bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of the insomnia assessment scale – adapted in a community sample of portuguese pregnant women
Authors: Marques M. , Pereira A.T. , Azevedo J. , Xavier S. , Bento E. , Soares M.J. , Freitas V. , Macedo A.
Published: May 2016

Introduction

Pregnancy is characterized by important changes in sleep and some of them (as insomnia) predict negative outcomes, like depression, through all the perinatal period. There are few Portuguese adapted and validated instruments assessing insomnia in pregnancy.

Objective

To validate the Insomnia Assessment Scale in a sample of Portuguese pregnant women.

Methods

419 pregnant women (mean age: 32.51 ± 4.759; weeks of gestation: 17.32 ± 4.803) answered the Insomnia Assessment Scale (IAS), constructed according to the DSM-V and the ICSD-3 criteria and presenting fourteen items: three evaluating insomnia symptoms (1 to 3); one assessing if sleep difficulties were present although there were adequate conditions to sleep (item 4); one assessing if sleep difficulties occurred three times/week (item 5); one evaluating if sleep was not restorative (item 6); three assessing daily impairment associated to insomnia symptoms (7 to 9); two assessing the use of prescribed and/or homemade medication (10 and 11); three excluding that sleep difficulties were not due to another sleep disorder, substance use, a physical condition or a mental disorder) (12 to 14).

Results

The IAS Kuder-Richardson alpha was very good (α=0.85) and none of the items increased the alpha if removed. A principal component analysis revealed a three factors solution, explaining a variance/EV of 63,74%: F1/Insomnia symptoms (items 1 to 6) (EV 36.02%; α=0.81); F2/Daily impairment associated to insomnia symptoms (items 7 to 9) (EV 18.67%; α=0.79); F3/Differential diagnosis (items 12 to 14) (EV 8.38%; α=0.81).

Conclusions

The IAS adapted for Portuguese pregnant women presented good reliability and validity.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Factors related to suicidal behavior in korean patients with bipolar disorder: The effect of mixed features on suicidality
Authors: Seo H.J. , Wang H.R. , Woo Y.S. , Kim H.C. , Bahk W.M. , Nam B.W. , Lim E. , Min K.J.
Published: May 2016

Introduction

The aim of the present study was to investigate various risk factors of suicidal behaviors, including the mixed features specifier, in Korean patients with bipolar disorder.

Methods

We retrospectively reviewed medical charts from 2005 to 2014. A total of 334 patients diagnosed with bipolar disorder using the DSM-IV TR were enrolled. Subjects were categorized into two groups according to their history of suicidal behavior and the demographic and clinical characteristics of the groups were compared, including the mixed features specifier. We re-evaluated the index episode using DSM-5 criteria and classified subjects into an index episode with mixed features group and an index episode without mixed features group. Logistic regression was performed to evaluate significant risk factors associated with suicidal behavior.

Results

Suicidal behavior had an independent relationship with mixed features at the index episode using DSM-5 criteria (OR = 3.39; 95% CI: 1.57–7.34) and number of previous depressive episodes (OR = 1.62; 95% CI: 1.34–1.95) in Korean bipolar patients. The mixed feature specifier was the strongest risk factor for suicidal behavior in the present study. Limitations: this was a retrospective study and structured psychiatric interviews were not conducted.

Conclusions

This study may help clinicians understand potential risk factors and manage bipolar disorders with suicidal behaviors. Clinicians should carefully monitor patients with bipolar disorder who exhibit numerous depressive episodes or mixed features for suicidal behavior.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Outpatient treatment engagement after suicidal attempt: A multicentre prospective study
Authors: Boniface B. , Castaigne E. , Balaguer E. , Ghanem T. , Bouhlal A. , Ivascu E.B. , Youssouf Abdou A. , Hardy P.
Published: May 2016

Introduction

Most suicide attempters are referred to community health professionals (CHP) after discharge from emergency department (ED). Thereafter, outpatient treatment engagement (OTE) is often poor. Strengthening it seems likely to reduce the risk of repeat suicidal behaviour.

Objectives

To identify the predictive factors of OTE.

Methods

Multicentre prospective study in true life conducted in adult patients (≥18) in 4 EDs of the Southern Paris region. Patients were referred to CHP. OTE was assessed by telephone calls at 1 and 3 months. OTE at 1 month was defined as having booked 1 appointment; OTE at 3 months as having attended 2 appointments and booked another one.

Results

One hundred and fifty-five patients were assessed at 1 month and 144 at 3 months. OTE at 1 and 3 months was observed in 58% and 51% respectively. A multivariate analysis showed factors significantly predictive of OTE at 1 month: a psychiatric follow-up before the suicide attempt (SA), ≥2 psychiatric interviews during the stay at ED, appointment with CHP booked before discharge from the ED; and at 3 months: college or university education, absence of alcohol intake during the SA, psychiatric follow-up before the SA, appointment with CHP booked before discharge from the ED.

