bluuebunny/crossref_metadata_2025 huggingface dataset:
Experiences of and Interventions for Adult Survivors of Childhood Sexual abuse in South Asia: A systematic review
Authors: Talwar S. , Osorio C. , Appleton R. , Billings J.
Published: August 2023

Introduction

Adult survivors of childhood sexual abuse (CSA) may experience psychological difficulties in adulthood. Such adverse experiences in the developmental years, sometimes for prolonged periods, could have an impact on their emotional, social and psychological resources. This impact is heightened in CSA adult survivors as the interpersonal nature of harm could reverberate throughout their adult relationships, with complex emotional responses to traumatic stressors. Despite the demonstrated effectiveness of trauma focused treatments in the West, culturally specific understanding of the needs and treatments for such survivors in South Asia is still in its infancy. This is important to address their meaning of presenting complaints in South Asia and offering them treatments suitable for them.

Objectives

In this systematic review, we aimed to synthesize the findings of existing research on the impact of CSA on adult survivors in South Asia and the current approaches used to treat them.

Methods

We searched nine databases and ‘hand searched’ important peer-reviewed journals published in South Asian countries from inception until 3rd April 2022. Searches focused on adult survivors of CSA of South Asian origin residing in South Asia, different treatments offered and the efficacy and acceptability of these treatments.

Results

We identified and screened 2608 records and included 56 articles in our full text screening. Out of those, we included 22 articles in the final review. Studies were from four out of the eight countries in South Asia; India, Sri Lanka, Nepal and Pakistan. Of note, only six of those studies focused exclusively on CSA whereas others included all forms of abuse and neglect. All except one article explored experiences of survivors. Only one article focused on their recovery process, within and/or outside of professional treatment with no published research on treatments for them in South Asia. Physical abuse and emotional abuse or neglect were more often reported in our included studies as compared to sexual abuse.

Conclusions

Our review suggests that even though the needs of adult CSA survivors in South Asia have been partly identified, there is very little research into the treatment of CSA adult survivors in this region. Perpetrators often come from their immediate or extended families, leading to their distrust of the familial and legal systems. Even when not diagnosed with a severe mental health condition, there are potentially serious implications for victims’ adult relationships and social functioning. There is a current lack of research and therefore, lack of evidence-based treatment for adult survivors of CSA in South Asia.

Disclosure of Interest

None Declared
From the beginning to the highest impact factor – the journey of World Psychiatry
Authors: Luciano M.
Published: August 2023

World Psychiatry, the official journal of the World Psychiatric Association, was founded in the year 2002. From the very beginning, its aims have been: a) to reach as many psychiatrists as possible worldwide, disseminating information on recent significant clinical, service and research developments, using a language that can be assimilated by most of them; b) to give voice to psychiatrists of all regions of the world, encouraging submission of research papers, commentaries and reports on innovative service modalities. The two main criteria by which an article submitted to the journal is evaluated have been from the beginning: a) its relevance to everyday clinical practice of the average psychiatrist; and b) its usefulness to foster the average psychiatrist’s professional growth. From its first issue, the journal has been freely available online. In the year 2008, World Psychiatry received its first impact factor, that was 3.896. On that same year, the publication of the Spanish edition of the journal was started. The impact factor of World Psychiatry has then increased year after year, up to the value of 79.683 reached in July 2022. For the eighth consecutive year, World Psychiatry has been no. 1 in the Clarivate’s category of Psychiatry, and for the fifth consecutive year no. 1 in the entire Clarivate’s Social Science Citation Index. All the issues of the journal are now freely available both on the PubMed system and on the WPA website. The journal reaches now, in its online or printed edition, more than 60,000 mental health professionals worldwide. One of the main factors explaining the success of the journal is the continuing attempt to identify in advance topics which are going to become very visible in the international literature and relevant to ordinary clinical practice. The journal has been recently praised by the World Health Organization for the representation of members from low/middle income countries in its Advisory Board, which was at that time 32.3%, while among the other top ten psychiatric journals it was 1.9%. Furthermore, every issue of the journal includes contributions from all continents.

Disclosure of Interest

None Declared
Assessment of Theory of Mind in Psychopathology: a Scoping Review
Authors: de la Higuera-Gonzalez P. , Galvez-Merlin A. , Rodríguez-Toscano E. , Andreo-Jover J. , Lopez-Soto T. , de la Torre-Luque A.
Published: August 2023

Introduction

Theory of Mind (ToM) is defined as the cognitive ability that infers other’s mental states (Premack & Woodruff. J Behav Brain Sci 1978; 1 515-526).The interest in the study of ToM distinguishing its affective and cognitive components has been growing. Its study in psychopathology has been evolved from its original studies in autism spectrum disorders (ASD), schizophrenia (SCZ) and, borderline personality disorder (BPD), to other mental disorders like major depressive disorder (MDD), bipolar disorder (BP), anorexia nervosa (AN) and social anxiety disorder (SAD).

