bluuebunny/crossref_metadata_2025 huggingface dataset:
Working Together for Early Detection of Psychosis
Authors: Riecher-Rössler A.
Published: June 2017

Introduction

In the last decades psychiatry has taken an important and overdue step which other medical disciplines had taken much earlier, i.e. recognizing the chances of early detection and intervention–first in the field of emerging psychosis, in the meantime also in other fields.

Objectives

To review new developments in the field of early detection of psychosis and to critically discuss the obstacles still depriving many of our patients of an immediate benefit.

Methods

Review and discussion.

Results

New developments are very promising. Identification of individuals at risk and prediction of transition to psychosis is possible with an excellent accuracy, comparable to other preventive approaches in medicine. And there is growing evidence how this accuracy can even be more improved by using not only clinical assessments but also additional domains such as neurocognition, neurophysiology, or MRI, as well as new methods for analyses such as pattern recognition. Staged intervention according to the degree of risk seems feasible.However, there are still many obstacles to a broad implementation of this new know-how into clinical practice such as lack of communication, political will and finances, or fears, stigma and prejudices.

Conclusions

For the benefit of those concerned - patients and their relatives - a great effort to work together is required from all of us: clinicians, researchers from psychiatry and many other fields, industry, politicians, and last, but not least, patients and their relatives.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Psychotherapies vs. Pharmacotherapies vs. Combination Therapies in Depressive and Anxiety Disorders
Authors: Cuijpers P.
Published: June 2017

Both psychological and pharmacological therapies have been found to be effective in the treatment of adult depression and anxiety disorders. Psychological treatments include cognitive behavior therapy, interpersonal therapy, behavioral activation, exposure therapies, and several other types of therapy. Pharmacological treatments include SSRIs, SNRIs TCAs, MAIOs and several other types. In this presentation the results of meta-analyses of trials directly comparing the effects of psychological and pharmalogical treatments will be presented, as well as meta-analyses of combined treatments versus either psychotherapy alone or pharmacotherapy alone. Results show that psychological and pharmacological treatments are probably about equally effective at the short term, and combined treatment is more effective than either psychotherapy or pharmacotherapy alone. In the presentation several other issues related to this group of trials will be discussed, like the influence of conflicts of interest and the (lack of) blinding in psychotherapy trials.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Joint Symposium: How Long Do We Have to Wait for the Antidepressant Effect? Mechanisms of Action for Delay of Onset Response to Antidepressants
Authors: Artigas F.
Published: June 2017

Major depressive disorder (MDD) is a severe psychiatric syndrome with very high prevalence and socioeconomic impact. Monoamine-based antidepressant drugs (AD) display slow onset of action and limited efficacy. Preclinical studies show that ADs trigger a series of slow adaptive mechanisms that limit the clinical response. These mechanisms result from the pharmacological blockade of monoamine transporters (SERT, NET) and involve presynaptic, such as autoreceptor desensitization (e.g., 5-HT1A and 5-HT1B for serotonin neurons) as well as postsynaptic mechanisms, such as increased neurogenesis and expression of trophic factors, increased dendritic complexity, etc.

Given the strong homeostasis of serotonin and noradrenaline neurons, a way to improve antidepressant action is to prevent self-inhibitory presynaptic mechanisms mediated by auto- and heteroreceptors after reuptake blockade. This strategy was used in the past with the non-selective 5-HT1A antagonist pindolol and has been incorporated by two recently developed AD (vilazodone and vortioxetine). Likewise, new molecular strategies using RNA interference (RNAi) show that the modulation of gene expression in serotonin neurons offers a great potential. Hence, local or intrnasal administration of small interfering RNA (siRNA) molecules targeting SERT or 5-HT1A autoreceptors evokes rapid and robust antidepressant-like effects in rodents.

Moreover, glutamatergic drugs such as the non-competitive NMDA receptor antagonist ketmaine, offer a potential for the development of fast-acting AD due to its rapid and persistent antidepressant effects in treatment-resistant unipolar and bipolar patients after single i.v. infusion, an effect that likely involves the activation of AMPA receptors in ventral areas of the cingulate gyrus and the subsequent fast activation of serotonergic function.

Disclosure of interest

F.A. has received consulting honoraria on antidepressant drugs from Lundbeck and he has been PI of grants from Lundbeck. He is also co-author of the patent WO/2011/131693 for the siRNA and ASO (antisense oligonucleotides) molecules.
Neuroimage Studies: The Effect of Methylphenidate in Cocaine Users with ADHD
Authors: Crunelle C.
Published: June 2017

Background

Attention deficit/hyperactivity disorder (ADHD) is an important contributing factor in the pathophysiology of substance use disorders (SUD), and ADHD occurs more often in populations with SUD compared to the general population. This high prevalence rate and comorbidity may relate to a shared neurobiological vulnerability, including a deregulation of the brain's dopamine system. This comorbidity directly impacts the treatment of ADHD: treatment with methylphenidate is less effective in patients with ADHD and SUD compared to ADHD patients without SUD.

