bluuebunny/crossref_metadata_2025 huggingface dataset:
New horizons of dual pathology, report of a case
Authors: Marin S. Garcia , Garcia I. De Haro , Pedrosa N. Martinez , García M.D. Ortega , Garnica V. Marti , Rus S. Galiano , Iborte A. Soler , Borja P. Lucas
Published: June 2017

Introduction

Pathological gambling, as behavioural addiction, is always related with psychosocial important problems. In this case, everything is even more difficult due to grave mental disease associated, Paranoid Schizophrenia. Man, 26 years old, single. He was diagnosed of psychotic disease at the beginning due to his grave addiction to THC and others stimulant drugs. His outpatient treatment was complicated and he needed to be hospitalised once (being diagnosed of Schizophrenia). After that, he improved till he got a standardised job. He was able to have his medical treatment (Aripriprazol 15 mgs per day and Biperidene 4 mgs per day) although he kept his isolation. Then, the patient could talk about his pathological gambling. He suffered from slot machine addiction, and he also suffered from depression symptoms closely related to family and economic problems due to pathological gambling. This patient was in contemplation state and he accepted to start with antidepressant (Mirtazapine 15 mgs per day) and psychological treatment. We agreed to make a record of his gambling uses (with regular self-reports). His salary would be administered by his parents and he only could take a little money every week. The treatment was useful; it increased the capacity of economic self-management and the recovery of depression disease related.

Conclusions

In our opinion, he used gambling as filling a need for activity, and as a way of connecting with society/world. These findings suggest the need for improved prevention and treatment efforts related to problem/pathological gambling in individuals with psychotic disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Gender differences in dual bipolar disorder
Authors: Mateu-Codina G. , Sauras-Quetcuti R. , Farre-Martinez A. , Galindo-Guarín L. , Marti-Bonany J. , Hurtado-Ruiz M.G. , Campillo-Saenz M. , Sanchez-Gonzalez R. , Castillo-Buenaventura C. , Torrens-Melich M.
Published: June 2017

Introduction

Women with bipolar disorder are more prone to psychiatric co-morbidity as anxiety, substance use disorders, eating disorders and borderline personality disorder. Nevertheless, substance abuse disorders as co-morbidity in bipolarity are higher in males than females.

Objectives

To describe differential characteristics of patients admitted to a psychiatric unit referring to gender in a group of patients with bipolar disorder co-morbid with substances disorders (dually diagnosed patients).

Methods

Sociodemographic, clinical and administrative data of all patients diagnosed with bipolar admitted to a dual diagnosis during a 3-year period were collected. The psychiatric diagnosis was made according to DSM-IV-R criteria.

Results

From the whole sample (n = 66), males (84.8%) were prevalent. Mean age were 37.71 ± 11.7 and mean length of admission was 24.94 ± 17.9 days. Cannabis (34.8%) and cocaine (33.3%) were the most frequent SUD diagnosis and main reasons for admittance were conduct disorder (33.3%) and mania (25.8%).

Women showed higher length of admission, higher severity scores at admission and greater reduction in severity scores along hospitalisation. No other clinical or sociodemographic differences were found comparing both groups of patients (Tables 1–4).

Conclusions

Women affected by dual bipolar disorder showed higher severity scores at admission but achieved better remission rates during hospitalisation.

Table 1

Demographic characteristics of both groups.

Table 2

Clinical and functional variables at admission in both groups.

Table 3

Historical data about age of drug use in both groups.

Table 4

Severity Scores for both groups of study.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Benzodiazepines abstinence syndrome with psychotic symptoms: Case report
Authors: Morales N.I. Núñez , Revuelta M. Gómez , Hernández B. González , Zufiaurre M. Laborde , Itoiz A. Aranzabal , Olivares O. Porta , González G. Montero , Martín M. Zubia , Arenaza J. Gaviña , Arrillaga A.M. González Pinto
Published: June 2017

Introduction

Several studies point to the importance that the complex formed by GABA and the benzodiazepine receptor play for cerebral dopaminergic transmission and, hence, to the pathophysiology of psychotic symptoms. The decrease in GABA neuratransmisión or the hypofunction of the system in the hippocampus, cortex and other limbic prefrontal or subcortical regions has consequences as emotional dysregulation, cognitive impairment and development of positive psychotic symptoms.

Objectives

We intended to show an additional practical example to the limited literature available based on a case linking the emergence of psychotic symptoms due to acute benzodiazepine withdrawal.

Methods

We present the case of a 21 year old man who was sent to the emergency room of our hospital after an episode of aggressiveness on the street. The patient showed a psychotic schizophrenic syndrome with significant emotional and behavioural impact with aggressive and bizarre movements. In parallel, restlessness, sweating, tremor, increased blood pressure and tachycardia were observed. Symptoms had started abruptly two hours earlier. The patient companion explained that he usually took Alprazolam at an of over 40 mg per day. He had decided to give up this consumption abruptly four days earlier.

