bluuebunny/crossref_metadata_2025 huggingface dataset:
Definitely, one (therapy) does not fit all (depressions): Mentalization based treatment for resentful self-critical depressive patients who abuse of attachment deactivating strategies
Authors: Ramos J. , Alonso E. , Tur N. , Sanz-Correcher P.
Published: May 2016

Depression is one of the most prevalent mental disorders and a notably heterogeneous condition with regard to etiology, symptom expression, course, and treatment response. This is why it is extremely unlikely that a “one size fits all” approach to the treatment of depression will be particularly effective. Quite the contrary, it is clear that the future of the treatment of depression may lie in a combined disorder- and person-centred, tailored-made approach, which takes into account the broader interpersonal context and life history of the individual. Depressed patients with a characteristic cognitive-affective schema of self-critical perfectionism are prone to typical dysfunctional transactional cycles or dominant interpersonal narratives in which rage, distrust and ambivalence are apparent. In addition to this, in these subtype of depressed patients is common to find the overuse of attachment deactivating strategies, in response to threats to attachment relationships specially, and the inhibition of mentalizing as a defensive response to the feelings of rage, emptiness and sadness that are developmentally linked to attachment experiences. The implications of these findings for treatment, particularly with regard to the nature of the therapeutic relationship, are readily important. In this poster we take several cases in order to detail the main psychodynamics and the dominant interpersonal narratives of this subtype of depressed patients and to specify a therapeutic proposal tailored for them.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Significant weight loss related to Briquet syndrome: A case report
Authors: Welte-Santana C.A. , Trombini Nunes F. , Carvalho de Toledo L. , Oliveira L.
Published: May 2016

Introduction

Somatization Disorder is more prevalent in females and is historically known as Briquet Syndrome. It is characterized by complaints in several systems, has early onset and chronic fluctuating course, but without organic substrate. When the duration of symptoms is less than two years or they are less obvious, it is called Undifferentiated Somatoform Disorder.

Objectives

This study reports the case of a female patient, previously healthy and with no psychiatric history, which abruptly presented lush somatic symptoms without organic origin.

Case Presentation

Case report of a previously healthy woman of 32 years, followed up for 14 months, by a sudden onset frame of profuse diarrhea, tenesmus, fecal incontinence, vomiting, anorexia and weight loss (18 kilos in 2 months), associated with headache and autonomic signs of anxious origin, without clear physical and/or psychogenic trigger. She had only a mild response to drug therapy and excellent improvement in symptoms after psychotherapy.

Results

Unconscious triggers came to light only after psychotherapy starts, justifying that the magnitude of autonomic somatoform symptoms surpasses the time period established by ICD-10 for Somatization Disorder. Therefore, the rapid resolution did not allow a diagnosis of Somatization Disorder, according to ICD-10. So, it was diagnosed as Undifferentiated Somatoform Disorder.

Conclusion

It is suggested that the grandeur of clinical symptoms in this case is caused by psychogenic factors.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Auditing of discharge summaries Contet at Al Amal medical complex
Authors: Al Solami N.
Published: May 2016

Introduction and aims

Patient's records are the most important clinical assets and tools which are required in consultations. Patient records also support the accurate continuity of care when patients return to other health providers.

Objective

Understand the extent of Discharge Summaries, which conform to the set best practise guidelines on the Mental Health Service.

Method

A cross-section retrospective study on Discharge Summary contents was conducted at Al Amal Medical Complex. Chart review of randomly selected patient files (200 of a total 495), of Discharge Summaries for Psychiatric Patients in 2014 was performed. The data was statistically analysed using descriptive statistics taking into account proportions and frequencies. Pearson chi square and Fisher's test methodologies were used.

Result

This study found of the 200 randomly selected Discharge Summaries that documented data of mental health examination 94% (n = 188), data of discharge date 100% (n = 200) while data of social investigation and family work up 82% (n = 164). The above three categories were the only categories to conform to standard discharge guidelines. The other thirteen items studies were found not conforming to the defined standard guidelines.

Conclusion and recommendation

There is an active challenge for clinicians to introduce good clinical practice in Mental Health. Standard guidelines must be followed by clinician's in order to reduce potential areas of concern and achieve a good clinical practise. Regular recurring audits are highly needed& recommended to ensure the alignment with standard guidelines for the writing of Discharge Summaries.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Quality management and economic downturn. Post-modern topics of community psychiatry
Authors: Zangrando A. , Babici F. , Pascolo-Fabrici E. , Riolo A.
Published: May 2016

Introduction

The reduction of the budget allocated to community psychiatry is part of financial needs in times of economic crisis. However, the community psychiatry is based on human resources rather than on technological devices and the economic downturn affects the quality of care in a field where the social and relational capital developed by mental health workers is fundamental. Some authors such as Serge Latouche propose to stem the economic decline with the concept of “degrowth”, a constructive idea but difficult to apply.

