bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethnic Immigrant suicide in a Canadian psychiatric service: A case series from 1966–1997
Authors: Husain N. , Martin B. , Husain M. , Duddu V. , Sakinofsky I. , Beiser M.
Published: May 2016

Introduction

Suicide is a major public-health problem in Canada. Data from ‘Statistics Canada’ suggests that there was a 10% increase in suicide rate between the years 1997 and 1999. Studies have found substantial differences in suicide rates (and patterns) amongst ethnic immigrants compared to Canadian-born individuals.

Aim

The aim of the study was to investigate whether ethnic-immigrant patients differed from Canadian-born patients in their social, demographic, psychiatric and historical associations.

Methods

All registered patients (n = 276) known to have completed suicide from 1966–1997 constituted the study sample. Data were extracted from the written case audits, autopsy and toxicology reports, and medical records.

Results

Of the 276 known cases of suicide, 11 were Afro-Caribbean, 24 were Eastern European, 14 were Asian and 215 were Canadian-born patients. The ethnic-immigrant groups were broadly comparable to the Canadian-born group in terms of the social, demographic, psychiatric and background historical factors (except that the latter had a higher prevalence of alcohol and substance misuse). There were no significant differences between different ethnic immigrant groups themselves.

Conclusions

The most salient implication of the findings are that social, psychiatric and historical associations of mentally ill patients who complete suicide are common across different ethnic immigrant groups, and as such a universal approach to mental health promotion, early identification and treatment would be similarly applicable to patients belonging to all groups.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Association between immigration status and inpatient psychiatric admission after attempted suicide: Results from a hospital-based observational study
Authors: Martinez-Ales G. , Jimenez E. , Roman E. , Sanchez-Castro P. , Suarez A. , Rodriguez-Vega B. , De Dios C. , Bravo M.F.
Published: May 2016

Introduction

Acute suicidality or a condition after attempted suicide frequently leads patients to both voluntary or involuntary inpatient admission. Emergency room psychiatrists decide whether such patients can be treated on an outpatient basis.

Objectives

To identify if immigration status is associated with the decision whether a patient needs a hospital admission.

Aims

To detect social determinants of hospital-based health resource uses.

Methods

A cross-sectional study including data from 323 patients treated in a general hospital's emergency room after a suicidal attempt during year 2014.

Results

Seventy-six patients were admitted to the hospital (23.5%). Hospitalization frequencies for immigrant and non-immigrant individuals were 6.3% and 26.5% (P = 0.002). No significant association was found between psychiatric admission and history of a diagnosed psychiatric disorder, previous suicidal attempts, previous emergency room care use, family support or current drug use. A subgroup of patients (n = 37; 9%) answered Beck's suicidal intent scale (SIS), a measure of risk in suicidal attempters. Mean SIS was found to be higher among hospitalized than discharged patients (8.5 vs. 16.5; P = 0.01). No significant difference was found in mean SIS between immigrant and non-immigrant patients (9.3 vs. 9.1; P = 0.3).

Conclusions

These preliminary results call for consideration. The highly significant lower rate of psychiatric admission among immigrant patients, without significant differences in mean SIS score in regard to non-immigrants, needs further study.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicidal ideation and organic diseases in acute female psychiatric patients
Authors: Solano P. , Ustulin M. , Vecchio R. , Rreshketa A. , Pizzorno E. , Serafini G. , Amore M.
Published: May 2016

Introduction

Physical illness has been recognized as a major risk factor for suicidal behaviours, especially among females. A higher number of physical comorbidities has been associated with higher suicide- risk, thus having a greater burden among the elderly.

Objectives

investigate this evidence to be able to estimate the load of physical illness on suicidality among psychiatric females of different age.

Aims

Evaluate the association between suicidal ideation, age, depression and physical comorbidities in a sample of acute females psychiatric in-patients.

Methods

81 psychiatric female in-patients were evaluated during their first day of hospitalization through MADRS, SSI and the presence of organic comorbidity has been collected together with demographic data. All the evaluations were carried out at the Psychiatric Clinic, University of Genova, Italy.

Results

Mean age 48 (age–range value: 74, high variability). Pearson's Chi-squared test showed: significant association between SSI and MADRS (P = 0,027; α = 0,05); no association between SSI and age (P = 0,194; α=0,05); no association between SSI and presence medical illness (P = 0,132; α = 0,05); no association between SSI and number of medical illness (P = 0,186; α = 0,05).