Methods

We investigate the underlying neurobiological background of reduced treatment effectiveness for adult ADHD patients with comorbid SUD.

Results

We observed lower available dopamine transporters, as well as a reduced binding of methylphenidate to these transporters, and more neurocognitive dysfunction in adults ADHD patients with SUD compared to ADHD patients without SUD.

Conclusion

Comorbid ADHD and SUD has a high prevalence rate and reduces ADHD treatment effectiveness, which makes it necessary to screen for the presence of ADHD in patients seeking SUD treatment. Neurobiological and neurocognitive differences are present between ADHD patients with and without SUD, which together may partially explain the reduced effectiveness of methylphenidate in adult ADHD patients with SUD.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Progressive Frontal Dysconnectivity During Working Memory in eos Patients: A Longitudinal Functional MRI Study
Authors: Frangou S. , Kyriakopoulos M. , Danai D.
Published: June 2017

Working memory (WM) dysfunction is considered a cardinal feature of schizophrenia. Typically developing adolescents show significant gains in WM performance, which have been attributed to increased “frontalisation” within the fronto-cingulate-parietal network that underpins WM. We used functional magnetic resonance imaging and psycho-physiological interaction to measure blood oxygenation level–dependent signal and functional connectivity in response to the 2-back WM task from 25 youths with EOS and 25 yoked healthy adolescents that were assessed twice with a mean interval of 4 years between assessments. Patients showed reduced prefrontal connectivity at baseline and the magnitude of this effect increased over the follow-up period. Our results suggest on-going functional connectivity abnormalities in EOS patients’ post-disease onset that are linked to prefrontal dysfunction and contribute to worsening WM despite anti–psychotic treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Baseline, Two-year, and Five-year Follow-up of Children and Adolescents with First-episode Psychosis: A Spanish Cohort
Authors: Janssen J. , Schnack H. , Martínez K. , Santonja J. , Aleman-Gomez Y. , Pina-Camacho L. , Fraguas D. , Moreno C. , Arango C. , Parellada M.
Published: June 2017

Background

Early-onset first-episode psychosis (FEP) and high functioning autism spectrum disorders (ASD) are complex neuro–developmental disorders that share symptomatology but it is not clear if they also share neurobiological abnormalities (Chisholm et al., 2015). We examined thickness, surface area and volume in a direct comparison of children and adolescents with FEP (onset before 18 years), high-functioning ASD, and healthy subjects.

Methods

Magnetic resonance imaging scans of 85 participants (30 ASD, 29 FEP, 26 healthy controls, age range 10–18 years) were obtained from the same MR scanner using the same acquisition protocol. The FreeSurfer analysis suite was used to quantify vertex-wise estimates of the metrics thickness, surface area, and volume.

Results

ASD and FEP had spatially overlapping insular deficits for each metric. The transdiagnostic overlap of deficits was greatest for volume (55% of all insular vertices) and smallest for thickness (18%). Insular thickness and surface area deficits did not overlap in ASD and overlapped only in 8% of all insular vertices in FEP.

Conclusions

Morphological insular deficits are common to FEP and high functioning ASD when compared to healthy participants. The pattern of deficits was similar in both disorders, i.e. a largely non-overlap of insular thickness and surface area. The non-overlap provides further evidence that these metrics represent two independent outcomes of corticogenesis, both of which are affected in FEP and ASD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Interventions in the Health and Non-health Sectors Aimed at Promoting Mental Health
Authors: Herrman H.
Published: June 2017

The impact of social determinants on women's mental health is becoming clearer worldwide. Poverty, violence and communal insecurity are among the main challenges to women's mental health and the health of their families. Depression is one of the most common mental disorders experienced by women. It typically has an early onset in life and is more frequently found in women made vulnerable by trauma.

Improving mental health for women and girls requires early intervention for depression and other mental disorders; with gender sensitive clinical care and support for recovery in primary health care, and mother, child and reproductive health settings. Early intervention in primary health care and collaboration with patients and family carers encourage integration of mental health with the health care system, in turn protective of human rights.

