bluuebunny/crossref_metadata_2025 huggingface dataset:
Mistreatment of Alzheimer's Patients: Predictive Factors
Authors: Ghal F. , El Karoui M. , Robbana L. , Beji R. , Jmii G. , Zghal M. , Ben Ghzaeil I. , Jouini L. , Rafrafi R.
Published: June 2017

Introduction

Violence against elderly persons is an intricate social, legal and ethic issue. Alzheimer's patients are the most vulnerable individuals to mistreatment and neglect. The aggressor can be even the main helper of the patient. We noticed a wide underestimation of this phenomenon, which remains taboo subject in our society.

Objectives and methods

– The aim of our study is to identify predictive factors of mistreatment of Alzheimer's patients through a prospective and descriptive study, within patients following in the department of neurology in Razi's hospital.

– we evaluate cognitive function (MMSE) and the importance of behavioural disorders.

– we explored helper's socio-demographic characteristics and the quality of aid relationship.

– anger and hostility within relationship were estimated through family attitude scale.

Results

Our sample accounts 60 informal caregivers predominately female (91.7%) with an average age of 49.67 years, mostly are married (71.66%) and jobless (38.88%):

– in 78.3% of cases, caregivers spent about 12 to 24 hours per day with Alzheimer's patient.

– the average score of FAS was about 52.4% with an important emotional charge (score >60).

– twenty-five caregivers wished the death of the patient and 42 others admitted being sarcastic with him.

– We noticed a correlation between mistreatment and both cognitive function and behavioural disorders.

Conclusion

Our results support the fact that mistreatment of people with dementia is closely related with the exhausting situation of the main caregiver.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Depression in Elderly Patients with Schizophrenia
Authors: Feki I. , Mdhaffar K. , Hentati S. , Sallemi R. , Masmoudi J.
Published: June 2017

Background

The presence of depressive symptoms impacts negatively the lives of patients suffering from schizophrenia-spectrum disorders. Likewise, the treatment poses many challenges for clinicians.

Objectives

To specify the profile of elderly with schizophrenia and to evaluate the prevalence of depression and its related factors.

Methods

A descriptive and analytic study involved 40 elderly patients aged 65 and over with DSM-5 diagnoses of schizophrenia or schizoaffective disorder, followed to the outpatient psychiatry department of Hedi Chaker University Hospital, in Sfax, Tunisia, during the two months of September and October 2015. Positive and negative syndrome scale (PANSS) and Calgary depression scales were used to assess respectively the symptoms of schizophrenia dimensionally and depression.

Results

The majority of our patients was male (62.5%), single (55%), with low school and socioeconomic level. The mean duration of disease was 45 ± 6.02 years and patients were mostly (90%) in classical neuroleptics. The scale of PANSS showed the predominance of negative symptoms (67.5% of cases). In addition, according to Calgary scale, depression was found in 25% of patients. Factors positively correlated to depression were: the female sex among single (P = 0.043), absence of family support (P = 0.001), treatment with conventional neuroleptics (P = 0.039) and negative symptoms (P = 0.001).

Conclusion

Depression in patients with schizophrenia is far from exceptional. It is often difficult to diagnose due to the recovery of other symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Antipsychotic Prescribing Practices Amongst the Elderly of St. James's Hospital (SJH), Dublin
Authors: Power C. , McCarthy B. , Lawlor B.A. , Greene E.
Published: June 2017

Introduction

Psychotic symptoms arise commonly in the context of behavioural and psychological symptoms of dementia (BPSD) in the elderly. While non-pharmacological interventions are preferable to manage such symptoms, antipsychotic medications are frequently used. This is largely unlicensed and associated with significant risks, particularly in dementia (1).

Objectives

To examine antipsychotic prescribing practices in SJH.

Methods

On 23rd February 2016 all inpatients aged over 65 who were prescribed antipsychotic medications were identified. Demographic and medical data were collected from medical and electronic notes and medication kardexes.

Results

Complete data were available for 53 of 59 identified cases. The cohort had a mean age of 80 (range 65–99) and 62% were male. Seventy-four percent (n = 39) had documented cognitive impairment or dementia. Fifty-eight percent (n = 31) were newly prescribed an antipsychotic following admission. The commonest indications for antipsychotics were: delirium (53%) and BPSD (25%). Haloperidol (56%), quetiapine (19%) and risperidone (8%) were prescribed most frequently. Non-pharmacological interventions were documented in 50% however in many cases it is not clear what these interventions were. Antipsychotic use was discussed with patients and/or next of kin in less than 25% of cases. Adverse effects were noted in 6/36 (17%) with equal incidence of falls, EPSEs and ECG changes.

