bluuebunny/crossref_metadata_2025 huggingface dataset:
On purpose of multiple cases: Quaternary prevention on mental health – “Primum non-nocere”
Authors: Lazo Chavez K.L.
Published: June 2017

Introduction

Quaternary prevention, concept coined by the Belgian Marc Jamoulle, are the actions taken to avoid or mitigate the consequences of unnecessary or excessive intervention of the health system. The concept alludes to actions to avoid the over-diagnoses and over-treatment, trying to reduce the incidence of iatrogeny in patients, which is a serious public health problem and even more in mental health.

Methods

Systematic review of bibliography.

Objectives

Do a systematic review of bibliography and through the results invite to the analytic and critic reflection of our professional activities and the current situation of mental health.

Results

There is not enough studies about quaternary prevention in mental health.

–Some studies found that about one-third of diseases of a hospital are iatrogenic, most of them for pharmacological causes.

–There is iatrogeny at different levels of the attention of mental health: primary prevention, diagnosis and treatment.

–Non-treatment indication avoids in multiple cases iatrogenesis and contributes to the correct distribution of the economic and care resources.

Conclusions

Since one of the fundaments of medicine is “primun non nocere” that means “first do no harm” and one of principles of bioethics is “non-maleficence”, quaternary prevention should prevail over any other preventive or curative option.

–We should define in a more realistic way the limits, benefits and damages of our interventions in order to not promote a passive and sick role.

–Must be recognized the non-treatment intervention as a therapeutic and useful intervention, and one of the best tools of quaternary prevention.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Multidisciplinary approach in old aged dying patients
Authors: Ogando Portilla N. , Bañon González S.M. , García Jiménez M.G.
Published: June 2017

Introduction

Over centuries, clinicians have had the responsibility to take care of dying patients. Lately, the withdrawal of life sustaining treatments have assumed a main role in these patients because of ethical aspects. Competent patients have the right to refuse medical care but not always these rights are respected or even explained to them, especially if they are old or they don’t have any close family. A multidisciplinary team should agree on how they think it is best to care for the patient and whether withdrawal of medical interventions is appropriate by using patient's wishes.

Objectives

To identify the most relevant aspects to deal with in old aged dying patients.

Methods

Systematic literature review in Up-to-date and Pubmed.

Clinical case 83 years-old-man with a gastric cancer state IV. Married with a woman with Dementia who is waiting for a long stay public residence. No children. No cognitive damage. Fatal prognosis with a need of permanent enteral nutrition, which, he doesn’t want to use and clinicians strongly recommends. Great anxiety and suffering. Decision making capacity. Wish to die.

Discussion

Patients with the capacity to make medical decisions can refuse medical care even if this refusal results in their death. Sometimes, a “comfort measures only” can be a better option than trying to keep life. Old people with no family are often less informed and taken in count in making decisions. A symptom management, good patient-clinicians communication, psychosocial, spiritual, and practical support and respecting patient's wishes and decisions is a main goal in any medical care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Evaluation of elder physical abuse
Authors: Buicu G.E. , Gabos Grecu M. , Salcudean A. , Gabos Grecu I. , Marinescu C. , Nirestean A. , Turliuc S. , Hadareanu V. , Udristoiu I.
Published: June 2017

Background

In the society we belong to, elders are the target of abuse which is many times generated by the social cultural tendency which promotes different expressions in terms of age, a tendency which also measures capacity in terms of age.

Objective

To evaluate elder physical abuse – cases reviewed at the Forensic Institute, Tirgu Mures County, Romania.

Methods

An experimental design was used, focusing on elder physical abuse cases involving victims aged 65 or older, who requested a forensic certificate. All cases were reviewed at the Forensic Institute Tg. Mures, Mures County, Romania between 1st of Jan–31st Dec 2014. Variables included: age, gender, environmental origin, physical abuse, sexual abuse, relationship with the perpetrator (relative, known person/neighbor, unknown person, husband/wife), the required number of days of hospitalization, victim previous psychiatric diagnosis, aggressor previous psychiatric diagnosis.

Results

A total of 5252 forensic medical certificates were issued at request by the Forensic Institute of Tg Mures. One hundred and twenty (2.28%) were related to acknowledgement of the aggression of an elderly peIntroductionrson (≥65 years, with an average age of 69.89 years CI: 68.8903–70.8930). The majority of subjects were males (65%), of rural origin (64.17%). The same address as the aggressor's was identified in most of the cases (41.66%). 35.83% were hurt by neighbours/acquaintances, 22.5% were attacked by strangers.