Conclusions

Our results show that the levels of suicidal ideation in psychiatric females are independent from age, presence and number of physical comorbidities. Suicidal ideation appears to be associated only with levels of depression. Our results challenge evidence from a large number of current studies and, if confirmed by further research, would lead to reconsider major suicide risk factors. Further research to investigate these associations on larger samples is needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Development and psychometric testing of the triggers of suicidal ideation inventory for assessing older outpatients in primary care settings
Authors: Tsai Y.F. , Lee S.H. , Wang Y.W. , Chen Y.J.
Published: May 2016

Introduction

Older adults with depression resist accepting depression screening and seeking treatment due to stigmatization of mental disorders and little knowledge about depression. This study was undertaken to develop and determine the psychometrics of an instrument for assessing triggers of suicidal ideation among older outpatients.

Method

Participants were recruited from older outpatients of two hospitals in northern Taiwan. An initial 32-item Triggers of Suicidal Ideation Inventory (TSII) was developed, and its items were validated by experts in two runs of Delphi technique survey. After this TSII was pre-tested in 200 elderly outpatients, 12 items were retained. The 12-item TSII was examined by criterion validity, construct validity, internal consistency reliability, and test-retest reliability.

Results

TSII scores were significantly and positively correlated with the Beck Scale for Suicide Ideation (r = 0.45, P < 0.01), and UCLA Loneliness scores (r = 0.55, P < 0.01), indicating satisfied criterion validity. Participants with depressive tendency tended to have higher TSII scores than participants with no depressive tendency (t = 8.62, P < 0.01), indicating good construct validity. Cronbach's α and the intraclass correlation coefficient for the TSII were 0.70 and 0.99 respectively, indicating acceptable internal consistency reliability and excellent test-retest reliability. Receiver operating characteristic analysis revealed that the area under the curve was 0.83, indicating excellent ability to detect triggers of suicidal ideation. With a cutoff point of 2, the sensitivity and specify were 0.86 and 0.67, respectively.

Conclusions

The TSII can be completed in 5 minutes and is perceived as easy to complete. Moreover, the inventory yielded highly acceptable parameters of validity and reliability.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Online destigmatization of schizophrenia: A Romanian experience
Authors: Ladea M. , Bran M. , Marcel Claudiu S.
Published: May 2016

Introduction

Mental illness stigma existed long before psychiatry, although sometimes the institution of psychiatry has not helped enough in reducing either stereotyping or discriminatory practices. Stigma of mental illness involves problems with knowledge, attitudes, and behavior and has important negative consequences for patients and their families. As new technologies become more reliable and accessible, mental health specialists are developing new and innovative methods through which they may provide services. Internet has an important role in the delivery of information because of its ability to reach a large number of people in a cost-effective manner.

Objectives

In order to reduce stigma an online platform with relevant information about schizophrenia was developed. Simultaneously a social media campaign to increase awareness was launched.

Methods

A multidisciplinary team of psychiatrists, web-developers, IT specialists and designers developed the platform www.schizophrenia.ro. The platform is intended to be simple and with a great visual impact and it gathers general information about schizophrenia. The social media campaign used emotional messages like “Diagnosis is not the end of the road” or “I’m a person not a diagnosis” combined with high impact images.

Results

From 1st January to end of September 2015 the platform had about 22,500 users and about 70,500 page views. The social media campaign had a reach of approximately 9700 people in just 2 months.

Conclusions

The World Wide Web is increasingly recognized as a powerful tool for prevention and intervention programs and could also play an important role in destigmatization campaigns.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Antipsychotic monotherapy versus combination in schizophrenia: Are there differences in cognition?
Authors: Ruiz A. , Brañas A. , Vicens M. , Orozco A. , Lahera G.
Published: May 2016

Introduction

Influential protocols in the treatment of schizophrenia recommend the use of antipsychotics in monotherapy, although combination is common in clinical practice.

Objectives/aims

To compare cognitive performance of patients with schizophrenia treated by antipsychotic monotherapy or polytherapy; secondly, to analyze clinical and sociodemographic differences.

Methods

Ninety-eight outpatients between 18 and 65 years, diagnosed with schizophrenia, based on the DSM-V were recruited. Seventy were in monotherapy and 28 in antipsychotic combination. Patients with comorbidity, moderate to severe motor impregnation, abuse-substance dependence or serious somatic illness were excluded. Both groups were compared in sociodemographic, clinical and cognitive measures: PANSS scale, short Akathisia Scale Simpson-Angus Scale, State-Trait Anxiety Inventory (STAI), face emotion recognition (FEIT) and global Functioning (GAF), speed processing - through the Trail Making Test, parte A, subtest of symbol coding of the Brief Assessment of Cognition in Schizophrenia (BACS) and Verbal fluency (animals)- and sustained attention (SA)–through the Continuous Performance Test (CPT).