Conclusions

This multicentre prospective study highlights the benefit of booking outpatient appointment before discharge from ED; of allowing patient to benefit from at least two psychiatric interviews; of being particularly cautious with patients who took alcohol concomitantly to their SA, patients with low level of academic achievement and patients without psychiatric follow-up.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicidal ideation among former prisoners of war's wives – a longitudinal dyadic study
Authors: Zerach G. , Levi-Belz Y. , Michelson M. , Solomon Z.
Published: May 2016

Introduction

The long-term associations between posttraumatic stress disorder (PTSD) and suicidal ideation (SI) among ex-prisoners of war (ex-POWs) has recently been exemplified. Several studies have revealed the toll of war captivity on secondary traumatization’ (ST) of ex-POWs’ wives. However, a question remains regarding the possible SI among ex-POWs’ wives.

Objectives

Understanding of SI phenomena among wives of severely traumatized ex-POWs in a longitudinal dyadic designed study.

Aims

Assessment of SI among ex-POWs’ wives and the longitudinal associations with their husbands’ PTSD. We also aim to assess the moderating role of the couple's dyadic adjustment in these associations.

Method

A sample of 233 Israeli couples (142 ex-POWs couples and a comparison group of 91 veteran couples) completed self-report measures at two time points: T1 30 (2003-4) and T2 37 (2010) years after the ‘Yom Kipur’ 1973 war.

Results

Surprisingly, no significant differences were found between ex-POWs wives and veterans’ wives, with and without husbands’ PTSD, in SI at T1 and T2. Only among ex-POW couples, an increase in the husband's level of PTSD and SI was related to a more moderate increase in their wives’ SI between T1 and T2. Interestingly, the more a wife reported positive dyadic adjustment, the more moderate the increase in her SI between T1 to T2, regardless of the study group.

Conclusions

Suicidal ideation among ex-POWs’ wives is closely related to their husbands’ PTSD and is moderated by their perception of marital adjustment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Interim results of remotely provided, one-on-one, tailored psycho-education and skills training to caregivers of patients with mental health difficulties
Authors: Ashcroft K. , Insua-Summerhays B.
Published: May 2016

In the past several decades, considerable evidence has emerged on the efficacy of caregiver and family interventions in the treatment of severe and enduring mental health disorders, particularly schizophrenia. Studies have demonstrated benefits of these interventions with regard to both reduced rates of burden in caregivers, and a reduction in relapse and improvement in symptoms of the person with psychosis. However, many caregivers who may benefit from such interventions are unable to access them, due to limited resources and geographical factors. Additionally, concerns about stigma and time constraints may deter caregivers from accessing support. The following study is among the first to address these barriers using a remotely delivered, one-on-one caregiver intervention. Caregivers (n = 93) of patients with severe and enduring mental health difficulties took part in a tailored psychoeducation and skills training intervention, consisting of weekly 40 minute videoconference or telephone sessions with a trained clinician. Caregivers completed the Involvement Evaluation Questionnaire (IEQ) and General Health Questionnaire (GHQ-12) at baseline, and eight sessions (mid treatment). It was hypothesized that caregivers would show a reduction of distress and burden in response to the intervention. Interim comparison of pre- versus 8th session measures demonstrated a highly significant reduction in GHQ scores (P < 001), as well as a highly significant reduction in IEQ scores (P < 001). Results suggest that remotely provided, one-on-one, tailored psycho-education and skills training may be an effective and accessible intervention to improve the well-being of, and decrease burden in, caregivers of mental health patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Comparison of metabolic syndrome between patients with severe mental disorders
Authors: Mata Saenz B. , Romero Guillena S.L. , Plasencia García de Diego B.O.
Published: May 2016

Introduction

Metabolic alterations are one of the main causes of mortality and morbidity associated with cardiovascular disease in patients with severe mental disorders. Polypharmacy has been shown to increase the risk.

Objectives

To check the patients with schizophrenia and bipolar disorder admitted to our unit and their metabolic parameters.

Aims

To assess the prevalence of thyroid dysfunction, diabetes and dyslipidemia in patients diagnosed with these disorders admitted to our unit between 2013 and 2014, and compare the results.

Methods

We conducted an epidemiological, observational, retrospective study of patients with these disorders admitted to our unit in this period. Clinical and socio-demographic variables were collected and analyzed by The Statistical Package for Social Science version 19.0.

Results

No association was detected between treatment with antipsychotics (typical/atypical) and metabolic variables. This may be due to the fact that mostly of patients received a combination treatment of both (Table 1).