Conclusion

Positive and negative aspects of current antipsychotic prescribing practices are highlighted. Antipsychotics were prescribed for a small number of patients for appropriate indications. However, there was poor consideration of non-pharmacological interventions and a lack of consultation with the patient/NOK. This may reflect, in part, inadequate medical documentation. A guideline needs to specifically address these areas of concern to improve safety and promote best practice.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mild Cognitive Impairments and Whole-body Cryotherapy – Placebo Control Study
Authors: Urbańska K. , Stańczykiewicz B. , Szcześniak D. , Trypka E. , Zabłocka A. , Rymaszewska J.
Published: June 2017

Introduction

Cognitive impairment is considered to be a result of oxidative stress and disturbances in inflammatory status. Whole-body cryotherapy (WBC), which is a short exposure to extremely low temperatures, probably regulates the release of cytokines and nitric oxide. The hypothesis is that WBC may be useful in the therapy of mild cognitive impairments (MCI).

Aims

The effect of the whole-body cryotherapy (WBC) on cognitive impairments was investigated.

Objectives

In this study the observation of several biological factors and cognitive functions were conducted to analyse the WBC influence on cognitive deficits.

Methods

People with MCI participated in 10 WBC sessions divided for experimental group (−110 °C till −160 °C) or control group (−10 °C till −20 °C). The MoCa test (scores 26 and lower) was used for inclusion criteria. Cognitive functions were measured with: TYM, DemTect and SLUMS at baseline and in follow-up. Biological factors (cytokines, BDNF, NO) were also assessed.

Results

It was shown that memory domains in experimental group improved after WBC sessions. Also modulatory effect on inflammatory mediators in plasma was shown. The results of this study consist of the comparison of experimental and control groups regarding to cognitive functions as well as biological factors.

Conclusions

Whole-body cryotherapy may be supposed to improve cognitive functions in MCI patients. The modulatory effect of WBC on immunological response may be considered as one of possible mechanisms of its action. However, there is no confirmation how long the effects resist so further investigations are needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Effect of a Sleep-hygiene Education and Sleeping Pill Reduction Program for Hospitalized Cancer Patients at a General Hospital
Authors: Youn S. , Park B. , Lee S. , Kim C. , Chung S.
Published: June 2017

Objectives

Sleep disturbances are common among cancer patients. Especially during hospitalization, not only adverse medical conditions but also ward environments can affect sleep. We have developed a program of sleep-hygiene education and sleeping pill reduction for inpatients (the i-sleep program) and applied it to cancer patients. This study aimed to explore the effect of the program.

Methods

In a general hospital with 2,715 beds, we estimated the proportion of inpatients prescribed hypnotics at admission to and discharge from the department of oncology before (2014) and after (2015) the program. In addition, we estimated the proportion of inpatients prescribed hypnotics among all inpatients in the department of oncology on the first day of each month of 2014 and 2015.

Results

A total of 12,382 patients (2014, before) and 12,313 patients (2015, after) were admitted to oncology department of Asan Medical Center. The proportion of inpatients prescribed hypnotics as discharge medication among inpatients who had been prescribed them at the time of admission decreased significantly, from 76.0% (2014) to 69.8% (2015), after the program (RR = 0.92, 95% CI: 0.87–0.98). The proportion of inpatients newly prescribed sleeping pills after admission to the hospital did not significantly decrease (4.03% to 3.98%; RR = 0.99, 95% CI: 0.87–1.12). The mean prescription rate of sleeping pills per day was 10.02% in 2014 and 7.99% in 2015 (P = 0.03).

Conclusions

Although the i-sleep program did not reduce the prescription rate of sleeping pills per day, it effectively reduced the proportion of cancer patients who continued to take sleeping pills from admission until discharge.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Screening for Cognitive Disorders in Elderly Diabetics
Authors: Baat I. , Abida I. , Omri S. , Ellouze S. , Hadj Kacem F. , Affes L. , Abid M. , Masmoudi J.
Published: June 2017

Introduction

Old people with diabetes are more likely to develop cognitive impairment, Alzheimer's disease and vascular dementia. However, the determinants of the association between diabetes and cognitive impairments are only partially known.

Objectives

To evaluate cognitive disorders in elderly diabetic patients and to identify risk factors of cognitive impairment in this population.

Methods

It was a cross-sectional study. It involved outpatients aged 65 and older, who were followed for diabetes in the endocrinology department at the Hedi Chaker University Hospital in Sfax (Tunisia), from October 1 to December 31, 2015. For each patient, we collected sociodemographic, clinical and therapeutic data. We used the Montreal Cognitive Assessment (MoCA) to identify mild cognitive decline (score < 26/30).