In addition, gender equity and observance of human rights need to be embedded in policy and practice in health and non-health sectors to ensure that women's mental health is promoted and mental illnesses adequately prevented and treated. Effective promotion of mental health and prevention of mental disorders is possible in countries of all income levels.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Women Mental Health and Trafficking
Authors: Schouler-Ocak M.
Published: June 2017

“Trafficking in persons,” “human trafficking,” and “modern slavery” have been used as umbrella terms for the act of recruiting, harboring, transporting, providing, or obtaining a person for compelled labor or commercial sex acts through the use of force, fraud, or coercion. Trafficking in persons is an insult to human dignity and an assault on freedom, and robbing basic human rights (US Report, 2015). Reliable data on trafficking are difficult to obtain owing to its illegal nature; the range and severity of trafficking activities; and variations in how trafficking is defined. It is supposed that 49 per cent of the victims are women, 21 per cent girls, 18 per cent men and 12 per cent boys. 53 per cent were involved in sexual exploitation and 40 per cent in forced labor (UN, 2014).

Research findings show that the limitations of current methodologies affect what is known about human trafficking and health. Moreover, findings demonstrate an urgent need for representative and non–purposive recruitment strategies in future investigations of trafficking and health as well as research on risk and protective factors related to human trafficking and health, intervention effectiveness, long-term health outcomes. The psychological impact of victimization may be more severe than the physical violence. Victims who have been rescued from sexual slavery, typically present with various psychological symptoms and mental illnesses, including the following: Post-Traumatic Stress Disorder (PTSD), depression, anxiety, panic disorder, suicidal ideation, Stockholm syndrome, and substance abuse. In this talk current findings will be presented and discussed.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Setting the Scene: The Evidence for Pre-clinical Change, Projections of the Impact of Intervention, and Implications for Public Health
Authors: Russ T.C. , Ritchie K. , Terrera G.M. , Ritchie C.W.
Published: June 2017

Alzheimer's disease has long been considered a neurodegenerative disorder of late life for which there is currently no disease-modifying treatment. This view is now being revised as increasing evidence suggests a long pre-clinical phase extending back into mid-life during which there is exposure to multiple potentially reversible risk factors. Further thought is now being given to the possibility of both early life intervention programs and development of new drug treatments focusing on the pre-dementia period. But how can the impact of such treatments be measured at this early stage since overt dementia may not be diagnosed for decades? In the four talks in this symposium, we will discuss evidence for pre-clinical change, theoretical models which have been used to project the possible impact of risk factor modification in mid-life and their integration into a future public health strategies. The development of new statistical risk models to determine the impact of such prevention measures will be outlined. We will consider the possibilities for drug development targeting the pre-clinical period before presenting the PREVENT Project and EPAD (http://ep-ad.org/), a multi-million euro IMI-Horizon 2020 funded project for the development of pre-clinical proof of concept trials. Titles of the four presentations: 1. Setting the scene: the evidence for pre-clinical change, projections of the impact of intervention, and implications for public health (TCR) 2. New statistical risk models for determining the impact of prevention measures in the pre-dementia period (GMT) 3. The PREVENT Study: a prospective cohort study to identify mid-life biomarkers of late-onset Alzheimer's disease (KR) 4. The European Prevention of Alzheimer's Dementia (EPAD) Project: developing interventions for the secondary prevention of Alzheimer's dementia (CWR)

Disclosure of interest

The authors have not supplied their declaration of competing interest.
How Can Guidance Recommendations Contribute to Better Mental Health?
Authors: Gaebel W.
Published: June 2017

Introduction

In European countries, the quality of mental healthcare services is often limited due to scarce and inequitable distributed resources, and inefficient use of existing resources. Against this background, the EPA Guidance provides recommendations on how to optimize quality of mental healthcare for all European countries.

Objectives

Provision of guidance recommendations in order to support optimization and harmonization of mental healthcare services in European countries.

Methods

By means of evidence and consensus-based methods EPA guidance papers are developed by experts in psychiatry and related fields [1].

Results

As of 2012, five EPA guidance series have been developed and published [2]. They focus on various aspects of mental healthcare and clinical situations that have not been covered by medical guidelines yet but are considered important to deliver high quality mental healthcare. Papers deal amongst others with topics relating to quality assurance of mental health services, as quality of mental health service structures and processes, and building trust in mental health services.

Conclusions

EPA guidance recommendations can improve mental healthcare provision and thereby contribute to better mental health of persons receiving mental healthcare. For this purpose, recommendations need to be widely disseminated and implemented in European countries.

Disclosure of interest

Unterstützung bei Symposien/Symposia Support

− Janssen-Cilag GmbH, Neuss

− Aristo Pharma GmbH, Berlin

− Lilly Deutschland GmbH, Bad Homburg

− Servier Deutschland GmbH, München− Fakultätsmitglied/Faculty Member

− Lundbeck International Neuroscience Foundation (LINF), Dänemark
Relationship and Family Therapy for Newly-resettled Refugees: A Qualitative Inquiry of an Innovative, Needs-adapted Approach in Sydney, Australia
Authors: Karageorge A. , Rhodes P. , Gray R. , Papadopoulos R.
Published: June 2017

Introduction

The needs of refugees are of pivotal concern internationally. Relational trauma, in particular, is an area that is under-emphasised and under-researched. The strength to strength program (STS) was a rare, innovative relationship and family counselling service for recently-arrived refugees in Sydney, Australia during 2006–2014. The service model built on post-Milan systemic family therapy principles to include innovative cultural and trauma-informed aspects of care.

