bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in the Psychotherapeutic Orientation Among Dutch and Belgian Psychiatric Residents
Authors: Dal S.
Published: March 2009

The psychotherapeutic education of psychiatric residents remains a poorly studied area. Until now, there have been a few mainly theoretical or local researches, mainly rooted in a psychoanalytical descriptive framework, and many normative guidelines. One could almost believe that psychiatrists are spending very little time considering their own social determinations. So we did a large scale study in 2006, among Belgian and Dutch residents. This allows us to present a few first results: notably the difference in orientation according to some demographic variables (a.o. religious background and language) and major dissimilarities concerning referential authors for Dutch, Flemish and Walloon residents. These objective points corroborate the idea that psychiatry is not (yet) an homogeneous field in Europe, but is subject to considerable cultural variations.
Effects of Somatopsychic Comorbidity on Lagtime and Length of Stay in Patients Referred to a Psychiatric Consultation Service in Germany [P02-213]
Authors: Diefenbacher A. , Strain J.J.
Published: March 2009

It is not clear whether psychiatric comorbidity in medically ill patients contributes to longer lengths of hospital stay (LOS), and whether interventions carried out by psychiatric consultation-liaison (c-l) services lead to a reduction of LOS. Furthermore, the lagtime paradigm, i.e. the notion that the earlier a psychiatric consultation takes place, the shorter LOS of the resp. patients are, has been questioned. To study if different degrees of somatopsychic comorbidity have effects upon Lagtime and LOS of patients seen by a c-l-psychiatric service. Patients consecutively referred to a c-l-service in Berlin during a one year study period were categorized into six groups of different somatopsychic comorbidity using a count-approach based upon ICD-10 psychiatric, and ICD-9 somatic diagnoses. The groups with more psychiatric than somatic diagnoses show shorter LOS and shorter Lagtimes. Patients with only psychiatric diagnoses overall show the shortest average LOS and Lagtime. For the groups, however, with more somatic than psychiatric diagnoses, LOS and lagtimes are longer. In the groups with equal numbers of psychiatric and somatic diagnoses, there is a trend with higher numbers of somatic diagnoses showing longer LOS and Lagtimes. On the other hand, in both groups with 2 and more somatic diagnoses, a trend can be seen toward shorter LOS and Lagtimes in such patients with more than 1 psychiatric diagnosis. Psychiatric comorbidity in medically ill patients does not sufficiently explain differences in LOS and Lagtime of patients seen in psychiatric c-l-services, but a complex interplay of somatopsychic comorbidity has to be taken into account.
The Role of Mother Communication Styles in Treatment of Stuttering in Children
Authors: Berberi F. , Harapi E. , Kabili E. , Gecaj M. , Dyrma A. , Dega Z. , Elezi F.
Published: March 2009

Stuttering is decribed as a disorder of fluency and characterized by part-word, whole-word and phrase repetitions; interjections; pauses; and prolonged. Studies done about communication patterns of parent and child generally focus on the negative of positive nature of the statements, such as verbal aggression, silents, and interruptions more excessively than the parents of non stutters; and at the same time, parents became a part of the therapy proccesses of stuttering.

The communication patterns used between Albanian mothers and her stuttering child and her normally fluent child were investigated. A total of 20 mother-stuttering child pairs and 20 mother-nonstuttering child pairs participated in the preswent study. All mother child pairs were administered a structured game to facilitate spontaneous speech. Comments, questions, critical statement, no response and interruptions were studied as negative statements. Verbal praise and verbal acknowledgments were accepted as a possitive statement.Interaction times and total amount of words were also measured.

A significant different was found between both mother and child groups only in the total words used. No significant differences were found for any other communication styles.

These findings suggest that the communication behaviour of mother of stuttering children is not different from that of the mothers of nonstutters.
The Social and Psychological Correlates of Happiness in Seventeen European Countries: Analysis of Data from the European Social Survey
Authors: Doherty A. , Kelly B.
Published: March 2009

Background:

Happiness has been associated with a number of individual and societal factors, but much of the individual-to-individual variation in happiness remains unexplained. The purpose of this paper is to examine a broad range of social and psychological correlates of self-rated happiness in Europe.

Methods:

We used data from the European Social Survey to determine levels of happiness in individuals (n=30,816) from seventeen European countries and to identify associations between happiness and age, gender, family relationships, satisfaction with income, employment status, community trust, satisfaction with health, satisfaction with democracy, religious belief and country of residence.

Results:

Self-rated happiness varies significantly between European countries, with individuals in Denmark reporting the highest levels of happiness and individuals in Bulgaria reporting the lowest levels. On multi-variable analysis, happiness is positively correlated with younger age, satisfaction with household income, being employed, high community trust and religious belief. Overall, these factors account for 22.5% of the individual-to-individual variation in happiness in Europe.