Discussion

GABAergic deficits cause the imbalance between excitatory and inhibitory neurotransmission that may relate the pathophysiology of psychotic symptoms. The dysfunction of the GABAergic cortical interneurons could affect to the modulating response from the association cortex, which, could also relate with the appearance of these symptoms.

Conclusion

This case could relate a decrease in GABAergic transmission with the appearance of psychotic symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Hepatic comorbidity in psychiatry. A case report
Authors: Santayana G. Pardo de , Landera R. , Juncal M. , Porta O. , Sánchez L. , Gómez M. , Núñez N.
Published: June 2017

Introduction

Comorbidity between mental and physical illnesses is very common and their possible interactions must always be taken into account. Hepatic disorders in particular, can affect the blood levels of antipsychotic drugs altering their effects on patients. Therefore, it is very important to assess in each case which treatment might be the most beneficial for the patient to avoid iatrogenic complications.

Aim

To review articles in Pub-Med and UpToDate about the possible iatrogenic complications that can arise using antipsychotic drugs in patients with hepatic disorders.

Methods

We describe the case of a 52-year-old male with Schizophrenia who was diagnosed of HCV infection ten years ago, for which he rejected any kind of treatment due to delirious ideation. In the past he was treated with oral Paliperidone with good tolerance, which he discontinued because of pour insight and stopped attending Psychiatric consultation. In April 2016 the patient was hospitalised suspecting a hepatocellular carcinoma.

Results

During hospitalization he began treatment with long-acting injectable formulation of Paliperidone Palmitate that improved his insight. The patient agreed to perform the necessary tests to verify the suspected diagnosis, which was sadly confirmed. He achieved psychopathological stability, but unfortunately the patient died 6 months later because of his hepatocellular carcinoma.

Conclusions

Paliperidone is a good therapeutic option in patients with hepatic disorders because it is not metabolised by the liver. It also has a depot formulation that improves adherence in patients with low insight, reducing the danger of future psychotic decompensation and improving the long-term prognosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Adult ADHD diagnosis and binge eating disorder
Authors: Sevilla Vicente J. , Basurte Villamor I. , Sedano Capdevila A. , Migoya Borja M. , Navarro Jímenez R. , Serrano Marugan L.
Published: June 2017

The association between attention deficit hyperactivity disorder (ADHD) and eating disorders has not been yet clarified. The presence of ADHD was significantly correlated with more severe binge eating, bulimic behaviors, and depressive symptomatology. The aim of this work is to study the relationship between ADHD subtypes in adults and the risk of food addiction (binge eating disorder).

The sample was collected on a specific program for adults with ADHD diagnosis in Madrid (Spain). In total, the sample was 110 patients, and we collected information about socio-demographic factors. All patients met DSM-5 criteria for ADHD in different subtypes. We used the conner's Adult ADHD rating scales and the Barrat impulsiveness scale. Also we used the Shorter Promise Questionnaire. This is a 16 scale self-report instrument to measure an individual's level of addictive tendency.

The 36.4% were at high risk of developing a food addiction. For binge eating disorder (BE), no statistically significant differences were found by gender within patients with ADHD.

Binge eating was significantly related to the impulsivity and emotional liability subscale of the CAARS (P < 0.05). The risk of develop BE in ADHD was 4.7 (CI 95% 1.8–12.07). Binge eating was significantly related to the total score on the Barrat scale (P < 0.05) Risk of 3,5 (CI 95% 1.5–7.9) and within the subtypes of impulsivity, motor impulsiveness was the one that was significantly related to BE (P < 0.001)

There is a clear relationship between impulsiveness symptoms and BE in patients with ADHD. It's important to note that there are no gender differences within ADHA patients to develop a BE disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Sleep disorders associated with interferon in chronic viral hepatitis C
Authors: Aarab C. , Bout A. , Aalouane R. , Rammouz I.
Published: June 2017

Chronic infection with hepatitis C is a public health problem in Morocco and in the world. The objective of the work screens for sleep problems during the disease and its management to better guide the monitoring and psychiatric interventions.

Methodology

Sixty-eight patients followed for hepatitis C were recruited. The treatment was based on the combination of pegylated IFNa or standard IFNa and ribavirin for 6 to 12 months. The evaluation was done by a questionnaire containing demographic information, medical and psychiatric history, substance use. Sleep assessment was made by Pittsburgh Sleep Quality Index, and measuring the quality of life by SF36. The assessment before starting treatment and at 1 month and 4 months. Statistical analysis by SPSS 21 software read.