Objectives

We were interested in the experiences of staff who delivered the program, and the ways in which more traditional, Western-informed modes of family therapy were transformed by the needs of refugee clients.

Aims

To identify and describe transformations to the delivery of relationship and family counselling with refugees that enabled care, from the perspective of staff.

Methods

A thematic analysis, guided by interpretive description, of individual interviews and focus groups with STS service staff (n = 20), including family therapists, bicultural workers and managers.

Results

Key themes pertaining to innovative aspects of the relationship and family counselling service provided by STS staff will be outlined and lessons for future service provision in this space considered.

Conclusions

STS is an example of staff-driven innovation to the therapeutic care of refugee families resettling in Western countries, taking into account the unique and complex set of cultural, practical and psychological needs. Important and timely lessons for future service delivery can be drawn from qualitative inquiry into the experiences of staff who deliver such programs, with refugee numbers continuing to increase internationally.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicide Risk Among Immigrants and Ethnic Minorities
Authors: Pompili M.
Published: June 2017

Introduction

Recent historical perspective suggests that suicide is a neglected issue among immigrants and ethnic minorities.

Objective

Given the need to delivering proper care to such populations, government is now requested to address suicide risk and involve proper interventions.

Aims

To provide comprehensive overview of suicide risk among immigrants and ethnic minorities and possible targeted preventive measures.

Methods

Given the relatively early and underdeveloped state of this area of inquiry, the author viewed his task as gathering and critically appraising the available research relevant to the topic, with the aim of formulating a hypothesis to be tested with further research.

Results

Evidence support the notion that certain communalities across ethnic groups are influenced in a considerable way by the suicide risk in the country of origin. Furthermore, some well-known risk factors for suicide may not play a central role in the case immigrants and ethnic minorities; on the contrary, adjustment problems point to the explanation that emotional distress may be caused by social problems, racism and discrimination. Suicide risk among these individuals may also be referred to the risk in the country of origin pointing to grater complexity when individuals immigrate into a country with different suicide rates as well as different contributing factors. Help-seeking barriers are still a major obstacle for delivering proper preventive intervention. The author aims at providing a comprehensive picture of suicide risk among this population and highlight possible preventive strategies.

Conclusions

Social interventions, culture-sensitive community projects or interventions targeting specific subgroups might be possible solutions.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Cannabis and Confabulation: An Intrusive Relationship
Authors: Barcelos A. , Lopes A. , Bernardo M. , Adriana C.
Published: June 2017

Introduction

The association between the neurocognitive impact of cannabis use and deficits in working and declarative memory is well documented. Studies with cannabis users suggest that recognition memory is particularly susceptible to cannabinoid acute intoxication. Studies carried out in the 1970s using free memory tests, showed that cannabis users not only named fewer words having also a tendency to evoke intrusive memories. Interestingly, a recent study has exposed an association between cannabis consumption and increased likelihood of creating fake memories.

Objectives

The main objective of this work is to do literature revision, framing old data with recent works, exposing the relationship between cannabis consumption and memory confabulation/intrusion.

Methodology

Literature review, comparison and description of empirical data [1].

Results

Recent studies show that both cannabis users and abstinents are more susceptible to create false memories, not being able to identify trap stimuli as events that never occurred.

Discussion/conclusions

Changes in perception and memory deficits are two common consequences of acute marijuana intoxication. The fact that these deficits remain during drug abstinence demonstrates the relevance of better understanding the mechanisms by which cannabinoids alter such cognitive functions. Reductions in the activation of brain areas comprised in the lateral and temporal lobe and in frontal cortex zones involved in the processes of attention and performance monitoring may be a possible explanation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Inter-analyzer Interaction (IAI) at Clinical Psychology: Possibilities and Challenges
Authors: Kovyazina M. , Fomina K.
Published: June 2017

Introduction

White matter is an anatomical bases of brain integration realization, it provides the connection between different cortex zones inside one hemisphere as well as other hemisphere. Hemispheric interaction research is basic aspect of brain integration activity problem. Not less important is the aspect related with the processes of IAI.

Aims

Evaluation of method by fixed set potential for neuropsychological research of inter-analyzer interaction.

Methods

Russian neurophysiologists confirmed the presents of nervous processes irradiation and considered it as fundamental mechanisms of the higher functions realization. IAI is a particular case of the irradiation.

Uznadze's fixed set method allows one to model “section of behavior”, which includes all general behavior mechanisms and provides a way to analyze complicated forms of activity. The central components of the set are related to different brain systems and analyzer's interactions. This is confirmed by the set irradiation experiments, performed by Uznadze's school and showed that the set forms in one sensory modality manifests in different.