Results

Both groups showed similar age, gender, number of hospitalizations, score in STAI-Trait, STAI-State, ANGUS, GAF, TMT-A, verbal fluency and face emotion recognition. Patients in politherapy had more years of evolution (P 0.047), higher score in positive PANSS (P 0.007), negative PANSS (P 0.008), general PANSS (P 0.001); they showed more detection errors in the CPT (P 0008), and a trend towards less processing speed through the symbol coding (P 0.063), compared to patients in monotherapy.

Conclusions

Antipsychotic polipharmacy is associated with an impairment in sustained attention in patients with schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Exploratory randomized controlled trial of a group psychological intervention for postnatal depression in British mothers of South Asian origin
Authors: Husain N. , Lovell K. , lunat F. , Atif N. , Bhokari A. , Bhojani I. , Tomenson B. , Waheed W. , Rahman A. , Chaudhry N.
Published: May 2016

Introduction

The rates of postnatal depression (PND) in British South Asian (BSA) women are higher than the general population. PND is known to cause disability and suffering in women and negative consequences for their infants and their family with huge costs to society. Due to linguistic and cultural barriers, BSA women do not access health care services.

Objectives

To conduct an exploratory trial to test the feasibility and acceptability of a culturally adapted group Cognitive Behavioural Therapy (CBT) intervention (Positive Health Programme (PHP).

Aim

We aimed to determine if depressed BSA women receiving the PHP intervention will show significant improvements in terms of severity of depression, marital support, and social support as compared to the control group.

Methods

We used a two-arm pragmatic single-blind randomised controlled design. Women meeting the inclusion criteria were randomised either to the experimental group receiving PHP or treatment as usual (TAU) that is standard care usually provided by the GP.

Results

A total of 615 mothers were screened for participation in the trial, of these 137 were assessed further to determine eligibility. Eighty-three mothers were randomized to receive either PHP (n = 42) or treatment as usual (TAU) (n = 41). Mothers found the intervention to be acceptable and felt an overall positive change in their attitudes, behaviour and confidence level.

Conclusion

The recruitment and retention figures (70%) highlight the ability of the research team to engage with the population. The findings suggest the acceptability of the culturally adapted PHP intervention for British South Asian women with postnatal depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Are there clinical and care differences in real care intensity among patients in general hospitals suffering from psychiatric comorbidity?
Authors: Valdes-Stauber J. , Bachthaler S.
Published: May 2016

Background

According to literature, about 30–40% of individuals admitted in general hospitals suffer from psychiatric comorbidity. Consultation-liaison services (CLS) cover internationally 1–10% of admissions and are able to improve care quality, treatment adherence and to reduce length of stay.

Objectives

To assess possible clinical and care differences between individuals with and without psychiatric comorbidity as well as differences among principal diagnostic groups.

Aims

To find out, whether individuals suffering from specific psychiatric diagnoses show a higher degree of care needs held by a CLS.

Method

Retrospective, ethical approved full-survey assessment (n = 2940) over three years (2012–2014). ICD-10 diagnoses, clinical factors and care variables were considered. Group differences were calculated by means of chi-square and ANOVA as well as Scheffé post-hoc estimation. Associations were conducted by means of multivariate regression as well as logistic regression models.

Results

Individuals suffering from psychiatric comorbidity (48% of sample) were seldom primarily oncologic patients (30%), they showed more distress (DT = 6.5), more performance limitations (ECOG = 1.38), and less functionality (GAF = 59.6). They received more contacts by CLS (1.95), more cumulative treatment time (89.7 min), and more psychopharmacological interventions (30.6%). People suffering from recurrent depressive and somatoform disorders received much more contacts and treatment time than other diagnostic groups. Age was negatively associated with care intensity.

Conclusions

CLS services are able to offer differentiated psychiatric care depending on diagnoses. Individuals suffering from classical psychiatric disorders received rather treatment as usual, oncologic patients more psychotherapeutic interventions. Depressive as well as somatoform patients seem to need more time and personal resources.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Making mental health part of the solution for reducing the negative impact of austerity – a perspective from England
Authors: Bailey S.
Published: May 2016

This paper will describe four initiatives in England to protect the mental health of the population.

1. Lobbying government – presenting the evidence about how mental health services can reduce the impact of austerity on families and communities.

2. Building psychosocial resilience in schools through well being programmes and through “enabling environments” in the workplace.

3. Delivering sustainability in mental and physical healthcare:

– prevention – don’t get ill in the first place;

– patient empowerment – if unwell patient to self manage where possible;

– lean service design – if healthcare services necessary, these should be efficient and high value;

– low carbon – reducing carbon footprint and waste.