Objective

We would like to analyze whether the economic downturn has consequences only for the organization of psychiatric services or even for people with severe mental disorders. Another issue concerns the possibility that economic downturn increases the social exclusion of vulnerable people.

Results

People who live on social welfare or disability pension remain on the margins of society but also those supported by families feel increasingly marginalized with respect to the future.

Conclusions

The provision of mental health services may not meet the implicit and explicit wishes in the demand for health by citizens and society. It's therefore necessary to review the quality management within community psychiatry.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psycho-educational program “+ family” – Pilot program
Authors: Lima C. , Cunha G. , Brandão F.
Published: May 2016

The CLDS + Paredes de Coura integrated in its action plan the implementation of a program for the development of strategies at the level of qualification of the families as it corresponded to one of the needs highlighted by the Social Municipality Action under the Social Diagnosis.

With a Psychologist/Family Therapist and a Conflict Mediator, have formed groups with parents and children separately.

Questionnaires were applied at the beginning and end of the program for evaluation of impact. The results showed that the personal development of children and adults was promoted, were broadcast techniques that facilitate the daily emotional management and improved is communication skills. This program will now be applied to other groups.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychosocial therapy in schizophrenia
Authors: Maroto Martin L. , Hervías Higueras P.
Published: May 2016

Introduction

Psychosocial interventions are an essential part of the treatment of schizophrenia and are aimed at promoting the social, family and occupational functioning of the patient and relapse prevention. They are considered proven clinical measures whenever necessary, however they tend to be underused.

Objective

Answer the question on psychosocial therapies available today for schizophrenia.

Methods

Review through PubMed by entering the following keywords: psychosocial therapy; schizophrenia; cognitive behavioral therapy, and clinical practice guidelines.

Discussion

There are several psychosocial therapies used in clinical practice. The main points of approach focus on self-management of the disease, everyday problems, education, crisis intervention, and acquiring insight. The cognitive impairment is an important aspect of schizophrenia to consider. It seems that cognitive remediation therapy has been associated with both neurobiological and cognitive improvement.

Conclusions

The combination of different therapies along with psychopharmacological treatment appears to provide better results in the reduction of negative symptoms, positive symptoms and reduced hospital stay.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The social cognition individualized activities lab: Implementation of a new remediation intervention for social cognition
Authors: Palumbo D. , Mucci A. , Piegari G. , Chieffi M. , Mazza A. , Giugliano R. , De Riso F. , D’Alise V. , Galderisi S.
Published: May 2016

Introduction

People with schizophrenia exhibit deficits in neurocognitive and social cognitive (SC) processes which limit their social reintegration. SC was found to mediate in part the impact of neurocognitive dysfunctions on real-life functioning.

Objective

The purpose of this study was to implement a new intervention for patients with schizophrenia, the Social Cognition Individualized Activities Lab (So.C.I.A.L.) which trains both social cognition and neurocognitive functions.

Aims

To determine the efficacy of the So.C.I.A.L in improving SC by a comparison with a validated cognitive remediation (CR) intervention: the Social Skills And Neurocognitive Individualized Training (SSANIT).

Methods

Nine stabilized patients accepted to participate in this pilot study. Five were randomized to So.C.I.A.L. and 4 to SSANIT. The two programs were matched for the overall treatment duration (20 weeks), as well as frequency and duration of the sessions. Both interventions included individual sessions of neurocognitive individualized training; So.C.I.A.L included group sessions on Emotion Recognition and Theory of Mind, while SSANIT group sessions of Social Skills Individualized Training.

Results

No group difference was found for changes in neurocognition, while a significant group effect was observed for changes in SC, due to improvement only in the So.C.I.A.L. group.

Conclusions

The study results showed a specific effect of the So.C.I.A.L. on SC, beyond the effect on neurocognition. Further studies are needed to assess the impact of So.C.I.A.L. on real-life functioning in a larger group of subjects.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Descriptive study of the treatment of delusional disorder. Survey study DELIRANDA
Authors: Girela Serrano B. , Aguado Bailón L. , Calvo Rivera P. , Muñoz Negro J.E. , Cervilla Ballesteros J.
Published: May 2016

Introduction

We currently lack clinical guidelines for the treatment of Delusional Disorder (DD) F-22, the low prevalence of the disease coupled with no awareness of illness and poor adherence to prescribed treatment make it difficult to study. The limited evidence available for the treatment is based mainly on clinical series.

Objectives

This study evaluates the knowledge and preferences in the treatment of the DD, in order to improve clinical practice and gain information of the DD to conduct clinical studies of effectiveness of the different treatments.