Results

We identified 70 patients, all with type 2 diabetes. The average age was 66.8 years. The sex ratio (M: F) was 0.7. The mean duration of diabetes was 14.76 years. The average MoCA score was 20.68 ± 6. Forty patients (57%) had cognitive decline. The cognitive impairment was statistically correlated with female sex (P = 0.02), low level of education (P = 0.00), high levels of glycated hemoglobin (Hb A1c ≥ 7%) (P = 0.00), presence of hypoglycemic episodes (P = 0.05) and presence of dyslipidemia (P = 0.00).

Conclusion

Our study confirmed the high rate of cognitive decline in older type 2 diabetes patients. The profile of subjects at risk was consistent with the literature: poorly controlled diabetes, severe recurrent hypoglycaemia and associated dyslipidemia. Acting on these risk factors would prevent cognitive decline and therefore progression to dementia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neurocognitive Profile Among Omani Who have Sustained Traumatic Brain Injury with Post-concussion Syndrome
Authors: Albalushi M.
Published: June 2017

Background

Neurocognitive disorders, previously not featured in the psychiatric nomenclature such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), have now been included in the latest, fifth edition of the DSM. There is a dearth of studies on neurocognitive disorders among non-western population.

Aims

The aim of this study is to compare neuropsychological functioning measured by tests of executive function and cognition among patients marked by apathy and impulsivity following a traumatic brain injury in a non-Western population, Oman.

Methods

Comparing the performance of various neurocognitive indices including negativistic features and disinhibition, which were identified using the symptom checklists Apathy Evaluation Scale and Disinhibited Evaluation Scale. Comparative neurocognitive measures included tapping verbal reasoning ability (Raven's Standard Progressive Matrices), working memory (Digit Span–Digit Forward–Digit Backward); Buschke Reminding Test, planning/goal-directed (Controlled Oral Word Association Test–verbal fluency, Tower of London(–planning time–number solved), (Wisconsin Card Sorting Test–perseverative errors, and–number of categories solved), and affective ranges (Hospital Anxiety and Depression Scale).

Result

Analysis showed that those participants who scored highly at Apathy Evaluation Scale and Disinhibited Evaluation Scale did not differ on indices measuring working memory/attention and affective ranges except for one measure: Digit span-Digit Forward. In the measures operationalized here to tap planning/goal-directed behaviour, the two cohorts differ on all indices except for Tower of London-Number Solved.

Conclusion

This study lays ground for further scrutiny in delineating the different characteristics of what previously labelled as frontal dysexecutive phenotype. It indicates that apathetic and disinhibited temperaments marked with specific neuropsychological performance.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
The Theme of Violence and the Teaching Strategies Used by Teachers of Nursing Undergraduate Courses
Authors: Scherer Z. , Scherer E. , Baragatti D.
Published: June 2017

Introduction

Understanding violence as a public health problem brings as required its inclusion in the curricula of undergraduate courses in health.

Objective

To describe the approach to the topic of violence and the teaching strategies used by teachers of undergraduate courses in nursing of two public higher education institutions of the State of São Paulo, Brazil.

Aims

Knowing the approach to the topic of violence in two nursing under graduation courses.

Method

Descriptive, exploratory qualitative study. For data collection, semi-structured interview was used; were subject of the study, 15 teachers of the institutions studied that ministered courses whose programs contained the word “violence” or related. The data were subjected to analysis of the “collective subject discourse”.

Results

The results referred to speeches about the importance of addressing violence in theory and practical course, the experience of violence in the everyday practice and pedagogical strategies in the theoretical and practical learning. Teachers recognize the importance of violence be crafted at graduation, describing that, although not always appear in the formal curriculum, the subject appears in an informal way in academic training. Recognize, however, that there is a fragmentation in the approach of the theme, because teachers are divided between theoretical and practical classes and not all of them study the subject.

Conclusion

It is essential that there should be more discussions on violence among teachers as well as be designed strategies to better approach the theme at graduation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
“It is safer to sell marihuana than heroin or cocaine and you make more money” qualitative study about drug traffic and consumption in Girona (eastern sector)
Authors: Calvo F. , Giralt C.
Published: June 2017

Introduction

Font de la Pólvora is a neighbourhood located on Catalonia, which has been one of the most important points of sale of heroin and cocaine in the country. The sale of drugs was also affected by the economic crisis, changing the behaviour pattern of patients with drug dependence.

Objective

To describe the changes in drug trafficking in this region and how these influence their consumption.

Methods

The investigation is carried out by the harm reduction outreach team, who selected, with a non-probabilistic method, a sample of 6 drug users. An in-depth semi-structured interview was conducted.

Results

From 2006 to 2012, there existed up to 19 points of drug sale of heroin and cocaine. There are currently 2. The reasons behind the decrease are:

–the demand for cocaine decreases;

–the sporadic consumption of heroin decreases;

–with the decrease in demand, drugs lose quality.

With the housing bubble in Spain and the rise in foreclosures on behalf of banks, empty flats proliferated in the area, which were eventually occupied illegally. This fact prompts the production of cannabis.