4. Working across medicine – choosing wisely:

– promoting conversations between doctors and patients to choose care that is:

– supported by evidence,

– not duplicative of other tests of procedures already received,

– free from harm,

– truly necessary.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Internally displaced persons in Ukraine
Authors: Korostiy V.
Published: May 2016

As of May 21, 2015 UNHCR has information about 1,299,800 IDPs, the data provided by the Ministry of Social Policy of Ukraine. Since the process of establishing a centralized system for registration is still pending, the actual number of persons displaced within the country may be higher.

We have a complex psychopathological and clinical research psychodiagnostic 97 internally displaced people in volunteer center, located at the central train station in Kharkiv to study the clinical features of neurotic disorders.

The results showed that 75.9% of IDPs observed have violations of adaptation: long-term depressive reaction (F 43.21) and predominant disturbance of other emotions (F 43.23). The clinical picture is dominated by the depression, anxiety, inner tension, inability to relax, asthenic symptoms, various fears and paroxysmal autonomic instability.

The results of the diagnostic psychological studies have found that men reactive alarm indicators (average – 37,7 ± 3,0) were higher than trait anxiety (average – 32,6 ± 2,9). On the contrary, women figures trait anxiety (average – 38,6 ± 2,9) were higher than reactive anxiety (average – 34,7 ± 3,0). Severity of depressive symptoms also slightly prevailed in women. The mean score on the Hamilton scale for men was 17,0 ± 2,3 points, women – 18,0 ± 2,3 points.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Can ecstasy treat the agony of PTSD?
Authors: Mithoefer M.
Published: May 2016

Introduction

Two serotonin reuptake inhibitors (SSRIs) have received FDA indication for treatment of PTSD, however the effectiveness of pharmacotherapy for PTSD is limited. Psychotherapy, including several well established evidence based methods, is the mainstay of PTSD treatment. Despite advances in this area, a significant percentage of PTSD patients are refractory to existing treatments. Recent research has explored the possibility that certain drugs could increase the effectiveness of psychotherapy when administered intermittently in conjunction with psychotherapy sessions. The most robust published. Results to date using this approach have been in early clinical trials of ± 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. These studies primarily involved civilians with treatment-resistant, crime-related PTSD. A more recent phase 2 trial, completed in 2015 yielded equally promising. Results in a cohort of military veterans, police officers and firefighters, mostly veterans from the wars in Iraq and Afghanistan.

Methodology

In these double blind controlled trials subjects with PTSD refractory to prior treatment are randomized to an active dose of MDMA or an active or inactive placebo administered to each individual on only two or three occasions during eight-hour psychotherapy sessions one month apart, in conjunction with preparatory and follow-up psychotherapy sessions. Outcome measures are repeated one or two months after the second MDMA-assisted session before the blind is broken. Subjects who were randomized to full dose MDMA are then eligible for one additional, open label, MDMA-assisted session. Those randomized to placebo or a lower dose of MDMA are eligible for three open-label full dose sessions. Outcome measures are repeated two months following the third MDMA-assisted session. The primary outcome measure is the Clinician Administered PTSD Scale (CAPS). Additional measures include the Beck Depression Inventory-II (BDI-II), Global Assessment of Functioning (GAF), Pittsburgh Sleep Quality Index (PSQI) and Posttraumatic Growth Inventory (PTGI).

Results

In the original study comparing MDMA with inactive placebo along with the same psychotherapy PTSD was resolved in 83% of the MDMA group vs. 25% of the placebo group receiving the same therapy. Improvement was maintained for at least 74% of subjects at long-term follow-up a mean of 45 months later. In a more recent, unpublished, study both the high dose and the medium dose of MDMA showed large effect sizes in reducing CAPS scores, and improvements in secondary measures: and BDI-II, PSQI, GAF and PTGI.

Conclusion

Evidence in phase II trials suggest that MDMA-assisted psychotherapy is effective in treating PTSD in both civilians and veterans who have not responded to established treatments. Phase III trials are necessary to definitively establish safety and efficacy of MDMA-assisted psychotherapy for PTSD.

Disclosure of interest

The author has not supplied his declaration of competing interest.
How EFPT trainee-led cross-national research can change training in psychiatry
Authors: De Picker L. , Mogren T. , Tomori S.
Published: May 2016

Established in 2008, the Research Working Group of the European Federation of Psychiatric Trainees (EFPT) creates a platform for trainee-led collaborative studies. Several large-scale transnational studies on training-related subjects have been initiated and carried out, driven by psychiatry trainees. Examples of recent and ongoing projects are the Brain Drain study, which investigated migratory experiences and attitudes among trainees in Europe, and the TEO-PC project, which aims to raise awareness on UEMS Psychiatric competencies as well as to compile data on trainees’ experiences and satisfaction with their national training programs.

