatments. A better understanding of its pathophysiological mechanisms is fundamental to promote development of new treatments. Recent models of avolition converge on dopaminergic circuits involved in motivation and its translation in goal-directed behavior. Deficits in task-related activation or connectivity within mesolimbic and mesocortical dopamine circuits were reported in schizophrenia but the relationship with avolition was not fully established.

Aims

The present study aimed to investigate resting-state functional connectivity (RS-FC) within the motivation circuits in schizophrenia patients and its relationships with primary and persistent avolition.

Methods

RS-FC, using VTA as a seed region, was investigated in 22 healthy controls (HC) and in 26 schizophrenia patients (SCZ) divided in high (HA) and low avolition (LA) subgroups. Avolition was assessed using the Schedule for the Deficit Syndrome.

Results

HA, in comparison to LA and HC, showed significantly reduced RS-FC with the right ventrolateral prefrontal cortex (R-VLPFC), right insula (R-INS) and right lateral occipital cortex (R-LOC). The RS-FC of these regions was negatively correlated to avolition.

Conclusions

Our findings demonstrate that avolition in schizophrenia is linked to dysconnection of VTA from key cortical regions involved in retrieval of outcome values of instrumental actions to motivate behavior.

Disclosure of interest

AM received honoraria or advisory board/consulting fees from the following companies: Janssen Pharmaceuticals, Otsuka, Pfizer and Pierre Fabre. SG received honoraria or advisory board/consulting fees from the following companies: Lundbeck, Janssen Pharmaceuticals, Hoffman-La Roche, Angelini-Acraf, Otsuka, Pierre Fabre and Gedeon-Richter. All other Authors declare no potential conflict of interest.
Workplace Stress Among Non-doctor Trainees in Psychiatric Rehabilitation
Authors: Volpe U.
Published: June 2017

Mental health care settings have long been associated to a specific and long-standing emotional involvement, eventually determining professional stress and burnout in psychiatrists. However, recent evidence demonstrated that also non-doctor mental health workers may be at high risk of developing job dissatisfaction. Previous studies also suggested that the longer exposure to psychiatric settings the higher the levels of burnout. We report here data from a survey conducted among first-year students of rehabilitation courses in psychiatry (n = 44) and logopedics (n = 39), before and after the first exposure to an health care environment over a 6-month term. We investigated their psychological wellbeing and risk of psychiatric morbidity (by means of GHQ-12), levels of burnout (with the Maslach Burnout Inventory) and knowledge about mental health (by means of the MAKS schedule). The two groups were comparable as for the main socio-demographic characteristics as well as for their knowledge about mental health before training. We found a significant difference between students in mental and general health care, with significantly higher emotional exhaustion and depersonalization and lower personal accomplishment levels in the former group, after 6-month training. Such changes were significantly correlated to variations in knowledge about mental health issues and risk of psychiatric morbidity. The implementation of a specific peer support group was perceived as extremely useful by the majority of the students (96%) and had a positive impact on their burnout levels and psychological wellbeing.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Exercise Interventions for Improving Mental and Physical Health in Schizophrenia
Authors: Malchow B.
Published: June 2017

Schizophrenia is a severe mental disorder that carries a high personal and socio-economic burden. Especially negative symptoms and cognitive impairments affect the long-term outcome and are the main contributors to disability. An often underestimated aspect of the disease are somatic comorbidities and the very high mortality rates of those with the disorder. The life expectancy is approximately 20 years below that of the general population and there is evidence that persons with schizophrenia may not have seen the same improvement in life expectancy as the general population during the past decades. Among others, lifestyle factors like sedentary behaviour, unhealthy diet, body weight and tobacco smoking are considered modifiable risk factors contributing to this excess mortality. Exercise interventions may be useful not only in attenuating symptoms of the disease but as well in help reducing risk factors for somatic comorbidities.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Impact of Age at Onset on the Long-term Course of Bipolar Disorder
Authors: Kupka R.
Published: June 2017

Introduction

Bipolar disorder (BD) typically starts in adolescence or young adulthood (early-onset; EO-BD), which may have different backgrounds and consequences than late-onset (LO) BD. There are controversies over pre-pubertal age of onset (AoO).