Conclusions

Dyslipidemia and diabetes seem to be more prevalent in patients with schizophrenia in our sample, but thyroid dysfunction is more prevalent in patients with bipolar disorder. However, the two samples are very different so more studies are needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Table 1
The psychiatry recruitment crisis across Europe: Evaluation by the European Federation of psychiatric trainees
Authors: Ryland H. , Baessler F. , Casanova Dias M. , De Picker L. , Pinto Da Costa M. , Kanellopoulos A. , Sonmez E. , Alfimov P. , Sebbane D. , Birkle S.M.
Published: May 2016

Introduction

Recruitment of medical students and junior doctors in to psychiatry is a long-standing concern in many countries, with low proportions of medical graduates choosing it as a specialty and ongoing stigma from within the medical profession. In some countries the reverse problem is the case, with too many doctors wishing to enter psychiatry, and insufficient training places available.

Objectives

To understand the current situation within Europe with regards to recruitment in to psychiatry and to identify existing recruitment initiatives.

Methods

The European Federation of Psychiatric Trainees conducts an annual survey of all member organisations. A delegate of each national association of psychiatric trainees is asked to identify if their country has a problem with recruitment and if so, whether there were too many or too few applicants for training places. Delegates from countries with recruitment initiatives were contacted to provide further details.

Results

In 2014, a total of 31 countries completed the survey, with 17 stating that too few medical practitioners choose psychiatry. In total 8 countries with recruitment problems reported that initiatives exist to encourage doctors to enter psychiatric training. Of these, 7 responded to describe the initiatives, which included national recruitment strategies, financial incentives, careers fairs, mentoring schemes and a whole host of other projects.

Conclusions

Recruitment in to psychiatry remains a serious problem in a significant proportion of European countries, but a wide range of initiatives exist which aim to combat this shortfall. It will be important over the coming years to establish which initiatives are most effective at increasing recruitment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The effect of Qing Huan Ling combined risperidone on the open field behavior of schizophrenic mice model
Authors: Zhang Y. , Liu F. , Dai Z. , Wu B. , Wu Q.
Published: May 2016

Objective

To observe the effect of Qing Huan Ling and (or) risperidone on locomotor activity and explorative behavior of schizophrenia mice model by open field test.

Methods

Seventy kunming mice were randomly divided into 5 groups, one group as blank group. The rest groups ip MK-801 continuously 14 day, then randomly numbered: model group, risperidone group, Qing Huan Ling group and risperidone combined Qing Huan Ling group. Ig give corresponding drugs for each group 4 weeks, observe the change of locomotor activity and explorative behavior by open field test.

Results

After Ig 4 weeks, compared with the blank group, there were no obvious difference in locomotor activity and explorative behavior between risperidone group, Qing Huan Ling group and the combined group. Compared with the model group, risperidone had statistics meaning in the repression of explorative behavior (P < 0.05),the combined group has statistics meaning in the repression of locomotor activity and explorative behavior (78.92 ± 36.18 m vs. 186.92 ± 41.08 m, P < 0.01).

Conclusion

Qing Huan Ling regulate the central nervous system of schizophrenia mice model; when combined with risperidone, it restrain the central nervous system of schizophrenia mice model and the effect is stronger than risperidone alone.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Choosing wisely – the viewpoint and experiences of the American Psychiatric Association
Authors: McIntyre J.
Published: May 2016

Choosing wisely, a program developed by the American Board of Internal Medicine in 2012, is advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments or procedures. Recommendations are chosen that have a strong evidence base. There are now over seventy specialty society partners including the American Psychiatric Association. The program attempts to involve patients in the dialogue and an important partner in the program is consumer reports. In this presentation, information about the origins of the program, its development and the impact it has on the practice of medicine will be reviewed. Also the measures developed and submitted by the American Psychiatric Association will be discussed and potential additional psychiatric measures will be discussed. The strengths and weaknesses of the program will be identified.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Prioritization in medicine – a special role for mental healthcare?
Authors: Meyer T.
Published: May 2016

The international debate on priority setting in health care has been around for more than 30 years now, Denmark, Norway, the US state of Oregon, Sweden, UK and the Netherlands being among their vanguards. From the beginning, the debate has been related to – or was even seen as identical to – the discourse on rationing in health care. Based on these international debates, the presentation will introduce different understandings and characteristics of the priority-setting concept in health care and will argue for a clear distinction between priority setting and rationing. Different ways of implementing priority setting, i.e., by means of guidelines or ethical frameworks, will be introduced to set the frame for the current choosing-wisely initiative. It will be argued that priority setting is important for the organisation of mental health care, as it is for health and social care of different chronic disorders.