Material and methods

A self-administered survey was conducted on a sample of 80 psychiatrists proceeding on a wide array of mental health care services. Participants provided socio-demographic data and information about clinical details, together with their opinions regarding the, epidemiological aspects, clinical management, diagnosis and therapy. Descriptive statistics were subsequently calculated with SPSS.

Results

Most of our sample's of Psychiatrists estimated that the DD prevalence was higher than the one previously established. Ninety-three percent of the sample considered the SGAs as the first treatment option in DD, being Aripiprazol 20.7%, Risperidone 17.4% and Paliperidone 15% the first line treatment chosen by our Psychiatrists.

Conclusions and proposals

There is an increasing gap between the old standard DD treatment and the clinical practice of Andalusian Psychiatrists, for this reason we emphasize the need of implementing clinical trials and effectiveness clinical studies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Rosenzweig picture-frustration test modification for a study of emotion regulation strategies among the patients with stress-induced hypertension
Authors: Pervichko E. , Zinchenko Y.
Published: May 2016

Introduction

Emotion regulation (ER) efficiency dwells among the most pressing issues of contemporary psychology and psychiatry. Further development of the methods of reliable assessments for ER makes it the task of current importance.

Objective

To modify Rosenzweig Picture-Frustration Test for the study of ER in health and in disease.

Methods

In the initial stage of testing participants had to look through a succession of Rosenzweig's pictures, and select potentially traumatizing situations.

In the second stage they answered the following questions:

– what would you say in this particular situation?

– what would you have in mind, saying this?

– could you think of an answer that would taper down the traumatizing character of the situation in your own perception? (Zinchenko, Pervichko, 2014).

A total of 85 patients with stress-induced hypertension (mean age was 45.9 ± 2.8) and 82 healthy subjects (mean age was 44.9 ± 3.1) took part in the study.

Results

We came to distinguish among four classes of ER strategies: internal, cognitively non-mediated; internal, cognitively transforming; external, cognitively non-mediated; and external, cognitively transforming (Pervichko, 2015). Hypertensive patients significantly more frequently than healthy subjects reveal wider set of emotionally grave events (19.8% vs 11.2%, P < 0.001), they are more prone to rumination, disasterization (19.0% vs 11.1%, P < 0.001) and suppression in display of their emotions (31.9% vs 20.2%, P < 0.001). The patients will seldom employ the strategy of interactive subject–subject transformations; their capability to actualize new meanings in traumatic situations is diminished.

Conclusions

Application of the described modification of Rosenzweig Picture-Frustration Test allows to distinguish and classify various ER strategies, and to demonstrate peculiarities in ER related behaviour of hypertensive patients as opposed to healthy subjects.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
New methodologies for faster study of new psychoactive substances: A proposal
Authors: Quintana Mathé P. , Grifell M.
Published: May 2016

Introduction

New psychoactive substances (NPS) are substances that have recently become available, and are not worldwide regulated. They often intend to mimic the effect of controlled drugs, becoming a public health concern. In 2014, 101 substances were reported for the first time in the EU, which may require to be studied and risk-assessed by the scientific community. The EMCDDA recognizes it as an emerging topic where research is most needed, as the scientific community is struggling to keep pace with the speed at which new substances appear. On the one hand, case reports and internet-based surveys are quickly published but do not provide enough evidence to guide clinical decisions. On the other hand, classical high-reliability methodologies such as Cohort and Clinical studies take too long and their cost is too high to be of much use for the study of NPS. We propose an intermediate methodology to tackle this unmet need.

Rationale

González and colleagues described a set of highly educated, experimental users of NPS with extensive knowledge and consumption of substances. These users usually look for drug checking of the substances they intend to consume. We suggest we could benefit from the collaboration of such users, and the possibility of obtaining analytical confirmation, to retrieve information about NPS in a quick and reliable fashion.

Outline of methodology

Recluting of subjects that submit NPS to a drug checking facility. Analysis of the samples for analytical confirmation. Check inclusion criteria and propose inclusion in the study. Give structured forms for reporting effects and adverse events.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Electroconvulsive treatment in Parkinson's disease and psychosis: A case report
Authors: Aparicio Reinoso T. , Gonzalez Parra S.
Published: May 2016

Background

Drug induced parkinsonism is a common side effect.

Objective

The present report describes the case of a schizophrenic patient who developed a parkinsonism after receiving antipsychotic drugs and who had improved his schizophrenia and parkinsonism after electrovulsive therapy.

Case summary

We report the case of a man, who is 35 years old and was admitted to a psychiatric ward, due to decompensated schizophrenia with psychotic features. The patient developed pronounced parkinsonian features, which did not improve with discontinuation of the drug or with carbidopa/levodopa. After several unsuccessful treatments, the patient was treated with ECT and showed improvement in both diseases.