Conclusion

We are aware of that an elder abuse appears to occur most often in domestic home situations, men from rural, more often than women, are involved that victims and may be perpetrated by adult family members, or other persons.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The prevalence of obesity among forensic intellectual disability inpatients
Authors: Denman R. , Chester V. , Watson J. , Nyakunuwa C. , Alexander R.
Published: June 2017

Background

Inpatient mental health settings have been described as “obesogenic” environments, due to factors including psychotropic medication, high calorie food, restricted physical activity and sedentary lifestyles. No research has investigated obesity among forensic intellectual disability inpatients, despite this populations’ increased risk. Therefore, this paper aims to evaluate the prevalence and correlates of overweight and obesity on, and during admission.

Method

The weight and body mass index data of 46 inpatients (15 women and 31 men) within a specialist intellectual disability forensic service was examined for the study.

Results

Only six patients (13%) were a normal weight at admission, whereas 40 (87%) were overweight or obese. During their admission, 28 (61%) gained weight (average 11.8 kg), and one (2%) maintained. However, 17 patients (37%) lost weight (average 6.2 kg), though 16 remained in overweight/obese categories. There was no correlation between length of stay and weight/BMI.

Conclusions

The majority of patients were overweight or obese on admission, and approximately 60% gained weight during their admission. Women appeared at greater risk of obesity. There was no relationship between length of stay and weight. This is potentially due to the high prevalence of obesity on admission and the impact of previous admissions on weight. The results highlight the need for effective weight management interventions with this population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Predicting offense recidivism in Schizophrenia patients
Authors: Oueslati B. , Ali M. , Ridha R.
Published: June 2017

Introduction

Schizophrenia increases the risk of offending. Recidivism rates are significant.

Aim

Identifying general and violent recidivism risk factors in schizophrenia patients.

Methods

We conducted a case control study. All included patients were admitted, at least once, to the forensic psychiatry department in Razi Hospital between January 1st, 1985 and December 31st, 2014 after a decision of irresponsibility by reason of insanity. All those who reoffended during this period were considered as cases. A draw was performed to create the control group. Both groups were matched according to their first offences’ types as well as to their ages. A multivariate analysis was performed.

Results

We included 25 cases and 38 controls. Eight recidivism risk factors were identified. Living in urban poor neighbourhoods (P = 0.039; OR = 1.23), having been unemployed (P = 0.047; OR = 1.22) and not having lived with the family (P = 0.039; OR = 1.36) after discharge were considered as risk factors. The same applied to alcohol (P = 0.032; OR = 1.29) and cannabis use disorders (P = 0.005; OR = 1.34). A hospitalization shorter than 6 months increased the risk by 1.44 (P = 0.039). A combination of conventional antipsychotics (P = 0.003; OR = 1.36) and a poor adherence (P = 0.006; OR = 1.36) were considered as recidivism risk factors too.

Conclusions

All eight recidivism risk factors are dynamic. This makes recidivism prevention conceivable. Measures involving the patient, the health care system, patients’ families, society and the government should be taken.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Sadistic sexual assault, perversion and schizophrenia: A case report
Authors: Zghal M. , Fekih Romdhane F. , Jmii G. , El Ghali F. , Belkhiria A. , Jouini L. , Ghazeli I. , Ridha R.
Published: June 2017

Introduction

In some forms of sexual perversion, sexual satisfaction is achieved only by treating one's partner violently (sadism) or conversely, by suffering pain (masochism).

Objective and method

The objectives of our study were to understand the complex relationship between psychotic and perverse structures, and discuss the importance of some criminal risk factors for psychotics who have sexually perverse behaviors, through clinical observation and review literature.

Case report

Mr AB was 35-year-old, single and unemployed. He was hospitalized in our forensic psychiatric department following a dismissal for criminal responsibility for an act of emasculation on a child aged 5 years without sexual abuse. In his biography we have objectified cruelty to animals, charged judicial history (imprisonment for theft, murder and escape from prison, hetero aggressive acts) and substance use.

The patient explained with indifference that he heard voices making fun of his “sexual impotence and loss of his manhood”. The day of the forensic act, he got an uncontrollable urge to emasculate the first man he met on his way at the behest of this hearing hallucinatory activity. Psychiatric experts retained the diagnosis of psychosis with perverse arrangements. Under neuroleptic treatment, psychotic symptoms disappeared but the patient's sadistic problems remained present and active throughout his hospitalization.