Earlier projects leading to publications have looked into drug prescription habits of trainees [1,2] and the interactions trainees with pharmaceutical industry [3]. Besides these projects, EFPT yearly gathers reports from the representatives of the national trainees associations on the structure, content and conditions of psychiatry training in all member countries. The information obtained through these channels is used actively to guide and influence policy related to psychiatry training, through collaboration with relevant organizations involved in the creation of guidelines, and through the EFPT statements, which serve to empower trainees themselves.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Developmental trajectories to bipolar disorder
Authors: Frangou S.
Published: May 2016

Background

Childhood subclinical phenotypes have been informative for etiological research and as a target for preventative interventions. Using a prospective longitudinal general population cohort we investigated whether childhood manic symptoms predicted a diagnosis of bipolar disorder (BD) or other psychiatric disorders by early adulthood.

Methods

Subthreshold manic symptoms at age 11 years (n = 1907) and clinical outcomes by age 19 years (n = 1584) were ascertained in the TRacking Adolescents’ Individual Lives Survey (TRAILS), a prospective Dutch community cohort. We used latent class analysis to stratify TRAILS participants at age 11 years into distinct classes based on the pattern and severity of childhood manic symptoms. We then determined the association between class membership and clinical diagnoses by age 19 years.

Results

At age 11 years, we identified a normative class with negligible symptoms (n = 862), a mildly symptomatic (n = 846) and a highly symptomatic class (n = 199). The risk of BD was moderately increased in individuals in the mildly symptomatic class (OR = 2.65, 95% CI 1.41–5.01), and substantially increased in the highly symptomatic class (OR = 7.08, 95% CI = 3.32–15.11). Children in the highly symptomatic class were additionally characterized by lower IQ and socioeconomic status, greater family dysfunction and increased rates of parental psychiatric morbidity. Class membership did not show significant associations with depressive, anxiety and substance abuse disorders by age 19 years.

Conclusions

The results provide support to developmental models of BD, and suggest that manic symptoms in childhood may be a marker for adult disorders and therefore potentially useful for early identification of at risk individuals.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Ethical challenges in the use of coercion
Authors: Kastrup M.
Published: May 2016

The use of coercive measures remains one of the great challenges in psychiatry.

Increased focus on patient rights and autonomy, concern from user and relatives organizations as well as from human rights organizations all have contributed to that the use of all kinds of coercion is high on the agenda. And yet, we are still faced with that a number of psychiatric patients will experience that coercive measures are used as part of their treatment.

The EPA Ethical Committee carried out a survey comprising the European associations of psychiatry in which a questionnaire was circulated regarding what the different associations found were the major ethical challenges in their respective countries.

Among the issues that have given rise to particular concern are the use of physical restraints including why some countries avoid physical restraints while other – e.g. Denmark – use it extensively. Why do we find such large differences? Is this due to different approaches to coercion, different traditions? Shortage of resources?

Another concern is that certain groups seem more likely to be subject to coercion compared to others. Thus, it has been demonstrated that patients belonging to ethnic minority groups are more likely to experience this.

The paper will focus on ethical problems and issues of concern related to the use of coercion. The focus will be on facets of international relevance with the aim to remain critical towards the use and when needed to strengthen the quality of coercive treatment care. URL:http://www.mariannekastrup.dk

Disclosure of interest

The author has not supplied his declaration of competing interest.
Does the use of coercion improve the outcome of patients with severe mental disorders?
Authors: Luciano M.
Published: May 2016

Coercive measures have always been part of the psychiatric armamentarium; however, the clinical and ethical dilemma between the use of a “therapeutic” coercion and the loss of patients’ dignity is one of the most controversial issues in mental health practice. According to International guidelines, coercive measures should be adopted only when all the other less restrictive approaches failed and should be considered as the “last restrictive alternative”. Although coercive measures are frequently used to manage patients’ aggressive behaviors and self-harm, refusal of medication and impulsivity, their effect on patients’ outcome is not clear. In fact, the use of coercive measures can reduce patients’ aggressiveness and improve psychiatric symptoms, but can also have a negative impact in terms of therapeutic relationship, engagement with mental health services and self-stigma, arising negative feelings on patients and on mental health professionals. International attempts have been made to improve and harmonize the use of involuntary treatments. Recommendations of good clinical practice on the use of coercive involountary treatments and forced medications have been proposed by the EUNOMIA consortium, and the effect of coercion on the outcome of patients with severe mental disorders have been described. Results of this study will be reported as well as lessons learnt from other international experiences.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Neural pathways of the association between pain and suicide
Authors: van Heeringen K.
Published: May 2016