Objectives

1) review the most commonly used instruments for ToM assessment; 2) to compile the evidence on ToM deficits across mental disorders. For both objectives, target disorders are previously mentioned.

Methods

The search was carried out on the PubMed, PsycInfo and Scopus databases, using the terms “Theory of mind”, “Mentalization” and the previously mentioned mental disorders and pertinent thesaurus. Articles in English, published since 2010 were considered. A 2-step strategy (first, article screening and full reading) was followed to select articles of interest.

Results

Reading the Mind in the Eyes (Baron-Cohen et al., J Child Psychol Psychiatry 2001; 42 241-251) and Movie for the Assessment of Social Cognition (Dziobeck et al. J Autism Dev Disord 2006; 36 623-636) were the most commonly used tasks to assess ToM. Regarding mental disorders, studies showed deficits in cognitive and affective ToM skills in ASD, SCZ, BPD, MDD and BP. Hypomentalization was mainly observed in ASD and MDD, while BPD and SCZ were featured by errors associated with hypermentalization. Studies in AN and SAD are scarce, but they mainly highlight a cognitive ToM deficit, with hypomentalization in AN and hypermentalization in ASD. In all of them, depressive symptomatology seems to be a critical moderator of ToM performance.

Conclusions

Although ToM impairments are well described for some mental disorders, more research is needed to reach solid conclusions for others. The use of different and heterogeneous ToM assessment instruments can strongly influence the results of studies. The study of ToM is essential to gain a better understanding of the diseases and to develop effective treatments targeting specific ToM deficits.

Disclosure of Interest

None Declared
Lithium: Managing Cognitive Impairment and Sexual Problems
Authors: Petta J. , Falcão A. L. , Soares G. , Lourenço A.
Published: August 2023

Introduction

Patients taking lithium complain of cognitive impairment. This was assumed to be real by expert clinicians for years until relatively recent objective neuropsychological studies have failed to verify much impairment.

Second and perhaps underemphasized side effect from lithium is sexual dysfunction.

Objectives

The objective of this review is to highlight for the cognitive and sexual problems, which are two very important areas for discussion with patients. It should be brought up right when beginning to prescribe.

Methods

Data was obtained through an internet-based literature review, using the research platform PubMed and the World Health Organization website. Eight articles from the last five years were included.

Results

Due to the lack of evidence in neuropsychological studies, what was considered to be impaired cognitive function in the past has been recently considered a loss of sharp thinking in manic states or mild persisting depressions.

About sexual dysfunction it is important eliminating other possible causes, lowering lithium dose, timing sex, and taking sildenafil and 240 mg/day of aspirin may help.

Conclusions

Cognitive impairment and sexual problems are two important subjects that involve the issues of dosing, of managing and dealing with people’s willingness to take lithium.

Providing psychoeducation about these possible effects can head off abrupt discontinuation impulses.

Disclosure of Interest

None Declared
Aripriprazole induced severe oculogyric dystonia treated with electroconvulsive therapy(ECT)
Authors: Bhat Shah K. , Bhat T. S. , Pawar J. S. , Pande N.
Published: August 2023

Introduction

Aripiprazole is the third generation Antipsychotic, and Dopamine serotonin system stabiliser.It is partial agonist at D2 and 5 HT1 A and antagonist at 5 HT2.Most commonly seen adverse effects are Akathesia, fatugue,insomnia and headache the major advanatage is less propensity for extrapyramidal side effects and lmetabolic side eefects.

Objectives

To report a case of Schizophrenia treated with Aripiprazole 15mg/day developiing occular gyric crisis which was tratment resistant.

Methods

We administered Electroconvulsvive therapy, bidirectional brief pulse constant current 8 ECTS, under General anesthesia with medical fitness .

Results

Patient Showed complete resolution of Dystonia after second ECTs and Showed improvment in Pyschosis Parameterd. Assessment using Naranjo Protocol made.

Conclusions

Electroconvulsive therapy therapy is viable alternative to manage Dystonia when medical treatment fails

Disclosure of Interest

None Declared
Psoriasiform rash after initiation of treatment with olanzapine and carbamazepine.
Authors: Abdelkefi M. , Guermazi F. , Trigui H. , Masmoudi R. , Baati I. , Masmoudi J.
Published: August 2023

Introduction

olanzapine and carbamazepine are effectively used in treatment of schizoaffective disorder but they can have numerous side effects including skin eruptions that can be severe sometimes.

Objectives

To study the relationship between toxidermia and treatment with Olanzapine and Carbamazepine.

Methods

We report the case of a patient who developed a psoriasiform skin rash following the intake of Olanzapine and Carbamazepine.

Results

Mrs SL, 46 years old, with no prior medical or surgical history, has been diagnosed with schizophrenia since the age of 26. She was initially treated with Haloperidol and Risperidone with an irregular follow-up. Then, due to the emergence of mood disorder symptoms, the patient was put on 20 mg/day of Olanzapine and 400 mg/day of carbamazepine. One month later, the patient presented a generalized rash requiring the discontinuation of the current medications. She was treated with corticosteroids, and then she was referred to our department to make the appropriate adjustment of her psychiatric treatment.