Disclosure of interest

The author has not supplied his declaration of competing interest.
The trainee perspective
Authors: Phanasathit M.
Published: May 2016

In Asia, while the postgraduate training in psychiatry employs the World Psychiatric Association (WPA) core training curriculum for psychiatry as a standard course, some adjustment to the course is required for the unique demographic and sociocultural characteristics of its region.

From the small group work in the 14th course for the academic development of psychiatrists (CAD), organized by the Japan Young Psychiatrists Organization (JYPO) in 2015, young psychiatrists form Indonesia, Japan, Philippines, South Korea, Taiwan and Thailand agreed that the core psychiatric curriculum must include both general and psychiatric knowledge which are fundamental to clinical practice and continuous learning. General knowledge consists of knowledge management, academic skills, epidemiology, research methodology and statistics, evidence-based medicine, bio-ethic and medicolegal issues, professionalism, and medical anthropology, while psychiatric knowledge incorporates basic science, diagnostic assessment skills, etiopathogenesis, pharmacological and non-pharmacological treatments, disease prognosis, and mental health promotion and prevention. Moreover, the curriculum for junior psychiatric residents has to be composed of courses from various departments that encourage them practice in holistic care and multidisciplinary approach including emergency medicine, internal medicine, neurology, pediatrics, community based medicine, anesthesiology, radiology and palliative care. For senior psychiatric residents, the training program should consist of in-depth psychiatric knowledge, general psychotherapy concept and basic skills, and free elective subjects.

Since Asia is different from Europe in terms of large population, shortage of psychiatrists, aging society, racial and cultural diversity, and high risk of natural disasters; the postgraduate training in psychiatry in Asia should focus on the subjects regarding health economy, geriatric psychiatry, cultural and trans-cultural psychiatry, ethnopsychopharmacology, disaster psychiatry and mental health. Furthermore, the cooperation among Asian countries should be promoted in order to initiate knowledge exchange and research collaboration. These could contribute to the sustainable advancement of Asian psychiatry and mental health in the future.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Psychiatric trainees’ view on a European curriculum of psychiatry
Authors: Pinto da Costa M.
Published: May 2016

The European Federation of Psychiatric Trainees (EFPT) represents the consensus of psychiatry trainees associations across more than 30 European countries, advocating for the improvement and harmonization of psychiatry training across Europe. This federation has as priority to get direct feedback from psychiatry trainees, analyzing the concerns related to psychiatry and training in Europe, collaborating with other national and international partners to translate trainees’ views into action, while offering trainees several opportunities.

Surveys of psychiatry trainees show that the main concerns around Europe revolve around differences of duration of training in the different countries, the discrepancies between the European training standards, the national programmes and the real experience of trainees. Likewise, levels of recruitment into psychiatry and inadequate working conditions also concern trainees, especially at the current times of economic challenge, where the choice to migrate abroad is quite frequent. Nevertheless, the involvement of psychiatry trainees in the development of national programmes and in the quality assurance of training varies significantly around Europe.

This presentation will highlight the current differences observed in the structure, content and duration of psychiatry training programs in Europe, reporting trainees’ views on a European curriculum of psychiatry, and exploring mechanisms to evaluate and harmonize the postgraduate training in Europe.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Can alcohol-dependent patients really reduce their alcohol consumption over time?
Authors: Mann K.
Published: May 2016

Introduction

Treatment of alcohol dependent patients is moderately successful but it only reaches about 10% of the population in need. A new harm reduction strategy aims at abstinence in the long run but claims to benefit patients already early on by reducing their alcohol consumption.

Objectives

A brief outline of the debate on abstinence versus controlled drinking will be followed reporting several RCTs striving for reduced drinking in alcohol dependent patients.

Aims

The participant will find guidance whether and how to treat patients following this new approach.

Results

Studies testing behavioural treatments and counselling (MATCH, UKATT) indicate that a reduction over time is possible. Using nalmefene (a mu and delta opioid antagonist and a partial agonist) RCTs with more than 2500 patients were performed showing a benefit over placebo. On this basis the EMA approved this drug for the reduction of alcohol consumption in alcohol dependent patients. Other compounds such as naltrexone showed similar effects in smaller trials but are not approved for reduction. More studies testing further compounds are underway.

Conclusions

This new approach has the potential to lower the barriers which to date prevent many patients from accepting treatment for their alcohol problems. Two research questions warrant further study: (1) does the reduction in alcohol consumption translate into health and other benefits, and (2) are there specific subgroups of patients who benefit more than others. Preliminary answers will be given in the lecture.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Should all psychiatrists be skilled to practice psychotherapy?
Authors: Sönmez E. , Gargot T.
Published: May 2016

Psychiatrists have a unique place in the spectrum of mental health services, as being able to integrate psychotherapy and pharmacotherapy in clinical practice. It is through psychotherapy training that a trainee gains optimal communicative skills and competence in establishing therapeutic alliance with a patient. It helps developing empathic understanding, which is very important for a good collaboration and enable understanding, diagnostic and treatment. It improves trainees’ own insight. All are these fundamental aspects of a biopsychosocial approach of psychiatry.