Conclusion

The following case illustrates the issue of dangerousness and responsibility in a perverse psychotic author assault of a sexual nature. Given their clinical history, the path between perversion and psychosis shows that perverse manifestations are prior to the first psychotic symptoms and the perverse constitution is developed parallel to the psychotic illness.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Family-based association study between the brain derived neurotrophic factor (bdnf) gene and the attention deficit hyperactivity disorder in a Mexican population
Authors: de la Cruz J.P. Sánchez , López López A. , Tovilla Zárate C.A. , Molina Sólis R. , Valencia Hernández A. , Gómez Valencia L. , Rivera Angles M.M. , López Narváez M.L. , Bermúdez Ocaña D.Y.
Published: June 2017

The attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disease in infancy and adolescence, its world prevalence in the general population is high 3.4%. There is genetic evidence that consistently supports the polygenic nature of ADHD with a heritability estimated between 75% and 91%; literature proposes that the brain derived neurotrophic factor (BDNF) is a candidate gene that participates in the ADHA pathogenesis. One of the most studied polymorphisms is the Val66Met. The aim of this study was to determine a family-based an association between the rs6265, rs122,733,63 and rs110,301,19 polymorphisms of the BDNF gene and the ADHD in a Mexican population. The ADHD diagnose was performed by a pedopsychiatrist utilizing the diagnostic and statistical manual of mental disorders (DSM-V) who selected 35 patients; along with the biological parents, a total of 105 individuals grouped in family-trios (mother, father and ADHD patient) were studied. Of the 35 probands, 32 were men and 3 were women (average age 7.7 years; age range 4–14 years). Subsequently, no statistically significant association was observed between the BDNF gene polymorphisms and the ADHD etiology in Mexican families: rs6265 (χ2 = 1.33; P = 0.24); rs122,733,63 (χ2 = 1.33; P = 0.24); rs110,301;19 (χ2 = 0.66; P = 0.41). Furthermore, no preference of transmission was observed for any of the haplotypes. In conclusion, it was not possible to prove any association between the BDNF gene polymorphic variants and ADHD in a Mexican population. Future studies comprising larger samples are necessary to determine the potential role of the BDNF gene in ADHD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Kleefstra syndrome: Considerations about treatment strategy in 2 patients with a causative Ehmt1 mutation and apathy
Authors: Verhoeven W.M.A. , Egger J. , De Leeuw N. , Kleefstra T.
Published: June 2017

Introduction

Kleefstra syndrome [OMIM: 610253] is caused by a 9q34.3 micro-deletion or an intragenic mutation in the EHMT1 gene. Its core phenotype comprises intellectual disability, childhood hypotonia and distinct dysmorphisms. The syndrome can be associated with congenital anomalies, epilepsy, cardiac arrhythmias and a typical sleep pattern. Starting from adult age, a regressive phenotype may develop.

Objectives

Further delineation of the neuropsychiatric phenotype.

Aims

Formulating a comprehensive treatment approach.

Methods

Detailed examination of two patients with EHMT1 mutation.

Results

Patient 1, male aged 34 years, showed recurrent behavioral problems with aggression and self-injuries as well as obstipation. Elsewhere, a diagnosis of autism was established. Aged 24, he suffered from some epileptic seizures. Recently, paroxysmal atrial fibrillation was diagnosed. Neither treatment with pipamperone and risperidone nor with valproate was effective for behavioral control. Array analysis and metabolic screening did not reveal abnormalities. Whole exome sequencing revealed an intragenic EHMT1 mutation. Patient 2, female aged 53 years, was known with childhood epilepsy and developed gradual decline of general functioning with motor slowing from her third decade. In her thirties, a mood/anxiety disorder was suspected for which several antidepressants were given without any effect. Array analysis was normal. A pathogenic nucleotide deletion was identified resulting in a frame-shift in exon 21 of the EHMT1 gene. In both patients marked apathy was observed (AES = 62 and 64, respectively).

Conclusions

Apathy syndrome in Kleefstra syndrome should be differentiated from depression and autism. Apart from treatment with selected psychotropics, individually targeted contextual measures should always be implemented.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A qualitative study of attitude towards people with mental illness among nurses in Saudi Arabia
Authors: Alshowkan A.
Published: June 2017

Introduction

Nurses are the most important contributor of care during patients’ hospitalization and have become an important source in the delivery of mental health care. However, the attitudes and ability of many nurses in providing this care have been shown to be deprived, and this may have a negative effect on providing patients’ care. There is a little is known about the attitude of nurses toward people with mental illness in Saudi Arabia.

Objective

This study has a qualitative research design. The main aim of this study is to explore the attitude of nurses toward people with mental illness in Saudi Arabia.

Method

Data were collected through semi-structured fact to face interviews with nurses. Thematic analysis was used for data analysis.

Results

Data analysis identified three main themes that affect nurses’ attitude toward people with mental illness. The identified themes are: 1) personal factors, 2) social factors, and 3) factors related to the view of mental illness.