Results

The patient's response to this treatment justifies the use of ECT in patients with both syndromes: a psychosis productive and Parkinson's disease. Even the maintenance therapy can establish the initial response achieved and keep it through time. We should keep in mind that the management of these patients, can be extremely difficult because the medications used to both disorders are antagonistic.

Conclusion

ECT can be considered in patients with a psychiatric illness associated with parkinsonism.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Intramuscular maintenance treatment with ultra-high-dose long-acting injectable aripiprazole in an elderly patient suffering from chronic refractory schizophrenia: A case report
Authors: Bartova L. , Dold M. , Praschak-Rieder N. , Naderi-Heiden A. , Kasper S.
Published: May 2016

Long-acting injectable (LAI) aripiprazole is increasingly appreciated in the course of a maintenance treatment of schizophrenia due to efficacy in delaying – and decreasing relapse, and low rates of feared side effects. In line with the prescribing information, the maximal starting – as well as maintenance dose was restricted to 400 mg following a 26-day interval between the single doses.

We present a 72-year-old female inpatient (66 kg) with an acute exacerbation of chronic refractory schizophrenia, exhibiting primarily positive symptoms including excessive persecutory delusions, self-care deficit, poor insight and insufficient adherence to continuous intake of oral medication. Since she developed a post-injection syndrome after an accidental intravascular administration of olanzapine LAI 405 mg, the antipsychotic treatment was switched to aripiprazole LAI 300 mg once monthly. Due to insufficient clinical response, aripiprazole LAI was gradually increased up to 1200 mg per month under continuous plasma level monitoring. Here, 2 single injections of aripiprazole LAI 300 mg were delivered into both gluteal muscles concurrently, every 14 days.

Consequently, we observed a clinically meaningful improvement (a total-score reduction from 111 to 75 on the Positive and Negative Syndrome Scale), as well as no objectifiable side effects, assessed by “The Dosage Record Treatment Emergent Symptom Scale” and “The Barnes Akathisia Rating Scale”, despite multi-morbidity and rather advanced age of the patient.

Our safe experience with applying the almost threefold higher monthly dose over 12 weeks may encourage researchers to further investigate the efficacy, tolerability as well as handling of highly dosed aripiprazole LAI in refractory schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Folie à deux
Authors: Cocho C. , Baquero M. , Vera I. , Alvarez-arenas J.
Published: May 2016

Introduction

The induced delusional disorder or folie à deux, is a rare condition characterized by psychotic symptoms at least in two individuals in close association.

Objectives

We report a case of shared psychotic disorder between mother and daughter. We briefly review both classical and current literature.

Methods

We summarized the results from articles identified via MEDLINE/PubMed using “induced delusional/shared psychotic disorder” as keywords. We report a case of a woman who develops psychotic symptoms characterized by delusions of persecution. Her daughter started, during the first high school grade with referring sexual threats and having delusions of persecution lived by her mother like a fact. They have very symbiotic relationship. Seven years later, the mother has required hospitalization for chronic delusions.

Results

The term folie à deux was first coined by Lasègue and Falret, they assume the transmission of delusions was possible when an individual dominated the other and existed relative isolation. Recent studies found no significant differences in age and sex, although described higher comorbidity with other psychiatric diseases. Relative to treatment, separation by itself is insufficient; an effective neuroleptic treatment is required.

Conclusions

Our case meets criteria for shared psychotic disorder. The daughter, with a ruling attitude who dominates the relationship, was the inducer. The mother showed no resistance in accepting delusions and remains them active after separation. This leads us to consider the possible predisposition to psychotic illness by both patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Headache and schizophrenia – A cross-sectional cohort study on prevalence, characteristics and management
Authors: Connaughton J. , Wand B.
Published: May 2016

Introduction

Headache is the most common pain reported by people with schizophrenia. Little research has been conducted into the characteristics and management of headaches in this population.

Objectives

Determine the prevalence, type and management of headache in people with schizophrenia.

Aims

Identify if best practice treatment of headache occurs and if changes are required to assure people receive appropriate management.

Methods

One hundred consecutive people with schizophrenia and schizoaffective disorder completed an extensive, reliable and valid headache questionnaire. Based on the questionnaire responses two clinicians independently classified each person's headache as either migraine headache (MH), tension type headache (TTH), cervicogenic headache (CGH) or other headache type (OH). Any discrepancies were resolved by consensus agreement.

Results

Twelve-month prevalence of headache (57%) was higher than the general population (46%) with no evidence of relationship between psychiatric clinical characteristics and presence of headache. Prevalence of CGH (5%) and MH (18%) were comparable to the general population. TTH (16%) had a lower prevalence. Nineteen percent of participant's headache was classified as OH type. No participant with MH was prescribed migraine specific medication. Only 1 of the 5 people whose headache was classified as CGH received manual therapy and none had been prescribed exercises. No people with TTH received manual therapy, exercise prescription or postural review.