In many countries psychiatry trainees have a positive attitude towards psychotherapy during their training. Moreover, patients often prefer and adhere to combined psychotherapy and medication than split-care treatments. Research in psychotherapy provides ample evidence that these treatments are effective. The UEMS considers psychotherapy education as mandatory. EFPT advocates that all trainees must gain competence in at least one recognised form of psychotherapy and have a basic knowledge for other forms. Altogether, there is a consensus among all actors of mental health services that psychotherapy training is essential and should be improved. Yet, it is still far from being a priority in psychiatric training and is subdued by biological training and research, which is easier, faster and prevailing in training institutions. Also, psychotherapy training is found less affordable by trainees.

With collaboration from other organizations, EFPT aims to improve standards of psychiatry training, including psychotherapy. We present some initiatives led by UEMS, EPA, WPA and ECNP. Today's technology allows trainees to reach various psychotherapeutic training availabilities, including online tools (Webinar, MOOCs, online guidebooks) and international courses. It is advisable that training institutions devote more time on psychotherapy training and supervision, associations provide costly training availabilities or scholarships, encourage more scientific research on psychotherapeutics and take into account the progress of research in psychology and neuroscience [1–5].

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Involving people with intellectual disabilities in the formal assessment of psychiatrists’ skills
Authors: Soni S. , Hall I. , Doulton P. , Bowie P.
Published: May 2016

Purpose

It is widely recognised that people with intellectual disabilities receive a poorer quality of healthcare than their non-disabled counterparts. Training for healthcare professionals in intellectual disability is often scant or non-existent. The purpose of this work is to explore the usefulness of employing actors with intellectual disabilities as simulated patients in the assessment of trainee psychiatrists.

Design/methodology/approach

The development of a structured clinical exam “station” designed to assess the ability of trainee psychiatrists to communicate with a simulated patient played by an actor with an intellectual disability is described. The paper also assesses the potential benefits of this kind of assessment and the experience of actors and examiners taking part in this process.

Findings

The station was found to perform well in discriminating between candidates of various abilities and was well received by actors, examiners and observers. The station is now routinely used in the formal assessment of trainee psychiatrists in the UK.

Practical implications

The use of people with intellectual disabilities in training and assessment appears to be advantageous in terms of improving knowledge, attitudes and skills amongst healthcare professionals and gives increased opportunities for people with intellectual disabilities to undertake valued social roles.

Originality/value

Few institutions currently employ actors with intellectual disabilities as simulated patients as part of their training programmes and as a result there is little in the way of literature on this subject. This paper describes an alternative approach to teaching and assessment which falls in line with recommendations from the UK Department of Health to involve service users in the training of healthcare professionals.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
GRIN2B mediates susceptibility to affective problems in children and adolescents
Authors: Nobile M.
Published: May 2016

Objectives

Association studies have implicated the N-methyl-D-aspartate receptor 2B subunit gene (GRIN2B) as candidate for different brain illnesses, also including both internalizing and externalizing disorders. Here, we explored the association between selected SNPs of GRIN2B (rs5796555-/A; rs1012586C/G; rs2268119A/T; rs2216128A/G; rs11609779C/T; rs2192973G/A) and attention problems in children an adolescents as assessed by CBCL 6/18 (Achenbach and Rescorla, 2001).

Methods

In a large cohort of 320 Italian nuclear families selected from an ongoing comprehensive project on child and adolescent psychopathology performed at two sites of our Institutes (BP and UD), we performed a family-based association study to determine whether the GRIN2B gene influence and/or mediates susceptibility to attention problems through time. Genetic association was investigated by the quantitative transmission disequilibrium test (QTDT, version 2.5.1; Abecasis et al., 2000). Quantitative traits were analyzed using the ‘-wega’ and the ‘-ao’ options. Empirical P-values were computed from 10,000 Monte-Carlo permutations, and the significance levels were adjusted by the false discovery rate method (Storey, 2002) applied to the tests performed for each marker (i.e., 8 phenotypes) at two different point times. Latent profile analysis was performed to assess the effect of gene on different trajectories over time. The effect of environmental determinants was also evaluated.

Results

Evidence for significant association of GRIN2B-rs5796555-/A was found with attention problems both at first and second evaluation. Latent profile analysis suggested significant association with specific trajectories and specific environmental factors.