Physical pain and psychological pain are risk factors for suicidal behaviour, and understanding of the neural pathways linking pain and suicide may contribute to suicide prevention. Neuroimaging studies have shown changes in association with physical and psychological pain and with suicidal behaviour. Psychological stressors such as social exclusion may trigger emotional pain that is associated with functional changes in the prefontal cortex, cingulate cortex, thalamus, and parahippocampal gyrus. This functional network shows considerable overlap with brain areas involved in physical pain and suicidal behaviour. Changes in the brain motivation-valuation circuitry may predict pain persistence and thus contribute to the development of suicidal thoughts and behaviours.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Interview and therapeutic rapport in diagnostic process
Authors: Küey L.
Published: May 2016

Diagnostic assessment in psychiatry, as a formulation and as a joint re-construction process between the clinician and the patient, is essential in clinical care. Clinical interview is the crucial tool of the clinician in this process. Accordingly, a two-fold task is faced. On one hand, the clinician is in need of making a comprehensive diagnostic assessment to construct a valid and working formulation of the patient's situation and a treatment plan.

On the other hand, the bases for a psychotherapeutic alliance and rapport should be established. A comprehensive diagnostic assessment aims to bridge the current scientific evidence and knowledge with the uniqueness of the specific person who presents for care. The clinician facing the complexities of the human existence in health and ill mental health constructs working hypotheses in the context of the interview, to understand and formulate the psychopathological state. Clinical interview serving as a practical channel in constructing these hypotheses, also serves as the main tool in establishing a therapeutic alliance. The theory and practice of different schools of psychotherapies offer considerable contributions to the clinician in managing these tasks.

Understanding the meaning of the human suffering through empathy in a judgment free milieu is essential in the establishment of rapport, compliance and a better clinical outcome. This presentation will discuss the complexity of diagnostic process in psychiatry and emphasize the contributions of psychotherapeutic theory and skills and humanistic approaches in this process. Brief clinical vignettes from the authors’ clinical practice will be used to broaden the scope of discussion.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Hallucinations without delusions in patients with first-episode psychosis: Clinical correlates and implications for pathophysiological models
Authors: Melle I.
Published: May 2016

Introduction

The symptomatic distribution in schizophrenia spectrum disorder is heterogeneous. Patients may experience hallucinations, delusions and combinations thereof, in addition to disorganized and negative symptoms. We have previously found that patients with monosymptomatic hallucinations exhibited a different clinical profile than patients with monosymptomatic delusions or combinations of the two; with an earlier age at onset and more suicidal symptoms.

Aims

To replicate findings in a new group of patients with schizophrenia spectrum disorders.

Methods

A total of 421 consecutive patients with schizophrenia spectrum disorders were included into the study. They were comprehensively assessed by specifically trained psychiatrists or clinical psychologists; using the SCID for DSM-IV for diagnostic purposes, the PANSS to assess current clinical symptoms and CDSS to assess current depression. Lifetime presence of different symptom types was ascertained during the diagnostic interview.

Results

A total of 346 (82%) had experienced both hallucinations and delusion, 63 (15%) had experienced delusions without hallucinations, 10 (2.5%) had experienced hallucinations without delusions and 2 patients (0.5%) had neither but experienced negative and severely disorganized symptoms. Contrary to hypothesis, we did not find any statistically significant differences in age at onset and in clinical symptoms (including suicidality) between these groups. We also did not find any differences in the type of hallucinatory experiences between hallucinating groups.

Conclusions

In a new sample of patients, we did not replicate previous findings of a different clinical profile in patients with monosymptomatic hallucinations. This type of psychotic disorder is relatively rare, which might pose a problem concerning statistical strength.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Modell Donaustadt: A best practice example for treatment of mental and physical comorbidity in long-term care
Authors: Hobl B. , Schreiber B.
Published: May 2016

Evidence consistently demonstrates that people with long-term mental health conditions develop serious physical comorbidities at an earlier age than the average population. These physical comorbidities are often exacerbated because long-term psychiatric conditions reduce the patient's ability to manage somatic symptoms effectively, thus hindering treatment. This highlights the critical importance of continuous support by primary care physicians and nursing staff. People with persistent mental illnesses typically require long-term care significantly earlier than people without mental illness.

As a consequence, elderly patients with chronic mental illnesses who are essentially unable or unprepared to function in the outside world or are in need of constant medical attention are typically placed into long-term care facilities and nursing homes geared to serving physically disabled elderly.