Objectives

To give an overview of the various concepts of AoO in BD, the impact of AoO on subsequent illness course, and findings of the Stanley Foundation Bipolar Network (SFBN) with relationship to AoO.

Methods

literature review and additional analyses of SFBN database.

Results

BD usually begins with a depressive episode. SFBN-data reveal that an earlier AoO is associated with a less favourable prospective illness course (more depression, mood instability and rapid cycling), longer delay to first treatment, past history of suicide attempts, being abused in childhood abuse, more psychiatric and medical comorbidities. Comparison of the US sample with the European sample of SFBN showed an earlier onset in US patients.

Conclusion

and early AoF of BD is associated with a poorer long-term outcome, despite adequate current treatment.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Mania and Depression: What's New?
Authors: Fagiolini A. , Amodeo G.
Published: June 2017

Despite the high burden of bipolar disorder and the noticeable progress in its treatment, the disorder still goes frequently misdiagnosed, unrecognized, or not optimally treated. To date, no medication has been specifically developed on the basis of a precise understanding of the pathophysiology of the disorder, or based on the unique characteristics of several subtypes of bipolar disorder or on the medication mechanism of action. Lithium remains on of the gold standard treatments for bipolar disorder. Its mood-stabilizing properties are thought to occur via specific cellular signaling pathways, such as inhibition of glycogen synthase kinase 3, which is considered to regulate cellular apoptosis. Divalproex, carbamazepine and several atypical antipsychotics are also approved for bipolar disease Evidence also suggests that antipsychotics show the ability to treat and prevent mania and/or depression but are often burdened by side effects such as sedation, hortostatic hypotension and weight gain. Hence, while it is clear that there still are several unmet needs especially for what pertains tolerability, efficacy for specific subtypes, and predictability. Novel and more effective treatments are needed and researchers are currently engaging in targeted drug development for bipolar illness, aimed at improving pharmacological strategies with marked and sustained effects. A variety of newer medications are being tested. Some of these drugs target pathways that are similar to those targeted by lithium, while others focus on newer targets, such as opiate receptor and N-methyl-D-aspartate (NMDA) receptors. Newer and older treatment strategies for bipolar disorder will be presented and critically reviewed.

Disclosure of interest

Andrea Fagiolini is/has been a consultant and/or a speaker and/or has received research grants from Allergan, Angelini, Astra Zeneca, Boehringer Ingelheim, Pfizer, Eli Lilly, Ferrer, Janssen, Lundbeck, Novartis, Otsuka, Roche.
Managing Cognitive Dysfunction in Bipolar Disorder
Authors: Miskowiak K.
Published: June 2017

Cognitive dysfunction, including memory and concentration difficulty, is an emerging treatment target in bipolar disorder. However, a key challenge in the management of these cognitive deficits is the lack of treatments with robust effects on cognition. Further, it is unclear how cognitive dysfunction should be assessed and addressed in the clinical treatment of the disorder. This talk will review the evidence for cognitive impairment in bipolar disorder, including its severity, persistence and impact on patients’ functional recovery. It will then discuss when and how to assess cognition and present some new feasible screening tools for cognitive dysfunction. Finally, it will highlight some novel candidate cognition treatments.

Disclosure of interest

I have acted as a consultant and received honoraria from Lundbeck and Allergan.
Mental Health Paraprofessional Training for Filipina Foreign Domestic Workers in Singapore: Feasibility and Effects on Knowledge About Depression and Cognitive Behavioral Therapy Skills
Authors: Wong M.H.M. , Keng S.L. , Buck P.J.B. , Ostbye T. , Wessels A. , Suthendran S.
Published: June 2017

Introduction

Approximately one in every five Singaporean households employs Foreign Domestic Workers (FDWs) (Humanitarian Organization for Migration Economics [Home], 2015). Mental health problems, especially depression, are prevalent among FDWs in Singapore (HOME, 2015). Yet, there is a lack of empirically-supported interventions to address their mental health needs.

Objective

To train FDWs as mental health paraprofessionals with selected CBT skills for depression, which may enable them to provide basic assistance to their fellow domestic workers with depressive symptoms.

Aims

To present and assess the effectiveness and acceptability of a 4 weekly 3-hour group CBT-based paraprofessional training program for FDWs.