Results

Setting experiments by formation of fixed set are done at haptic sphere: two different in volume spheres are given into both respondents’ palms. Critical experiments are done at visual sphere: two equal in diameters circles are exhibited to respondent for comparison. The amount of illusion in visual modality is an index of IAI features.

Conclusions

The fixed set method acquires a special relevant at the modern stage of clinical psychology development, since the IAI research seems to be important in psychiatric and neurological diseases, related with brain integration disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Current Hot Topics in Working with Service Users and Family Carers Towards a Human Based Psychiatry
Authors: Amering M.
Published: June 2017

Context

The significant role of family as a resource for mental health, psychiatric care and recovery and rehabilitation is well documented. However, despite ongoing family advocacy the situation in most settings is still characterized by significant unmet needs and lack of resources and expertise in working with families.

Key messages

This presentation will highlight pertinent issues and present data, concepts and experiences towards an improvement of partnership work with users of services and their families in a human based context.

Topics will include the needs of specific types of relatives, such as siblings, children, partners, grandparents, members of the peer group of friends as well as the need for support for families without patient consent. Recent developments with regard to individual and group therapy as well as multilevel interventions to further family advocacy and the fight against stigma and discrimination will be presented and discussed.

Special attention will be given to new roles and responsibilities arising from the historical challenge of the UN-Convention on the Rights of persons with disabilities for mental health professionals, users of services as well as relatives and friends including changes in national guardianship laws, new rights to patient autonomy as well as new entitlements for support for living in the community including the right to family life, reasonable accommodation and supported decision-making.

Conclusion

Current developments with regard to needs and rights of users of services and their families and friends urgently warrant attention and common efforts in Trialogue and other participatory approaches.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Interrelationships between cortisol, cognition and dementia: A review of the literature and new own findings
Authors: Ouanes S. , Julius P.
Published: June 2017

Introduction

Cortisol exerts effects on the brain via two different receptors, producing complex and sometimes opposite effects on the brain structures involved with the different cognitive functions.

Objective

To scrutinize the interrelationships between cortisol, cognition and dementia.

Methods

Review of the literature and new own findings.

Results

Animal and clinical studies showed an association between increased cortisol and poorer overall cognitive performance, declarative memory, language, processing speed, executive functioning, spatial memory, as well as social memory. High cortisol may exhibit neurotoxic effects on the hippocampus, and exacerbate oxidative injury and amyloid β peptide toxicity. Increased CSF cortisol levels have been found in subjects with dementia and Mild Cognitive Impairment (MCI) due to Alzheimer's disease (AD) compared to control subjects with normal cognition. In MCI due to AD, high CSF cortisol may also predict a more rapid cognitive decline. Higher cortisol levels have been also observed in delirium. Increased cortisol levels interact with inflammatory mediators, neurotransmitters, and growth factors, and may mediate the effects of depression, stressful life events, and personality traits, sleep disturbances, and cardiovascular risk factor on cognitive performance and cognitive decline.

Conclusions

High cortisol levels may exert deleterious effects on cognition and exacerbate AD pathology. Further studies are needed to explore glucocorticoid-based interventions in the management of cognitive disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Residential Unit for the Elderly: Cases Study and Reflections on the First 18 Months of Functioning
Authors: Amaral A. , Machado A.S. , Costa I.
Published: June 2017

Introduction

The Residential Unit for the Elderly (RUE) was established in August 2015 and has capacity for 8 inpatients. It is intended to behavioral reorganization and caregiver rest of elderly patients with behavioral changes, particularly in cases of cognitive impairment.

Aim

We intend to describe the hospitalized population in the first 18 months and discuss the unit functioning and its impact on clinical stability of patients.

Methods

Socio-demographic and clinical data were analyzed using the STATA v13.1 software, using multivariate regression model with a 0.05 significance level.

Results

We present preliminary results from the first twelve months. Twenty-six patients admitted, 18 (69.2%) were female, with an average age of 76.7 years-old (IQR 71–86-years-old). The main reasons for referral were: caregiver rest (38.4%), psychopathological stabilization (30.7%) and autonomy training/cognitive stimulation (15.4%). Most patients had dementia (65.4%). Patients were hospitalized on average 78 days (IQR 30–98 days). Complications occurred in 18 patients (69.2%). There was an 85.7% reduction in the number of hospitalizations for any cause within 6 months after hospitalization in the RUE (P < 0.001) and a 75% reduction in hospitalizations from psychiatric cause (P = 0.001). Regarding visits to the emergency room (ER), we found a decrease of 87.1% in visits for psychiatric motive (P < 0.001) and 85.4% in visits for any cause (P < 0.001).