Conclusion:

For the individual, this study highlights the strength of association between happiness and the individual's attitudes towards various aspects of their personal, household and societal circumstances. For social policy-makers, this study confirms the potential usefulness of civic measures to increase community trust and social capital. Further studies of the inter-relationships between individual and community-level variables would assist in further explaining the variance in happiness between individuals and countries.
Dayhospital of the Psychiatry Department of Hospital De São João: The Last Three and a Half Years
Authors: Domingues I. , Pedrosa R. , Sousa V. , Marques J. , Martins A. , Curral R. , Palha A. , Torres A. Roma
Published: March 2009

The Day Hospital of Hospital de São João was one of the pioneers in Portugal, and it began to work in July 1970. In those days, the main purpose was to reduce the number of full hospitalizations, and to aid the reinsertion of patients discharged from the Inpatient Unit. In a previous study, presented in the I Congresso Nacional de Psiquiatria (2005, Portugal), the first 34 years of this Day Hospital (from 1970 to 2004) were analyzed - some changes were noted during that period, namely the type of diagnosis and the hospitalization length. The main purpose of the present study was to characterize the patients that were treated in the Day Hospital of Hospital de São João during the last 3 and half years (Jan 2005- Jul 2008; n = 302), according to age, gender, diagnosis, length of hospitalization, and occupation rate. Then, these data were compared to the data of the previous study (firsts 34 years, in groups of 5 years). For this purpose, the authors used the Qui Square Test and the Kruskal - Wallis Test. It was also analyzed the distribution of the diagnosis according to gender and to length of hospitalization.
Costs of the Inward Stay of Psychiatric Patients Referred from an International Airport
Authors: Cerezo E. Benítez , Velasco M.F. Pando , Bonafonte A. Regidor , Soriano R. Martínez de Velasco , Ferrando I. Gobernado , Sierra C. Erausquin , Bermudo-Soriano C. Riaza
Published: March 2009

Introduction:

Ramón y Cajal Hospital is the reference centre for Madrid-Barajas airport. Passengers at the airport who need medical assistance are brought to this hospital. A percentage of these passengers require psychiatric evaluation and frequently need to stay inward for a certain term.

Objective:

Calculate the approximate costs derived from the inward stay at the Psychiatry ward of patients referred from Madrid-Barajas airport.

Methods:

Revise retrospectively clinical histories of inward psychiatric patients referred from Barajas airport in the last 5 years. The Department of Economic management of the hospital has provided the costs of stay at the Psychiatry ward for the year 2007 (395 euros per day). Data is analyzed using the SPSS software 15.0 version.

Results:

The average stay of these patients is 13.96 days. Then, the average cost is 5514.2 euros. Extrapolating these data to our sample, we notice that being the reference centre for an international airport supposes an estimated cost of 545.905.8 euros (109181.16 per year) due to inward stay of psychiatric patients.

Conclusion:

The psychiatric attention to the airport population represents an economic extra charge that has an impact on the hospital and the National Health System. We only expose the charge derived from inward stay. To obtain a more realistic overall result we should add the costs of the attention at the emergency room to the result above.
Latency Period Between TBI and the Beginning of Psychosis
Authors: Euba O. , Zallo E. , Torreblanca M.
Published: March 2009

Aims:

Latency period between brain damage and the beginning of the psychotic symptoms is a very controversial remark, when we are trying to sharpen in the etiology of a postraumatic psychosis.

Methods:

Our work is based on a systemic review of the articles published related to TBI and psychosis.

Results and conclusions:

The average latency period is between 4 and 5 years, including a wide range of time from days to years.

Results may not be very accurate because in some articles any psychotic sympton is included even if there is not a complete psychotic disorder as described in DSM-IV.
Postraumatic Psychosis. Clinical Features
Authors: Euba O. , Zallo E. , Torreblanca M. , Arroita A. , Sánchez N. , Barreiro A.
Published: March 2009

Aims:

Traumatic brain injury (TBI) cause a wide range of after-effects, including psychiatric disorders. Psychosis although uncommon is a very serious consequences with important functional, therapeutical and legal implications.

Methods:

Our work is based on a systemic review of the articles published related to TBI and psychosis.

Results and conclusions:

Delirious psychosis are twice more common than schizophrenia-like psychosis (28% to 14%).

Delusions and hallucinations are predominant over passive phenomena or negative symptoms.

Evolution and chronicity of postraumatic psychosis depends on the severity of the TBI and on the psychiatric and neurological previous conditions.

Treatment is the same as used for typical psychosis, even though side effects are more frequent.
What Does it take to Become a Psychiatrist? Results from a Survey on Quality of Training
Authors: Silva V. Barbanti , Forghieri M. , Ferrari S. , Volpe U. , Fiorillo A.
Published: March 2009

As models of mental health care and the professional identity of psychiatry are dramatically changing throughout Europe, a constant redefinition of aims, procedures and standards of training in psychiatry is widely perceived as necessary. The aim of the present study was to assess, in a group of trainees in psychiatry and early career psychiatrists, facts and opinions about their own training.

A 30-item ad hoc structured questionnaire, with both yes/no questions and rating scales, was administered to 92 Italian trainees in psychiatry and young psychiatrists, during a training event. The questionnaire focused on general work-related aspects (job satisfaction, self-confidence in different skills and therapeutic interventions) but also on more specific training-related aspects (supervision, training in psychotherapy, methods of evaluations, training in research).