Methods

Participants were randomized into either an intervention or a wait-list control group. Participants in the wait-list group received the training after the intervention group completed the training. Both groups completed questionnaires assessing attitudes towards seeking psychological help; stigma towards people with depression; self-confidence in delivering CBT; general self-efficacy; knowledge of depression and CBT before, immediately after, and two months following the training.

Results

Thirty-eight out of 40 participants completed the program. Both groups did not differ on changes in any of the outcome variables. However, within-group analyses showed improved attitudes towards seeking professional health for mental health issues; greater depression literacy; and CBT knowledge following the training. These changes were sustained at 2-month follow-up. All participants indicated high level of satisfaction with the program.

Conclusions

These preliminary results highlight the potential effectiveness and feasibility of implementing the training as a stepped-care mental health service to address the high rate of depression among the FDW community.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Major Depressive Disorder Comorbid Severe Hydrocephalus Due to Arnold Chiari Malformation in an Apathetic Patient
Authors: Kandeger A. , Guler H.A. , Guler O.
Published: June 2017

Objective

Arnold Chiari Malformation (ACM) is a disorder of embryologic development that is characterized of herniation of the cerebellar structures through the foramen magnum by four types. ACM type 1 (ACM 1) consists in cerebellar tonsil herniation, which is sometimes associated with other abnormalities, including syringohydromyelia, hydrocephalus and skull base alterations. To date, five cases of psychiatric disorders comorbid with ACM-I have been reported. We here present an apathetic patient have delayed diagnosis ACM-I and severe hydrocephalus and comorbid major depressive disorder.

Case

A 36-year-old, male patient who is married and two children, was admitted to hospital with don’t want to make anything, despondency, thoughts of have an incompetency, uselessness and want to death, tiredness, weakness complaints which are increased day by day last 2 months. He was diagnosed with major depression after the psychiatric evaluation and hospitalised. He has unwillingness, tiredness and headache complaints which are started when he was 20 years old and he used antidepressant, anxiolytic, and low dose anthipsycotic drugs under psychiatrist control at this years. In radiologic evaluation, Arnold Chiari type 1 and severe hydrocephalus was detected in brain magnetic resonance imaging.

Discussion

ACM 1 is related to hydrocephalus as a result of posterior fossa hypoplasia and causes spinal injury by obstruction to cerebrospinal fluid (CSF) flow at the foramen magnum. Apathy is a common yet often overlooked symptom in hydrocephalus. This symptom may be a significant obstacle for cognition and quality of life and is associated with increased level of depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Theoretical Background of Human Based Psychiatry
Authors: Musalek M.
Published: June 2017

Every medical intervention is embedded in the prevailing spirit of its particular time. The world of modern medicine that is still shaped by positivism is often revered as a world of rational calculation and reason, a world in which mathematical calculation and so-called objectivity are prized above all else. Indeed, today's modern medicine in general and its battlewagon evidence-based medicine is a world of sober number games, reduction and fragmentation, of demystification and de-subjectification. As important and indispensable the achievements of EbM are, it nevertheless needs to be expanded by a medicine, which focuses not just on illness and its treatment but which places the concrete individual with all his or her sufferings and potentials. Such a human-based medicine (HbM) is no longer indebted to modern positivism, but seeks its foundations in the maxims of post-modernism. Moving away from classical “indication-based medicine” toward a medicine based on human sufferings and potentials necessarily requires a fundamental change in diagnostics and treatment.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Psychotic Symptoms in Patients with Nmda Antibodies
Authors: Fourcade J. Cru. , Poggio M. Garcia , Aragón R. Martín , Domenjó A. Muñoz , Cambra R. Molina
Published: June 2017

Introduction

This paper is a review of literature about the relation in some cases between psychotic symptoms and NMDA antibodies. Most of these cases are early observed and treated by psychiatry, observing torpid evolution and symptoms that are rarely observed in Psychiatry patients, like visual hallucinations or rapid fluctuations of symptoms.

Objectives

Make a review of psychotic symptoms and NMDA antibodies, to think about other options when we are in front of some unusual cases in psychiatry, and it seems that “nothing is working”

Methods

Systematic review of pub med literature, applying the keywords: “psychotic” and “NMDA antibodies” of last 5 years.