Results

Fifty-six patients were able to complete the monitoring. 36 women to 20 men. The average age is 59.1years old (standard deviation 9.88). A quarter of patients still gainfully employed. 64.3% of participants live in couple. Seventy-six point eight percent of patients live in the city. Seven percen consume tobacco and single patient use cannabis occasionally. Sleep disorders increased from 37.5% before the start of the treatment to 55.4% after its start. While 44.5% have kept a sleep disturbed to 4 months. At first, the quality of life had more impaired scores on psychological than physical scores. The overall score declined significantly way after initiation of treatment (0.04). A larger decline on the psychological component (0.000) while the physical score did not significantly decrease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Postictal psychosis – A complex challenge
Authors: Marinho M. , Marques J. , Bragança M.
Published: June 2017

Introduction

Patients with epilepsy have 6–12 times higher risk of suffering from psychosis, with a prevalence of about 7–8%, and the coexistence of these two conditions is associated with increased morbidity and mortality. The psychosis of epilepsy is generally split into two groups: interictal psychoses and postictal psychosis (PIP), and the latter has been estimated to represent 25% of all types. However, many of these episodes remain under-recognized and/or are often misdiagnosed.

Objectives

To provide an overview of PIP.

Methods

Literature review based on PubMed/Medline, using the keywords “epilepsy” and “psychosis”.

Results

PIP has been recognized since the 19th century, when Esquirol described postictal “fury”. Although its etiology and pathogenesis remain poorly understood, several risk factors and etiopathogenic mechanisms have been suggested and analysed. An essential step in PIP management is its accurate and early diagnosis. Generally, before the onset of PIP there is a lucid period of one to six days after the seizure(s). PIP frequently has a polymorphic presentation, tends to be affect-laden and symptoms often fluctuate. It is of limited duration and frequently responds very rapidly to low doses of benzodiazepines and antipsychotics. However, the propensity of the antipsychotics to provoke seizures and the risk of pharmacokinetic interaction with anti-epileptics are important considerations. Recurrence rates range 25% to 50%.

Conclusions

Given the negative impact of PIP in morbidity and mortality among these patients, it is crucial that neurologists and psychiatrists are able to adequately recognize and treat this clinical condition.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Impact of classification systems (DSM-5, DSM-IV, CAM and DRS-R98) on outcomes of delirium
Authors: McCarthy G. , Meagher D. , Adamis D.
Published: June 2017

Introduction

Previous studies showed different classification systems lead to different case identification and rates of delirium. No one has previously investigated the influence of different classification systems on the outcomes of delirium.

Aims and objectives

To determine the influence of DSM-5 criteria vs. DSM-IV on delirium outcomes (mortality, length of stay, institutionalisation) including DSM-III and DSM-IIR criteria, using CAM and DRS-R98 as proxies.

Methodology

Prospective, longitudinal, observational study of elderly patients 70+ admitted to acute medical wards in Sligo University Hospital. Participants were assessed within 3 days of admission using DSM-5, and DSM-IV criteria, DRS-R98, and CAM scales.

Results

Two hundred patients [mean age 81.1 ± 6.5; 50% female]. Rates (prevalence and incidence) of delirium for each diagnostic method were: 20.5% (n = 41) for DSM-5; 22.5% (n = 45) for DSM-IV; 18.5% (n = 37) for DRS-R98 and 22.5%, (n = 45) for CAM. The odds ratio (OR) for mortality (each diagnostic method respectively) were: 3.37, 3.11, 2.42, 2.96. Breslow-Day test on homogeneity of OR was not significant x2= 0.43, df: 3, P = 0.93. Those identified with delirium using the DSM-IV, DRS-R98 and CAM had significantly longer hospital length of stay(los) compared to those without delirium but not with those identified by DSM-5 criteria. Re-institutionalisation, those identified with delirium using DSM-5, DSM-IV and CAM did not have significant differences in discharge destination compared to those without delirium, those identified with delirium using DRS-R98 were more likely discharged to an institution (z = 2.12, P = 0.03)

Conclusion

Assuming a direct association between delirium and examined outcomes (mortality, los and discharge destination) different classification systems for delirium identify populations with different outcomes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Evaluating quality of sleep in patients with diagnosis of chronic obstructive pulmonary disease
Authors: Akhan L. Utas
Published: June 2017

Background

Multicenter study showed that sleep disorders was diagnosed in approximately 40% of patients with chronic obstructive pulmonary disease. COPD is a condition that is most widely investigated regarding its relation with sleep.

Objectives

Our study is a complementarily one that is carried out to determine how COPD affects the quality of sleep.

Methods

This study enrolled 300 patients with COPD, who receive treatment in an occupational diseases hospital of ministry of health, Turkey, and control group of 100 healthy volunteers. This definitive, cross-section study was conducted between 01.02.2016–31.04.2016. Socio-demographic details form, epworth sleepiness scale and Pittsburgh sleep quality index are used to gather the study data. Any disease that affects sleep structure (Obstructive sleep apnea syndrome, substance abuse, irritable leg syndrome, depression, anxiety disorder, peptic ulcer) and a treatment that can affect sleep patterns (antidepressant, anxiolytic, diuretic) and to work all patients who were planned to receive Hamilton depression and were assessed with anxiety scale and anxiety, depression those who have high points to think of the reins are not included in the study.