In view of the persistence of a dry erythroderma with erosive lesions of scratching and palmoplantar keratoderma, a skin biopsy was performed showing a psoriasiform and eosinophilic dermatosis that could be consistent with a toxidermia. The pharmacovigilance investigation concluded the incrimination of Olanzapine and carbamazepine in this symptomatology and recommended to avoid their prescription for this patient.

The need for a mood stabilizer presented us with a challenge, particularly in view of the potential risk of cross-toxicity. We opted for the reintroduction of Risperidone with strict monitoring of the skin condition.

Conclusions

Each prescribed drug must be considered as potentially capable of causing cutaneous reactions as an adverse effect. Both the prescriber and the patient must be made aware of this phenomenon.

Disclosure of Interest

None Declared
Clinician’s attitude towards clozapine prescription
Authors: Brugue O. , Gonzalez M. , Moreno L. , Ivorra C. , Hernandez R. , Cepedello S. , Labad J.
Published: August 2023

Introduction

Current clinical guidelines recommend the use of clozapine for the treatment of refractory schizophrenia, present in up to a third of patients with this disease. Despite the evidence, the data point to low prescription, underdosing, and delayed initiation.

Objectives

The objective of the study is to elucidate which factors may interfere in clozpine prescription.

Methods

This is a cross-sectional observational study, carried out using a survey designed specifically for it.

It was answered online by seventy psychiatrists affiliated with the Catalan Society of Psychiatry.

Results

More than half admitted having prescribed two or more antipsychotics without having previously ruled out pseudorefractoriness through depot treatment. 70% recognized the need for monitoring as the main prescription barrier, while the main reason for withdrawal was its adverse effects. The most alarming was considered agranulocytosis, with drooling, drowsiness and weight gain being the most reported.

Statistically significant differences (p=0.031) were found in relation to the years of experience and the device where clozapine was preferred to be started: <10 years in hospital, 10-20 years in partial hospitalization and >20 years outpatient office.

Statistically significant differences were observed in the preference of the device for its initiation depending on the usual work device: hospitalization (p<0.000) and partial hospitalization (p=0.046) preferred to schedule it from their respective devices, without any preference in consultations.

The level of experience and the most reported side effect were statistically significant: for the newest psychiatrists it was weight gain (p=0.031), without presenting differences in the rest of the groups.

Conclusions

Clozapine is the psychoactive drug of choice in refractory schizophrenia, so efforts should be devoted to reducing prescription barriers, offering training on its management and innovating forms of monitoring to promote its use.

Disclosure of Interest

None Declared
Myocarditis induced by clozapine and COVID-19 infection: a case report
Authors: Veloso P. , Gomes M. , Faria R. , Matos D. , Pereira F.
Published: August 2023

Introduction

Clozapine is the only available treatment for refractory schizophrenia and is rarely associated with the development of myocarditis. Usually, the onset of symptoms occurs within the first month of treatment. The symptoms of myocarditis include fever, flu-like symptoms, fatigue, and dyspnea, symptoms that overlap with the COVID-19 infection. Coronavirus has been associated with cardiovascular complications, including myocarditis. It is not known whether clozapine increases the risk of developing viral myocarditis in patients with COVID-19 infection.

Objectives

Report a case of myocarditis in a patient treated with clozapine, who also had a history of COVID-19 infection.

Methods

Collection of clinical information and review of the literature.

Results

A 24-year-old man was admitted following severe psychotic symptoms that have been developing for the past several months. He presented with disorganized speech and behavior, paranoid delusions, thought alienation, auditory hallucinations, and blunted affect. He had no known medical co-morbidity, but he had tested positive for COVID-19 the month before admission. The lab and imaging tests and the electrocardiogram (EKG) were normal. He was diagnosed with schizophrenia and after treatment failure with three antipsychotics, the patient was started on clozapine, with symptom improvement. Two weeks after clozapine initiation, he started flu-like symptoms, fever, chest pain, and tachycardia. Lab tests showed leukocytosis (12 400 cells/uL), elevated inflammatory markers (C-reactive protein 143,30 mg/L) and cardiac biomarkers (troponin I 12.139 ng/mL, NT-proBNP 9321 pg/ml). The evaluation for viruses, including SARS-CoV-2, was negative. The EKG revealed ST-segment elevations and a transthoracic echocardiogram showed systolic dysfunction (left ventricular ejection fraction was 37%). Cardiac magnetic resonance confirmed severe left ventricular dysfunction and diffuse myocardial edema. The patient’s symptoms resolved following the discontinuation of clozapine and supportive therapies. Troponin and EKG normalized over the following 7 days. By this time, the patient tested positive for COVID-19.