Results

We found that in most of cases the patients presents Opisthotonus, catatonia, and rhythmic and non-rhythmic involuntary movements of the mouth and jaw, and most of them had a psychiatric evaluation for those symptoms. There was no response to antipsicotic treatment. The treatment with corticoids and rituximab was effective.

Conclusions

In psychiatry we have to think in some cases that maybe “the patient could have something else than a psychiatric disease”, most when we found that the symptoms has a rare presentation and the treatment is not effective.

We encourage our colleagues to “think outside the box” when something like this occurs, and hesitate about our own valuations of the patients, when the case is atypical strange.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
I Don't Recycle! An Organic Hoarding Disorder
Authors: Garcia Ayala L. , Gomez Revuelta M. , Martin Requena C. , Garcia de Acilu E. Saez de Adana , Porta Olivares O. , Juncal Ruiz M. , Nuñez Morales N. , Zubia Martin M. , Laborde Zufiaurre M. , Gonzalez Hernandez B. , Aranzabal Itoiz A. , Lopez Peña M.P. , Gonzalez-Pinto Arrillaga A.M.
Published: June 2017

Introduction

Hoarding often occurs without the presence of obsessive-compulsive disorder (OCD), showing distinguishable neuropsychological and neurobiological correlates and a distinct comorbidity spectrum. Furthermore, it presents itself secondarily to other psychiatric and neurobiological disorders. Therefore hoarding disorder has been included as independent diagnosis in DSM-5.

Objectives

We aim to expose the possible organic etiology of a hoarding disorder case with atypical presentation.

Materials and methods

We present a case of a 48 years old male patient who was brought to the hospital by the police after being reported for unhealthy conditions in his home. In the home visit paid by the Social Services an excessive hoarding of objects and trash was detected. A possible hoarding disorder was diagnosed in the psychiatric assessment. Among other diagnostic test, a brain CT was conducted, in which a frontal meningioma was identified. After surgical treatment, hoarding symptoms diminished significantly.

Discussion

A significant part of the hoarding disorders are attributed to primary psychiatric disorders, resulting in potentially treatable organic pathology going unnoticed.

Conclusion

It's important to rule out organic etiology before proceeding to make a definitive hoarding disorder diagnosis, optimizing that way the treatment options.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
“The Old Lady and the Dead Bird”–A Case of Very-late-onset Schizophrenia-like Psychosis
Authors: Covelo V. , Marinho M. , Machado A.S. , Rebelo J. , Moreira R.
Published: June 2017

Introduction

In 1943, Bleuler defined “late-onset schizophrenia” as a form of schizophrenia with onset after the age of 40. Half a century had passed with no consensus on the late psychosis’ terminology, when in 1998 the international late- onset schizophrenia group Consensus proposed a nosology for these disorders: late-onset schizophrenia and very-late-onset schizophrenia-like psychosis.

Objectives

Presentation of a case and diagnostic discussion.

Methods

Interviews with the patient during his hospitalisation.

Results

We present a case of a 73-year-old single woman, with no psychiatric history, who was driven to the emergency department by her relatives when they noticed her bizarre behaviour: she had drowned and strangled her pet bird. At examination she was agitated, had persecutory delusions, thought broadcasting, cenesthetic and auditory hallucinations in the form of a masculine voice, who sang and dialogued with her. Symptoms had evolved during the past six months with no apparent functional impairment. During hospitalisation she was treated with risperidone (up to 5 mg/day) with improvement in a few days. There were no significant abnormalities on cerebral tomography and analytical exams. Neuropsychological evaluation ruled out cognitive deficits. At the time of discharge although the patient kept referring auditory hallucinatory activity, she had an appropriate behaviour, and no evidence of negative symptoms.

Conclusions

The small group of patients who meet schizophrenia's criteria for the first time at a later age present some particular clinical characteristics to be taken into account. This case highlights some of them, drawing attention to this uncommon diagnosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
New Insights in the Pharmacotherapy of Psychosis: The Example of Parkinson's Disease Psychosis
Authors: Fontaine A. , Radu G.
Published: June 2017

Introduction

With 10 million of patients across the world, Parkinson's disease is the second most common form of neurodegeneration, after Alzheimer's. Among half of patients develop psychotic symptoms, such as visual hallucinations and delusions, which are correlated with higher rate of placement in nursing home, are difficult to treat and severely affect quality of life, making Parkinson's disease psychosis (PDP) a major public health issue.