Results

Score obtained from Pittsburgh sleep quality index–A subjective test - was significantly high in the COPD group. Actigraphic sleep parameters that include ‘actual wake time’, ‘actual wake %’, ‘total activation score’ and ‘fragmentation index’ were significantly high in the COPD group comparing to control group. Among actigraphic sleep parameters, ‘actual sleep time’, ‘actual sleep’ and ‘sleep efficiency’ were significantly lower in the COPD group comparing to control group.

Conclusions

The study demonstrates that chronic obstructive pulmonary disease poses negative influence on the quality of sleep and leads to sleep disorders.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Long-term validation of the SAD PERSONS scale for prediction of repeat self-harm in A&E patients with and without a prior self-harm history
Authors: Zakaria Y. , Mitchell A.
Published: June 2017

Objective

Repeated self-harm is difficult to predict particularly in the long-term. Scales that help identify risk of repetition are widely used, and the most popular is the modified SAD PERSONS scale (mSPS). We aimed to clarify the accuracy of the mSPS in first time and non-first time patients presenting with self-harm with an extended follow-up period of observation.

Method

We conducted the UK's first long-term prospective risk prediction study of patients to an Accident and Emergency (A&E) department. We followed up 774 patients for a mean period of 7.4 years. At the time of study 429 patients presented with their first episode of self-harm and 345 had a hospital record of past history of self-harm.

Results

During 7.4 years of follow-up 54.7% of those who initially presented with self-harm represented with a repeat self-harm episode. Four hundred and twenty-one patients had a mSPS score less than 6 (low risk), 260 had a score between 6 and 8 (moderate risk) and 94 scored 9 or higher usually notated as high risk. The clinical utility of the mSPS was “poor” for predicting future self-harm but at cut-offs ≥7 it was “fair” for predicting non-repetition. Of the individual questions in the mSPS, a positive answer to “stated future wishes” was a true positive in 74.0%.

Conclusions

We found the mSPS was a relatively poor indicator of future self-harm risk in a long term follow-up of patients who self-harmed regardless of hospital record of previous self-harm history. However, mSPS did have modest value in predicting non-repetition.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Gypsies's beliefs about the evil eye in relation to mental illness
Authors: Paralikas T. , Kotrotsiou S. , Kotrotsiou E. , Gouva M. , Hatzoglou C. , Kavadias D.
Published: June 2017

Introduction

The focus of Medical Anthropology is, among other things, the study of medicine as an expression of culture and involves the analysis of healing traditions, both “traditional” and biomedical.

Objectives

Greek Gypsies who have their own habitus, language, and culture.

Aims The discussion of treatment options that gypsies have or seek in order to address critical life situations outside a biomedical context.

Methods

Field research with interviews and observation.

Results

Using Geertz's analytic approach of symbolic interpretation, this paper focuses on the mobilization and transformation of religious symbols in the clinical setting: how these “converse” with biomedicine and how they participate in the process of healing. Painful life experiences drive subjects to seek recourse in remedies outside the biomedical system. At the center of these experiences are thought to be attacks from the “evil eye.” According to the subjects’ worldview, all people are potential victims of the evil eye. A person's glance can provoke the injury, illness, mental illness or even death of another. Consequently, there is a hierarchy of therapeutic choices in which first preference is given to their own means for addressing a situation—only in the case of failure do they turn to specialists.

Conclusions

The beliefs of the subjects are strongly influenced by their worldview, a historically inherited model of health and healing that, unlike the biomedical model, expresses a belief that ailments are successfully cured “wıth God”.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Strategies to reduce the stigma toward people with mental disorders in Iran based on stakeholders view: A qualitative study
Authors: Taghva A.
Published: June 2017

Introduction

Stigma effects on the process of mental disorders and many researchers consider it as the most serious risk factor and inhibitor in promoting mental health.

Aims

The aim of this study was to explore the strategies to reduce the stigma toward people with mental disorders in Iran.

Methods

This qualitative study, using content analysis method, was undertaken from 2013 to 2015. All participants were recruited by purposive sampling method. They were stakeholders of mental health in Iran. Data were collected through 16 individual interviews, 2 focus group interviews and 6 written narratives. The data were collected, coded and analyzed simultaneously.

Results

The major themes were: “Emphasis on education and changing attitudes”, “Changing the culture”, “Promoting services and support coverage”, “Role of various organizations and institutions”, “Integrated reform of structures and policies to improve the performance of custodians”, and “Evidence-based actions”.

Conclusion

It seems crucial to adopt strategies that lead to reduce the stigma of mental illnesses and increase awareness among people, scholars and service providers in the field of mental health. Additional studies are needed to evaluate the effectiveness of the emerging strategies to reduce stigma.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Major depressive disorder: Recurrence risk factors
Authors: Ellouze F. , Bouali W. , Marrag I. , Chaabouni A. , Soussia R. Ben , Nasr M.
Published: June 2017

Introduction

Despite the frequency and the severity of depressive episodes, the major depressive disorder (MDD) is today inadequately diagnosed and treated, and the risk factors for its recurrence are not well elaborated. The objectives of this study were to describe the sociodemographic, clinical evolutionary and therapeutic features of this disorder and to identify the factors involved in the risk of its recurrence.