Mean (SD) age of respondents was 30 (3.51) years, with a M/F ratio of 0.31. Sixty-nine percent of respondents deemed themselves generally “satisfied” with their training, but when considering some specific areas of training, such as psychotherapy and forensic psychiatry, the satisfaction rates were sensibly lower (33 and 19% respectively). Lower levels of professional self-confidence were associated to forensic psychiatry, child and adolescent psychiatry, and emergency psychiatry. Respondents also reported problems in the definition and application of training instruments such as supervision and a training log-book.

The definition and implementation of minimum educational international standards for training in psychiatry is still necessary. Thus, continuous research on definition of educational standards in psychiatry has to be promoted throughout Europe.
Ventral Prefrontal Function Mediates Resileince to Bipolar Disorder: An fMRI Study of BD Patients and Their Unaffected Siblings
Authors: Haldane M. , Kempton M. , Frangou S.
Published: March 2009

Background and aims:

Bipolar disorder (BD) is characterised by emotional dysregulation; abnormal emotional information processing is likely to be a component of genetic predisposition to BD.

Method:

Functional magnetic resonance imaging data was collected during an event-related facial affect recognition task (fearful, angry, sad expressions), from: 41 BDI patients, 22 of their unaffected siblings, and 51 controls. A random effects analysis was implemented using SPM5.

Results:

Patients, relative to controls had significantly:

a.

reduced activation in the left inferior frontal gyrus and middle occipital gyrus and,

b.

enhanced activation bilaterally in the posterior cingulate and in the left postcentral gyrus; in the temporal lobe, increased activation was seen in the hippocampus and amygdale bilaterally and in the middle and inferior temporal gyri.

Siblings, relative to controls showed significantly enhanced activation in the inferior frontal gyrus and in the parahippocampal gyrus and amydgala. Siblings relative to patients had significantly higher activation in the inferior frontal gyrus.

Conclusions:

In BD patients there is evidence of increased limbic activation and decreased cortical efficiency during facial affect processing; increased ventral PFC activation in siblings, in the presence of increased limbic activation, may serve as a compensatory mechanism mediating resilience to disease expression.
Corpus Callosum Size and Shape in Individuals with Bipolar Disorder and Their Relatives
Authors: Walterfang M. , Wood A. , Barton S. , Velakoulis D. , Chen J. , Pantelis C. , Reutens D. , Kempton M. , Haldane M. , Frangou S.
Published: March 2009

Objective:

To examine genetic influences the anatomy of the Corpus Callosum (CC) in Bipolar Disorder (BD) by examining first-degree relatives in addition to BD patients.

Methods:

We compared CCl size and shape in 180 individuals: 70 with BD, 45 of their unaffected first-degree relatives, and 75 healthy controls. The CC was extracted from a mid-sagittal slice from T1-weighted magnetic resonance images; its total area, length and curvature were compared across groups. A non-parametric permutation method was used to examine for alterations in width of the callosum along 39 points.

Results:

Validating our previous findings, a significant global reduction in CC thickness was seen in BD patients, with a disproportionate thinning in the anterior body. First-degree relatives did not differ in CC size or shape from controls. Duration of illness was associated with thinning in the anterior body, whereas Lithium treatment associated with thicker anterior CC midbody.

Conclusions:

Global and regional CC thinning is a disease related feature of BD and may not represent a marker of familial disposition.
Epidemiological Characteristics of an Outpatients Population Followed-Up by a French Network of Psychiatrists: New Clinical Data
Authors: Gheysen F. , Khalifa-Soussan P. , Dufour C. , Carrière P. , Modavi D. , Gaussarès C. , Sontag H. , Gailledreau J.
Published: March 2009

Rationale:

Prevention of suicidal risk is the primary goal for private psychiatrists. However there are few evidence-base data to guide clinicians in the management of suicidal patients.

Objective:

To describe the epidemiological profile of psychiatric outpatients at severe risk of suicide and to compare it with patients at no suicidal risk.

Methods:

The GICIPI database totalized 7508 outpatients having at least one diagnosis on the MINI 5.0.0 life version, as of 31DEC2007. Patients with either no suicidal risk or a severe risk on the MINI were selected for analysis. Demographic, socio professional, diagnostic and psychometric parameters were compared between the two groups.

Results:

Both groups had a similar mean age (40.3 vs 41.4 years). Data showed that the patients with a severe risk of suicide were more likely to be separated (13.29% vs 5.17%), divorced (10.76% vs 5.36%) or single (43.54 vs 28.48%). The mean weight of the two groups was comparable (72.1 kg vs 70.7 kg). The sex ratio was similar in both groups (69.6% women vs 68.6% men). There were no differences in the distribution of socio professional categories. Most strikingly, although the initial MADRS scores were higher in patients at high risk of suicide (27.1 vs 23), the HAMA scores were significantly lower (5.4 vs. 15.2).