Conclusions

The temporal relationship with the initiation of clozapine supports the diagnosis of clozapine-associated myocarditis. However, the COVID-19 infection may have played a part in the emergence of cardiac alterations. We hypothesize that the co-occurrence of COVID-19 and clozapine treatment may act synergically as both factors increase the risk of developing myocarditis. However, further studies are needed to evaluate the relationship between these factors. While clinicians should stay alert for the risk of clozapine-associated myocarditis, the overall risk is low, and given the effectiveness of clozapine, as well as the absence of other evidence-based treatments, people with refractory schizophrenia should be given a monitored trial of clozapine, regardless of their COVID-19 status.

Disclosure of Interest

None Declared
Mirtazapine-induced psychosis on a young patient with severe malnutrition
Authors: Sollano R. T. E. , Enriquez A. K. L.
Published: August 2023

Introduction

Mirtazapine is an antidepressant commonly prescribed to patients with depression and problems with weight and sleep. Case reports on Mirtazapine-induced psychosis either on initiation or increase in dosage in elderly patients and those with renal and liver impairment are found in the literature.

Objectives

To present a case of Mirtazapine-induced psychosis in a patient with severe malnutrition, and with no history of psychosis and despite on sedating antipsychotic.

Methods

This is a case report.

Results

Ms. NC, a 40-year-old female with major depressive disorder, anorexia nervosa, stimulant use disorder, and sedative, anxiolytic, hypnotic use disorder with no history of psychosis even when intoxicated or during withdrawal, was admitted for involuntary inpatient psychiatric care for detoxification and management of severe malnutrition. Ms. NC has always been conscious with her weight growing up but it was only during the COVID-19 pandemic that excessive preoccupation with weight and symptoms of clinical depression were noted. Ms. NC restricted her diet and engaged in excessive exercise resulting to BMI of 16.1. She started use cocaine and diazepam daily to address the weight and mood, and sleep and anxiety, respectively. Due to a suicidal attempt, consult was done with a psychiatrist, and patient was eventually maintained on Mirtazapine 30mg and Gabapentin 100mg which addressed the mood and sleep. Despite improvement in mood and decrease in use of cocaine and diazepam, patient started to use methamphetamine around once a week. Despite with euthymic mood, preoccupation with weight resurfaced. After a few months, she restricted her food intake to only four times a week with no binge-eating or purging resulting to BMI to 13.8. Upon admission, Mirtazapine 30mg was continued and Gabapentin was increased to 300mg. Special care in her food intake was done to prevent refeeding syndrome. Benzodiazepine withdrawals symptoms were minimal. She has normal values for electrolytes, liver function tests and creatinine. On the first days of admission, she was noted to be irritable and was mostly asleep. On the fifth hospital day, she started to have difficulty sleeping and was placed on Olanzapine up to 10mg and Gabapentin 600mg but no improvement in sleep. On the tenth hospital day, Mirtazapine was increased to 45mg and later in the night, had visual and auditory hallucinations and paranoia. Upon discontinuation of Mirtazapine and initiation with Clozapine up to 75mg, the psychosis resolved after five days.

Conclusions

Mirtazapine-induced psychosis may be seen in patients with severe malnutrition. Despite its advantages in terms of weight gain and sleep, psychiatrists should be wary of this possible side effect when initiating or increasing Mirtazapine for patients with severe malnutrition.

Disclosure of Interest

None Declared
Locus of control as a personal coping resource of a sportsman
Authors: Fedorchuk S. , Petrovska T. , Kohut I. , Hanaha O. , Arnautova L.
Published: August 2023

Introduction

In sports psychology, the issue of finding resources to overcome stress remains relevant at present. Currently, the priority is the search for personal resources that can help overcome difficult life situations. Currently, the priority is the search for personal resources that can help overcome difficult life situations. Research by many psychologists (Folkman S., Hobfoll S., Haan N.A., Heim E., Lazarus R., Moos R.N., Schaefer C., Grin O.R., Dementiy L.I., Kalnysh V.V., Tukaiev S.V., Khazova S.A. et al) is devoted to this topic. Among the coping resources, the authors single out motivation, locus of control, resilience, self-control, purposefulness, outlook, intelligence, etc.

Objectives

The purpose of the study is the analysis of literary sources regarding the study of the locus of control as a personal coping resource of an athlete.

Methods

To realize the goal of the work, the following were used: theoretical analysis and generalization of literary sources and Internet data.

Results

According to the results of research by domestic scientists, the locus of control and responsibility can act as a coping resource. It was found that the internal locus of control is associated with a low level of anxiety, and the external one with a high one; in addition, an inverse relationship between the locus of control and the level of neuroticism was found (Dementiy, 2005). This indicates that respondents with an internal locus of control are more stable in their behavior in situations that provoke anxiety and actualize personal anxiety. Internality allows a person to maintain a sense of control over the situation and his condition. It has been proven that the relationship between the locus of control and the state of anxiety depends on volitional self-control. However, along with this, the phenomenon of “heaviness of responsibility” is known in the scientific literature, which manifests itself in a sharp increase in anxiety with an internal locus of control. This may indicate that internality “loses” its resourcefulness under certain conditions: relationships between internality and anxiety are evident only at a low level of self-control. In the case when a person has developed self-control, such a connection is broken.