Conclusions

It is recommended that education is required for patients and mental health workers about headache classification and the appropriate care pathways for different headache types.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Socio-demographic features of first-episode psychosis associated with an increased likelihood of subsequent schizophrenia in a psychiatric inpatient sample
Authors: Enatescu V.R. , Munteanu R.B. , Romosan R. , Toader A. , Papava I. , Pinzaru V.A. , Draghici A.M. , Enatescu I.
Published: May 2016

Introduction

Early diagnosis of schizophrenia is often delayed in first-episode psychosis and this could be viewed as an obstacle for a proper therapeutic approach and optimal clinical management.

Objective

Our main objective was to identify baseline socio-demographic variables in first-episode psychosis which are associated with an increased likelihood of diagnosing schizophrenia in the second episode of psychosis. As a secondary objective we aimed to assess the diagnostic stability between first and second episode psychosis.

Material and methods

Data belonging to 100 patients that were twice admitted in Timisoara Psychiatric Clinic, between 2010 and 2015, for two distinct and consequent episodes of psychosis, were analyzed. The first admittance had to coincide with first episode psychosis.

Results

Logistic binary regression showed that a younger mean age (OR = 0.90; 95% CI = 0.85–0.95), a more unfavorable professional status (OR = 3.75; 95% CI = 1.10–12.74) and a lesser quality of social support (OR = 3.47; 95% CI = 1.11–10.82) at the onset of the first episode of psychosis were associated with an increased likelihood for a subsequent diagnosis of schizophrenia.

Conclusions

Identifying an initial socio-demographical profile with a high predictive value for a subsequent outcome towards schizophrenia should encourage using this diagnosis starting with the first episode of psychosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Schizophrenia spectrum disorders: Focus on social cognition and empathy
Authors: Gramaglia C. , Gattoni E. , Giovanna G. , Gili S. , Feggi A. , Binda V. , Prosperini P. , Zeppegno P.
Published: May 2016

Background

Schizophrenic patients show deficits in social cognition, functioning and in interpreting facial expressions. These disabilities contribute to global impairment in social and relational skills. Data started being collected in the context of the Italian Network of Research on Psychosis headed by Prof. Maj and Prof. Galderisi (Galderisi S et al. The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry 2014:275–87. Mucci A et al. The Specific Level of Functioning Scale: Construct validity, internal consistency and factor structure in a large Italian sample of people with schizophrenia living in the community. Schizophr Res 2014;159(1):144-50); collection in our centre went on also after the conclusion of the national project.

Aims

To identify the correlations among social inference, facial emotion identification and clinical history and therapies in schizophrenic patients.

Material and methods

We recruited patients with Schizophrenia referring to our Psychiatry Ward, AOU Maggiore della Carità, Novara, Italy. Socio-demographic characteristics were gathered; assessment of patients included The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test (FEIT), the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS).

Results

Data collection is still ongoing. In a previous study we pointed out that schizophrenic patients showed social skills deficits and difficulties in identifying facial emotions. These features underlie poor and limited social relationships proper to schizophrenia. Our preliminary results revealed thatidentification of facial emotions is influenced by psychopathological symptoms especially by avolition, blunted affect and alogia. Implication will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effect of switching to long-acting injectable (LAI) aripiprazole on long-lasting antipsychotic-induced hyperprolactinemia: A report of two cases
Authors: Juncal Ruiz M. , Fernández-Abascal Puente B. , Landera Rodríguez R.
Published: May 2016

Introduction

Antipsychotic-induced hyperprolactinemia (> 29 ng/ml in women) is associated with relevant side-effects.

Aim

We describe the case of two women aged 50 and 54 years, respectively, diagnosed with schizophrenia who were receiving outpatient treatment with paliperidone depot 100 mg/month and risperidone depot 50 mg/2 weeks, respectively and complained of oligoamenorrhoea and amenorrhoea for at least 6 months.

Methods

Routine blood tests showed hyperprolactinemia of 203.5 ng/ml and 306.2 ng/ml, respectively. The patients were evaluated by the Endocrinology unit and an MRI was performed discarding the presence of any primary brain condition. Both patients were switched to LAI aripiprazole due to its partial agonism of D2-brain receptors. At the time of switching both patients were stable in terms of psychopathology.

Results

Changes in prolactin levels 3 months after switching are shown in the Fig. 1. Two months after switching, both patients regained cyclic menstrual function. After 6 months, they still showed psycopathological stability.