Conclusion

Many of the strictly punitive actions in the control of narcotics lead to the dealers coming up with new ideas and new patterns of consumption which complicate the intervention of the teams working in the territory.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Job satisfaction, burnout and coping strategies: Comparison between medical and surgical specialties
Authors: Derbel C. , Braham A. , Souilem A. , Ben Romdhane A. , Gallala R. , Ben Nasr S. , Bannour A.S. , Ben Hadj Ali B.
Published: June 2017

Introduction

Doctors have many constraints in their professional practice, which influence negatively the quality of their performance. This causes a psychological distress.

Aim

To compare job satisfaction (JS), burnout (BT), anxiety, depression and coping strategies among doctors of medical (DMS) and surgical specialities (DSS).

Method

Comparative and cross-sectional study conducted among 33 DMS and 63 DSS with different grades, in the university hospital Farhat Hached Sousse, Tunisia. We used job satisfaction scale (JSS) to determine the degree of JS, hospital anxiety and depression scale (HADS) to evaluate anxiety and depression, the Maslach burnout inventory to assess the BT and the brief cope to determine coping strategies.

Results

DMS were older than the DSS (P = 0.005). The MSC had more unsettled family life (P = 0.04) and more monthly guard (5.87 vs. 4.96, P = 0.03). DMS had more days of outpatient (P = 0.00), were more satisfied with the work schedule (P = 0.00), conditions of the guards (P = 0.02). Relationships with colleagues were more satisfactory among DMS (P = 0.001). DMS were less confronted to violent events (P = 0.03). The average score of JSS was higher among DMS (P = 0.014). The BT was more reported in the DSS (P = 0.049). An average sub-score HADS-D (depression) was higher in the DSS (P = 0.00). An avoidance-focused coping was more adopted by the DSS (P = 0.02).

Conclusion

DSS were generally less satisfied in their work than DMS with obvious psychological repercussions. This incites to intervene in factors that interfere with job satisfaction to improve the quality of physicians’ performance.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Diagnoses among students, patients of psychiatric outpatient ambulatory in student health centre of ljubljana university
Authors: Kajin E.
Published: June 2017

Introduction

Health care for students in Slovenia was organized immediately after the WWII. It slowly developed and in late 1960's extended with specialist ambulatories, including psychiatric.

Objectives

Survey of primary psychiatric diagnoses in one school year.

Method

Research of patient's primary psychiatric diagnoses of the school year 2015/2016.

Results

During 1.9.2015–31.8.2016, there were 1126 patients diagnosed in the age group younger than 29 years, while number of diagnoses was 90 (see Table 1).

Conclusions

Most patients were diagnosed with one among anxiety disorders, followed by one of the mood [affective] disorders while the third most common diagnosis was one of schizophrenic spectre. The findings are at least approximately consistent with data elsewhere.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Malingering and medicalization in Israeli higher education: A critical inquiry of students feigning learning disorders
Authors: Katchergin O.
Published: June 2017

This lecture stimulates new thinking about learning-disorders. Previous research in Israel regarding students with learning-disorders did not analyze the social processes through which students acquire the disability label. Therefore, the scenario of some students seeking the learning-disorder label in order to gain academic advantage has not been discussed in the professional literature within this context. The lecture is based on forty in-depth interviews conducted with self-testified malingering students who, nonetheless, were diagnosed as learning-disordered. Using sociological and narratological frameworks, the lecture discusses the strategies used by the students prior to, and during, their formal diagnoses, in order to influence the diagnosis outcome and convince the diagnosticians that they were genuinely “learning-disordered”. The strategies are divided into three clusters corresponding to the pre-diagnostic, diagnostic, and diagnostic-interview stages. The students’ stories challenge a number of assumptions that are embedded in the educational–academic and medical discourses regarding students with learning-disorders. Moreover, the lecture maps the reasons used by the interviewees in order to justify pretending to be learning-disordered. Prominent among these rationalizations are claims of “equal opportunity”, “objective science”, “lack of choice”, “everybody does it” and “it's a unique situation”, as well as minimizing statements. Finally, the clinical cases described are placed within the current Israeli educational and cultural context characterized by medicalization trends as well as the negative images of “effort” on the one hand, and the meritocratic ethos of “success” on the other. It is suggested that these may shed some light on the ever-growing number Israeli learning-disordered students.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Serotonin syndrome with SSRIs augmentation of amisulpride: Two case report and literature review
Authors: Preve M. , Ruccia A. , Traber R. , Colombo R.A.
Published: June 2017

Introduction

Serotonin syndrome is a potential adverse reaction to drugs increasing serotoninergic activity in the nervous system, some of them being frequently prescribed, such as antidepressant drugs. The association of myoclonus, diarrhea, confusion, hypomania, agitation, hyperreflexia, shivering, in-coordination, fever and diaphoresis, when patients are treated with serotoninergic agents, could constitute a “serotonin syndrome”. The purpose of this report is to review the clinical evidence of serotonin syndrome with SSRIs augmentation of amisulpride. We propose two case report and literature review.