Conclusion

This study concluded that there are a number of factors that affect nurses’ attitude toward people with mental illness. Several recommendations were discussed related to nurses’ education, continuous mental health training courses, public education about mental health and mental health nursing, and mental health care and resources.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
A Proposal of an innovative program for informal caregivers of patients with mood disorders
Authors: Cabral J. , Carvalho C. Barreto , Freitas P. Castilho , Pato C.
Published: June 2017

Introduction

Intervention with informal caregivers (IC) of psychiatric patients is internationally recognized as relevant and a priority. However, the existing responses in this area are still insufficient, especially regarding caregivers of individuals with mood disorders (MD). Mindfulness and compassion focused therapy have proven to be an effective approach in stress reduction and in improving emotional and social well-being of caregivers of patients with other conditions. However, no studies testing these new approaches in IC of patients with MD have been carried out. The objective of this work is to present a research project that aims to develop, implement and empirically test the effectiveness of an innovative group program to help informal caregivers of individuals with mood disorders to cope with the negative impact of the disease and reduce caregiver burdens.

Methods

The design of this experimental study to test the program's efficacy is a non-randomised controlled trial (nrct) with 12 months follow-up, with a mixed assessment methodology (quantitative and qualitative analysis). A sample of 60 informal caregivers of individuals with chronic MD will be constituted (n = 30 Control group; n= 30 Experimental group).

Results

We expect the program to promote significant changes in participants in terms of several emotional variables (eg: burden, stress, resilience, compassion and quality of life).

Conclusions

Further efforts to continue studying the impact of interventions in caregivers should be carried out, as a way to improve the quality of life of caregivers and their ability to provide informal care to MD patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Burnout of Caregivers in Geriatric Institution: “Coping” Strategies
Authors: ammar H. Ben , Hamdi G. , hechmi Z. El
Published: June 2017

Introduction

The health sector has long been recognized to be a very stressful work environment for teams that can lead to “burnout”. Geriatric institutions are no exception to this observation; this state has deleterious effects on health care as on the quality of care.

Objectives

Measure the burnout rate among caregivers in geriatric institutions and identify associated factors and coping strategies specific to this population in order to provide the necessary preventive measures.

Subjects and method A cross-sectional study, conducted among caregivers exercising at the shelter for aged subjects of Manouba, Tunisia. We used a pre-survey exploring the socio-demographic data associated with two validated scales: the Maslach Burnout Inventory assessing the level of burnout and the Brief COPE assessing coping strategies.

Results

Thirty-one subjects were recruited. The prevalence of burnout was 45.16%. Respectively 32.26%, 25.80% and 45.16% of the respondents had high scores in dimensions emotional exhaustion, depersonalization and personal accomplishment at work. The analytical study revealed that seniority in work increased the risk of burnout. The coping strategies of caregivers in geriatric institution facing burnout were mainly centered on emotion. The number of years of experience has been associated with burnout in our study.

Conclusion

This work reaffirms that the population of caregivers in geriatric institution is at risk of burnout and allows to identify predictors. The establishment of individual and collective measures is essential for appropriate treatment references (In the body text, a publication should be referred to by a consecutive number between bracket)

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Assessment of a Drama Therapy Process for Patients with Severe Psychiatric Patients
Authors: Sancar F. , Şahin S. , Şahin G. , Eren N.
Published: June 2017

Introduction

Drama therapy is a useful therapy method for improving the life quality of psychiatric patients. Drama therapy is a rehearsal of everyday life. In this therapy method, clients actively join the creative process in order to better understand their life experiences.

Objectives

Drama therapy may improve patients’ ego functions, psycho-social and self-expression abilities, problem-solving skills, real-life adaptations and contribute to patient's psychiatric treatment.

Aim

The main aims were to examine the curative effects of drama group therapy and the effects of drama therapy on functionality in psychiatric patients.

Method

The study was performed at the Istanbul University Faculty of Medicine. Patients were referred from the Psychiatry Polyclinic of this university to Art Therapy and Rehabilitation Program. Drama therapy is an applied drama-based art group therapy. The 10 subjects in our study, ranged from 20 to 50 years old. This therapy group gathered once a week for a ninety minute session. Subjects continued their medical care and received psychotherapy throughout the 24-week study. The therapy plan included an introduction, a warm-up session, a drama therapy work and a sharing session. Patients were assessed in pre and post-treatment with Global Assessment of Functioning and Wilcoxon Signed Ranks Test was used for statistical analysis. Yalom's Group Curative Factors Scale was applied.

Result

There was a significant decrease in loss of functioning (P < .05). In Group Curative Factors, the means of hope, identification, group cohesion and altruism were determined high.