Objectives

The aim of this study is to identify treatment options that could be used to treat PDP and clarify underlying pathophysiology.

Method

We conducted a literature review on Pubmed, Goggle scholar and Cochrane library, using a combination of the following: “Parkinson's disease Psychosis” “visual hallucinations” “Pimavanserin” “Clozapine” “atypical anti-psychotics” 120 articles were screened.

Results

Considering that hallucinations arise from overactivation of dopaminergic receptors, treatment options include reducing the dopaminergic drugs used to control motor symptoms; using atypical anti-psychotics such as Risperidone, Olanzapine, Quetiapine, which often results in the worsening of extra-pyramidal symptoms. Another option is the use of low doses of Clozapine, which has been proven efficient with no worsening of non-motor symptoms, suggesting the implication of other pathways, such as serotonin. Finally, Pimavanserin, a 5-HT2A receptor inverse agonist, without any dopaminergic activity, has been demonstrated to be effective in the treatment of PDP, well tolerated and easy to use.

Conclusion

Serotonin inverse agonists represent a major breakthrough in the pharmacotherapy of PDP, and may lead the way to changes in the treatment of schizophrenia and other psychotic disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Burden of Caregivers of Patients with Alzheimer
Authors: Jmi G. , Robbana L. , Ghali F. , Zghal M. , Mezghani M. , Lamia J. , Rafrafi R.
Published: June 2017

Introduction

The Alzheimer's patient assistance relationship is a morally painful experience, most frequently discussed in terms of “burden” in the literature, especially as professionals and institutional intermediaries are underdeveloped in Tunisia.

Goal

It is intended to assess the level of burden among caregivers of patients with Alzheimer's disease and to search factors associated with a high level of burden.

Methodology

This is a retrospective descriptive study. Patients were recruited from neurology department of Razi hospital, which were hospitalised between the months of December 2012 and March 2013. The burden was measured using the Zarit inventory.

Results and discussion

Thirty patients were included. The majority female, most caregivers are descendants (60%), then, daughters in law (33%), and finally the spouses (23%). 80% of caregivers lived in the same home as patients. Caregivers were asked about all the items of the grid Zarit. The average burden in our sample is 59.9 + 16 3. We observed that 33% have absent to light burden (score <21), 10% have a light to moderate burden (between 21 and 40), 36, 66% have moderate to severe burden (between 41 and 60) and 50% have a severe burden (>60), according to the classification proposed by Zarit. Sex, kinship and cohabitation with the patient were not associated with a higher burden.

Conclusion

The study of factors correlated with high levels of burden aims at finding ways of intervention and support to fight against the isolation of caregivers and the occurrence of anxiodepressive complications.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Behavioral and Psychological Symptoms: A Contribution for their Understanding Based on the Unmet Needs Model
Authors: Ferreira A.R. , Martins S. , Dias C. , Simões M.R. , Fernandes L.
Published: June 2017

Introduction

Behavioural and psychological symptoms (BPSD) are frequent in dementia and their contribution to poor health outcomes is well recognized. Four major frameworks attempt an explanation their aetiology: biological, behavioural, environmental vulnerability and unmet needs models. The latter states that BPSD are symptoms of needs that are not being met due to patients’ decreased ability to communicate/fulfil them. This model also implies that if needs were met, BPSD would improve.

Aims

To explore the relation between needs and BPSD, and describe which unmet needs were contributing to BPSD in an elderly sample.

Methods

A cross-sectional study was conducted in three Portuguese nursing homes. All residents were considered eligible. However, those unwilling or unable to participate were excluded. For each elderly patient, needs were assessed with camberwell assessment of need for the elderly/cane and BPSD with European Portuguese neuropsychiatric inventory/NPI.