Conclusion

Inpatient care in RUE has contributed to the clinical stability of patients with consequent reduced use of health services. Although the results still concern a short operating period, they appear to be promising.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Role of Telomeres and Telomerase in the Clinical Effect and Mechanism of Action of Psychopharmacological Interventions
Authors: Bersani F.S.
Published: June 2017

Originally studied in relation to aging and cancer research, telomeres and telomerase are now also investigated in relation to psychiatric disorders and treatments. Based on findings emerging from clinical and preclinical data, we hypothesize that the telomere–telomerase system represents a novel element mediating the mechanism of action of certain psychopharmacological interventions.

In this symposium I’ll present the preliminary evidence on the complex translational relationships between specific psychiatric medications (i.e. antidepressants, lithium and antipsychotics), the telomere–telomerase system and clinical outcomes. The modulation of intracellular Wnt/b-catenin or PI3 K/Akt signaling pathways, the interaction with BDNF and 5-HT, and the antioxidant properties could represent possible mechanisms by which the different types of psychiatric medications could modulate telomere length and telomerase activity. The potential of the telomere–telomerase system in promoting cellular survival and/or function in the brain and in the periphery could, in turn, represent a neurobiological substrate through which these molecules can mediate the therapeutic effect of such interventions.

Further, in the present symposium I’ll show data from our research team on telomere length and telomerase activity in leukocytes predicting clinical response to serotonin–specific reuptake inhibitors (SSRIs) in subjects with major depressive disorder.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Quality of Life and Depression in Caregivers of Patients with Cancer
Authors: Feki I. , Hentati S. , Sallemi R. , Moala M. , Masmoudi J.
Published: June 2017

Background

Most elderly patients, with cancer are cared for, by a family member who may be affected by various stressors that can influence their health and quality of life (QOL).

Objectives

To explore depression, quality of life and its related factors among caregivers of elderly patients with cancer.

Methodology

This is a descriptive and analytical cross-sectional study including 40 primary caregivers of old patients aged 65 or older, with cancer in oncologic radiotherapy service in university hospital Habib Bourguibain Sfax, Tunisia. The short form health survey (SF-36) and Beck inventory (13 items) were used to assess respectively QOL and depression.

Results

The average age of caregivers was 44.62 years. The sex ratio (M/F) was 0.9. Most of caregivers (75%) had impaired QOL (score ˂ 66.7). The two main components of SF-36 were altered with a standard score of 45 for the physical component and 41.1 for mental component. According to Beck inventory, Depression was present in 67.6% of cases. Impaired QOL of life was significantly correlated with somatic illnesses in the caregiver (P = 0.016), advanced stage of cancer (P = 0.01), financial difficulties (P = 0.04), the non-cohabitation with the patient before the disease (P = 0.031) and depression (P = 0.00).

Conclusion

According to our study, caregiving can have a negative effect on the caregiver's mental and physical health. Assistance and information from healthcare professionals are the key to improving the ability of caregivers to cope with caring for older patients with cancer.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Portuguese Version of Delirium Experience Questionnaire (DEQ): Feasibility Study
Authors: Martins S. , Pinho E. , Correia R. , Fernandes L.
Published: June 2017

Introduction

Delirium is a frequent and serious acute neuropsychiatric syndrome, namely in elderly hospitalised patients, described as a psychologically traumatic experience by patients, family/caregivers and health professionals(HPs). In this context, the Delirium Experience Questionnaire (DEQ) was developed as a face-valid instrument assessing the delirium experience recall and the degree of distress related to delirium episodes in patients, family/caregivers, and HPs.

Aim

To present the translation and cultural adaptation of the Portuguese version of DEQ (DEQ-PT).

Methods

The translation process followed ISPOR guidelines. After preparation, forward translation, reconciliation, back translation, back translation review, harmonization and cognitive debriefing (involving experts’ consensus), the DEQ-PT was tested (pre-test) in a group of elderly patients with delirium(≥ 65 years) in two Intermediate Care Units (Intensive Care Medicine Service-CHSJ, Porto). Exclusion criteria were: brain injury, blindness/deafness, unable to communicate, and Glasgow Coma Scale ≤ 11. Their families were also assessed, as well as the HPs (physicians/nurse) in charge of patients during hospitalisation.

Results

After obtaining permission to use the instrument, the DEQ was successfully translated into Portuguese, with harmonization of all new translations. Pre-test included a group of 5 patients, 5 families and 5 nurses. This version revealed good cognitive equivalence with the original English version and also a good level of comprehensibility.

Conclusion

The DEQ-PT showed good feasibility, being suitable, quick and easy to use in the assessment of delirium experience in intermediate care units. These findings will be further developed by an ongoing validation study.

Acknowledgement

This work was supported by foundation for science and technology (SFRH/BPD/103306/2014).