Conclusion

Our study demonstrates that drama therapy has positive effects on patients with severe psychiatric patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Attitudes Towards Psychiatry Among Physiotherapy Students in Poland – pilot Study
Authors: Szczegielniak A.R. , Szczegielniak J.
Published: June 2017

Poor knowledge regarding mental health in general population in Poland, along with media coverage limited to repetition of harmful stereotypes towards patients treated at psychiatric wards and reinforcement of discriminative attitudes, results in an unfair evaluation and stigmatization of mental healthcare services. As a consequence, psychiatry, in comparison to many other medical fields, is unpopular among physiotherapy students, even though there is a compulsory subject in the university curriculum that covers, in theory, all the important knowledge that healthcare worker should possess in this regards. Young physical therapists are not taught about specific needs of the psychiatric patients. After graduation, they are lacking all basic skills on how to communicate with the patient. Being devoid of a direct contact with people suffering from mental disorders, physical therapists do not feel comfortable placed in the mental healthcare facilities. The aim of the study was to assess the extent of a basic psychiatric knowledge and general attitudes towards mentally ill of the physiotherapy students. The group consisted of 147 students. The pilot study has been limited to those studying physical therapy within borders of the Opole voivodship. Authors’ questionnaire has been developed in order to reach the aim and answers were gathered between January and June 2016. The results will be used to develop questionnaire suitable to share with physiotherapy students within the whole country and, consequently, formulate recommendations on necessary changes that must be introduced to the physical therapy curriculum in Poland by Polish Society of Physiotherapy (Psychiatry Section).

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Feelings of Guilt and Fantasies in Life Experiences of Brazilian Parents Due to Death of their Newborn: A Clinical-qualitative Study Conducted at a University Hospital
Authors: Rodrigues L. , Freitas-de-Jesus J.V. , Lavorato-Neto G. , Lima D.D. , Turato E.R. , Campos C.J.G.
Published: June 2017

Introduction

The relationship between parents and children is a complex link. In the process of pregnancy-birth-puerperium, frequent feelings such as responsibility, love, fear, uncertainty, generate strong expectations at birth. The death of a newborn may not be perceived as natural by the parents, considering the local culture and the context of great technological development of neonatology.

Objective

To explore possible guilt and fantasies in life experiences of parents during mourning process due to death of their newborn.

Method

Clinical-qualitative design, a particularization of qualitative methods here applied in clinical assistance settings with highlight to psychological aspects. Data collection with the technique of semi-directed interview with open-ended questions, in-depth. Sample intentionally constructed, with closure by theoretical saturation of information. The participants were 7 parents, mourning by the death of their child at the neonatal intensive care unit, in a university hospital of Campinas, São Paulo State.

Results

Feelings of guilt - conscious or not - lead to an internal and particular movement so that mourning can be lived. The participants showed certain embarrassment, accompanied by natural suffering facing to the cultural pattern that permeates the emotional experience. It predicts types of psychological meanings that the experience will give to the person.

Conclusion

Health professionals working with bereaved parents should consider more deeply the moment these one experienced, with emphasis on the details of the death scenery, beside the problems of illness and death properly so called.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Stigma as an Obstacle to Paradigm Change in Mental Health Care in Lithuania
Authors: Sumskiene E.
Published: June 2017

The paper is based on the data gathered during implementation of the “Project paradigm change of mental health and Well-being in Lithuania: towards empirically valid model”. This project is aimed to contribute to the paradigmatic change by scientific research and evaluation of efficacy of pharmaceutical and psychotherapeutical treatment to psychological and social functioning and to estimate economic burden of treatment and mental diseases. Aim of the research is to analyse stigma as an obstacle for transition from biomedical to bio-psycho-social paradigm. Objectives are as follows: to evaluate manifestations of stigma in mental health care from the point of view of different experts; to discuss influence of stigma on different levels of mental health care; to identify consequences of stigma to mental health care reform. A qualitative experts’ research was implemented in order to reveal professional discourse around stigmatization of mental health and consequences of this phenomenon to mental health care reform. Research data reveal the strong prevalence of stigma on all levels mental health care. Individuals with psychosocial disabilities tend to choose medication instead of psychotherapy. Under influence of stigma, they prefer rapid daily consumption of medication as a substitute to active participation in the process of treatment. Politicians are influenced by stigmatizing attitudes in the society towards individuals with psychosocial disabilities, the persisting pressure to isolate them in closed facilities. Under influence of stigma, the process of reform lingers or obtains a shape reverse to a modern transformation.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Vascular Disease and Trajectories of Late-life Major Depressive Disorder in Secondary Psychiatric Care
Authors: Musliner K. , Laursen T. , Munk-Olsen T. , Liu X. , Mortensen P. , Zandi P. , Eaton W.
Published: June 2017

Objectives

To examine 5 years trajectories of secondary-treated late-life major depressive disorder (MDD), and evaluate whether pre-existing cerebrovascular disease and related risk factors are associated with more severe trajectories of late-life MDD.