Results

The final sample included 166 elderly with an average of 80.9(sd = 10.2) years. Significant correlations between NPI and unmet and global needs were found (rs = 0.181,P = 0.020; rs = 0.254,P = 0.001, respectively). Additionally, the unmet needs of daytime activities (P = 0.019), company (P = 0.028) and behaviour (P = 0.001), presented significant correlations with NPI.

Conclusion

In this sample, a high number of unmet needs were found. The absence of daytime activities, company and behaviour contributed to the identified BPSD, which is in line with other studies also highlighting the importance of these needs in nursing homes. This not only provides a framework for understanding BPSD, but also points to the identification of unmet needs as pivotal in prevention and treatment of these symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Acute Catatonic Syndrome Associated with Hyponatraemia
Authors: McGuire E. , Yohanathan D.M. , Lally D.L. , McCarthy D.G.
Published: June 2017

Introduction

A 71 year old gentleman presented with two discrete episodes of delirium with prominent psychotic features and catatonia, over a 3-year period. Symptomatically, he was suffering from fluctuating consciousness, paranoid ideation and both auditory and visual hallucinations. He went on to develop catatonia, demonstrating negativism and mutism and he also exhibited pseudoseizures. His symptoms resolved entirely after three weeks. He re-presented 3 years later with profound psychosis and hyponatraemia. On this occasion, he exhibited catalepsy, negativism, echolalia and mutism, which resolved when his sodium was corrected.

Objectives/aims

To illustrate 2 episodes of acute catatonia temporally associated with hyponatraemia in an otherwise healthy elderly gentleman.

Methods

This is a case study. Consent was sought from the patient to write up his case and distribute it for educational purposes. His medical inpatient notes, psychiatric inpatient notes, correspondence and bloods pertaining to both admissions were reviewed and analysed. A literature review was carried out using Pubmed.

Results

Low sodium levels were a common factor in his presentations and normal sodium levels were associated with a return to normal consciousness.

Conclusions

While medical issues confounded his first presentation of hyponatraemia associated catatonia, his second presentation was directly related to hyponatraemia. Given the coincidence of hyponatraemia during his first admission, it would strongly suggest that low sodium levels were an important factor in this gentleman's presentation. Importantly, this is the first case in the literature to demonstrate catatonia related to hyponatraemia on two separate occasions in the same individual.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Evaluation of Dependence Among Benzodiazepines in Population of Elderly Subjects Followed in Psychiatric Service in Sfax
Authors: Messedi N. , Feki I. , Baati I. , Sellami R. , Trigui D. , Masmoudi J.
Published: June 2017

Introduction

Benzodiazepines (BZD) are the most consumed psychotropic drugs by the elders. This prescription can lead to the dependence which is a major public health problem particularly in this population.

Objectives

To study the prevalence of dependence of the (BZD) in elderly subjects followed as outpatients and to identify the factors associated with it.

Methods

It was a cross-sectional study of 60 patients aged 65 years and older followed at the psychiatric consultation of the UH Hédi Chaker of Sfax; for 3 months. We used:

– Questionnaire containing demographic and clinical data.

– The cognitive scale of attachment to benzodiazepines (ECAB), a score ≥ 6 indicates dependence.

Results

The average age of patients was 67.78 years, with a sex-ratio M/W = 0.46. They were smoking in 58.3% of cases. The most frequent psychiatric disorders were mood disorders (40%) followed by anxiety disorders (13.3%). The absence of diagnosis was observed in 23.3% of cases. A psychotropic drugs were associated with BZD in 86.7%. The most prescripted BZD was lorazépam (90%). Withdrawal signs were present in 90% of cases. The prevalence of BZD dependence has been estimated at 80%.

BZD dependence was significantly correlated with smoking (P = 0.00), with psychotropics association (P = 0.04) and with signs of withdrawal (P = 0.001).

Conclusion

It appears from our study the importance of BZD dependence in the elderly what it is a source of withdrawal difficulty. So we need make more effort to comply with recommendations regarding the prescription of these molecules.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Parkinson Psychosis: A Complex Interaction of Disease and Medication Related Factors
Authors: Petrykiv S. , de Jonge L. , Arts M.
Published: June 2017

Introduction

Psychotic symptoms are the most important non-motoric symptoms of the Parkinson disease (PD). The quality of life of those patients can be significantly improved with an appropriate therapy. In this article we provide evidence about the etiology, differential diagnosis and therapeutic possibilities with a work-up for the clinics.