Methods

This is a retrospective, descriptive and analytical study, involving 150 patients with MDD, isolated episode or recurrent major depressive disorder (RMDD) with a follow-up for at least two years. Data collection was performed using two pre-established questionnaires for the MDD isolated episode and for the RMDD respectively with 51 and 92 items. A study of the recurrence period was performed by Kaplan–Meier method. The Cox-test was used to determine the survival curves and to look for the risk factors significantly associated with MDD recurrence.

Results

A total of 150 patients was gathered, predominantly female, married and from urban origin. The average age at the beginning of the disorder was 35 years. The recurrence period was 109 months and the factors associated with recurrence were the early age of onset of the disorder, family history of mood disorders, the severity of MDE index, residual symptoms and discontinuation of treatment.

Conclusion

The study of factors involved in MDD recurrence is of a particular importance since it allows not only to know the group of patients at risk but also to improve their therapeutic care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
An expressive group approach to borderline personality disorder in patients with bulimia nervosa: A clinical case
Authors: Martín I. Baños , Gómez E. Guerra , Itúbide K. Eaton , Conde B. Unzeta , Besteiro P. Vilariño , Franco C. Pérez , Jorge P. García
Published: June 2017

Introduction

It is widely known comorbid Bulimia Nervosa (BN) with Borderline personality disorders (BPD). This is associated with worse prognosis and resistance to pharmacological and psychotherapeutic treatments. In integrated treatment, both disorders are addressed, not being frequent psychotherapy groups that address only the personality traits. Some studies have proposed the brain basis of psychodrama intervention in both pathologies.

Objectives

To highlight the clinical effectiveness of adding a nonverbal orientation (psychodrama) to the treatment of BN patients; to specifically address personality traits, by presenting a clinical case. We rely on studies.

Methods

Clinical case: 42-year-old woman patient with BN (DSM-5) severe degree, BITE: Symptoms scale = 28; S. Severity = 13; and BPD (7 DSM-V); MCMI-III: BPD = 115 She is incorporated into a day hospital with integrated and multidisciplinary approach: psychotropic drugs, individual, group and family psychotherapy. This patient is added to an open psychodrama group; where he works exclusively personality pathology, during one year.

Results

Improvement was observed in BN (she switched to intermediate grade); BITE: Symptom scale = 23, S. Severity = 8; also improves BPD criteria of DSM-V = 4 (minimum = 5) MCMI-III: BPD = 104.

Conclusions

(1) Psychodrama psychotherapy groups to treat Bulimia and BPD could provide an added clinical improvement in both pathologies.

(2) Insufficient RCTs compared to other models of psychotherapy (mentalizing, interpersonal, dialectical behavior) do not allow to speak even scientific evidence of psychodrama.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
New technologies as risk factor for eating disorders
Authors: Rojo S. Fernandez , Mora F. , Banzo C. , Quintero J.
Published: June 2017

Introduction

Eating disorders (ED) have a significant prevalence in children and adolescents. The use of new technologies allows to access to a big amount of information. Excessive use of these technologies at this stage of life decreases social and family relationships and provides access to online content in favor of these disorders, which can affect to the development of an ED. The aim of this study is to analyze the relationship between the use of new technologies and the risk of developing an ED.

Material and method

We have selected a sample of 500 patients who were in the 2nd year of secondary school to which has been applied a battery of scales, including the EAT-26 scale for ED; and has been collected socio-demographic data, including the use of internet and mobile phone. We used SPSS to analyze the relationship between these variables.

Results

We have analyzed clinical and socio-demographic characteristics of the sample. In relation to the risk of developing an eating disorder we have found that high frequencies of use of the Internet and high frequencies of use of mobile phones (especially more than 4 hours a day) increases significantly the score in EAT-26 scale for ED (P < 0.05).

Conclusions

Regarding the results, we can say that, in our sample, the use of Internet and/or mobile phone more than 4 hours a day significantly increases the probability of having a high score on the scale for ED. This data can be essential when planning treatment or establishing a preventive strategy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Reconceptualization of recovery from anorexia nervosa: Patients’ perspective
Authors: Jarrige M.
Published: June 2017

Outcome research has not found a consistent definition of recovery from anorexia nervosa by consensus of experts, or by empirical validation. Therefore, medical criterion of recovery varies between studies and results are not comparable. This poster refers to a study of 44 participants treated for anorexia nervosa and who believe they have recovered. The purpose of this study is to reconceptualize recovery from patients’ perspective. The Free Association about Recovery – Questionnaire (FAR-Q) is a new tool by which to explore and understand the anorexic's account of recovery. Content analysis reveals four subjective definitions of recovery: (1). Return to the social normality; (2). Cohabit with eating disorder; (3). Self-acceptance; (4). Rebirth. This study assesses patients’ stages of recovery process and gives recommendations to health professionals.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Eating disorders in Malays in Singapore
Authors: Kwok V. , Lee H.Y. , Tan S.M. , Chee W.S.A. , Ann K. , Binte Kamaruzaman N.R.
Published: June 2017

Introduction

The prevalence of eating disorders has been increasing in the Asian countries. Malays in Singapore are at the crossroads because they are largely traditional in practice and almost all are Muslim, but are exposed to western culture. Studies found that Malays at increased risk of eating disorders but yet those that present for treatment are very small, and this study aims to study Malays with eating disorders to unveil this contradiction.