Discussion and conclusion:

These results will be compared to the literature, and a profile of the patient at high risk of suicide, as seen in everyday private practice, will be described, hence helping to improve the management of these suicidal outpatients.
Escitalopram Prolonged Fear Induced by Simulated Public Speaking and Released Hypothalamic-Pituitary-Adrenal Axis Activation
Authors: Garcia-Leal C. , Del-Ben C.M. , Leal F.M. , Graeff F.G. , Guimarães F.S.
Published: March 2009

Simulated Public Speaking (SPS) test is sensitive to drugs that interfere with serotonin-mediated neurotransmission and is supposed to recruit neural systems involved in panic disorder. The study was aimed at evaluating the effects of escitalopram, the most selective serotonin selective reuptake inhibitor available, in SPS. Healthy males received, in a double-blind, randomized design, placebo (n=12), 10 (n=17) or 20 (n=14) mg of escitalopram two hours before the test. Behavioural, autonomic and neuroendocrine measures were assessed. Both doses of escitalopram did not produce any effect before or during the speech, but prolonged the fear induced by SPS. The test itself did not significantly change cortisol and prolactin levels, but under the higher dose of escitalopram, cortisol and prolactin increased immediately after SPS. This fear-enhancing effect of escitalopram agrees with previously reported results with less selective serotonin reuptake inhibitors and the receptor antagonist ritanserin, indicating that serotonin inhibits speaking fear.
Demographic and Clinical Features and Suicidality in Conversion Disorder Patients in Turkey
Authors: Gokalp P.G. , Erdiman S. , Akyüz F. , Oflaz-Batmaz S. , Karsidag C.
Published: March 2009

Aims:

The incidence of DSM-IV conversion disorder in outpatients is 4.5-32 %, with childhood trauma being an important etiological factor. This study aims at investigating the symptom pattern, comorbidity, suicidal behavior in this patient group.

Method:

Outpatients who were diagnosed as DSM-IV Conversion Disorder were included in the study except those with a neurological disorder, mental retardation, alcohol and subtance abuse/ dependency, bipolar, schizophrenic and other psychotic disorders and tardive dyskinesia. The assessment instruments are Demographic and Clinical Questionnaire developed by the authors, Childhood Trauma Questionnaire ( CTQ-28), ve Hamilton Anxiety and Depression Rating Scales (HARS-HDRS).

Results:

25 female outpatients’ mean age 34.48 (SD ± 10,21). 76% were married, 24% had no formel education. 48% (n=12) were physically, 28% (n=7) were sexually abused. 36% (n=9) of the patients had attempted suicede at least once. There was no significant link between childhood trauma and suicide attempt. There was a significant relationship between pseudoepilepsy symptom and suicidal tendency ( p: 0,021). Mean HDRS score was 7,88 (SD: 4,43), mean HARS score 13,56 (SD: 7,42). There was a significant relationship between HARS scores and suicide attempt (p:0,037). CTQ-28 subgoup mean scores were: emotional neglect 2,86 (SD:1,32), physical neglect 2,04 (SD:0,52), emotional abuse 2,25 (SD:1,26), physical abuse 1,98 (SD:1,56), overall 10, 98 (SD:4,15).

Conclusion:

Conversion disorder patients are a neglected group in health care system. Past traumatic experiences, comorbidity rate and suicidality have to be addressed in assessment and treatment for a better prognosis.
Autistic Children and Familiar Animals: What Types of Interactions? A Parent Survey
Authors: Grandgeorge M. , Lemonnier E. , Tordjman S. , Deleau M. , Hausberger M.
Published: March 2009

Animals are considered to act as social substitute, allowing people with autism spectrums disorders (ASD), a cognitive disorder, with social withdrawal, first to establish bonds with them and second to extend these bonds to humans. However, clear scientific bases proving such effects are still lacking. As a first step, the present study describes the interactions between 190 subjects with ASD and their pets, and investigates the possible influence of the subject's age and of the pet species. On the one hand, parents reported that their 6-to-12 year-old children mainly interacted by physical contacts whereas adults with ASD mostly interacted with visual contact, both with dogs and cats. On the other hand, some environmental factors and pet characteristics seemed to modulate the relation described; for example, the relation between 6-to-9 year-old children with ASD and their dog seemed to be related to dog size and purchase origin. Such study could be considered as a first characterisation of the relation that subjects with ASD could develop with their pets and the basis for thoughts about what animals and how animals could potentially help developing cognitive or social skills in such children.
Spirituality and Religiosity in the Treatment of Mentally Disordered Persons in Bosnia and Herzegovina
Authors: Pajević I. , Hasanović M.
Published: March 2009

Spirituality and religiosity in the treatment of persons with mental disorders have a rich tradition in Bosnia and Herzegovina, but in the last half century these dimensions were unjustifiably ignored. Working with a large number of difficult traumatized people during the war, we perceived that religious people coped more successfully with a variety of difficulties that have afflicted them, than those who were not religious. Psychiatrists, who had the sensitivity to indicate the religious needs of certain clients in indicated cases, used the spirituality and religiosity in the process of healing. Following the trail of such remarks a number of empiric researches were done, which confirmed the justification for this approach. In that way the spirituality and religiosity found their place in the educational programmes for professionals in the field of mental health and psychotherapeutic treatment of psychiatric patients. Thereby, we as mental health providers, established cooperation with certain religious institutions and religious officials in that field, and we arranged in the framework of hospital institution adequate rooms for spiritual and religious needs of patients, which received their equal place with other necessary facilities.
Reasons for Choice of Medication - Baseline Data of the Outpatient ADHD Treatment Study “Comply”
Authors: Wehmeier P. , Schacht A. , Dittmann R.W. , Banaschewski T.
Published: March 2009

Aims:

Patient-related factors and physicians’ attitudes leading to the decision which particular treatment is prescribed for attention-deficit/hyperactivity disorder (ADHD) have not been investigated in detail. We assessed the reasons for choice of medication and the socioeconomic status of treatment-naïve ADHD patients when initiated on ADHD medication.