Method

We conducted a systematic review of the literature with the principal database (PubMed, Enbase, PsychInfo) and we present two case report [1,2].

Results

We describe two different case report with SSRIs augmentation of amisulpride.

Discussion and conclusion

To our knowledge this is no report about the emergence of serotonin syndrome due to the use of SSRIs augmentation of amisulpride. Serotonin syndrome symptoms include high body temperature, agitation, increased reflexes, tremor, sweating, fever, dilated pupils, and diarrhea. Further research is warranted to replicate our clinical and qualitative observations and, in general, quantitative studies in large samples followed up over time are needed. Methodological limitations, clinical implications and suggestions for future research directions are considered.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Influence of the Emotional Burnout on the Relational Maintenance Strategies
Authors: Kato L. , Radchuk O. , Tukaiev S.
Published: June 2017

The syndrome of emotional burnout is developed in people whose profession requires a lot of communication, and the effectiveness of their work depends on its quality. The aim of our study was to determine the influence of burnout on relational maintenance strategies.8 professors of università della Svizzera italiana, Lugano, Switzerland participated in this research. We used Maslach Burnout Inventory and The relational maintenance strategies scale. Moderate level of emotional exhaustion was detected in the majority of the participants. This condition is characterized by the urge towards finding a place to stay alone and get some rest from everything and everybody. It is accompanied by the feeling of emptiness, depression, and apathy. These indicate pronounced tiredness, disappointment, and unwillingness to work among our participants. The high level of Lack of personal accomplishments phase is being developed in all the participants. It indicates the pronounced doubts in the necessity to keep performing the work and in the fact that the work is needed and recognized by other people. We demonstrated that among the professors with burnout such strategies as conflict management, openness, assurances and positivism are the most widespread. Our data indicate that the readiness to work together on certain project or scientific problem (Openness), the willingness to support a student (Advice Giving) and the help to find necessary support outside of current academic environment (Social Networks) decreases with the development of emotional burnout. Understating the level of one's self-appraisal, observed during the development of burnout, ruins effective collaboration between professors and their PhD students, and formalizes their relationships. Thus, burnout is an important mediating variable between interpersonal aspects of work environment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Use of Paliperidone Palmitate Long-acting Injectable in a Patient with a Personality Disorder
Authors: Martinez N. , Benitez Cerezo E. , Garcia Marin S.
Published: June 2017

Patient of 32 years old, sent to the psychiatric unit, because he had an aggressive behaviour after he suffered a car accident with a traumatic brain injury. The patient had a huge amount of problems with family, friends and even with police (even being in jail), due to the impulsive conduct the brain injury had created. It was added a self-referential, which produced a disruptive behaviour that he could not avoid, when someone looked at him in a strange way or was not agreeing with him. After the aggressive response, he regretted of his actions, getting to try to commit suicide in several times. It was decided, reaching to an agreement with the patient, to use the paliperidone palmitate long-acting injectable. After the first dose, the patient began to be more serene and calm, the aggressive conducts were reducing until being disappeared, improving his mood and reaching a normal life, with a better relationships with his family and social environment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Role of Personality Traits in Mobile Dependency of High School Students
Authors: Nasiri Kenari M. , Homayouni A. , Shafian Z. , Bialayesh S.
Published: June 2017

In recent years, mobile phone is a necessary device in life, because it provides much easiness in education, work, business, etc. but extreme use of communication devices, especially among young people are related with mental health problems. So, the aim of this study was surveying of relationships between personality traits with Mobile dependency in high school students. The research method was correlation. The population were included all high school students that 220 students were selected by cluster sampling method. Research data were collected by McCare & Costa's NEO personality traits (Neuroticism, Openness to new experience, Extroversion, Agreeableness, and Conscientiousness) and Jenaro's Mobile dependency inventory, and were analyzed by Pearson correlation formula. The results showed that there is positive and significant relationship between Neuroticism and openness to new experience with Mobile dependency, and positive and significant relationship between extroversion, agreeableness, and conscientiousness with mobile dependency. Thus, it can be concluded that personality traits have main impact on mobile dependency.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Stability of Results of Treatment and Therapeutic Compliance of Patients with Organic Non-psychotic Mental Disorders
Authors: Rudnitsky V. , Nikitina V.B. , Axenov M.M. , Garganeeva N.P. , Schastnyy E.D.
Published: June 2017

Introduction

Non-psychotic mental disorders of organic register tend to have protracted progressive course, to respond poorly to treatment. Traditionally it is explained by features of cerebral-organic process. However, affective, behavioural and cognitive disturbances can be complicated by medico-social problems including treatment-related.