Conclusions

The generally accepted structure of personal resources, which determine the effective behavior of an individual under conditions of stress, has not yet been formed. Locus of control can act as a coping resource in the structure of self-regulation of an individual.

Disclosure of Interest

None Declared
ELECTROCONVULSIVE THERAPY FOR AGITATION IN LEWY BODIES DEMENTIA
Authors: Echeverria C. , Libuy J. , Alarcón J. , Rodriguez J.
Published: August 2023

Introduction

Dementia with Lewy Bodies (DLB) is a primary degenerative dementing syndrome characterized by visual hallucinations, fluctuation in cognition, depressive symptoms and parkinsonism. Literature has shown the utility of electroconvulsive therapy (ECT) in demented patients regarding depressive symptoms and agitation. Nevertheless, the majority of cases described include patients with vascular dementia and Alzheimer’s disease. There are no cases informed concerning ECT in DLB patients with agitation and aggressive behaviors.

Objectives

Evaluate the impact of electroconvulsive therapy (ECT) for agitation in a patient with diagnosis of Lewy Bodies Dementia (DLB).

Methods

Case report. 68-year-old male, with no prior neuropsychiatric history, was present for psychiatric evaluation for 5 year history of progressive dementia with fluctuations in cognition, complex visual hallucinations, delusional beliefs, depressive mood, anhedonia, irritability, associated to parkinsonism and increasing autoaggressive behaviors and agitation.

An extensive neurologic workup including neuroimaging, EEG and laboratory studies failed to reveal a specific etiology. Neuropsychological testing reveals frontal, attentional, and visuospatial dysfunction. A presumptive diagnosis of DLB was made.

Medication trials including donepezil, memantine, lamotrigine, sertraline, quetiapine, risperidone and melatonin failed to manage his depressive, psychotic and behavioral disturbances.

Results

Considering past medication failures and prominent behavioral disturbances family consented for an acute course of ECT.

Initial acute phase consisted of 6 sessions of right unilateral, brief pulse width (0.3 ms) ECT tri-weekly utilizing Mecta Spectrum. Anesthesia was induced with propofol, and received succinylcholine for muscle relaxation. Initial charge was 115 mC (6x seizure threshold), then raised to 192 mC. Seizure duration averaged in 22 seconds. No adverse reactions reported.

Clinical outcomes were measured with the CGI-Efficacy Index. Pre-ECT CGI-SI score was 6 (severely ill) and post-ECT CGI-I was 3 (minimally improved).

Conclusions

Mood and behavioral disturbances are a frequent primary motive consultations in DLB patients. The treatment is challenging due to the sensitivity to antidopaminergic medications evidenced in this type of patients. This case suggests that ECT has an impact in the treatment of agitation and aggression in DLB patients, although further investigation is needed.

Disclosure of Interest

None Declared
Cognitive behavioral therapy for patients with schizophrenia
Authors: Binic I. , Petrovic J. , Antonijevic J. , Pancic D. , Zdravkovic M. , Petrovic F.
Published: August 2023

Introduction

In treating schizophrenia, there is growing interest in introducing and renewing psychosocial therapies, including psychotherapy. In recent years, this has specifically entailed the adaption of particular cognitive behavioral therapy (CBT) approaches, which were previously only utilized for treating anxiety and mood disorders. The negative symptomatology of schizophrenia, which has proven to be especially difficult to treat, can be a challenge for CBT, particularly in terms of enhancing relationships with family and friends and work engagement.

Objectives

The objective was to summarize the advantages of CBT treatment in schizophrenia briefly.

Methods

Patients with schizophrenia frequently have comorbid problems, such as anxiety disorders (and disorders) and traumatic experiences, which can be effectively treated with CBT. In addition to pharmacological therapy, CBT is acknowledged as the gold standard in several countries for the treatment of schizophrenia. According to studies, combining CBT with medication can minimize psychotic symptoms.

Results

Regarding treatment, Beck describes the use of typical CBT techniques: building trust and engagement; working collaboratively to understand the meaning of symptoms; understanding the patient’s interpretation of past and present events, particularly those that the patient believes are related to the development and persistence of his or her current problems; normalizing these experiences and educating the patient about the stress-vulnerability model, and socialization. Clarifying the emotional and behavioral repercussions of a delusion’s activation leads to an initial examination of the evidence-based on more peripheral interpretations. It is recommended to treat negative symptoms such as amotivation, anergia, anhedonia, and social disengagement with behavioral self-monitoring, activity scheduling, ratings of mastery and enjoyment, graded work assignments, and assertiveness training.

Conclusions

In treatment settings where physicians are already utilizing high-quality psychoeducational materials to enhance adherence, an excellent foundation exists for introducing individual CBT for schizophrenia patients.