Method:

Multicenter, prospective, 6-month observational study in children and adolescents with ADHD (ICD-10 or DSM-IV). Demographic, disease, and socioeconomic characteristics, and ADHD-related symptoms (ADHD-RS, CGI-S, GIPD) were captured at baseline, and compared between two medication groups (non-stimulant vs. stimulant). Physicians’ reasons for choice of medication were recorded. Correlations between those reasons were explored by Pearson"s correlation coefficient, Cohen"s Kappa, and cluster analyses.

Results:

Overall, 504 patients, mean age 9.6 years (range 6-17), 27.4% female, were included. Non-stimulant medication was prescribed in 50.0% and stimulant in 49.0% of patients (1% received both). In the non-stimulant group, patients were significantly older (0.6 years), had significantly more problems with regard to their psychosocial situation, and had more concomitant psychiatric disorders. There were no significant differences in questionnaire scores. Physicians’ reasons for prescribing medication differed for non-stimulant vs. stimulant treatment: duration of action (73.4%/28.7%), beneficial for compliance (60.3%/40.1%), and patient/parent decision (33.7%/26.3%) were reasons in favor of non-stimulant treatment; good efficacy (93.1%/73.0%), good tolerability (66.4%/44.1%), and well-priced (38.1%/2.8%) in favor of stimulant treatment.

Conclusion:

Patients initiating stimulant or non-stimulant ADHD treatment differed significantly on some points according to their baseline characteristics. Physicians’ reasons for choice of medication clearly differed between the two medication groups.
Malingering in Sickle Cell Disease (SCD)
Authors: Alao A. , Howard L.
Published: March 2009

Many people who suffer from SCD experience debilitating bone pain crises, which often bring them to seek emergency care. The following is a case report of a 27 year old male patient who expressed suicidal ideation during a Sickle cell bone pain crisis. He went to the emergency room with intense pain in his right leg, which was not relieved by Ibuprofen. He has had several visits to the emergency room including three previous hospitalizations for sickle cell bone pain crisis management. In the emergency room he was treated with 50 mg of meperidine and re-hydrated with normal saline. After two hours, the emergency room physician discharged him. The patient felt he was not adequately treated and requested more pain relief, but was denied. At this point, he expressed suicidal ideation with a plan to shoot himself when he got home. As a result, psychiatric consult was requested. Upon psychiatric evaluation, he expressed to the psychiatrist that he didn't really plan to kill himself. The psychiatrist recommended hospitalization of the patient in the medical unit and aggressive pain management protocol. This is a case of a patient with SCD in bone pain crisis who expressed suicidal ideation as a cry for help. While this behavior from patients should not be encouraged, patients with documented SCD in bone pain crisis should be adequately treated. It is better to error on the side of treatment than risk negligence and sub-standard care.
Comparison Between Prevalence and Patterns of Cigarette Smoking Amongst Sixth form Students in the United Kingdom and Pakistan
Authors: Husain M. , Khan S. , Husain M. , Saeed M. , Chaudhry N.
Published: March 2009

Background:

Tobacco smoking is one of the major preventable causes of premature death and disease in the world. Adolescents are amongst the most vulnerable group of individuals in society and are highly susceptible to cigarette smoking. Sixth Formers being the most senior members of the school act as role models to younger pupils and could influence smoking behaviour.

Objective:

In a cross sectional and comparative study we aimed to determine the differences in smoking prevalence and patterns between Sixth Form students in Pakistan (a developing country) and the United Kingdom (a developed country).

Method:

A self-administered questionnaire, adapted from the WHO questionnaire, about tobacco smoking for health professionals was distributed amongst the students. The responses were anonymised to encourage truthful answers; there was no pressure to respond.

Of the 235 participants in the UK, 38 (16%) were regular smokers. Of the 297 participants in Pakistan, 20 (7%) of participants were regular smokers. In both countries there was a significant difference between the genders, with males being more likely to smoke. In Pakistan it was identified that the main reason for smoking was due to peer pressure, where as in the UK it was for recreational and social purposes.

Conclusions:

The prevalence of smoking was higher in UK compared to Pakistan. There was a significant difference in the smoking behaviour patterns in the two countries.
Chris Hani Baragwanath Hospital (CHB) Neuropsychiatric unit: HIV Positive Psychiatric Patients on Antiretrovirals
Authors: Jonsson G. , Moosa M. , Jeenah F.
Published: March 2009

Aim:

To describe the characteristics of a group of HIV positive psychiatric patients on highly active antiretroviral therapy (HAART).

Method:

All mentally ill patients admitted to the psychiatric unit at CHB that were HIV positive where included in the audit. Patients that met the following criteria where initiated on HAART: CD4 of 200 or less cells/mm3; diagnosis of a WHO Stage 4 condition.