Methods

Data were obtained from Danish registers. The sample included 11,184 adults ≥ 60 at index MDD diagnosis. Trajectories of in or outpatient contact at psychiatric hospitals for MDD over the 5 years period following index MDD diagnosis were modeled using latent class growth analysis. Risk factors included cerebrovascular disease, cardiovascular disease, hypertension, diabetes, and vascular dementia defined based on hospital diagnoses and prescription medications, demographic characteristics and characteristics of the index MDD diagnosis.

Results

The final model included classes with consistently low (66%), high decreasing (19%), consistently high (9%) and moderate fluctuating (6%) probabilities of contact at a psychiatric hospital for MDD during the 5 year period following the index MDD diagnosis (Fig. 1). Older age, greater severity, inpatient treatment and > 12 antidepressant prescriptions within 5 years of the index MDD diagnosis predicted membership in more severe trajectory classes. Cerebrovascular disease and related risk factors were not associated with trajectory class membership.

Conclusions

A substantial proportion (34%) of individuals diagnosed with MDD in late-life require specialized psychiatric treatment for extended periods of time. We found no evidence that cerebrovascular disease or related risk factors predicted course trajectories in secondary-treated late-life MDD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Self-stigma, Hope, Dissociation, and Personality Features in Treatment of Depressive Inpatients Resistant to Pharmacotherapy
Authors: Prasko J. , Ociskova M. , Sigmundova Z. , Kasalova P. , Grambal A. , Holubova M. , Marackova M. , Vrbova K. , Latalova K. , Slepecky M. , Zatkova M. , Kotianova A.
Published: June 2017

Objective

The goal of this study was to examine the influence of dissociation, hope, personality trait and selected demographic factors in treatment response of this group of patients.

Methods

Pharmacoresistant depressive inpatients completed clinical global impression – both objective and subjective form, Beck depression inventory, and Beck anxiety inventory at baseline and after six weeks of combined pharmacotherapy and psychotherapy (group cognitive behavioral or group psychodynamic). The Internalized Stigma Of Mental Illness Scale, Dissociative Experience Scale Adult Dispositional Hope Scale, and temperament and character inventory were completed at the start of the treatment with the intention to find predictors of treatment efficacy.

Results

The study included 72 patients hospitalized for the pharmacoresistant major depression, 63 of them finished the study. The mean scores of BDI-II, BAI, subjCGI, and objCGI significantly decreased during the treatment. BDI-II relative change statistically significantly correlated with the total ISMI score, discrimination experience (ISMI subscale), and harm avoidance (TCI-R personality trait). According to stepwise regression, the strongest factors connected to BDI-II relative change were the duration of the disorder and discrimination experience (ISMI). ObjCGI relative change significantly correlated with the level of dissociation, the total ISMI score, and hope in ADHS total score, and self-directedness. According to stepwise regression, the strongest factor connected to objCGI relative change was discrimination experience (ISMI).

Conclusions

According to our results, the patients with pharmacoresistant depressive disorders, who have had more experience with discrimination because of their mental struggles, showed a poorer response to treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mental Health Stigma: What's Been Done? Where to Go?
Authors: Macedo P. , Silva M. , Fornelos A. , Figueiredo A.R. , Nunes S.
Published: June 2017

Introduction

Negative attitudes towards psychiatric patients still exist in our society. Persons suffering from mental illness frequently encounter public stigma and may internalize it leading to self-stigma. Discrimination occurs across many aspects of economic and social existence. It may represent a barrier for patients to receive appropriate care. Many anti-stigma campaigns have been taken to decrease people's prejudice, but its effects are not well documented.

Objectives

To characterize anti-stigma initiatives and its effects on diminishing negative consequences of stigma.

Methods

Bibliographical research using PubMed using the keywords “stigma” and “mental illness”.

Results

Despite several approaches to eradicate stigma, it shows a surprising consistency in population levels. It was expected that focus on education would decrease stigma levels. The same was expected following concentration on the genetic causation of pathology. Most studies have revealed that education has little value and endorsing genetic attributions has led to a greater pessimism on the efficacy of mental health services, sense of permanence and guilty feelings within the family.

Conclusion

Public stigma has had a major impact on many people with mental illness, especially when leading to self-stigma, interfering with various aspects in life, including work, housing, health care, social life and self-esteem. As Goffman elucidated, stigma is fundamentally a social phenomenon rooted in social relationships and shaped by the culture and structure of society. Social inclusion has been pointed as a potential direction of change.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pharmacological Issues in Cancer Patients
Authors: Alves M. , Tavares A.
Published: June 2017

Introduction

Depression and anxiety are the main causes of psychiatric disorder in cancer patients, associated with a decreased tolerance and adherence to cancer treatment, longer hospital stays, decreased quality of life and possibly influence prognosis and mortality.