Objective

To analyse efficiency and stability of results of the therapy of organic mental disorders and propose approaches and means of their improvement.

Methods

Clinical-psychopathological, epidemiological, clinical-dynamic, catamnestic, experimental-psychological, medical statistics.

Results

The most frequent causes of decompensations of organic mental disorders in patients with positive results of the therapy were analyzed. Sixty-four percent (58 patients) after 6 months showed partial recurrence of symptoms and after a year the condition practically returned to the initial one. However, only 12.22% (11 patients) passed recommended course of maintenance therapy to sufficiently full extent, 23.33% (21 persons) have discontinued it due to subjective causes during a month after discharge, about 2/3 of patients during the first two months of the therapy. Patients showed low indicators of therapeutic compliance, low level of therapeutic alliance, little familiarity with the illness and treatment and unrealistic expectations about prospects of the therapy. During insignificant difficulties in the therapy, it usually was discontinued and renewed during relapse of symptoms. A medico-social approach with support of psychotherapeutic and psycho-corrective work and information educational programs were developed.

Conclusion

Proposed psychotherapeutic and educational approach heightens efficiency and stability of treatment and can serve a basis for further improvement of psychiatric, psychotherapeutic and medico-social assistance for patients with organic mental disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Dangerous or Vulnerable? A Genealogy of “Difficult and Violent Adolescents” in France
Authors: Gansel Y.
Published: June 2017

Introduction

Difficult adolescent is a clinical category, defined by psychiatrists’ expertise and referred to psychoanalytical concepts. Since the end of the 1990s, it has been extensively used to describe a marginal population in public institutions managing youth deviancy in France. This success occurs against a backdrop of institutional reforms, converging towards politics of suffering and risk management.

Objectives

Contributing to the anthropology of mental health, this communication provides comprehensive elements to this success.

Methods

Interconnected networks of 49 documents were analyzed using a genealogical method based on Foucault's late conceptions and Ian Hachking's works on constructivism.

Results

Results have shown that the category of difficult adolescents found its ecological niche in the 1960s, revealing a moral tension in the use of constraint. At that time, the introduction of the psychoanalytical notions of transference and counter transference depicted a clear distinction with previous categories such as the “abnormals” or “maladjusted youth”. Since then, it has defined an ambiguous condition, suspended between the trouble of caregivers and the adolescents’ individual disorder. In addition, the extension of clinical expertise silences social issues, such as gender discriminations, ethnicity and access to employment.

Conclusions

The reforms of custodial treatments represented the initial conditions of detection for difficult adolescents, raising new problems of intractable individual and institutional linkage. Driving towards a biographical personalization, the category allows new forms of regulation in the use of institutional power.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Religious Beliefs and Post-traumatic Growth Following Stillbirth in a Sample Moroccan Women
Authors: Goutaudier N. , Nahi H. , Boudoukha A.H. , Séjourné N. , Chabrol H.
Published: June 2017

Introduction

While research on religious beliefs as an adjustment is on the rise, less is known regarding such process following stillbirth and no study has been conducted on a sample of Moroccan women.

Objectives

The aim of the present study is to extend the current literature by:

– identifying a typology of Moroccan women who experienced stillbirth based on several dimension of religious coping strategies;

– examining whether these profile differ on grief, anxiety, posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) symptoms.

Methods

One hundred Moroccan women who experienced stillbirth were recruited through a Moroccan public hospital. At 6 weeks following stillbirth, they completed questionnaires assessing Religious Coping Strategies (RCS), PTSD, PTG, anxious and grief symptoms.

Results

Five clusters were identified: one with high level of plead and religious avoidance coping strategies, one with high level of interpersonal coping strategies, one with multiple religious coping strategies, one with discontent religious coping strategies and one with low religious coping strategies. High levels of psychological symptoms were found in the 5 cluster and PTG symptomatology was as associated with increased RCS.

Conclusion

Our findings suggest that, while religious beliefs and practices as a coping strategy do not protect from short-term psychopathological symptoms in the immediate aftermath of stillbirth, they play an important role in the development of positive reactions. As PTG symptoms have been reported be a protective factor for long term psychiatric symptomatology further longitudinal studies focusing in this area is warranted.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mental Disturbances on Anti-terrorist Combatants in Ukraine
Authors: Mykhaylov B.
Published: June 2017

In Ukraine, the significant participants of the “Anti-Terroristic Operation” (ATO) need to provide a system of psychiatric, psychotherapeutic assistance. The 6 groups of disorders:

– non-pathological reaction (Z65.5);

– pathological reactions (F43.0);

– neurotic disturbances (F45);

– psychotic disturbances (F44);

– PTSD (F43.1);

– chronic personality changes (F62.0).