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effects of the Person-centered Environment Program (Belmont Village's Memory Care) on Behavioral and Emotional Problems in Mexican Senior Living Residents, Six Week Trial
Authors: Mesa Rios F.J.
Published: June 2017

Behavioural and psychological symptoms of dementia include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, wandering, and a variety of inappropriate behaviors. One or more of these symptoms will affect nearly all people with dementia over the course of their illness. These symptoms are among the most complex, stressful, and costly aspects of care, and they lead to a myriad of poor patient health outcomes, healthcare problems, and income loss for family caregivers. The complexity of these symptoms means that there is no “one size fits all solution, and approaches tailored to the patient and the caregiver are needed”. Non-pharmacologic approaches should be used first line, although several exceptions are discussed.

The current pilot study examined the effects of the Person-Centered Environment Program (Memory Care®, developed by Belmont Village Senior Living) on agitation, cognition, stress, pain, sleep, and activities of daily living for Mexican senior living residents with dementia. Thirty individuals participated in the study. Memory Care® included sensitive, cognitive and affective stimulation, based on participants’ preferences and needs. memory care sessions were held daily (7 days per week, 8 hours) and a total of 6 weeks were performed at the first Belmont Village Community in Mexico City. Findings showed that agitation and pain improved with the Memory Care® Program (t = 2.91, P < 0.02; t = 4.51, P < 0.002, respectively). Findings suggested that a better study design, repeated with a bigger sample size, must be considered, but promissory results are shown.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
First Neuropsychiatric Symptoms and Neurocognitive Correlates of Behavioral Variant Frontotemporal Dementia
Authors: Santamaría García H. , Reyes P. , Santacruz-Escudero J.M. , Matallana D. , Ibañez A.
Published: June 2017

Previous works highlight the neurocognitive differences between apathetic and disinhibited clinical presentations of the behavioral variant frontotemporal dementia (bvFTD). However, little is known regarding how the early presentation (i.e., first symptom) is associated to the neurocognitive correlates of the disease's clinical presentation at future stages of disease. We analyzed the neurocognitive correlates of patients with bvFTD who debuted with apathy or disinhibition as first symptom of disease. We evaluated the neuropsychological, clinical and neuroanatomical (3 T structural images) correlates in a group of healthy controls (n = 30) and two groups of bvFTD patients (presented with apathy [AbvFTD, n = 18] or disinhibition [DbvFTD, n = 16]). To differentiate groups according to first symptoms, we used multivariate analyses. The first symptom in patients described the evolution of the disease. AbvFTD and DbvFTD patients showed increased brain atrophy and increased levels of disinhibition and apathy, respectively. Whole brain analyzes in AbvFTD revealed atrophy in the frontal, insular and temporal areas. DbvFTD, in turn, presented atrophy in the prefrontal regions, temporoparietal junction, insula and temporoparietal region. Increased atrophy in DbvFTD patients (compared to AbvFTD) was observed in frontotemporal regions. Multivariate analyses confirmed that a set of brain areas including right orbitofrontal, right dorsolateral prefrontal and left caudate were enough to distinguish the patients’ subgroups. First symptom in bvFTD patients described the neurocognitive impairments after around three years of disease, playing an important role in the early detection, disease tracking, and neuroanatomical specification of bvFTD, as well as in future research on potential disease-modifying treatments.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicide Risk in Cancer Patients – Are We Prepared?
Authors: Alves M. , Tavares A.
Published: June 2017

Introduction

Individuals with cancer are at increased risk for suicidal ideation and behaviour when compared to the general population. Suicidal thoughts are sometimes minimized and considered by clinicians as a normal reaction to diagnosis of oncological disease. Less severe forms of suicidal ideation, such a fleeting wish to die may happen in all stages of the disease.

Objectives

We aim to highlight the cases of cancer patients that present an imminent suicide risk and its related psychopathological aspects, psychosocial and physical risk factors that may increase the probability of suicidal attempt.

Methods

Non systematic literature review through the Medline and Clinical Key databases, with time constraints.

Results

Individuals with cancer have twice the risk of suicide compared to the general population. It was found that suicidal thoughts are more common in patients with advanced disease, in hospital or in palliative care settings or in those who are experiencing severe pain, depression, cognitive impairment or delirium. The first months following the diagnosis are the period of greatest risk and the highest suicide risk occurs in men with respiratory cancers. Death by suicide occurs more often in cancer patients in the advanced stages of disease.