These LTC institutions have no capacity to provide specific care for mentally ill patients. Difficulties in treating psychiatric patients in these LTC facilities often result in transfers to and repeated admissions in acute psychiatric hospitals.

In an effort to resolve the “revolving-door” situation of these patients and reduce the rates of re-admission to acute psychiatric hospitals, Modell Donaustadt was developed. In the talk, Modell Donaustadt will be presented as a best practice example for the treatment of mental and physical comorbidities in long-term care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Sex offenders and intellectual disability
Authors: Goethals K.
Published: May 2016

Ethical controversies in patients with intellectual disability who are sex offenders.

Patients with an intellectual disability (ID) have a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains (according to the DSM-5). These deficits in adaptive functioning result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life. Therefore, it is not surprising that these patients cross physical/sexual boundaries quite often. Above that, a proportion of all sex offenders have an intellectual disability.

The treatment of these sex offenders with an ID has to focus on protective factors, next to risk factors in order to decrease the risk of recidivism. Due to the chronicity of their disorder, quality of life is an important issue in these patients.

In this paper, we want to address some ethical controversies:

– hormonal treatment in patients with ID who are sex offenders;

– the right to have a ‘normal’ sexual life in these ID offenders, and the Dutch experience of the Stichting Alternatieve Relatiebemiddeling (SAR, that can be translated as foundation of alternative relationship mediation).

The SAR is an alternative dating service, giving information about the sexuality of physically or mentally disabled people and organizing sexual encounters for them.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Being on the edge: The psychopathology of the accelerated, agitated and anxious subject
Authors: Madeira L. , Figueira M.L.
Published: May 2016

The accurate identification of accelerated, agitated and anxious states is of paramount relevance for the correct diagnosis and the selection of a suitable psychopharmacological treatment. Choosing antidepressants, antipsychotics and/or mood stabilizers is presently contingent to the identification of specific phenotypic profiles in anxiety disorders, mixed and manic episodes and/or delirium states. Today, the anamnesis and psychopathological examination are hindered by the vagueness of the conceptualization of these experiences in diagnostic textbooks. We propose a selective review of literature of how these have been conceptualised aiming at increasing the segregation of specific phenomenological profiles across these phenomena.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Feasibility and effectiveness of aerobic exercise training interventions in schizophrenia
Authors: Keller-Varady K. , Hasan A. , Schneider-Axmann T. , Hillmer-Vogel U. , Adomßent B. , Wobrock T. , Schmitt A. , Niklas A. , Falkai P. , Malchow B.
Published: May 2016

Patients with schizophrenia might benefit from exercise via multiple ways. It can be assumed that positive effects observed in healthy people counteract different pathological dimensions of schizophrenia or add to a better compensation. E.g. exercise may serve as a coping strategy, produces changes in brain structure and function and is already known to improve mood and cardiovascular health. First studies have shown beneficial effects of exercise in schizophrenia. These studies feature a multitude of exercise types and diagnostic tests and also lay emphasis on different research questions.

From the diverse information of the studies, heterogenic character conclusions for future therapy and research can be derived. From the point of view of sports science, feasibility and effectiveness of endurance training will be discussed on the basis of current literature and results from our own research. In a controlled trial 22 patients with schizophrenia participated in 12 weeks of endurance training using bicycle ergometers resulting, e. g., in improvements of endurance capacity and functioning. A special focus was laid on analyzing the differences between the adaptations of patients and healthy controls to test the transferability of methods and effects of endurance training. The exercise intervention was feasible and effective for both healthy controls and patients but some interesting differences could be found.

Additionally, ideas and special circumstances regarding the implementation of endurance training in clinical settings or for outpatients will be considered. From the current knowledge it can be concluded, that the implementation of endurance training in multimodal therapy strategies can be recommended to promote recovery.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The impact of racism and discrimination on mental health of refugees and asylum seekers
Authors: Kastrup M.
Published: May 2016

With the strong focus on terrorism in recent years, there is an increasing concern that the fundamental rights of refugees and asylum seekers may be violated in the interest to combat acts of terrorism. It may also lead to increasing racism and discrimination towards these populations.

Racism and discrimination encompass the negative stereotypes and prejudicial beliefs that people may hold, as well as inequitable practices that may result hereof.

Knowledge about the mental health consequences of racism and discrimination is of clear clinical relevance for psychiatrists worldwide, as a significant proportion of psychiatric patients will have a background as refugees and asylum seekers. Many of them have experiences of war, strife, persecution and torture that further ads to their mental distress.

The paper will outline the psychiatric symptomatology related to racism as well as ethical dilemmas and educational needs for the psychiatric profession.