Conclusions

Several studies have described an improvement of drug-induced hyperprolactinemia after switching to or adding oral aripiprazole. In these two cases, the normalization of prolactin levels and the resolution of oligoamenorrhoea/amenorrhoea were observed as soon as 2–3 months after switching to LAI aripiprazole. These findings suggest that switching to LAI aripiprazole may be an effective alternative for managing antipsychotic-induced hyperprolactinemia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The cremation of care ritual: Burning of effigies or human sacrifice murder? The importance of differentiating complex trauma from schizophrenia in extreme abuse settings
Authors: Kurz R.
Published: May 2016

Introduction

This session explores Human Sacrifice killings in extreme abuse cult settings disclosure of which often leads to a misdiagnosis of ‘Schizophrenia’.

Objectives

The purpose of the paper is to raise awareness and signpost professional development resources regarding extreme abuse ‘Death Cults’ that operate largely with impunity across the world.

Aims

Case study materials and documentary evidence will be utilised to illustrate criminal practices and the impact on survivors.

Method

Accounts of extreme abuse and ritual violence were identified in the context of an adult survivor assessment intervention.

Results

There are supporters of abuse survivors who bore witness to and believe disclosures of extreme abuse and ritual violence, and ‘False Memory’ adherents who consider Ritual Abuse an unfounded ‘moral panic’. Survivors provide chilling accounts of ritual killings in Scott (2001), Becker, Karriker, Overkamp and Rutz (2008) and Epstein, Schwartz and Schwartz (2011). In the wake of institutional abuse enquiries and the ‘unbelievable’ child abuse perpetrated by celebrities like Jimmy Saville and Ian Watkins, a ‘new reality’ is setting in that child abuse is pervasive and knows no limits. Reports of elaborate rituals with ‘mock’ human sacrifices at the highly secretive annual ‘Bohemian Grove’ summer festival point towards a pervasive interest in the occult in high society.

Conclusion

Mental health professionals have a ‘duty of care’ towards their service users. Unless clear and irrefutable counter-evidence is available it is inappropriate to claim that disclosures of extreme abuse and/or human sacrifice rituals are ‘delusions’ and indicative of Schizophrenia.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Comparison of defence mechanisms in adolescent patients with deliberate self-harm behaviour and without it
Authors: Vuk A. , Razic Pavicic A. , Santric L. , Tomac A.
Published: May 2016

Introduction

Twenty percent of children and adolescent population are suffering from psychiatric disorders, according to World Health Organization. Above that, clinical work and previous published reports point to increase of self-harm behaviour incidence and prevalence in many countries, including Croatia.

Aims

To compare defence mechanisms in adolescent patients with deliberate self-harm behaviour and without it.

Objectives

To explore differences in adaptive and maladaptive defence mechanisms in adolescent patients with self-harm behaviour and without this behaviour; to gain better insight in possible perception and functioning patterns in these two patient subgroups. To assess the effect of possible differences on early diagnostic procedure and therapeutic plan.

Methods

Defence Style Questionnaire (DSQ) was administered to 150 patients aged between 14 and 18 years on their first visit to child and adolescent psychiatrist. Sevety-nine patients had history of self-harm behaviour and 81 patients had negative anamnestic data on such behaviour.

Results

Comparison of defence mechanisms in these two patient subgroups showed a statistically relevant difference in using defence mechanisms.

Conclusion

Results of this study showed significant difference between patients with self-harm behaviour and without such behaviour regarding used defence mechanisms. Awareness of specific mental patterns in patients with self-harm behaviour provides better assessment of suicidal risk and optimal individual approach planning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Schizophrenia and sexual desinhibition
Authors: Palomo Monge M. , David G.M. , Arántzazu D.D. , Maria Fernanda A.L. , Maria Fernanda T.G. , Gemma M.M. , Sandra D.C.
Published: May 2016

Introduction

Sexual disinhibition is uncommon in patients with schizophrenia and are included within the behavioral disorders along with others such as agitation, aggression, sleep disorders and circadian rhythm, due to multiple reasons: isolation, rejection, difficulty in personal relationships.

Objectives

We report the case of a male patient aged 58 with multiple previous admissions for behavioral alteration symptoms, including exhibitionism. He is referred as irritable, uninhibited and sleeping disorders. There is a risk of flight as he is difficult to be held so it is feared that he can be run over by a car. He shows a marked self-referentiality.

Methodology

The patient is admitted. He properly gets used to the rules of the Ward. Pharmacological adjustment is performed. During his admittance he shows no behavior disorders neither episodes of self or hetero aggression and poor impulse. He properly makes comments of what happened during his stay. He responds well to treatment prescribed. Sleep pattern is restored.

Results

Schizophrenia (undifferentiated) 295.90 (F.20.3); intellectual disability mild 317 (F70); neurocognitive disorder (possible).