Conclusions

These results provide preliminary evidence of an association between the GRIN2B polymorphism and continuity of attention problems throughout adolescence within an Italian population of referred children and adolescents, suggesting that the GRIN2B genes could play a role in susceptibility to attention problems during developmental age.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Brain glutamate levels and antipsychotic response in schizophrenia
Authors: Egerton A.
Published: May 2016

There is considerable interest in identifying biomarkers of antipsychotic response in schizophrenia. Glutamate is one key candidate. The development of brain imaging techniques for measuring brain glutamate levels has allowed this hypothesis to be tested directly in patients. This talk will present our ongoing research examining the relationship between brain glutamate levels and antipsychotic response in first-episode psychosis and in treatment-resistant schizophrenia. I will summarise our results from both our completed and ongoing studies, to consider whether glutamate imaging might be useful in the future to identify patients who would benefit from non-dopaminergic antipsychotic drugs and inform novel, glutamate-based, treatment strategies.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Hikikomori and modern-type depression in Japan
Authors: Kato T.
Published: May 2016

Maladaptive social interaction and its related-psychopathology have been highlighted in psychiatry especially among younger generations. “Hikikomori” defined as a syndrome with six months or longer of severe social withdrawal was initially reported in Japan, and the prevalence rate has been reported as 1.2% in Japanese population. The majority of hikikomori patients are adolescents and young adults who become recluses in their parents’ homes for months or years. They withdraw from contact with family, rarely have friends, and do not attend school or hold a job. An international vignette-used questionnaire survey indicates the spread of hikikomori in many other countries (Kato et al. Lancet, 2011; Kato et al. Soc Psychiatry Psychiatr Epidemiol, 2012). In addition, our international clinical studies have revealed the prevalence of hikikomori outside Japan (Teo et al., 2015). On the other hand, a novel form of maladaptive psychopathology, called modern-type depression has emerged in Japan (Kato et al. J Affect Disord, 2011; Kato et al. Psychiatry Clin Neurosci, 2016).

In this presentation, I will introduce “Hikikomori” and “modern-type depression” in Japan, and also propose novel diagnostic/therapeutic approach against them.

Disclosure of interest

The author has not supplied his declaration of competing interest.
After all, is E-Mental Health capable of making a paradigm shift?
Authors: Krausz M.
Published: May 2016

Only a very small percentage of adolescents and young adults with mental challenges is able to access specialized care. Access is limited due to a lack of capacity but also internal hurdles and stigma especially among young males. The web creates a new environment for them, which is defining a new culture of communication and interaction. The majority is using smart phones to access the Internet and make that their main communication device.

Walkalong is a web-based platform, which aims to provide a range of opportunities and tools for youth with especially mood challenges. These tools include screening and assessment, online resources and all kind of orientation and interaction for informed decision-making.

We are working on that to develop a framework for better online-based mental health care including useful tools beyond crisis based on the principles of empowerment and strength based approaches.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Digital healthcare: Fools gold or a promised land?
Authors: Wise M.
Published: May 2016

Digital healthcare is the use of technology to deliver healthcare. There are many facets of it. The paradigm of care at a distance e.g. a live interface is the most understood, whether it is the old fashioned analog phone call or that of todays Millenial who ‘get’ Skype or see video calling as a day to day reality.

This has moved to non-live uses, asynchronous, the modern version of written communication, email, videomessage, Instagram, twitter or any one of a multitude of social media.

It has progressed beyond that though to a plethora of devices, apps and cross breeds that promise to maximise your patients health, and often your practice income! Grand claims, if not ones supported by the evidence.

They have broadened the range of providers from the plain vanilla (group) therapist to the Cyber support groups; from patient information sheets, to sophisticated hyperlinked, video embedded ‘hope box’, or manual on your phone. They have changed in vivo exposure from what was limited by travel time, to what is limited by the programmers imagination.

Telemdecine can connect patients and providers worldwide – how can that not be an amazing promise, today's truly outstanding goal – tomorrow commonplace event.

The promise of near infinite data; if only we can measure enough, we can treat better, may hold true for a physical paradigm such as mobile ECG or BP monitoring, but is it true for mental health?

Science is not a door to infinite wisdom, but a rescue from unending ignorance. The evidence is that technological innovations are not a magic solution but tools widening access, they are to travel what the motorway is to the dust track. They are an equaliser in that more people can be reached than ever before–but they do not replace human skill and ability.

By December 2015, 500 million smartphone users worldwide will be estimated to be using a health care application. Yet, there is no evidence of a systematic evaluation of a fraction of these apps. They may not be snake oil salesman, but has the placebo effect graduated from molecules to ones and zero's?