Conclusions

An appropriate therapeutic response should include empathy, active listening, management of realistic expectations and permission to discuss psychological distress. The first intervention should focus on determining imminent risk of suicidal behaviour and act for patient safety.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Association of Stress Hormone System, Epigenetics and Imaging
Authors: Frodl T. , Tozzi L. , Farrell C. , Doolin K. , O’Keane V. , Pomares F. , Carballedo A. , Booij L.
Published: June 2017

Introduction

Major depressive disorder (MDD) is a common psychiatric condition, affecting up to 350 million people worldwide. Its pathogenesis seems to involve dysregulation of the hypothalamic-pituitary (HPA) axis and inflammation as key elements of the condition. Stressful life events and in particular early life adversity seem to play an important role as risk factors for MDD. Epigenetic, which has been found to impact in the transcription of genes, seem to be associated with brain structure and function. Aim of the research was to provide an overview about neuroimaging (epi)-genetics in MDD.

Methods

Functional MRI, epigenetic and genetic information was obtained in a cohort of patients with MDD and healthy controls. Associations between, early life adversity, methylation of FKBP5 and SLC6A4, genetic variants and brain function and connectivity have been analysed.

Results

Higher methylation of SLC6A4 gene was associated with higher BOLD response during emotion processing and lower BOLD response during higher order cognitive processes. Healthy participants with higher SLC6A4 methylation involved prefrontal cortical regions to a greater extent than the participants with lower SLC6A4 methylation, when trying to switch attention away from negative emotional stimuli (Frodl et al., 2015). Moreover, FKBP5 methylation was association with HPA axis functioning and amygdala brain function in patients with MDD. FKBP5 methylation also was related to grey matter volume.

Conclusions

Our study provides further support to the hypothesis that DNA methylation plays a role. Particular peripheral DNA methylation states of MDD candidate genes are associated with brain function during emotion processing in patients with MDD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychological Effect of Semi-permanent Tattooing Rehabilitation in Patients with Mastectomy in 12 Months Period
Authors: Argitis P. , Platari P. , Gatsiou K. , Chatzidai C. , Paschalidis K.
Published: June 2017

Introduction

Breast cancer is the most common cancer type in Greek women as more than 4000 new cases are diagnosed every year. Seventy percent of those patents performs a type mastectomy. The breast has a societal and social connotation of femininity, motherhood, and sexuality.

Background

Several studies support the existence of the relationship between psychological problems and mastectomy surgery. Body image and feminine self-concept also seems to influence quality of life of those women, considering the breast association of femininity, motherhood, and sexuality. During this study, we try to investigate how a non-psychiatric intervention might influence the mental state and the quality of life of those women.

Material

A clinical interview was performed in 53 women with partial or total mastectomy before 3 and 52 weeks after the rehabilitation with the method of semi-permanent tattooing.

Methods

Data were collected during the personal interviews, using Hamilton anxiety rating scale (Ham-A), body image scale and sexual activity questionnaire.

Results

Moderate levels of anxiety were identified before the rehabilitation, associated with poor body image scale scores and sexual difficulties. Both Ham-A and body image score ameliorated after 3 weeks with unchanged sexual behaviour. One year after rehabilitation, anxiety scale score raises close to initial values, body image remains unchanged, comparing with the 3rd week interview and significant improvement noticed in sexual activity.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mental Disorders in Patients Breast Cancer: Differentiated Approach to the Study Nozogeny
Authors: Shushpanova O.
Published: June 2017

Objective

The problem of mental disorders in patients with breast cancer is relevant due to the high prevalence of pathological changes in the mental health patients, insufficient development of clinical typology of psychosomatic correlations of the contribution of constitutional features.

Methods

Nozogeny disorders are clinically heterogeneous and are represented by two nosologic categories: reaction and nosogenic patho-characterological personal development. The basic method of work was a clinical follow-up and statistical research methods (method using contingency tables and Fechner coefficient method using the χ2 – test).

Results

The manifestation of a nozogeny reaction is closely correlated with his premorbid personality characteristics. Anxious-depressive nozogeny reaction was recorded in 17 patients of the first sample with high direct correlation (coefficient Fechner F = 0.76, P < 0.01) with respect to accentuation of personality in the alarm type, and the weak direct link to the personal characteristics of the affective (bipolar) range (F = 0.22, P < 0.01). Anxious-nozogeny dissociative response was detected in 9 patients with hysterical (55.5%) and expansive schizotypal (vershrobene) (44.4%) lung cancer with a significant (F = 0.65, P < 0.01) a direct correlation with constitutional hyperthymia, anxiety-hypomanic nozogeny response was observed in patients c schizotypal RL (n = 4) paired with symptoms of persistent hyperthymia (F = 0.39, P = 0.012).

Conclusion

Patho-characterological development of personality are formed on the remote catamnestic stage breast cancer and show the clinical heterogeneity of differentiation into 4 types: (1) the type of hypochondriacal dysthymia, (2) the type of “paranoia struggle”, (3) in an “aberrant hypochondria” and (4) the type of “new life”.

Disclosure of interest

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