Methods

All Malay patients presenting to Singapore General Hospital (SGH), which hosts the only specialized eating disorder programme in Singapore, between 2003 and 2014 were identified and medical records studied retrospectively.

Results

Malays constitute only 42 out of 1340 patients treated in the same period. The mean age at presentation is 18.81 years (SD = 5.54) and the majority are students (78.6%). A total of 92.9% are single. There are more cases of bulimia nervosa than anorexia nervosa (45.2% vs. 26.2%). In total, 54.8% have psychiatric comorbidities, the most common is depression (31.0%), 38.1% have a history of deliberate self-harm and 21.4% attempted suicide. A total of 52.4% reported teasing as a trigger, while 16.7% were triggered by being overweight.

Discussion

There is only a small number of Malays that presented. Fasting is commonly which may be confused with restriction. Other factors could be lack of awareness. The higher prevalence of bulimia nervosa suggests that purging is recognized as abnormal. High prevalence of comorbidities suggests that family members recognize comorbidities better. Outreach programs for Malay will help increase awareness.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Prenatal stress exposure as a risk factor for anorexia nervosa: A controlled study
Authors: Michelon S. , Tenconi E. , Bonello E. , Degortes D. , De Toffol M. , Favaro A. , Santonastaso P. , Nassuato M.
Published: June 2017

Introduction

Prenatal risk factors, such as gestational complications and exposure to stress during pregnancy, may have a role in the development of many psychiatric disorders including eating disorders.

Aim

To investigate the impact of prenatal stress exposure on the development and clinical features of anorexia nervosa.

Methods

One hundred and nine patients with a lifetime diagnosis of anorexia nervosa and 118 healthy controls underwent a clinical assessment, which included interviews, questionnaires and a neuropsychological battery. The mothers of the patients and controls underwent a specific interview focused on stressful life events, which occurred during pregnancy. Obstetric and neonatal records were consulted.

Results

The mothers of patients experienced more severe stressful episodes during pregnancy than the mothers of controls and the perceived distress showed significant positive correlation with both total number of obstetrical complications and placental weight. In patients, the severity of stressful events was strongly associated to cognitive rigidity and perseverance.

Conclusions

Prenatal stress exposure might be a risk factor for the development of anorexia nervosa and it is associated with cognitive traits of rigidity and perseverance.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cortisol awakening response in binge-purging and restrictive anorexia nervosa
Authors: Nigro M. , Monteleone A.M. , Pellegrino F. , Cimino M. , Di Maso V. , Volpe U. , Monteleone P.
Published: June 2017

Introduction

Anorexia nervosa (AN) is a complex psychiatric disorder characterized by severe restriction of food intake and aberrant behaviours. The endogenous stress response system, including the hypothalamus-pituitary-adrenal (HPA) axis, may have a role in the pathophysiology of AN.

Objectives

It has been shown that specific clinical traits of AN, such as binge-purging behaviours, may be associated with higher psychopathology and poorer outcomes. Therefore, the HPA axis functioning could differ between patients with restrictive AN (ANR) and those with binge-purging AN (ANBP).

Aims

In order to evaluate whether HPA axis functioning differs between the two subtypes of AN, we assessed the cortisol awakening response (CAR) of symptomatic ANR and ANBP patients.

Methods

Our sample included 17 ANBP and 18 ANR patients, and 42 healthy women. All of them filled in the Eating Disorder Inventory-2 (EDI-2). For CAR assessment, participants collected saliva samples at home. Saliva cortisol concentrations were measured by an enzyme immunoassay method.

Results

ANR and ANBP patients exhibited a CAR significantly higher than healthy women. Furthermore, the CAR of ANBP women was higher than that of ANR women and positively correlated with the bulimia subitem score of the EDI-2.

Conclusions

Present findings show, for the first time, differences in the CAR between ANBP and ANR subtypes supporting the idea that binge-purging behaviours may have a specific connection with HPA axis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Eating problems and body image among Finnish adolescents
Authors: Sourander A. , Maezono J.
Published: June 2017

Objective

To study prevalence of self-reported body image and eating distress symptoms among Finnish adolescents, and to study associations between psychopathology, body image and eating distress.

Design

Cross-sectional population-based, survey subjects, 7th to 9th grade students aged 13–15: 3154 in Finland in 2014.

Methods

Data were collected by student self-reported questionnaire including scale designed for evaluating attitudes and behaviors towards body shape and eating, and Strengths and Difficulties Questionnaire (SDQ) for assessing emotional and behavioral problems.