Conclusions

This is unusual case because it is normal that the sexual function of such patients is adversely affected, not finding numerous cases of disinhibition in our medical consultation. This is due to the different aspects that are affected, biological (drugs), psychological and social levels. We have different therapeutic alternatives to address this problem. However, they may hinder sociability and patient rehabilitation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pruritic urticarial papules and plaques of gestation in perinatal depression
Authors: Hassan F. , Azaaibi M. , Shahid S. , Saimwala T.S. , Kalar N. , Mughal M.T. , Wahab A. , Wahab G. , Haider F. , Azam A. , Shahid N. , Mujeeb E. , Kalar M.U.
Published: May 2016

Introduction

The cutaneous polymorphic eruption of pregnancy (PEP) is presented by skin lesions usually in the third trimester of gestation and about 13% of women also suffer from perinatal depression.

Objective

To determine the frequency of pruritic urticarial papules of gestation with and without perinatal depression.

Aim

To assess the maternal causes for polymorphic eruption of pregnancy (PEP) in patients with and without perinatal depression.

Methods

Cases and controls were matched on the grounds of maternal weight gain in gestation, hormonal changes, deficit in iron and zinc, dysregulation of hypothalamic pituitary axis, pre-maturity, pre-eclampsia, pre-term labour. Univariate and multivariate analysis, adjusting for important demographic factors and comorbodities was conducted to assess the relationship of PEP with and without perinatal depression in reduced and full models of ANOVA in regression analysis. (Reduced model Y = β0 + β1X1 + … and the full model Y = β0 + β1X1 + β2X2 + β3X3 + β4X4 + β5X5 + β6X6 + …)

Results

Polymorphic eruption of pregnancy with perinatal depression was statistically significant in maternal weight gain in gestation [odds ratio (OR) 1.20; 95% (CI): 1.15–1.30], hormonal changes [(OR) 2.78; 95% (CI): 2.52–2.82], deficit in iron and zinc [(OR) 2.18; 95% (CI): 2.04–2.38], dysregulation of hypothalamic pituitary axis [(OR) 1.37; 95% (CI): 1.18–1.49] and was not statistically significant in pre-maturity, pre-eclampsia and pre-term labour in cases and controls.

Conclusion

Pruritic urticarial papules and plaques of gestation are commonly associated in patients with perinatal derpession.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Preventable schizophrenia
Authors: Silvia C.F. , Gómez Peinado A. , Cano Ruiz P.
Published: May 2016

Introduction

Schizophrenia is a psychiatric disorder with multiple causes, including genetic, immune, environmental causes of various kinds, which all increase the vulnerability and predisposition to the disorder. Among them stand out prenatal infections, thus being a preventable risk potential factor in our daily clinical practice.

Objectives

To analyze the relation between prenatal infections and schizophrenia.

Methods

Review of the subject and recent articles on schizophrenia in psychiatric guides and magazines.

Results

After analyzing several studies, it have shown that prenatal infections, where the nervous system is not yet fully developed, may be a risk factor for the development of schizophrenia in adults, in relation with genetically predisposed individuals. Infections such as influenza, especially during the first quarter of gestation; rubella, toxoplasma and herpes simplex virus-type 2 are related to potentially increase risk of suffer schizophrenia.

Conclusions

Prenatal infections, especially in the first quarter and the periconceptional period, constitute a risk factor in individuals with vulnerability to develop schizophrenia. Awareness and prevention is important in the pregnant population of the influence of these infections on the possible origin of psychotic episodes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Medication adherence in schizophrenia
Authors: Fatma F. , Baati I. , Omri S. , Sallemi R. , Masmoudi J.
Published: May 2016

Introduction

Compliance is a major issue in the treatment of schizophrenia. Many studies have attempted to identify factors that influence it.

Objective

To assess treatment adherence in patients with schizophrenia. To identify factors correlated with poor adherence.

Methods

It was a cross-sectional, descriptive and analytical study, involving 37 outpatients with DSM-IV diagnosis of schizophrenia, followed in the psychiatry department at the Hédi Chaker University Hospital of Sfax (Tunisia). The questionnaire included socio-demographic, clinical and therapeutic data. We also used the Medication Adherence Rating Scale “MARS”, the Insight Scale “IS” and the Stigma Scale (9 items).

Results

The average age was 36.4 years. The majority of patients was male (68.8%), did not exceed the level of secondary education (89.2%) and had a low socioeconomic level (84.4%).

Paranoid schizophrenia was the most frequent type of schizophrenia (54.1%). Atypical antipsychotic were prescribed in 40.5% of cases.

Patients were non-adherent to treatment in 56.8% of cases. The factors correlated with poor adherence were: psychoactive substance use (P = 0.036), sexual dysfunction (P = 0.036), complexity of treatment (P = 0.036), poor insight according to the subscale “awareness of the need for treatment” of the IS (P = 0.047) and high score on the subscale “discrimination” of the Stigma Scale (P = 0.008).