Disclosure of Interest

None Declared
“Clinical café meeting” - a clinician peer support and case discussion meeting: A tool for reflective practice and consolidation of resilience
Authors: Raji A. , Rogers J. , Foley B. , Roxburgh B. , Nawaz S. , Milligan S. , Ali J. , Shullaih Z. , Libbus Y.
Published: August 2023

Introduction

Previous studies have shown that Peer Support Programs (PSPs) promote workforce wellness by supporting clinicians during times of heightened stress and vulnerability (Keyser, et al., 2021). Inclusion of case discussions in PSPs can provide opportunity for reflective practice, quality improvement, and professional development, in addition to strengthening clinicians’ resilience.

Objectives

To describe the experience and perceived benefits reported by participants (psychiatrists) of a peer support and case discussion group meeting, of a clinical department of psychiatry (DOP) in Cape Breton, Canada, which the group calls “clinical café meeting”.

Methods

Qualitative data collected, were informal comments (with focus on the participants’ experience and perceived benefits) from the group participants during the once a month, one-hour clinical cafe meetings.

Results

From September 2015 to September 2021, attendance ranged from 2 to 10 participants. All participants voiced that, they see each meeting as an opportunity to “analyze their feelings and knowledge relevant to clinical practice situations, especially those associated with uncomfortable feelings (Atkins & Murphy reflective model, 1993), and challenges they face, in relation to the healthcare system. Many participants voiced how input from group participants help them with gaining a new perspective on practice situations that were discussed, and ideas on how they could deal with similar clinical situations or challenges, in a more robust way, in the future. Many participants also find the clinical café meetings to be helpful in consolidating their resilience.

Conclusions

PSP (with case discussion) participants, in a Canadian DOP, described their experience of the group meetings, as beneficial, including contributing to strengthening of their resilience.

Disclosure of Interest

None Declared
Taiwan National Health Insurance and Proportional Physician Fee of Psychiatrist in General Hospital during the COVID-19 pandemic : Case Report
Authors: Wang S.-C. , Lin Y.-H.
Published: August 2023

Introduction

In Taiwan, National Health Insurance has been implemented for 27 years and continues to receive international recognition. People pay part of the quota at the time of medical treatment, and the rest of the medical expenses will be paid by the national health insurance. In this study, the researcher, a psychiatrist in the general hospital, investigated the correlation between service and revenue. He has started to work in this hospital since November 1st, 2021, without any other psychiatrist peers.

Objectives

This study used proportion of PPF as performance indicator and aimed to observe the changes of PPF unit from November 1st, 2021, to January 31st, 2022, examining the trend of PPF growth. The purpose is to figure out an appropriate model to optimize medical services and performance outcomes.

Methods

Demographic data were collected through PPF projects, consisting of 17 inpatient ward items and 14 outpatient items from November 1st, 2021, to January 31st, 2022, and items with no performance or related to physiological examination has been excluded. In addition, items with a ratio of greater than 1.5% are presented in the bar graphs, as shown in
Figure 2 and 3. The performance proportion of inpatient ward and outpatient were calculated separately.

Results

Demographic data found PPF rises significantly over time
(Figure 1). The 2nd month PPF unit (27.09%) was 2.5 times the 1st month PPF unit (10.70%), and the 3rd month PPF unit (62.21%) was 2.2 times the 2nd month PPF unit (27.085%). The highest proportion of PPF items were general hospital bed inpatient consultation fee for inpatient ward item
(Figure 2) and psychiatric outpatient consultation fee for outpatient item
(Figure 3). Furthermore, only the proportion of psychiatric outpatient consultation – more than two consecutive transfers increased continuously and the proportion of psychiatric outpatient consultation – adjusted by the hospital decreased, the other items has not changed significantly.

Image:

Image 2:

Image 3:

Conclusions

In the first three months of the psychiatrist employment, the performance showed an increasing trend. These findings may suggest that the psychiatrist could be competent in a general hospital with patients’ confidence. In addition, under an optimal model of PPF and medical service, psychiatrists would more like to work in the general hospital, to serve acute psychiatric patients in need.

Disclosure of Interest

None Declared
Clozapine use in drug induced psychosis in Parkinson´s disease: a case report and review of literature.
Authors: Sanz Giancola A. , Setién Preciados P. , Arroyo Sánchez E. , Romero Gerecther I. , Martín Velasco M. , Díaz Mayoral C.
Published: August 2023

Introduction

The occurrence of psychotic symptoms induced by dopaminergic drugs marks a new phase in the course of Parkinson’s disease (PD). The term drug induced psychosis may be used when other significant psychiatric diseases are excluded in patients with no history of psychosis. The prevalence of dopaminomimetic psychosis varies from 5% to 20%. Therefore, knowledge of the psychopharmacological management of this condition is essential.

Objectives

The purpose of this case report and literature review is to to learn the psychopharmacological management of this not uncommon medical complication.

Methods

Descriptive case study and review of literature

Results

We present the case of a 71-year-old man with a medical history of Parkinson’s disease with partial response to treatment with high doses of levodopa and carbidopa.

He was brought to the emergency department by his family due to the presence of behavioural alterations at home.