Results

The female adolescents reported much more dissatisfaction and concerns with their bodies than the males, high levels of distress with body emotional, behavioral and peer problems measured with SDQ. Body image and eating problems were higher in Finnish than Japanese females with peer problems.

Conclusion

The finding was in accordance with previous studies that found that body image and eating distress are associated with to gender and wide range of psychiatric problems.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Bulimia nervosa in Singapore: Clinical profile, comorbidity and gender comparisons
Authors: Zainal K.A. , Ng K.W. , Lee H.Y.
Published: June 2017

Introduction

Though eating disorder cases have been on the rise in Asia, little is known about them. Bulimia nervosa (BN) has been associated with poor treatment outcome and high mortality risk, and is the second most commonly diagnosed eating disorders in Singapore, after anorexia nervosa (AN), yet no report thus far has explored this condition.

Objectives

The current study seeks to describe the clinical population diagnosed with BN in our hospital treatment program, as well as to compare their clinical characteristics with a previously published local study on patients with AN.

Method

Retrospective medical records review was carried out for patients diagnosed with BN in our hospital's eating disorders treatment program. Patient records from 2003 to 2013 were retrieved and analyzed. We also further compared presenting characteristics across genders and with AN patients.

Results

Between 2003 and 2013, 348 patients were diagnosed with BN by psychiatrists based on the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR). BN patients presented with high rate of self-harm behaviors (37.1%), previous suicide attempts (19.0%) and psychiatric comorbidities (67.5%), many of which require inpatient treatment. Significant differences were found between genders and in comparison with the AN patients.

Conclusion

Our results suggest that many patients with BN present with severe psychiatric comorbidities, in some aspects more severe than the AN population. The current study appeals for the development of more effective detection and treatment of vulnerable populations in Singapore. We further discuss about the potential roles of mental health literacy and stigmatization in influencing treatment-seeking behaviors.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neuroleptic malignant syndrome: A rare, life-threatening and not fully understood condition
Authors: Cabral Barata P. , Melo J.C. , Maia T.
Published: June 2017

Introduction

Neuroleptic Malignant Syndrome (NMS) is a rare life-threatening idiosyncratic reaction associated with the use of neuroleptics. It is characterized by delirium, muscular rigidity, fever and autonomic nervous system dysregulation. Its diagnosis represents a significant challenge for clinicians and many aspects regarding its epidemiology, etiopathology and nosology remain controversial.

Objectives

Summarize current knowledge to facilitate NMS diagnosis and allow a fast onset of therapeutic and life-saving interventions.

Methods

Non-systematic review of the literature–scientific publications from Pubmed and a Psychiatry Textbook.

Results

NMS typically develops during the first week after the neuroleptic is introduced, although it may also appear after years of treatment. Its incidence is of 0.02 to 3% in patients taking antipsychotics; the mean age of its patients is 50 years. Typical symptoms are muscle rigidity and temperature greater than 38hC in a patient on antipsychotic; however, recent reports indicate that these core symptoms may not always be present. Several risk factors have also been identified and must be addressed. NMS may be fatal in 10 to 20% of cases or may produce residual sequelae, like cognitive dysfunction or neurological deficits. NMS must be managed by aggressive use of supportive measures, as well as specific interventions. It recurs in 30% of patients, which can be diminished by specific measures.

Discussion

NMS requires timely and accurate diagnosis and treatment. Antipsychotics should be used cautiously in patients at increased risk. When recognizing this condition, prompt withdrawal of the offending agent is the most important step. Wise approaches can diminish morbidity, mortality and recurrence.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Reducing restraint with clozapine in involuntarily admitted patients with schizophrenia
Authors: Ifteni P. , Teodorescu A.
Published: June 2017

Introduction

In the entire world, restraint and seclusion are common interventions in psychiatric in-patient settings due to aggressive behavior.

Objectives

Our objective was to test for the immediate anti-aggressive property of clozapine compared to other antipsychotic treatments in an enriched cohort with high rates of restraint during early hospitalization.

Methods

We present a retrospective chart review in all involuntary admissions with schizophrenia during 2011–2014 in Psychiatry and Neurology Hospital, Brasov, Romania. Timing and number of restraints in addition to clinical, demographic and treatment characteristics were extracted. Based on our earlier observation of clinical efficacy of early, fast titration of clozapine, we tested the hypothesis that clozapine treatment was associated with reduced use of restraint, and with longer restraint-free periods.

Results

In 115 patients with schizophrenia (age = 39.7 ± 11.1 years; male = 59%) involuntarily admitted due to externalized (74.78%) or self-directed violence (25.22%), restraint was used in 89.6%; with a median duration of 3 hours until restraint past admission. Antipsychotics used immediately after hospitalization included haloperidol (70.4%), clozapine (11.3%), olanzapine (10.4%) and other second-generation antipsychotics (7.9%). Comparison of restraint characteristics favored immediate clozapine use with highly reduced rates of restraint (38.5% vs.95.6%. P < 0.001) and significantly extended hours until restraint ([118 h,24 h, 426 h] vs.[3 h,0.25 h, 48 h]; median; 25th, 75th percentile; P < 0.001) relative to the remaining cohort. These effects remained highly significant after controlling for potential moderators of restraint use in multivariate models.