Conclusion

Tunisian schizophrenic patients have a poor adherence to treatment. Acting on risk factors (such as substance use, sexual side effects, poor insight and discrimination perception) would improve patient compliance and management of schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Biomarkers of response to transcranial magnetic stimulation in youth with treatment resistant major depression
Authors: Wilkes T. , Jasaui Y. , Kirton A. , Langevin L.M. , Sembo M. , MacMaster F.
Published: May 2016

Background

Major depressive disorder (MDD) affects approximately 15% of youth, half of who do not respond to standard treatment. One promising intervention is repetitive transcranial magnetic stimulation (rTMS). However, response is limited, highlighting the need to focus on biomarkers to predict treatment response.

Objectives

To explore baseline biomarkers of response associated with rTMS treatment in adolescent MDD.

Aims

To determine the association between dorsolateral prefrontal cortex (DLPFC) glutamate levels, cortical thickness, and cerebral blood flow (CBF) with MDD symptomatology decrease after rTMS intervention.

Methods

Twenty-four MDD youth underwent 3 weeks of rTMS, baseline and post-intervention magnetic resonance imaging scans, and short echo proton magnetic resonance spectroscopy. Response was determined by a 50% reduction of depression scores.

Results

Depressive symptoms decreased with rTMS (t = 8.304, P = 0.00). Glutamate levels differed significantly between responders and non-responders (t = 2.24, P = 0.0039), where higher glutamate changes were associated with a better response (r = 0.416, P = 0.038). Responders also exhibited thinner DLPFC (r = –0.797, P = 0.000) and lower CBF levels.

Conclusions

The development of biomarkers for rTMS represents a novel and encouraging technique for a personalized and effective treatment while reducing ineffective treatment costs and personal burden in adolescent MDD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A journey across perversions history – from Middle Age to DSM
Authors: Amaral A. , Ferraz I. , Mota M.
Published: May 2016

Introduction

Psychiatry's viewpoint of sexual deviance has waved between the normal and the pathological. “Normal” is not determined by nature but by the values of a specific society.

Aims

To review the main landmarks in paraphilias history and the importance of social and cultural dimensions to it.

Methods

PubMed database was searched using the keywords perversion, sexual deviance, paraphilia, culture and society.

Results

Throughout Middle Age and Renaissance any sexual act that differed from the natural/divine law was considered a vice. Unnatural vices (masturbation, sodomy, bestiality) were the most severely punished, as they could not result in conception. In 1886, Krafft-Ebing stated perversions were functional diseases of the sexual instinct caused by “hereditary taintedness” in the family pedigree and worsened by excessive masturbation. Proper perversions were sadism, masochism, antipathic sexuality (homosexuality, transvestism, transsexuality) and fetishism. Later, Havelock Ellis and Hirschfeld claimed sexual interest in the population followed a statistical norm, opposed the idea that masturbation led to diseases and demanded the decriminalization of homosexuality. Freud believed the “perverse disposition” to be universal in the childhood giving rise to healthy and pathological adult behaviors. In 1950's, Albert Kinsey surprised America when he proved many supposedly deviant sexual practices were quite common. The first Diagnostic and Statistical Manual (1952) was mainly psychoanalytic. Later, by 1973, homosexuality was removed from classifications. Recently, DSM-5 distinguishes between paraphilias and paraphilic disorders.

Conclusion

A progress in the paraphilic instincts’ acceptance has occurred. We hypothesize, in the future, paraphilias will follow homosexuality out of the diseases’ classifications.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Primary and secondary transsexualism, really?
Authors: Jurysta F. , Hladki G.
Published: May 2016

Introduction

Transsexualism suffers from several definitions that evolve across time. Therefore, some discrepancies appear progressively in regard of evidence-based medicine and psychological approaches as sexo-analysis.

Objectives

In our present study, we test if “primary” or “secondary” transsexualism defines in accordance with sexo-analysis definitions will be reliable with the pathology course.

Aims

Clarify the definition of transsexualism to obtain a better understanding of this trouble and perhaps to change psychological approaches of gender disorders.

Methods

Nine transsexual male-to-female (MtF) aged between 25 to 65 were voluntary recruited. They were diagnosed by a psychiatrist. We adapted the GID scale to measure the lifetime process. Descriptive statistics were reported. Results are expressed as mean ± standard deviation.

Results

Age of the group is 41 ± 12. All subjects were treated by hormone therapy. One of them was surgical reassigned. All subjects reported a persistent feeling to be a woman across their entire life. None showed a decreased female feeling during a part of their life or a brutal apparition of this trouble during the adult period.

Conclusions

In regards of our preliminary results, we concluded that secondary transsexualism should be redefined and was probably induced by sociocultural aspects. Our results are limited by amount of subjects and should be confirmed by a large population included MtF and FtM people.

Disclosure of interest

The authors have not supplied their declaration of competing interest.