Results:

Since the inception of the service, the hospital admitted 573 mentally ill patients of which a group of 42 (7.3%) where confirmed as HIV positive. The mean age of the group was 39.2 years with a male: female ratio of 1:4.3. 42.9% of the patients presented with maniform symptoms. For 20 patients this was their first episode of mental illness. Only 11 (26.2%) patients were subjected to a CT scan and 18 (42.9%) to a lumbar puncture. In this group of HIV positive patients, 30 met the eligibility criteria and were commenced on HAART: 28 were treated with regimen 1b and 2 with regimen 1a. 16 patients had subsequent CD4 counts and 14 follow up viral loads performed. The viral loads of 13 patients had reached the required decrease in Log value at six weeks of HAART.

Conclusion:

A significant percent of all mentally ill patients admitted to the psychiatric unit at CHB are found to be HIV positive despite the fact that HIV screening is not done routinely on all patients. The majority of these patients have advanced disease and are eligible for HAART.
Dysmorphic Features and Development of Children with Infantile Autism
Authors: Kapinos-Gorczyca A. , Gorczyca P. , Kapinos M.
Published: March 2009

Childhood autism is a neurodevelopmental disorder that is characterized by impairments in social interactions, verbal and non-verbal communication and a pattern of stereotypical behaviours and interests. Contemporary studies show significant genetic and neurobiological factors in autism. Numerous authors described certain dysmorphic features, commonly occurring separately in autistic persons. These features are considered to be the potential indicator of early neurodevelopmental disorders.The aim of the study was to establish the dysmorphic features of the face in a group of autistic children and to compare the results to normal controls.We examined 30 children with childhood autism and 30 healthy controls.Criteria DSM-IV and Childhood Autism Rating Scale (CARS) were used in diagnosis. The photoanthropometric method followed the protocol established by Stengel-Rutkowski et al.

Statistical analysis was conducted with the use of ANOVA Kruskal-Wallis and U Mann Whitney tests, correlation analysis was made using χ2; test and Spearmann index. A level of p< 0,05 was accepted as statistically significant.

Dysmorphies of the ear as well as nose were found in the group of autistic children in comparison with the controls. In the examined group there was the correlation between the amount of dysmorphies and the presence of some somatic disorders in the first-degree relatives. The presence of these disorders showed also the connection with the scores in Childhood Autism Rating Scale. Besides there was a relationship between the amount of dysmorphies and the motor development of autistic children. The greater number of dysmorphies had a connection with delayed motor development and poor motor coordination.
Teaching Cultural Competence in Medicine
Authors: Kaufman K.
Published: March 2009

Introduction:

Understanding how different cultures perceive illness and treatment are fundamental elements of cultural competence in medicine. Knowledge alone is not sufficient; physicians must be open to these cultures and, as appropriate, inclusive of such in comprehensive treatment plans. Medical schools increasingly address this important issue by accepting student bodies with broad cultural diversity and focus education on attaining cultural competence. This paper addresses the unusual circumstance when medical students’ cultures are in direct conflict with western medicine and analyzes the perception of appropriate intervention.

Method:

Composite case analysis with literature review.

Result:

A 24-year-old male medical student of Asian heritage was asked to comment on how he would treat cancer patients who were expected to die without chemotherapy. He responded: “teach alternatives/benefits/risks; patients can be persuaded with knowledge but one must accept their decisions; patients may have had enough and want to start anew.” This last point addressed the Hindu concept of “peaceful death with reincarnation” which was consistent with his heritage. He had not considered refusal of chemotherapy in the context of western cultures wherein reincarnation may not be a belief and the desire to die may be secondary to depression.

Conclusion:

Cultural knowledge and diversity may lead to inappropriate approaches toward medical care in western cultures. As much as medical schools need to diversify, learn about other cultures, and incorporate such in patient-care, it is critical that medical schools teach students from other cultures about western culture.
Silence
Authors: Kaufman K.
Published: March 2009

Less can be more, much more. This brief four-stanza poem on “Silence” has served well as a focus in family psychotherapy addressing the changes in relationships between child and parent: inherent trust, perceived betrayal, attempts to heal, and communication. All parents and children at some time have felt or witnessed aspects of this poem. Poetry can be the catalyst for a deeper understanding of self, especially in the context of family. Poetry and poetry therapy permit the expression and analysis of powerful emotions and thoughts often too painful to vocalize.
Unconditional Love and the Loss of Children
Authors: Kaufman K.
Published: March 2009

Parental alienation syndrome is a process wherein children are alienated from the non-custodial parent by the custodial parent during, and even after, divorce processes. The poison used by the custodial parent can destroy all family relations among the non-custodial parent and these children. Classically, the eldest child turns away first and, like dominoes, the younger children follow. Years later, these children may argue that unconditional love never existed. It is the duty of the non-custodial parent to work with these children, however painful, such that they may move toward a more truthful and meaningful life. Poetry therapy can be utilized to address both cognitive and emotional aspects to loss, including the loss of children secondary to parental alienation syndrome.
Development of an Interview Version of the HOME Assessment Tool
Authors: Lai W.W. , O'Mahony M. , Mulligan A.
Published: March 2009

Aims:

To develop an interview version of the HOME assessment tool and compare the interview version of the HOME with the home visit version.