We will explore the evidence to understand some of the promises and the realities of what was once Tomorrows World, here today.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Medical students choice of psychiatry – an international survey
Authors: Bhugra D.
Published: May 2016

The appeal of psychiatry as a speciality varies around the globe for a number of reasons. In a majority of countries, medical students are reluctant to choose psychiatry and this has become a much more evident matter of concern in the past three decades. The factors, which affect the choice of psychiatry as a specialty by medical students include external and internal stigma, quality of teaching of the subject as well as research exposure and clinical experience during placements. In many countries, a placement may last only two weeks and the exposure is to patients in asylums, whereas a majority of psychiatric conditions are treated in primary care. In addition, personal factors such as the ability to deal with openness and ambiguity play a role in the choice of speciality. A study in 19 countries to explore factors prior to entering medical school, experiences in medical school and postgraduate in the choice of the subject showed that those medical students who are likely to choose psychiatry fall into three major categories:

– those who had decided prior to joining medical school that they wanted to choose psychiatry;

– those who decide during medical school placements and, finally;

– those who select the specialty after having finished their medical school training.

The latter group has two further subgroups: one, which falls passively into psychiatry and another who make an active choice to take it up. Among 2198 students who participated, 4.5% of the sample planned to become psychiatrists, with a further 15% considering it as a possible career. Women (21%) were more likely to consider psychiatry than men (16%). Key factors associated with choosing psychiatry were personal as well as based on teaching/learning experiences. In order to recruit into psychiatry, better teaching, exposure to common mental disorders and small research projects may prove to be helpful.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Methylome modifications in monozygotic twins and in depression
Authors: Fañanás L. , Córdova-Palomera A.
Published: May 2016

Epigenetics is the study of gene expression changes that are produced by heritable, though potentially reversible, modifications of chromatin structure or DNA methylation. DNA methylation is interesting in epidemiological studies, due to its accessibility and since previous evidence indicates that large inter-individual differences in methylation levels at some loci may correlate with phenotypic plasticity in changing environments.

Prior genome-wide methylomic research on depression has suggested that, together with differential DNA methylation changes, affected co-twins of monozygotic twin pairs have increased DNA methylation variability, probably in line with theories of epigenetic stochasticity. However, the putative biological roots of this variability remain largely unexplored.

This study evaluate whether DNA methylation differences within MZ twin pairs were related to differences in their depressive status. Genome-wide DNA methylation levels were measured in peripheral blood of 34 twins (17 MZ pairs) using Illumina Infinium Human Methylation450 Beadchip. Two analytical strategies were used to identify differentially methylated probes (DMPs) and variably methylated probes (VMPs).

The majority of the DMPs were located in genes previously related to neuropsychiatric phenotypes, such as WDR26, a GWAS hit for MDD whose expression levels have been found altered in blood of depressed individuals.

VMPs were located in genes such as CACNA1C, IGF2 and the p38 MAP kinase MAPK11, showing enrichment for biological processes such as glucocorticoid signaling.

The findings expand on previous research to indicate that both differential and variable methylation may play a role in the etiopathology of depression, and suggest specific genomic loci of potential interest in the epigenetics of depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Epigenetic modifications in anorexia nervosa patients and remitters compared to healthy control women
Authors: Ramoz N. , Clarke J. , Gorwood P.
Published: May 2016

Introduction

Anorexia nervosa (AN) is the most severe in terms of morbidity psychiatric illness with the highest mortality rate increased by 23 fold. Treatments are limited effectiveness. AN has a strong genetic component with heritability at 70% but despite ∼ 200 studies no major gene was identified. Epigenetics, such as DNA methylation, is another component of heritability that could explain the high heritability. Methylation is poorly studied in AN from small samples, and is focused on few candidate genes among publications. Under publication, a first genome-wide methylation study investigated 10 restrictive type AN patients, 19 binging/purging type of AN patients and 15 normal eaters using DNAs from whole blood (Booij, 2015). Of the 480K CpG sites that can be methylated of Infinium Human Methylation450 BeadChip Kit, authors focused on 24,000 sites located close to genes and they identified candidate genes with a different profile of methylation between AN and controls.

Objectives

Our work is to replicate the results of Booji and also to investigate the AN remitters.

Aims

Our goal is to identify epigenetic signatures of the AN disorder and the prognostic of remission.

Methods

Twenty-four AN patients, 24 AN remitters will be compared to 48 healthy control women for methylation using the Infinium Human Methylation450.

Results

As Booji et al., we will compare methylation for 24,000 sites located close to genes for 24 AN, 24 remitters and 48 controls.