Objectives

This review will address psychopharmacological options in cancer patients, side effects and possible drug interactions between psychotropic drugs and chemotherapy, either by toxicity, to which these patients are more sensitive, or a reduction in efficacy in anti-tumor treatment.

Methods

Non systematic literature review through the Medline and clinical key databases, with time constraints.

Results

Selective Serotonin Reuptake Inhibitors are the first line treatment for depression, because of their tolerability and safety profile. Venlafaxine is the safer choice for the treatment of depression and hot flushes in women with breast cancer undergoing chemotherapy with tamoxifen. Tricyclic antidepressants are used in patients with neuropathic pain, due to its analgesic properties. Haloperidol is the safest antipsychotic, with less drug interactions and lower metabolic risk. Benzodiazepines are used in anxiety states for short periods. Psychostimulants are an option in patients with depression and life expectancy of less than one month. Mood stabilizers are recommended to treat mania, commonly induced by corticosteroids.

Conclusions

Treatment of psychiatric disease in cancer patients leads to an increased adherence to anti-tumoral treatment and improves quality of life. Regardless of the cancer stage there is indication to start treatment. We must, however, take into account possible side effects and drug interactions between psychotropic drugs and chemotherapy, through toxicity or diminished efficacy, when combined with anti-tumoral treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicides and Cancer Mortality in Russia: A Comparative Analysis of Trends
Authors: Razvodovsky Y.
Published: June 2017

Introduction

The association between suicide and cancer is complex. Hopelessness and depression are the common risk factors for both suicide and cancer. There is also evidence that suicide rate in cancer patients are higher than in the general population. However, the real occurrence of suicide in cancer patients is considered to be underreported. This is a good reason to expect a positive relationship between cancer mortality and suicide rates at the population level.

Aims

The present study aims to test the hypothesis of the close aggregate level link between cancer mortality and the suicide rates in Russia.

Methods

Trends in sex-specific cancer mortality and the suicide rates from 1956 to 2010 were analyzed employing a distributed lags analysis.

Results

The results of analysis indicate the presence of a statistically significant association between trends in suicides and cancer of the upper digestive tract (mouth, oral cavity and pharynx), larynx, bronchus and lungs, stomach, colorectal, uretus and leukemia for male. There is also a statistically significant association between trends in suicides and cancer of the upper digestive tract (mouth, oral cavity and pharynx), larynx, bronchus and lungs, stomach, colorectal, uretus, breast, cervix, uterus and leukemia for female.

Conclusions

Common confounding variables, including binge drinking and psychosocial distress, may explain positive aggregate-level association between the cancer mortality and suicides time series in Russia.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Vulnerable Narcissism as Key Link Between Dark Triad Traits, Mental Toughness, Sleep Quality and Stress
Authors: Annen H. , Nakkas C. , Sadeghi Bahmani D. , Gerber M. , Holsboer-Trachsler E. , Brand S.
Published: June 2017

Introduction

The concept of the Dark Triad (DT) consists of the dimensions of Machiavellianism, narcissism, and psychopathy, and has gained increased interest within the last 15 years for its predictive power to explain success in the fields of economy, politics, and professional sport. However, recent research suggests that the associations between DT and behavior are not as uniform as expected.

Aims

Investigating the associations between DT traits and vulnerable narcissism, mental toughness, sleep quality, and stress perception.

Methods

A total of 720 participants between 18 and 28 years took part in the study. The sample consisted of military cadres in the US (n = 238), Switzerland (n = 220), and of students from the university of Basel (n = 262). Participants completed self-rating questionnaires covering DT traits, mental toughness, vulnerable narcissism, sleep quality, and perceived stress.

Results

Irrespective of the sample, participants scoring high on vulnerable narcissism also reported higher DT traits, lower mental toughness, poor sleep quality, and higher scores on perceived stress.

Conclusions

The present pattern of results suggests a more fine-grained association between DT traits and further behavior, calling into question to what extent DT traits might be a predictor for greater success in the fields of economy, politics or elite sports. Specifically, vulnerable narcissism seems to be key for more unfavourable behavior.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Effect of Treatment Recognition Based on Mental Conscious on Decreasing Depression and Stress on Those Affected by Lupus Disease and by 3 Months Follow Up
Authors: Farrokhi N. , Golmohammadi A. , Ghahari S.
Published: June 2017

Introduction

Systemic lupus erythemataus is a chronic inflammatory disease of the multimedia system that appear on renal involvement, cortical-mucous, bloody, and neurotic.