Methods:

Families whose child under 10 years of age attending the Mater CAMHS, with first attendance in the past two years were contacted. 100 of the 247 contacted agreed to participate and consented to a family visit. The study had prior ethics approval. A brief interview version of the HOME devised by substituting questions for the observer rated part of the HOME questionnaire was administered prior to the home-visit, where the home-based version of the HOME was performed. Both interviews were then compared and statistically analysed.

Results:

The mean score for the home visit HOME was 46.93 ± SD. The comparison of the telephone data with the home visit data suggested that there is a small significant difference between total score for the telephone and the home visit HOME score, with a difference of 0.96 - 3.20 (95% CI), when each of the assessments were scored out of 100. Bell- curves and T-Pairing scores of subscales and individual questions of both interviews suggest similarity.

Conclusion:

These results suggest that an interview version of the HOME assessment can be administered in the clinic or by telephone.
Do Patients Follow-Up with Discharge Advice After Psychiatric Assessment and Discharge from Emergency Department?
Authors: Lari H. , Bullard M. , Colman I. , Le Melledo J.-M. , Tibbo P.
Published: March 2009

Aims:

To assess if patients follow-up with discharge advice after psychiatric assessment and discharge from Emergency Department (ED).

Method:

All patients with psychiatric complaint who presented at three ED's in Edmonton, Alberta, Canada were identified via ED Information System (EDIS). Patients presenting complaint were entered onto the EDIS by Triage Nurse along with demographic information. All charts were reviewed and clinical data was obtained. Patients who were assessed by Psychiatry and discharged home were contacted via telephone to determine if they followed-up with discharge advice of psychiatry team.

Results:

A total of 1420 patients have been identified during April and May 2008.Chart review has been completed. Data entry and follow-up is in progress. Preliminary data of 250 patients is presented here. 55% were male. Mean age 37 years (SD 12). 47% presented voluntarily. Psychiatry was consulted for 53% of patients. The presenting complaint was “Suicidal Ideation” in 29% and “Bizarre behaviour” in 24%. Primary diagnoses for those seen by Psychiatry were mood disorder (30%) and psychotic disorder (26%). Out of those seen by Psychiatry 36% were admitted. 44% of those admitted by psychiatry were diagnosed with psychotic disorder followed by mood disorder in 31%. The patients who were discharged home by Psychiatry were advised to follow up with their family doctor 7%, psychiatrist 15%, outpatient psychiatry services 16% and addiction services 16%.

Conclusion:

This is the first report of outcome of discharge advice and will help in developing and planning community follow-up system for psychiatric patients.
Work Place Phobia and Type of Job
Authors: Linden M. , Muschalla B.
Published: March 2009

Background:

Conditions at the work place affect in many ways the well being of empoyees. One frequent reaction is anxiety because opf threads by superiors, colleagues or customers, the possibility of failing and not fullfilling job demands, accidents, or the possiblity to lose the job.

Method:

230 patients (71% female) from a psychosomatic inpatient unit were interviewed with as DSM-based half standardized interview in respect to work related anxiety.

Results:

58% of the patients reported about work related anxieties.

Across all areas generalized work related worrying is most frequent (26% service, 35% office/civil servants).

Anxieties related to specific situations at work were most frequent in patients working in schools/education (32%) and in production/construction workers (28%).

Anxiety related to feelings of insufficency and adjustment related anxiety were most often seen in office workers/civil servant (37% and 26%).

Hypochondriac anxieties were mostly reported by school/education employees (18%) and construction/production workers (17%) but to a much lower degree by health workers (6%).

Work related phobic reactions were reported by 17% of all patients and most frequent by office workers/civil servants (22%), followed by health workers (21%), service jobs (16%), construction/producrtion workers (11%) and patients working in schools and education (9%).

Conclusion:

Work related anxieties are frequently seen in patients with mental and psychosomatic disorders. There are different types of anxieties which are differently related to different types of jobs.
Publishing as Resident Education: The ASCP Model Psychopharmacology Curriculum
Authors: Madaan V. , Kratochvil C.
Published: March 2009

The ACGME has defined six core competencies for residents, including medical knowledge, practice-based learning and improvement, professionalism, and interpersonal and communication skills. While clinical learning and experience contribute to improving interpersonal skills, professionalism, and general medical knowledge, residents and training programs struggle with educational models that help address more rigorous education in evidence-based medicine and scholarly projects. In this regard, we developed a collaborative academic project for a resident and faculty member that exemplifies these ACGME requirements in a practical and purposeful manner. This project was aimed to enhance the resident's psychopharmacology knowledge, learn evidence based child psychiatry, and develop writing and editing skills; a means to improve clinical as well as academic abilities.