Conclusions

We expected to replicate the published results of Booji and to identify genes with a methylation signature specific of the AN remission.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Community-based 4-level approach: Background, implementation and evidence for efficacy
Authors: Hegerl U. , Arensman E. , van Audenhove C. , Baader T. , Gusmão R. , Ibelshäuser A. , Merali Z. , Rummel-Kluge C. , Peréz Sola V. , Pycha R. , Värnik A. , Székely A.
Published: May 2016

The community-based 4-level-intervention concept developed within the “European Alliance against Depression” (http://www.eaad.net/) combines two important aims: to improve the care and treatment of patients with depression and to prevent suicidal behavior. It has been shown to be effective concerning the prevention of suicidal behavior [1–4] and is worldwide the most broadly implemented community-based intervention targeting depression and suicidal behavior. The 4-level intervention concept comprises training and support of primary care providers (level 1), a professional public relation campaign (level 2), training of community facilitators (teacher, priests, geriatric caregivers, pharmacists, journalists) (level 3), and support for self-help of patients with depression and for their relatives (level 4). In order to deepen the understanding of factors influencing the effectiveness of the intervention, a systematic implementation research and process analysis was performed within the EU-funded study “Optimizing Suicide Prevention Programs and Their Implementation in Europe” (http://www.ospi-europe.com/; 7th Framework Programme) [5]. These analyses were based on data from four intervention and four control regions from four European countries. In addition to intervention effects on suicidal behaviour, a variety of intermediate outcomes (e.g. changes in attitude or knowledge in different populations) were considered. Strong synergistic as well as catalytic effects were identified as a result of being active simultaneously at four different levels. Predictable and unpredictable obstacles to a successful implementation of such community-based programs will be discussed. Via the EAAD, the intervention concept and materials (available in eight different languages) are offered to interested region in and outside of Europe.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Abnormal time experience, bizarre delusions and verbal-acoustic hallucinations in schizophrenia
Authors: Stanghellini G.
Published: May 2016

The integrity of time consciousness is the condition of possibility of the identity through time of an object of perception as well as of the person who perceives it. I will present our findings about abnormal time experience (ATE) in people with schizophrenia. These data may support the following hypothesis: if the continuity of temporal experience disintegrates (of which ATE are experiential manifestations), overarching meaningful units are no longer available, thereby creating temporal gaps, e.g., in one's stream of consciousness. In some cases, thoughts that are no longer experienced as embedded in one's stream of thoughts are experienced as, e.g., thought interferences, blockages, insertion or withdrawal. These symptoms cannot be explained as a mere disturbance of attention or comprehension at the level of semantic combinations. Rather, the disturbance could be searched for at a more basic level where the temporal coherence of conscious awareness is constituted. A failure of the constitutive temporal synthesis may create micro-gaps of conscious experience. In the most severe cases, thoughts or other mental phenomena that are no longer embedded in the continuity of basic self-experience may appear in consciousness as “erratic blocks” and experienced as being inserted, or, if further externalized, as auditory hallucinations (“voices”). This coheres with the hypothesis that a breakdown of temporality may be bound up with the breakdown of prereflexive self-awareness.

Disclosure of interest

The author has not supplied his declaration of competing interest.
New platform of data analytics for mental health
Authors: Suzuki K.
Published: May 2016

Introduction

Mental disorder is a key public health challenge and a leading cause of disability-adjusted life years (DALYs) due to its high level of disability and mortality. Therefore, a slight improvement on mental care provision and management could generate solid benefits on relieving the social burden of mental diseases.

Objectives

This paper presents a long-term vision of strategic collaboration between Fujitsu Laboratories, Fujitsu Spain, and Hospital Clinico San Carlos to generate value through predictive and preventive medicine improving healthcare outcomes for every clinical area, benefiting managers, clinicians, and patients.

Aims

The aim is to enable a data analytic approach towards a value-based healthcare system via health informatics. The project generates knowledge from heterogeneous data sources to obtain patterns assisting clinical decision-making.

Methods

This project leverages a data analytic platform named HIKARI (“light” in Japanese) to deliver the “right” information, to the “right” people, at the “right” time. HIKARI consists of a data-driven and evidence-based Decision Support and Recommendation System (DSRS), facilitating identification of patterns in large-scale hospital and open data sets and linking data from different sources and types.

Results

Using multiple, heterogeneous data sets, HIKARI detects correlations from retrospective data and would facilitate early intervention when signs and symptoms prompt immediate actions. HIKARI also analyses resource consumption patterns and suggests better resource allocation, using real-world data.

Conclusions

With the advance of ICT, especially data-intensive computing paradigm, approaches mixing individual risk assessment and environmental conditions become increasingly available. As a key tool, HIKARI DSRS can assist clinicians in the daily management of mental disorders.

Disclosure of interest

The author has not supplied his declaration of competing interest.