The patient reported seeing men in foam trying to harm his family. In a disjointed way in his speech, he links this idea with the delusional belief that he is being watched by electronic devices placed throughout the house. In a variegated manner he links this with a coelotypical type of discourse, however the delusional ideation remains unstructured throughout.

With no previous personal or family history of mental health and ruling out underlying organic conditions, a diagnosis of psychosis secondary to pharmacological treatment for Parkinson’s disease is presumed.

Considering the risks and benefits, it was decided to maintain the anti-Parkinson’s dose in order to avoid worsening the patient’s motor function. Therefore, after reviewing the literature, the best option was to introduce clozapine at low doses, up to 50 mg at night, with the respective analytical control. After a week’s admission, the patient began to improve psychopathologically, achieving an ad integrum resolution of the psychotic symptoms.

Conclusions

Despite the availability of other antipsychotic treatments such as quetiapine or the more recent pimavanserin, clozapine remains the treatment of choice for drug-induced psychosis in Parkinson’s disease.

Disclosure of Interest

None Declared
Relation between stressful life events and psychosis
Authors: Osca Oliver A. , Pérez Iglesias R. , López Rodrigo M. V. , Ros Fons V. , D´Hiver Y. , Sánchez G. , Pérez Fominaya M.
Published: August 2023

Introduction

Numerous studies establish clear connections between traumatic childhood experiences and the risk of developing psychosis. According to the study carried out by Filippo Varese, childhood traumas, understanding by; physical, psychological or sexual abuse, abandonment, death of the parent and “bullying”, increase up to three times the risk of suffering from psychosis.

Objectives

-

Determine the prevalence of traumatic events in the sample studied.

-

Determine which traumatic event has a greater relationship with the risk of presenting a psychotic episode.

-

To determine whether traumatic events may be more strongly associated or not with gender differences, age at onset and family story.

Methods

A descriptive study is carried out in which the traumatic events are evaluated (through the CAVE questionnaire) of 98 patients who have been treated for a psychotic episode in the last two years in the Early Intervention Unit for Psychosis (ITPCan).

The stressful life history questionnaire (CAVE) consists of 52 questions divided into blocks: school stage, work, partner, family, health and other stressful events. All of them focused on those stressful events prior to the onset of psychotic symptoms. Stressful events have been considered to be those events in which the patients studied have scored 10 (maximum score) on the anxiety scale.

Inclusion criteria:

-

Older than 18 years-old

-

Having presented a first psychotic episode.

Exclusion criteria:

-

Intellectual disabilities

Results

For now, the data studied in this sample are similar to those described in most of the studies reviewed: more than half of the patients present at least one traumatic event before the onset of psychotic symptoms and a third of these have had any traumatic experience before the age of 18.

The percentage of the presence of at least one traumatic event within the categories of the CAVE questionnaire would be:

14.2% in the school stage

26.7% in the workplace

26% in relationships

24.3% in family relationships

12.1% in events related to the patient’s own health problems

Conclusions

We continue to increase the sample to have a more significant result.

Disclosure of Interest

None Declared
Late-onset schizophrenia: a differential diagnosis
Authors: López Rodrigo M. V. , Palomo Monge M. , Osca Oliver A. , Tascón Guerra F. , Ros Fons V.
Published: August 2023

Introduction

Regarding the diagnosis of schizophrenia, a peak of onset of symptoms is considered at 25 years. The debut after 60 years is considered late onset and is rare, generating controversies in the diagnosis

Objectives

We present the case of a 58-year-old patient with no personal or family history of mental health, who came to the emergency room for the first time, reporting feeling in danger. He comments itching on his skin, verbalizing seeing bugs running through it, relating this phenomenon to “witchcraft by my brothers”, he also refers to feeling like “they watch my thoughts and block it through a mobile application, they enter through my eye right and this gives me less vision and a headache. He also refers to having the ability to listen to how his brothers talk about how they are going to “hurt me.” Psychopathologically, we highlight that she is oriented in the three spheres, presenting delusional ideation with an experience of harm, a phenomenon of thought theft and auditory and tactile hallucinations.

Methods

Analytical and imaging tests, as well as toxins in urine, were negative.

Results

Diagnosis of psychotic episode is made to see evolution. The clinic partially yields to treatment with atypical antipsychotics. At this time, the patient has no awareness of the disease.

Conclusions

Despite being a diagnosis that is scarcely prevalent, once organic disease has been ruled out.

Disclosure of Interest

None Declared
EEG power spectrum analysis for Tunisian schizophrenic patients
Authors: Mnif M. , Smaoui N. , Triki L. , Donia J. , Feki R. , Gassara I. , Omri S. , Maalej M. , Charfi N. , Zouari L. , Ben Thabeut J. , Masmoudi K. , Maalej M.
Published: August 2023

Introduction

Schizophrenia (SCZ) is a common and disabling psychiatric condition. Its diagnosis is entirely clinical. Many researchers have looked into electroencephalogram (EEG) power spectrum analysis for SCZ to find specific abnormalities.

Objectives

The objective of this study was to analyze the EEG of patients with SCZ using power spectral density and to compare them with those of healthy controls, in order to look for specificities.