Conclusions

These retrospective data suggest an early anti-aggressive effect of clozapine during the immediate use of clozapine in highly problematic patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Screening for mental health problems as indicator for evaluation of needs for mental health services
Authors: Fanaj N. , Mustafa S. , Shkëmbi F. , Kabashaj B. , Fanaj B.
Published: June 2017

Background

Screening questionnaires for mental health problems are useful tools for research and clinical practice.

Objectives

To identify mental health problems and overall emotional functioning among general population samples in Kosovo as indicators for evaluation of needs for mental health services.

Methods

It is cross-sectional quantitative study. Participants from two samples: students (filled-out directly) and online respondents (n = 540; mean age = 24.84; SD = 8.29) were included in this study. All participants were asked to complete the Albanian translation of Mental Health Inventory (MHI-38). Data processing was done with SPSS 21.0 and Microsoft Excel 2007.

Results

In total 11.2% of participants ranged at low level of mental health index. Regarding anxiety the high level is found at 51.3% and regarding depression high level is found at 24.5% of participants. A significant gender difference is found whereas females show greater depression (P = .022, r = .09), greater psychological distress (P = .000, r = .17) and lover mental health index (P = .000, r = .17), than males. A significant difference between samples is found whereas online sample show greater psychological distress (P = .000, r = .18), less anxiety (P = .001, r = .13) and lower mental health index (P = .000, r = .22) than direct sample.

Conclusions

The findings are quite intriguing. Future research is needed to find out more understanding on gender, anxiety, depression, psychological distress and mental health. Socio-cultural aspects can be of great importance to be examined. Despite this, needs for mental health services are inevitably and must be addressed properly.

Disclosure of Interest

The authors have not supplied their declaration of competing interest.
Attitude to and social distance from schizophrenic patients as forms of stigmatization, investigated by a group of medical professionals and a group of non-professional subjects
Authors: Grbesa G. , Simonovic M. , Stankovic M.
Published: June 2017

Introduction

The attitude to schizophrenic patients has always been considered a significant indicator of stigmatization of mental patients. The social aspect of stigmatization involves the social distance when speaking about the attitudes towards mental patients. The social distance is defined as “a various degree of understanding and feelings existing among the groups”.

Objectives

The investigation included 120 participants divided into two groups. The first group included 60 participants; psychiatrists (38) directly involved in treating schizophrenia and 28 nurses working in wards where schizophrenic patients were treated. The second group of 60 participants included non-professionals divided according to age and gender to match the experiment group.

Aims

Investigating the correlation between the proclaimed attitudes to and social distance from schizophrenic patients: medical professionals and non-professional subjects.

Methods

Semantic differential scale was used to examine the personal attitudes towards a stigmatized group. To examine social distance, the modified Bogardus Social was used.

Results

The results obtained using the Semantic differential scale to examine the attitudes did not show statistically significant score difference between the two groups of patients Bogardus Social Distance Scale score showed statistically significant difference (P > 0.03). A significant score on the scale of social distance can be recognized in both psychiatry professionals and non-professionals.

Conclusion

Stratification of items on the social distance scale shows a great social distance in the sphere of intimacy and slightly lower score on the level of social relations. The group having competent knowledge concerning the disease shows sophisticated way of hiding behind professional reasons.

Disclosure of Interest

The authors have not supplied their declaration of competing interest.
Comparison between patients who did not show up for their first visit and the ones who did
Authors: Saenz B. Mata , Fernández L. Nuevo , Aguerri L.M. Asensio , Fernández L. Beato , Cano T. Rodríguez
Published: June 2017

Introduction

Referrals to psychiatry from primary care has increased in recent years. This can be the result of the global economic situation and represents a problem for specialized care, because patients can’t usually be correctly attended to. On the other hand, patients who don’t come to visits make up other important issues that we must analyze.

Objectives

To analyze the differences between patients who did not come for their first visit and those who did in order to try to describe variables that could be affecting them.

Methods

This is an epidemiological, analytic, prospective study of patients referred to our department. The following variables were collected: (1) referral protocol, (2) reason, (3) demographic data, (4) attendance to appointment, (5) diagnosis impression and (6) destination of referral. The SPSS 19.0 was used to analyze the data.

Results

We studied a total of 1.048 patients for 15 months, of which 20.6% did not come to their first visit. A statistically significant relationship between attendance and gender, year of the appointment, adequate demand or not, previous follow-up and diagnosis was found (Chi2). However, if a logistic regression was carried out, only the adequacy of the demand was included in the model.

Conclusions

Coordination with general practitioners is essential to improve referrals and, most importantly, the attention to patients. If we can agree on the referral criteria, a better-personalized assistance can be offered to patients who have more difficulties in coming (because of characteristics of illness, place of residence, and other variables).

Disclosure of interest

The authors have not supplied their declaration of competing interest.