The system of complex assistant was provided. Step 1: emergency psychological assistance. It is carried out on the basis of crisis intervention, that is defined as the emergency and urgent medical and psychological first aid, aimed at the return of the victim to the adaptive level of functioning, preventing progredient development of mental disorders, reducing the negative impact of a traumatic event. Step 2: medical and psychological support. The purpose is the relief of mental and behavioral disorders, prevention (secondary and tertiary), psychological maladjustment, progressive course of mental disorders, with the purpose, rational, suggestive, cognitive-behavioral (CBT), and others. The aim of psychotherapy is to support the patient's assistance, processing traumatic material revaluation of the crisis, a change of attitude, increased self-esteem, develop realistic perspectives and active life position. It is important to restore a sense of competence and design future in which you can use a good past experiences. Step 3: the primary goal of treatment is relief of anxiety and fear, stress, adaptation to the human life and activity in conditions of continuing psychogenic. The most effective method of psychotherapy in these cases is CBT. Step 4: supportive. All steps developed by multimodal model of psychotherapy.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Prevalence and Consequences of Bullying: What Could Healthcare Services Do for Intervention?
Authors: Wolke D.
Published: June 2017

Bullying is the systematic abuse of power and defined as aggressive behavior or intentional harm doing by peers that is carried out repeatedly, and involves an imbalance of power between the victim and the bully. One in 3 children report having been bullied at some point in their lives, and 10 - 14% experience chronic bullying lasting for more than six months.

Longitudinal research indicates that children who were victims of bullying are at higher risk for common somatic problems, internalizing problems and anxiety or depression disorder, psychotic symptoms and are at highly increased risk to self-harm or think about suicide in adolescence [1]. The mental health problems of victims and bully/victims remain in adulthood. Indeed, we showed that peer bullying in childhood has more adverse effects on diagnosed anxiety and depression disorders than being physically or sexually abused or neglected by parents. Victims also report to have more trouble with making or keeping friends in adulthood and were less likely to live with a partner and have social support. In contrast, bullies had no increased risk for any mental or general health problems, were healthier than their peers, emotionally and physically.

Sadly, many bullied children suffer in silence. To prevent dropping out of school, violence against oneself (e.g. self-harm) and reduce mental and somatic health problems, it is imperative for health practitioners, families and schools to address bullying.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Probability of Relapse Scale (PRORES) for psychiatric inpatients
Authors: Shoka A. , Lazzari C.
Published: June 2017

Introduction

The prediction of relapse in presentation is central to psychiatric prognosis.

Objectives

The Probability of Relapse Scale (PRORES) (Table 1) is used by the authors to predict the likelihood of relapse by psychiatric inpatients.

Aims

To tailor better care plans by knowing the likelihood of relapse and readmission to hospital.

Methods

Eighteen inpatients were diagnosed with the ICD-10 codes. Results were reported on a 5-point probability scale from 0 (less severe) to 10 (most severe). The 5 items are: degree of severity of illness, degree of patient's insight, frequency of readmission into hospital, probability of discontinuation of therapy and probability of relapse in the 4–6 weeks after discharge.

Results

With the cut-off score at 25 (score 5 × 5 items), indicating a moderate level of relapse, we ascertained that 100% of patients with a personality disorder (usually borderline) and substance misuse relapse are readmitted shortly after discharge, compared with 85.71% of those with psychoses and 66% of those with mood disorders.

Conclusions

The PRORES can help support those patients who are at elevated risks of relapsing due to any of the major causes: discontinuation of treatment, chronicity and poor insight into their own condition (Table 1).

Table 1

PRORES Scale.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effectiveness of stress and burnout management training for employees of an industrial company
Authors: Salehe P. , Khademi Ashkzari M. , Mohebbi M. , Ezzat K.
Published: June 2017

Introduction

Burnout is a state of physical and emotional exhaustion. It can occur when people experience long-term stress in job, or when they have worked in a physically or emotionally draining role for a long time. There have been numerous studies done showing the results of stress and burnout in the employee's profession across many areas of health care.

Objectives

The purpose of this study was to investigate the effectiveness of stress and burnout management training on employees using experimental method to help employees to understand available resources and help them find better ways to manage stress in the workplace.

Aims

This study aims to discusses how organizations can assist in combating stress in ways that benefit both the employees involved and the organization itself.

Method

A curriculum-based intervention was developed to provide education in a classroom setting. The sample included 14 nurses with various nursing backgrounds who were selected randomly and were assigned randomly in two experimental and control groups, which contained 7 employees in each group. The experimental group received the training while the control group was in waiting list. The instruments were the General Health Questionnaire and Burnout Checklist, and demographic questionnaire. Data was analyzed by covariance analysis method.