Aim

The target of this study is to examine the effect of treatment recognition based on mental conscious on decreasing depression intensity on lupus disease and three month follow up.

Method

The method of study is semi test by targeted random selection in access in which we have used of pre-test by observe group. Volume of sample includes 200 women afflicted by lupus and among them about 20 ones were ready to cooperate and in study duration were in related improvement situation and has been evaluated. They have been grouped in the two test group (ten persons) and observe one (10 persons) in which two persons has been excluded from test group and we have excluded two persons from observe group, too. Test group have received eight MBCT treatment sessions but observe group has not received any treatment. Beck depression questionnaire (BDI-II) and brief signs of psychology questionnaire (BSI-53) has been performed as pre-test and after clinical test, post-test and three-month-follow up has been done. We have used of descriptive statics and co-variance for analysis.

Results

Findings has shown that treatment recognition based on mental consciousness, meaningfully have an effect on decreasing remained signs of depression.

Conclusion

Three-month-follow up has shown that treatment recognition based on mental consciousness, had an effect on depression disorder, anxiety disorder, and lupus patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Factors Underlying Distressful and Recurrent Hallucinations, Perceptual Distortions, Dissociations and Impulses Associated with Playing Video Games
Authors: Ortiz de Gortari A.
Published: June 2017

Introduction

Failures in cognitive and behavioural inhibition are the core of mental disorders, but they are also part of everyday life. Research on Game Transfer Phenomena (GTP) has shown that images, sounds and thoughts from the game manifest, and involuntary actions toward game-related cues are performed, after playing. GTP is generally not associated with psychopathology, substance use, distress or dysfunction but a small number of gamers reported severe GTP (i.e. different types and frequently).

Aim

Understand the underlying factors (e.g. medical conditions, drugs, problematic/gaming addiction) associated with experiencing several episodes of particular GTP (e.g. hallucinations).

Methods

A total of 1,782 participants who experienced GTP “many times” or “all the time” was extracted from a larger sample recruited via an online survey. The 20 GTP-related items were categorized into: (i) hallucinations, (ii) distorted perceptions, (iii) dissociations, and (iv) urges/impulses.

Results

Pearson's Chi2 test showed that: (i) 18–22-year-olds were more prone to experience several episodes of GTP and females were more susceptible to hallucinations; (ii) all four categories were associated with mental disorders and distress/dysfunction; (iii) drugs were associated with almost all categories with the exception of distorted perceptions; (iv) visual disorders were associated with hallucinations and dissociations; and (v) problematic/gaming addiction was associated with all categories except urges/impulses.

Conclusions

The findings suggest that individuals with mental disorders are more prone to experience several episodes of GTP, which can lead to distress/dysfunction. Substance use appears relevant but not for all manifestations of recurrent GTP. The relation between gaming disorder and GTP requires further investigation.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Impact of an Intervention of Neuro-cognitive Rehabilitation in Treatment Resistant Schizophrenia (TRS) Compared to Schizophrenia Responder Patients
Authors: D’Ambrosio L. , Prinzivalli E. , Oliviero N. , Balletta R. , Callovini G. , Benedetta A. , Formato M.V. , Lattanzio S. , Razzino E. , Avagliano C. , Iasevoli F. , de Bartolomeis A.
Published: June 2017

Introduction

Schizophrenia is a condition with high impact in terms of disability, also because between 30% and 60% affected individuals do not respond to treatment. It has been proposed that cognitive functioning is strongly impaired in schizophrenia and even more in TRS patients. Cognitive dysfunctions are regarded to worsen psychopathology, psychosocial functioning, and overall course of the illness.

Objectives

To investigate the impact of Cognitive Remediation (CR) on psychopathology and psychosocial functioning in TRS vs. schizophrenia responder patients.

Aims

To determine whether a CR intervention could improve functional outcomes in TRS patients.

Methods

We evaluated proximal and distal effects of CR on approximately 20 schizophrenia responders and 20 TRS patients. Patients in each group were randomized to receive CR or not. Patients were assessed in training task performance, neurocognition, functional capacity, symptoms and psychosocial functioning. Evaluations were conducted at baseline, at the end of the 4-month intervention, and at 6-month, 1 and 2 year-follow-ups. The study is still in active recruitment phase.

Results

Both TRS and schizophrenia responder patients exposed to CR exhibited a significant improvement in specific neurocognitive domains, and in psychosocial functioning as assessed by either rating scales (SLOF and PSP) and performance-based measures (UPSA) at the 4-month time-point.

Conclusions

CR improved psychosocial functioning in both group of patients, however, they were more pronounced in TRS patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.