Objectives & aims

To provide a case report of patient with PD who developed a paranoid psychosis after administration of levodopa/carbidopa, followed by a literature review on psychotic symptoms evoked by psychotropic medication by patients with PD.

Methods

An English-language literature search was conducted using Pubmed, EMBASE searching for case reports and observational studies reporting iatrogenic psychotic symptoms by patients with PD.

Results

Ms. C. was a 65-year old woman with PD who was observed in a polyclinic setting and who used a levodopa/carbidopa combination. She developed paranoid psychosis with a following admission to the psychiatric ward. We have gradually lowered the dose of anti-Parkinson medication. Subsequently, treatment with clozapine was initiated and the psychotic symptoms resolved within five months.

Conclusion

Parkinson psychosis is due to a complex interaction of neurodegenerative changes and pharmacological therapy. Therefore, the role of iatrogenic factors must be always carefully assessed. Psychosis inducting agents should be lowered or stopped before the treatment with antipsychotic medication.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Strategy to Combat Dementia in Russia
Authors: Pishchikova L.
Published: June 2017

The 139th Executive Committee WHO was held in May 2016. The Russian delegation took part in its work. The main issue on the agenda was the report on “Dementia”. It was noted that each year dementia develops in 8 million people in the world. It is expected that this figure will increase to 145 million by 2050. In Russia the national plan to combat dementia is missing. In the resulting meeting, all the WHO country-members voted for immediate action on the adoption of the strategy for the fight against dementia by 2017. We developed a strategy for dementia, which includes the following tasks;

– The need of epidemiological research in the field of dementia;

– Research on etiology, prevention, early diagnosis and treatment of dementia;

– The expansion of the network of specialized stationary and nonstationarny facilities for patients with dementia;

– Development of programs of psychological care to patients with dementia and to caregivers;

– Development of palliative care for patients with dementia;

– Cross-sectoral cooperation and multidisciplinary approach in assistance to patients with dementia;

– Training in the field of geriatric psychiatry, denomination of the specialty of geriatric psychiatrist;

– Fighting stigma of patients with dementia, protection of their rights, including in psychiatry and forensic psychiatry.

The solution of these objectives requires foundation of the Russian observatory on dementia, the WHO cooperating center. The tasks of such an Observatory will be: centralization and coordination of actions concerning strategic planning, implementation of mechanisms of a multispectral cooperation, assessment of services, monitoring and providing reports on dementia issues in Russia.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Risperidone Induce Recurrence of Severe Acute Respiratory Distress in a Patient with Psychotic Disorders
Authors: Amel N. , Hadjadj M. , Maoudh W.
Published: June 2017

Mrs. R, 61-years-old was admitted into the department on July 2015 with a history of major paranoid psychosis. Notion of asthma was indicated in the medical file without any specific treatment. At the admission she received risperidone 4 mg/day and duloxetine since one year. Between October 2015 and June 2016, the patient presented 19 episodes of respiratory decompensation, six of them required transfer in the emergency unit, and 3 in the intensive care unit (ICU) with the assistance of mechanical ventilation. During the last episode, transfer in the intensive care unit was refused by the ICU physician because of the high frequency of recurrence and the difficulty to extube the patient. “End of life” was therefore considered. Nevertheless, medical physician in charge of the patient decided to continue symptomatic treatment and to stop all anti-psychotic drugs susceptible to deteriorate respiratory disease. On the first day we observed a dramatic improvement and no recurrence occurred since now 3 months without any treatment. Between the admission and the occurrence of respiratory decompensation, hypereosinophilia (1610/mL) was observed with recovery in normal value after interruption of risperidone. We also noted an improvement of functional respiratory test. In conclusion, risperidone is an anti-psychotic drug largely used. Severe side effect may endanger life-threatening as described in this case. The recurrence of severe acute respiratory distress without induced factors founded needs to discuss the potential role of this drug.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Social Phobia and Co-morbid States-diagnostics and Importance
Authors: Anakiev S. , Tasic G.
Published: June 2017

Introduction

The roots of social phobia, lay in the social nature of human beings who fulfil their basic needs in social relations. By the definition, it is the fear of witnessing the negative judgement and the criticism of other people, which is so intense that, is followed by reactions of avoidance of phobic situations and doings, followed by intense vegetative symptoms.