Results

Result indicated that stress and burnout management training was efficient on reducing stress and burnout symptoms in employee.

Conclusion

It is concluded that stress and burnout management training is an effective group intervening method for reducing the dysfunctional effects of stress and job burnout in employees.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychopathology of depersonalization and de-realization. What is the limit between normal and pathological?
Authors: Hernandez Santillan G.
Published: June 2017

A 21-year-old woman, distance-learning psychologist with a history of parent violence during her early childhood in the context of her father's alcohol poisoning, describes experiences of depersonalization and de-realization, of which she is aware since the age of five years, in situations of stress or out, for example, when looking in the mirror or even playing. She consulted to psychiatry, seven months after his father died of lung cancer, he frequently smoked tobacco and cannabis at home, had been diagnosed a year before his death. The patient described increased anxiety symptoms, with panic attacks, hypnopompic and hypnagogic hallucinations, and increased depersonalization and de-realization phenomena. She denies the use of psychoactive substances in addition to tobacco and alcohol, occasionally. Likewise, the depressive symptomatology was objectified in relation to the grief for the loss of his father. She received treatment with SSRIs and two months later, referred partial remission of symptoms, with persistence of dissociative symptoms. In addition, she presents emotional instability, feelings of emptiness, self-defeating ideas without structured suicide ideation. In recent months, he has presented avoidant behaviors and isolation with affectation in his habitual functioning. Now, in this case: are depersonalization and de-realization normal, part of the anxiety crisis, a sign of a high-risk mental state, or a prelude to a serious mental illness?

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Behavioral addictions and the associated mental health issues and psychopathology
Authors: Starcevic V.
Published: June 2017

Introduction

Behavioral addictions are conceptually controversial and their relationship with mental health problems and psychopathology is poorly understood.

Objectives

To review the relationships between personality traits, mental health issues and mental disorders on one hand and several behavioral addictions on the other. The latter include problematic Internet use, Internet gaming disorder, hypersexual disorder/compulsive sexual behavior disorder, compulsive buying and exercise addiction.

Methods

Literature review and conceptual synthesis.

Results

Mental health issues, personality dimensions and mental disorders are commonly associated with behavioral addictions. Although some relatively specific associations were found (e.g., between Internet gaming disorder and attention deficit/hyperactivity disorder, between compulsive buying and pathological hoarding and between exercise addiction and eating disorders), the specificity of most associations was low. Most studies were cross-sectional and the direction of causality, if any, was uncertain. Therefore, it is unknown under what circumstances certain mental health issues predispose to the particular behavioral addiction or represent a primary problem and when they are a consequence of behavioral addictions. This review also underscores the importance of distinguishing between certain behavioral addictions and overlapping conditions, e.g., between compulsive buying and bipolar disorder (mania/hypomania).

Conclusions

These findings suggest that proper conceptualization of behavioral addictions as distinct conditions or a manifestation of an underlying psychopathology will have to await results of the prospective studies. In the meantime, there are implications for treatment in terms of the importance of identifying and addressing the underlying or associated mental health problems in individuals with behavioral addictions.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Lithium and EKG abnormalities. A review
Authors: Ballesteros A. , Rosero Á.S. , Sáiz H. , García-Parreño E. , Carlos G. , Manrique E.
Published: June 2017

Introduction

The literature concerning possible cardio-toxic effects of lithium therapy in man is reviewed.

Methodology

A review was conducted to clarify the mechanisms associated with the occurrence of conducting abnormalities when using lithium and investigating (if so) whether these alterations depend on the dose. The literature search was conducted in PubMed data reviewing articles between 1982 and 2015.

Results

(1) Related to pathopsychiology/risk factors: reports indicate T wave morphology changes with lithium therapy. Of particular concern are cases of sinus mode dysfunction or sinoatrial block and the appearance or aggravation of ventricular irritability. The incidence of cardiac complications, in general terms, may increase with age. Recent findings (a retrospective study of bipolar patients) of lithium-associated hypocalcaemia showed that hypocalcaemia resulting from medical diseases and bipolar patients with lithium-associated hypocalcaemia had significantly higher frequencies of conduction defects. (2) Related/unrelated to dose: therapeutic and toxic levels of lithium have infrequently been associated with serious cardiac dysfunction. Several case reports demonstrate two important points about Brugada syndrome unmasking: electrocardiograph abnormality severity may correspond to lithium levels and unmasking may occur in the therapeutic range of lithium. Other report shows a case of lithium induced sinus-node dysfunction in a patient with serum lithium levels in therapeutic range.

Conclusions

Lithium abnormalities are rare and mostly not related to dose. Conducting heart anomalies may occur, especially when several factors are present (such as age or co-morbid illnesses that affect calcium serum levels).

Disclosure of interest

The authors have not supplied their declaration of competing interest.