Methods

This was a cross-sectional, descriptive, and analytical case-control study conducted with patients followed for SCZ in the psychiatry "C" department at the Hedi Chaker hospital in Sfax. Healthy controls were included. Patients were assessed by the Positive and Negative schizophrenia scale (PANSS). All participants benefited from an EEG at rest condition at the service of the functional exploration at the Habib Bourguiba hospital in Sfax. We have measured the powers of each band using Welch power spectral density method called absolute power (AP). Statistical analyses were carried out.

Results

Fifteen schizophrenics and 15 controls, all male, were included. The average age of schizophrenics and healthy controls was 40 years ±12.72 years and 47.93 ± 15.61 years respectively. There were no significant differences in age between patients and controls. Schizophrenics had a mean PANSS of 64.6±22.7.

At the quantitative EEG, differences appeared to be insignificant. There was an overall decrease in AP for the alpha band particularly in the parietal and occipital lobes in schizophrenics (53,16 ± 48,83 μV2 and 75,17 ± 56,28 μV2 respectively) compared to controls (335,15 ± 994,73 μV2 and 400,24 ± 1109,95 μV2 respectively). There was also an overall decrease in AP for the different frequency bands in schizophrenics compared to controls. However, values persisted high in the temporal lobe for all frequency bands.

Conclusions

In conclusion, this decrease in AP for the alpha band in the parietal and occipital lobes in schizophrenics can be a sensitive biomarker for diagnosing SCZ.

Disclosure of Interest

None Declared
Persistent delusional disorder: psychopathological remission associated with clozapine-induced epileptic seizures
Authors: Felizardo M. , Freitas C.
Published: August 2023

Introduction

Persistent delusional disorder has some features similar to schizophrenia, although the functionality of patients with this diagnosis is usually higher and is diagnosed at an older age. Although the pharmacological treatment of schizophrenia has been studied extensively, there is not much data on the treatment of persistent delusional disorder. Regarding the use of clozapines specifically in persistent delusional disorders, there are some case reports with encouraging results. Electroconvulsive therapy is not generally used as a treatment for persistent delusional disorder.

Objectives

To reflect on the relevance of using electronvulsive therapy in the treatment of persistent delusional disorder.

Methods

Through the description of a clinical case in which there was evidence of remission of resistant psychotic symptoms after clozapine-induced epileptic seizures, the authors hypothesize the existence of a direct relationship between the crisis and the resolution of a persistent delusional disorder.

Results

A.F., 78 years old, male. No personal history of psychiatric or medical-surgical illness. Admitted for psychotic decompensation framed in persistent delusional disorder. The patient underwent pharmacological treatment with resistance to three lines of antipsychotics. With the introduction of clozapine 100mg/day, the patient had two epileptic seizures, followed by complete remission of psychotic symptoms.

Conclusions

The clinical case described refers to a patient diagnosed with resistant persistent delusional disorder, with almost immediate resolution of the condition after epileptic seizures induced by clozapine. Taking into account the clinical response in our patient to two spontaneous epileptic seizures, we hypothesize that electroconvulsive therapy may be effective in the treatment of persistent delusional disorder.

Disclosure of Interest

None Declared
Assessing the impact of Tadalafil on the sexuality and quality of life after acute urinary retention: a randomized controlled Trial
Authors: Bouassida K. , Loghmari A. , Ben Othmen M. , Tlili G. , Acacha E. , Ben Abdallah W. , Kahloul M. , Hmida W. , Jaballah R. , Zorgati A. , Boufek R. , Jaidane M.
Published: August 2023

Introduction

Acute urinary retention (AUR) is known to have major impact on the quality of life and sexuality of patients with benign prostatic hyperplasia (BPH). However, little is known about specific approachs that could reduce this impact. Tadalafil, an efficient medication in uncomplicated BPH, may be also useful in serious complications, especially the AUR.

Objectives

The aim of this study is to assess the impact of Tadalafil on sexuality and quality of life in patients AUR related to BPH.

Methods

This is a randomized, double-blind clinical trial conducted in the Urology and Emergency Departments of Sahloul Teaching Hospital, between June 2020 and January 2022. Consenting men over the age of 45 who had an AUR complicating a BPH were included. Fifty three patients were enrolled and randomized into two groups: intervention group (n=29) in which patients received 5 mg/day of Tadalafil, and control group (n=24) in which patients received a comparable tablet of placebo. The evaluation focused on sexuality and quality of life. For theses purposes we used SF-36 short form and IIEF 15.

Results

Socio-demographic characteristics were comparable between both groups. Sexuality assessed by IIEF 15 was significantly better in the intervention group (p=0.02). The four SF-36 domains were also significantly improved by Tadalafil: “Physical Function” (p=0.046), “Pain” (p=0.01), “General Health” (p=0.029) and “Health change” (p=0.02).

Conclusions

Sexuality and quality of life could be improved by Tadalafil in complicated BPH.

Disclosure of Interest

None Declared