Aim

Introduce social phobia as an important social and medical problem with common co-morbidity and exceptional risk of suicide. At the same time it gives special accent to the diagnostic procedures and differential diagnosis.

Method

Analysis of the information from literature and practice and coming to conclusions with the inductive method.

Results

Social phobia is a chronicle illness, equally present in both sexes. The central position is taken by all-the-time present intense irrational fear. Alcoholism, misuse of sedatives, depression, and panic with agoraphobia, OCD are common followers of social phobia. Differential diagnosis witch eliminates panic with agoraphobia, or just the lack of social skills allows the right therapeutic approach.

Conclusion

Social phobia, alone or combined with other disorders, has a huge medical and social value. Coming back to regular life tracks depends on the right diagnosis and the right time to go into the healing process.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Development of a preliminary tool to assess care-giving practices by family members with Schizophrenia: A report from India
Authors: Das S.
Published: June 2017

Introduction

Care-giving practices by family members have inherent value and importance in the provision of care for patients with schizophrenia. There is dearth of assessment tools that focus on practices followed by caregivers’ while dealing with their relatives with schizophrenia, especially from India.

Objective

To develop a tool for the assessment of ‘care-giving practices’ followed by family members while caring for their patients with schizophrenia.

Aims

(a) To construct a reliable and valid tool on ‘care-giving practices’ followed by family members while caring for their patients with schizophrenia; (b) To determine the various ‘good’ and ‘bad’ practices within this tool.

Methods

Initial detailed literature (Pubmed, Goggle search with input by the caregivers generated a list of 24 commonly used practices; which was shortened to 17 statements whose face validity was tested by 14 mental health professionals. Hindi translation with ‘test-retest’ reliability was conducted. Finally, ‘Consensus based approach’ was adopted by the mental health professionals to arrive at objective (b) i.e. statements reflecting ‘good’ or ‘bad’ practice.

Results

Final questionnaire comprised 15 statements with adequate face and content validity and high test-retest reliability (Cronbach's alpha = 0.747). 6 items reflected ‘good’ and 9 reflected ‘poor’ practice respectively with maximum score of 15; and categorization from ‘very poor’ to ‘very good’ practices.

Conclusion

This preliminary yet simple and easy to use tool will give better understanding about how family members provide ‘care-giving’ practices for patients with schizophrenia. However, this needs further validation, replicability, and possible modifications in a multi-cultural, multi-linguistic country like India.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Can psychopathy be treated?
Authors: Durães D. , Borralho R.
Published: June 2017

Introduction

Psychopaths are incapable of feeling empathy and guilt, being responsible for most violent crimes. To date, confinement has been the option of choice to minimize the harm they inflict. However, a deeper understanding of the neurobiology of psychopathy may lead to new insight on possible treatment approaches.

Aims

This work aims to review the current knowledge in psychopathy treatment.

Methods

A literature search of MEDLINE (2000-present) was conducted using the search terms “psychopathy” + “treatment” and “drug therapy”.

Results

Defects in the amygdala and the prefrontal cortex have been implicated in the pathological basis of psychopathy. The most affected areas are the ventromedial prefrontal cortex (VMPC) and the associated anterior cingulated cortex. Alterations in connectivity between the amygdala and the VMPC with other areas of the brain have been demonstrated and seem to be responsible for the non-empathetic, unemotional, and amoral features of psychopaths. Also, they present an increase in dopamine turnover and metabolism and a serotonin dysregulation.

As not all individuals with the biological substrate for psychopathy become violent, it seems that plasticity in forebrain circuits may allow the development of more prosocial responses, especially in youth. Some authors emphasize the need to address other behaviours that can be responsible for violent actions, namely, impulsive aggression. Some drugs have shown efficacy in controlling impulsive aggression.

Conclusions

Pharmacological approaches to treating psychopathy have been disappointing. A more reasonable goal would be to focus on impulsive aggression, for which treatment effectiveness has been demonstrated. Additional research is needed if we hope to design rational therapeutic strategies for this disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.