Further the role of national psychiatric associations in combating racism and discrimination by e.g. defining best practices and revising medical training curricula will be outlined.

http://www.mariannekastrup.dk/

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Room for hope: How to deal with growing racism and discrimination?
Authors: Küey L.
Published: May 2016

Discrimination could be defined as the attitudes and behavior based on the group differences. Any group acknowledged and proclaimed as ‘the other’ by prevailing zeitgeist and dominant social powers, and further dehumanized may become the subject of discrimination. Moreover, internalized discrimination perpetuates this process. In a spectrum from dislike and micro-aggression to overt violence towards ‘the other’, it exists almost in all societies in varying degrees and forms; all forms involving some practices of exclusion and rejection. Hence, almost all the same human physical and psychosocial characteristics that constitute the bases for in-group identities and reference systems could also become the foundations of discrimination towards the humans identified as out-groups. Added to this, othering, arising from imagined and generalized differences and used to distinguish groups of people as separate from the norm reinforces and maintains discrimination.

Accordingly, discrimination built on race, color, sex, gender, gender identity, nationality and ethnicity, religious beliefs, age, physical and mental disabilities, employment, caste and language have been the focus of a vast variety of anti-discriminatory and inclusive efforts. National acts and international legislative measures and conventions, political and public movements and campaigns, human rights movements, education programs, NGO activities are some examples of such anti-discriminatory and inclusive efforts. All these efforts have significant economic, political and psychosocial components.

Albeit the widespread exercise of discrimination, peoples of the world also have a long history of searching, aiming and practicing more inclusive ways of solving conflicts of interests between in-groups and out-groups. This presentation will mainly focus on the psychosocial aspects of the anti-discriminative efforts and search a room for hope and its realistic bases for a more non-violent, egalitarian and peaceful human existence.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Self-related networks and negative symptoms in psychotic disorders
Authors: Aleman A.
Published: May 2016

Objective

Two factors of negative symptoms in schizophrenia have been consistently described based on factor analysis, “expressive deficits” and “social amotivation”. We aimed to investigate the putatively differential involvement of self-related networks, as measured with BOLD fMRI during a self-evaluation task, in two dimensions of negative symptoms in schizophrenia (reduced expression and social amotivation).

Method

Forty-five patients with a diagnosis of schizophrenia participated in an fMRI study in which they performed a self-evaluation task. The task comprised a self-reflection, close other-reflection, and a semantic (baseline) condition. We compared correlates of Expressive versus Social amotivation factors (summed items from the PANSS interview) for the contrasts self-baseline and self-other. Significance threshold was set at P < 0.05 family-wise error (FEW) corrected.

Results

Social amotivation correlated significantly with self-evaluation vs. baseline in right and left ACC, and in the sulcus of frontal lateral lobe between inferior frontal triangularis and middle frontal gyrus. This was also significant, but less pronounced, in the direct comparison of social amotivation vs. expressive deficits scores (for the self-baseline contrast). No activation differences survived critical thresholds for the self-other contrast.

Conclusion

Differential neural correlates for the two dimensions of negative symptoms support the validity of this distinction based on factor analyses. Intact functioning of brain circuitry for self-referential processing may be of relevance to actively seek social interaction.

Disclosure of interest

The author has not supplied his declaration of competing interest.
The social self in schizophrenia: A neural network perspective on integrative external and internal information processing
Authors: Ebisch S.
Published: May 2016

Social impairment is recognized as a basic aspects of schizophrenia. Although the nature of aberrant self-other relationship in schizophrenia is still poorly understood, it has been suggested that some social impairments could have their roots in self-disturbances typical of schizophrenia. For instance, experiencing otherness could become problematic with anomalous self-recognition. Furthermore, deficits in the processing of self-relatedness of social stimuli disconnect the self from its social environment. On the one hand, this could lead to problems in self-other distinction caused by misattributions of ownership of experience and agency in social interaction. On the other hand, this could result in feelings of isolation and reduced intersubjectivity due to interrupted self-referential processing of social stimuli, likely also mediated by memory and emotion. Brain networks involved in self-referential processing, sense of ownership, and agency also have been implied in social cognition. Whereas cortical midline structures are associated with self-referential processing of external stimuli including social information, sensorimotor and affective networks involved in bodily and interoceptive self-processing are also involved in the ability to share others’ experiences. Schizophrenia has been linked with a reduced integrity of these networks underlying various aspects of self and social impairments, though rather separately. Recent neuroimaging findings will be highlighted explaining how self-disturbances can pervade the social domain in schizophrenia. In particular, disruptions of the social self in schizophrenia will be addressed from a neuronal network and connectiomics perspective providing a unifying framework.

Disclosure of interest

The author has not supplied his declaration of competing interest.