One senior faculty member and one child psychiatry resident were invited to become section editors for the child and adolescent section of the American Society of Clinical Psychopharmacology Model Psychopharmacology Curriculum for psychiatry residents. Authors from various university programs nationally, prepared or revised lectures based on their expertise and areas of interest. The authors were provided with as much support and assistance as they desired from the section editors. The resident author/editor met in person with the faculty to plan the project and routinely throughout the process, with frequent e-mail communication throughout the writing and editorial work. After submission of lectures, the section was reviewed and revised by the resident and faculty editors, and submitted for publication. This mentorship experience with psychopharmacology curriculum is an exciting tool that will continue through biennial revisions.
Effect of Self - Care Program on the Self- Esteem of Multiple Sclerosis Patients
Authors: Madani H. , Navipoor H. , Roozbayani P.
Published: March 2009

Aims:

According to decreased self- esteem in multiple sclerosis (MS) patients, it is necessary to utilize appropriate methods in order to improve self- esteem in MS patients. So this study was conducted on patients with MS supported by the Iranian MS society for determining the effect of self - care program on their self- esteem.

Method:

In this semi - experimental study 34 patients with MS who were not in the acute phase of disease were selected. The data were collected via personal questionnaires, problem list, Cooper and smith standard questionnaire for self- esteem and self report check lists. Self - care program(self - care for muscular spasm, fatigue, constipation and amnesia and …) was educated, then it was performed for one month period and the data were analyzed using paired t- test, wilcoxon, croscal - wallis and manwithney tests.

Results:

Application of self - care program improve the self- esteem and reduced some symptoms such as muscular spasm, fatigue, constipation and amnesia in MS patients. The mean valve of self- esteem increased from 54 before performing the program to 68 after the program ( p < 0.05).

Conclusion:

Using self-care program can be an effective method for improving self- esteem of MS patients.
Fibromyalgia and Cannabinoids: Emerging Issues
Authors: Madeira N. , Cerejeira J. , Miguel C. , Matos M. , Santo S. , Carriço P. , Quartilho M.J.
Published: March 2009

Fibromyalgia is a chronic disorder characterized by widespread and long-lasting pain, tenderness, and fatigue. It is associated with impaired quality of life, and significant social and health burden.

The etiopathogenesis of this condition is presently undefined, but is probably multifactorial. The hypothesis of a clinical endocannabinoid deficiency has been proposed. In fact, recent studies suggest that synthetic cannabinoids might be an effective therapy in patients with fibromyalgia.

Based on the clinical case of a female patient whose cannabis use was related to symptomatic relief of fibromyalgia, the authors review issues concerning the endocannabinoid system, its possible relation to this challenging pain disorder, and therapeutic possibilities with synthetic cannabinoids.
Cotard’s Syndrome - a Case Study
Authors: Maia J.
Published: March 2009

Cotard"s Syndrome (CS) is a relatively rare but highly impressive psychopathological condition. It is characterized by the presence of nihilistic delusions concerning the body and the non-existence of the self, with general feelings of unreality and the belief that one is dead or the world no longer exists, hypochondrial delusions, ideas of guilt and immortality.

First reported in 1880 by Jules Cotard, a French psychiatrist who described a "delire de negation", this clinical state was then believed to be a new type of agitated melancholia. Since then, similar cases have been reported worldwide and many authors have written about its possible etiology, some seeing CS as a syndrome, others as an independent entity, many including it in the psychotic disorders, but with the majority still defending it belongs to the affective spectrum.

It has been found that advanced age increases the likelihood of developing CS, being mostly found in middle-aged or old people. Although infrequently occurring in young people, some cases have been reported, 90% of these being females.

We present the case of a 31 year-old male who developed CS after one week at a traumatology ward, with a vertebral fracture and no neurologic commitment. He improved dramatically after a few days on antipsychotics and one antidepressant. We find this case relevant, not only because of the rarity of this syndrome in young males, but mainly to highlight the effectiveness of a prompt referral to the liaison psychiatry and its extreme importance at a general hospital.
The Efficacy of the PECS for Improving the Communicative, Relational and Social Skills in Children with Autistic Disorder: Preliminary Results
Authors: Lerna A. , Esposito D. , Russo L. , Massagli A.
Published: March 2009

The aim in the current study was to investigate the efficacy of the PECS (Picture Exchange Communication System) in a sample of children with Autistic Disorder (AD) in the development of the communication, alternating gaze and pointing in children with Autistic Disorder (AD).

The sample included 5 children diagnosed with AD (DSM-IV-TR), no verbal language, followed by the team of the Rehabilitation Centre belonging to Scientific Institute “E. Medea”, Association “La Nostra Famiglia” Branch of Ostuni (Italy). The children were tested on their ability with neuropsychiatric, psycholinguistics and psychological assessment at the pre and post of the trial.

The treatment PECS has gone on for two years with a frequency of three times a week (45 minutes each one).

The observed behavioral variables were: spontaneous request of objects using the notebook PECS, alternating gaze, pointing, and possible vocalizing and verbalizing on imitation.

The data were collected at the beginning and at the end of the trial, using play-interaction videotapes, lasting 20 minutes each. Segments (10 min) of videos were randomly selected for coding.

The behaviours were coded using the Observer XT. 7 and the results were analyzed statistically with the SPSS programme.

The results show a significant increase in the number of spontaneous requests, in the capacity of alternating gaze, pointing, vocalizing and verbalizing on imitation.

Finally the PECS seems to allow not only to develop a functional communication in AD, but also to increase social communicative behaviours of children with AD. Nevertheless further studies are necessary.